# Nurse compliance with personal protective equipment when handling chemotherapy: a multicenter cross-sectional study in Palestine

## TL;DR

This study examines how Palestinian oncology nurses follow safety rules when handling chemotherapy drugs and finds that their compliance is only moderate.

## Contribution

The first study to assess personal protective equipment compliance among oncology nurses in Palestine.

## Key findings

- Nurses showed moderate compliance with personal protective equipment during chemotherapy handling.
- Compliance was highest during administration and lowest during disposal.
- Certification and on-the-job training were linked to better compliance.

## Abstract

Occupational exposure to chemotherapy poses acute and long-term health risks, including cancers. Personal protective equipment is fundamental to reducing these risks; however, compliance among nurses is still inadequate worldwide. Most existing studies have occurred in industrialized countries, and no published studies have examined compliance with personal protective equipment by oncology nurses in Palestine. This study aimed to assess compliance with personal protective equipment and identify factors influencing compliance.

A cross-sectional descriptive design was employed. One hundred oncology nurses (68.5% response rate) from six Palestinian hospitals completed the Hazardous Drug Handling Questionnaire. A Pearson correlation analysis explored relationships between compliance with personal protective equipment and independent variables.

Nurses demonstrated moderate compliance with personal protective equipment (mean = 2.3, standard deviation [SD] = 0.67), with the highest compliance during chemotherapy administration (mean = 2.41, SD = 0.68) and the lowest during disposal (mean = 2.2, SD = 0.90). Influencing factors included insufficient knowledge of chemotherapy exposure risks, perceived barriers to using personal protective equipment, low self-efficacy, moderate perceived exposure risk, and a moderate workplace safety climate. Compliance improved among those with oncology certification (p = 0.005) and those who received on-the-job training (p = 0.03).

Moderate compliance with personal protective equipment indicates that oncology nurses remain at risk of exposure to chemotherapy. Targeted interventions are required, including continuous education, structured training in safe handling, and developing a supportive workplace culture through monitoring and reinforcement of safety measures. These findings present evidence to guide policymakers and healthcare leaders in strengthening chemotherapy safety standards in Palestinian healthcare centers.

The online version contains supplementary material available at 10.1186/s12913-026-14132-x.