Assessment of Institutional Support on Healthcare Workers in Safe Handling of Cytotoxic Agents and Related Waste at Kenyatta National Hospital

Abstract

Healthcare workers are exposed to cytotoxic agents and waste in their day to day practice as they handle them. These agents are known to be carcinogenic, mutagenic and teratogenic hence posing a risk to those handling them. Institutions needs to protect their workers from exposure to cytotoxic agents by provision of the necessary personal protective equipment (PPEs) for use, providing frequent trainings on the need for protection and giving policies to guide the use and handling of cytotoxic agents and their wastes. Few studies have focused on safe handling of cytotoxic drugs by healthcare workers in KNH. The main objective was to assess the institutional support of healthcare workers in safe handling of cytotoxic agents and related waste at Kenyatta National Hospital. This was a descriptive cross-sectional study involving both qualitative and quantitative methods. A questionnaire, an observation check list and an interview guide were used to collect data. The study was carried out at KNH oncology wards/units. The study population included consultant doctors, registrars, nurses, pharmaceutical technologists, pharmacists and cleaners. The sample size was one hundred and sixty two respondents. The healthcare workers who consented to participate in the study were included while those who were on leave were excluded. Stratified simple random sampling was used to select the study participants. Pretesting of the study tool was done in KNH private wards to ascertain reliability and validity. Data analysis was done using SPSS and presented in graphs, charts and tables. Ethical approval was obtained from joint Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (KNH-UON ERC) and permission to conduct the study from the heads of various departments at KNH. The study findings have been shared with the school of nursing sciences, UON libraries and the investigator intends to publish a manuscript in peer reviewed journals. From the results, the response rate in this study was 92.5% with majority (77.3%, n=116) of the respondents being females. The mean age of the respondents was 35.9±9.98 years. Only 12% (n=20) of the healthcare workers in the oncology units had a specialized oncology training. Further analysis showed that healthcare workers with specialized oncology training were likely to practice safe handling compared to the ones who lacked specialized training (P=0.000). All the key informants were nursing officer in-charge of the oncology wards with mean age of 24.5±6.41. Most, 54% (n=81) of the respondents had no any form of training on handling of the cytotoxic drugs and wastes with majority being registrars at 71.4% (n=15). Further analysis showed that there was no association between safe handling of cytotoxic drugs/wastes and training on the same. Majority, 52% (n=78), of the respondents were not aware of existence of any policy document and this was corroborated by 50% (n=2) of the key informants. There was no association between accessibility of the institutional policy and safe handling of the cytotoxic drugs and wastes. Hospital did not provide the PPEs as required especially the shoe covers, eye and face shields and hair covering however there was statistical significance between provision of PPEs during waste disposal and safe handling of the cytotoxic drugs and the waste among nurses (P=0.02). Most, 82% (n=124) of the respondents reported that there are no spill kits available in various wards for cleaning of the chemotherapy drug spills. This was further confirmed by key informants. In conclusion, there was shortage and lack of appropriate personal protective equipment and spill kits in the various KNH wards for handling cytotoxic drugs. Most of the healthcare workers in the various oncology wards lack specialized training in oncology and a basic training in the handling of the cytotoxics drugs and related wastes. The healthcare workers were not knowledgeable about the available policy regarding handling of the cytotoxic drugs and disposal of related wastes to minimize the exposure. This therefore, underscores the need to conduct training of HCW, equip the wards with supplies and policy/guidelines on safe handling of cytotoxic drugs/wastes.