Randomized Controlled Trial to Improve Oncology Nurses' Protective Equipment Use

描述（由申请人提供）：有充分证据表明，在处理化疗时不适当和不经常使用个人防护装备（PPE）会导致危险药物暴露，这与癌症、生殖问题以及严重的中枢神经系统、呼吸和皮肤状况有关。在门诊肿瘤学设置护士是高风险的，因为大量的药物管理。大量初步数据显示，在门诊肿瘤科环境中，危险药物暴露频繁，药物暴露的感知风险较低，关于个人防护装备使用的知识不足，护士使用个人防护装备较少，此外，暴露护士和未暴露护士之间的组织因素也存在差异。尽管有这方面的知识，但缺乏旨在增加处理危险药物的护士使用个人防护装备的经过测试的干预措施。考虑到该小组有能力开展基于网络的个人防护装备使用调查，并收集护士血浆，使用高灵敏度和特异性串联液相色谱/质谱法检测22种危险药物的存在，审计和反馈干预评估是适当的。长期目标是提高化疗给药的质量和安全性，以保护医护人员。具体的项目目标是评估审计和反馈干预的有效性

DESCRIPTION (provided by applicant): There is ample evidence that improper and infrequent use of personal protective equipment (PPE) when handling chemotherapy leads to hazardous drug exposure, which has been linked to cancer, reproductive problems, and serious central nervous system, respiratory, and skin conditions. Nurses in ambulatory oncology settings are at high risk given the large volume of drugs administered. Extensive preliminary data show frequent hazardous drug exposure in the ambulatory oncology setting, low perceived risk of drug exposure, inadequate knowledge about PPE use, and low PPE use by nurses, in addition to differences in organizational factors between exposed and unexposed nurses. Despite this knowledge, there is an absence of tested interventions aimed at increasing PPE use among nurses who handle hazardous drugs. An audit and feedback intervention evaluation is appropriate given the team's ability to conduct web-based surveys on PPE use and collect plasma from nurses to detect the presence of 22 hazardous drugs using highly sensitive and specific tandem liquid chromatography/mass spectrometry methods. The long-term goal is to improve the quality and safety of chemotherapy administration to protect heath care workers. The specific project objective is to evaluate the efficacy of an audit and feedback intervention to improve PPE use by nurses who handle hazardous drugs in the ambulatory oncology setting. This project will pursue three specific aims: 1) Evaluate the efficacy of an audit and feedback intervention to improve recommended use of PPE; 2) Determine whether the intervention effects on PPE use are mediated by knowledge about PPE use and perceived risk of hazardous drug exposure, and; 3) Determine whether the intervention effects on PPE use are moderated by personal (experience, education, certification) and organizational factors (workloads, practice environments, safety organizing). To achieve these aims, 382 nurses employed in 11 oncology centers will participate in a cluster randomized controlled trial. Sites will be randomized so participants will receive a one-hour web-based educational module on hazardous drug safe handling with quarterly email reminders about the educational content (control) or the web-based educational module plus quarterly feedback on hazardous drug spills and drug levels measured in the study population (treatment). The hypothesis is that nurses in sites who receive the treatment will report significantly higher PPE use compared to nurses in sites assigned to receive the control. Data will also identify organizational factors that can be targeted for future interventions. The project's innovation is the paradigm shift from descriptive to intervention research and the use of novel techniques to measure hazardous drug exposure in nurses with sensitive, specific, and efficient methods. This project will be one of the few, if only, experimentally-tested intervention studies designed to increase PPE use among nurses who administer hazardous drugs. The project is significant because it will generate essential data to change the current practice of PPE use in an understudied, high-risk setting.