Knowledge, Attitude, Practice, and Challenges in the Safe Handling of Cytotoxic Drugs: A Study of Nurses in Sri Lankan Cancer Units

Introduction: Cytotoxic drugs are used primarily for the treatment of cancer. Long-term occupational exposure to cytotoxic drugs is associated with various carcinogenic, teratogenic, and mutagenic effects in the human body. Nurses come into contact with cytotoxic drugs and related waste during their daily work in cancer care units. This study aimed to explore the level of knowledge, attitude, and practice in the safe handling of cytotoxic drugs among nurses working in two cancer units in Sri Lanka. It also examined the challenges they faced in ensuring safe handling practices.
Methods: In this cross-sectional descriptive study, a self-administered structured questionnaire was used to collect data from 90 nurses working in two cancer units at National Hospital Kandy and Base Hospital Tellipalai, Jaffna. Data analysis was performed using SPSS software (version 22.0). Spearman’s rank correlation coefficient was used to find the correlation between knowledge, attitude, practice and demographic data. Fisher’s exact test was used to determine whether there any association between knowledge, attitude, practice and demographic characteristics. In all analyses p-value <0.05 was considered as statistically significant
Results: Of the study participants (n=90), the majority were females (n=77,85.7%) and 87 were completed diploma-qualified (96.7%), and most of them did not receive formal training (n=76,84.4%) on the safe use of cytotoxic medicines. The majority of the participants had a high level of knowledge (n=69, 76.7%) and high attitude (n=74, 83.2%). However only one participant (n=1,1.1%) scored ‘good’ on practice in the safe handling of cytotoxic drugs. The main challenges affecting the study participants were the shortage of staff (n=84, 93.34%), high workload (n=83, 92.23%), shortage of PPE and other facilities (n=82, 91.12%), and lack of in-service training (n=78, 86.67%).
Conclusion: Nurses demonstrated high knowledge and good attitudes toward the safe handling of cytotoxic drugs, but practice levels were fair (59.65%). Regular training, adequate staffing, resource availability, and continuous professional development are essential for improving patient safety and nurse well-being.