Randomized Controlled Trial to Improve Oncology Nurses' Protective Equipment Use

描述(由申请人提供)：有充分的证据表明，在处理化疗时不适当和不经常使用个人防护装备(PPE)会导致危险的药物暴露，这与癌症、生殖问题以及严重的中枢神经系统、呼吸和皮肤疾病有关。由于使用了大量药物，门诊肿瘤科的护士处于高风险状态。广泛的初步数据显示，在门诊肿瘤科环境中经常接触危险药物，药物暴露的感知风险较低，对个人防护用品使用的知识不足，护士个人防护用品使用率较低，此外，暴露于危险药物环境中的护士与未接触个人防护用品的护士在组织因素上存在差异。尽管有这些知识，但目前还没有针对处理危险药物的护士增加个人防护用品使用的测试干预措施。鉴于该小组有能力对个人防护用品的使用情况进行基于网络的调查，并收集护士的血浆，以使用高灵敏和特定的串联液相色谱/质谱仪方法检测22种危险药物的存在，因此进行审计和反馈干预评估是适当的。长期目标是提高化疗的质量和安全性，以保护卫生保健工作者。具体的项目目标是评估审计和反馈干预措施的有效性 提高在门诊肿瘤科环境中处理危险药物的护士的个人防护用品的使用。该项目将追求三个具体目标：1)评估审计和反馈干预措施的有效性，以改进个人防护用品的推荐使用；2)确定对个人防护用品使用的干预效果是否通过个人防护用品使用知识和危险药物暴露的感知风险来调节；以及3)确定个人(经验、教育、认证)和组织因素(工作量、练习环境、安全组织)是否调节对个人防护用品使用的干预效果。为了实现这些目标，受雇于11个肿瘤中心的382名护士将参加一项整群随机对照试验。网站将是随机的，因此参与者将收到一个小时的危险药物安全处理网络教育模块，每个季度都会收到关于教育内容(控制)或网络教育模块的电子邮件提醒，以及关于危险药物泄漏和在研究人群中测量的药物水平的季度反馈(治疗)。假设是，接受治疗的地点的护士报告的个人防护用品使用量比指定接受对照的地点的护士要高得多。数据还将确定可面向未来的组织因素 干预措施。该项目的创新是从描述性研究向干预研究的范式转变，并使用新技术以敏感、特定和有效的方法测量护士的危险药物暴露。该项目将是为数不多的经过实验测试的干预研究之一，旨在增加使用危险药物的护士的个人防护用品的使用。该项目意义重大，因为它将产生必要的数据，以改变目前在研究不足的高风险环境中使用个人防护装备的做法。

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.