Factors Influencing the Use of Personal Protective Equipment in the Handling of Chemotherapy Drugs Among Nursing Staff in Cancer Hospitals: A Cross-Sectional Study.

AIM: To assess the current use of personal protective equipment (PPE) among nurses handling chemotherapy drugs in cancer hospitals in China and to explore the factors associated with PPE use by nurses. BACKGROUND: Nurses, the primary handlers of chemotherapy drugs, face significant exposure risks. Accurately assessing PPE use and its determinants is therefore crucial for developing targeted interventions to mitigate exposure and increase occupational safety. METHODS: Convenience sampling was used to select nurses from cancer hospitals in 30 provinces in China from December 1, 2024, to January 6, 2025. A cross-sectional survey was conducted that utilised a general information questionnaire and the Hazardous Drug Handling Questionnaire. Data analysis was performed using SPSS 24.0 and SmartPLS 4.0 software. RESULTS: SmartPLS analysis revealed significant direct effects of interpersonal influences, workplace safety, self-efficacy, perceived barriers, and perceived risks on PPE usage. The mediation analysis revealed that self-efficacy, perceived risk, perceived barriers, and chemotherapy exposure knowledge mediated the relationship between chemotherapy handling experience and PPE use, whereas perceived barriers and interpersonal influences mediated the effect of workplace safety factors on PPE use. Perceived conflict of interest sharing negatively moderated the interaction between interpersonal influences and PPE usage and moderated the mediating effect of interpersonal influences. CONCLUSION: The results validated and extended the applicability of the health promotion model in the field of occupational safety behaviour. The findings revealed that a multilevel intervention system should be developed to increase the PPE utilisation rate among oncology nursing staff. IMPLICATIONS FOR NURSING MANAGEMENT: Management should foster safe environments that enable positive peer interactions, systematically transform nurses' experience into knowledge and risk awareness, and reduce perceived nurse-patient conflicts to strengthen trust and safety norm effectiveness.