Factors Influencing Nurses’ Use of Hazardous Drug 
Safe-Handling Precautions

PROBLEM IDENTIFICATION: Nurses taking measures regarding the safe handling of hazardous drugs (HDs) can reduce their risk of exposure and environmental contamination. However, the findings of studies examining factors influencing the use of HD safe handling precautions by nurses have been inconsistent. LITERATURE SEARCH: An integrative review of the Embase® and Scopus® electronic databases was performed. DATA EVALUATION: The search strategy yielded 907 articles. Ten quantitative studies and two qualitative studies met the inclusion criteria. The Health Evidence Bulletin Wales checklist was used to evaluate the quality of the articles. SYNTHESIS: The outcome variables were categorized as engineering controls, work practice controls, and personal protective equipment (PPE) use. The frequency of PPE use was measured as an outcome variable in all reviewed studies. Associated factors were based on the behavioral-diagnostic model. Perceived barriers to PPE use, perceived safety climate, and workload were common factors related to the use of safety precautions. IMPLICATIONS FOR PRACTICE: Nurses should proactively obtain information about the safe handling of HDs and share their perceptions and experiences of it with their colleagues. Managers should actively construct a safe environment by adopting high reliability principles and provide nurses with sufficient and easy-to-use PPE.