Knowledge, handling practices, and systemic challenges regarding safe chemotherapy management among Libyan healthcare providers in Benghazi

Abstract :

Healthcare professionals handling chemotherapy drugs are at occupational risk if proper precautions are not taken. Despite international recommendations for the safe handling of hazardous drugs, data on healthcare providers' knowledge, handling practices, and challenges in Libya are limited. The study aimed to assess the knowledge and safe handling practices of healthcare providers regarding chemotherapy in two hospitals in Benghazi, Libya, and identify factors associated with safe handling practices. A cross-sectional study was conducted between October 2024 and August 2025 among pharmacists and nurses at Benghazi Medical Centre and Children's Hospital. Participants completed a questionnaire on demographics, knowledge, handling practices, and workplace challenges. Non-parametric tests and Cronbach's alpha were used to analyse the data and assess questionnaire reliability. A total of 56 healthcare workers participated. Respondents demonstrated partial understanding of chemotherapy-related concepts, with 21.4% achieving good knowledge, and over one-third demonstrating poor knowledge. Pharmacists scored significantly higher than nurses (p = 0.001). Half of the participants reported safe handling practices, and previous chemotherapy safety training was significantly associated with higher practice scores (p = 0.022). Participants showed good knowledge of general chemotherapy principles but limited knowledge of oral chemotherapy and protective glove use. The main challenges identified were heavy workload (85.7%), lack of management support (66.1%), and inadequate chemotherapy training (64.3%). The knowledge and practice scales demonstrated modest (Cronbach’s α = 0.548) and good (Cronbach’s α = 0.717) reliability, respectively. Healthcare providers demonstrated acceptable handling practices but insufficient knowledge of chemotherapy safety and reported limited organisational support. Regular training, stronger institutional support, and clear policies are needed to improve the safe handling of chemotherapy in Libya.

References

1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024; 74(3): 229-263. doi: 10.3322/caac.21834
2. Connor TH, McDiarmid MA. Preventing occupational exposures to antineoplastic drugs in health care settings. CA: A Cancer Journal for Clinicians. 2006; 56(6): 354-365. doi: 10.3322/canjclin.56.6.354
3. Sinclair KN. United States Pharmacopeia (USP) <800> standards: increasing compliance of safe handling and proper administration of USP General Chapter <800> drugs. 2022.
4. Olsen MM, LeFebvre KB, Brassil KJ. Chemotherapy and immunotherapy guidelines and recommendations for practice. Pittsburgh (PA): Oncology Nursing Society; 2023. ISBN: 9781635930559.
5. Power LA, Coyne JW. ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacy. 2018; 75(24): 1996-2031. doi: 10.2146/ajhp180564
6. Walton A, Olsen M. Behind the scenes: a look at the process and evidence behind the ONS safe handling of hazardous drugs, 4th edition. Oncology Nursing Forum. 2024; 51(2): E298-E299. doi: Nil.
7. Alehashem M, Baniasadi S. Safe handling of antineoplastic drugs in the university hospitals: A descriptive survey study among oncology nurses. International Journal of Cancer Management. 2018;11(2): e6482. doi: 10.5812/ijcm.6482
8. Sa B, Aa H, Sa E-N, Mf Z. Role of occupational health and safety program in improving knowledge and practice among nurses exposed to chemotherapy at Zagazig University Hospitals. Egyptian Journal of Occupational Medicine. 2016; 40(2): 219-235. doi: 10.21608/ejom.2016.842
9. von Grünigen S, Geissbühler A, Bonnabry P. The safe handling of chemotherapy drugs in low- and middle-income countries: an overview of practices. Journal of Oncology Pharmacy Practice. 2022; 28(2): 410-420. doi: 10.1177/1078155221995539
10. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Journal of Clinical Epidemology. 2007; 370(9596): 1453-1457. doi: 10.1016/j.jclinepi. 2007.11.008
11. Cuschieri S. The STROBE guidelines. Saudi Journal of Anaesthesia. 2019; 13(Suppl 1): S31-S34. doi: 10.4103/ sja.SJA_543_18
12. Khadim MQ, Kadhim DJ. Assessment of the knowledge and practice on safe handling of anticancer drugs among pharmacists in Iraqi healthcare settings. Al-Rafidain Journal of Medical Sciences. 2024; 7(1): 85-92. doi: 10.54133/ajms.vil.1040
13. Abu Sharour L, Subih M, Bani Salameh A, Malak M. Predictors of chemotherapy safe-handling precautions and knowledge among a sample of Jordanian oncology nurses: a model-building approach. Workplace Health and Safety. 2021; 69(3): 115-123. doi: 10.1177/2165079920959991
14. Waheida SM, Abd-Elgaffar SI, Atia GA. Evaluation of handling practices of oncology nurses during chemotherapy preparation and administration in Menoufia Oncology Hospital. International Journal of Novel Research in Healthcare and Nursing. 2015; 2(3): 107-119. doi: Nil.
15. Qadir CS, Mahmood EK, Osman GA, Esmail DH, Omar YB. Safe handling knowledge and practices of chemotherapy among oncology nurses in Erbil City. Kufa Journal of Nursing Sciences. 2016; 6(1): 19-25. doi: 10.36321/kjns.vi20161.2623
16. Hamed H, Sheble A, Soliman H. Antineoplastic agent safety training module: Its effect on nurses’ knowledge and practice in Sabha Oncology Center. Mansoura Nursing Journal. 2023; 10(2): 247-253. doi: Nil.
17. Chand D, Mohammadnezhad M, Khan S. Levels and predictors of knowledge, attitude, and practice regarding the health hazards associated with barber’s profession in Fiji. Inquiry. 2022; 59: 00469580221100148. doi: 10.1177/0069580221100148
18. Kaliyaperumal K. Guideline for conducting a knowledge, attitude and practice (KAP) study. AECS Illum. 2004; 4(1): 7-9. doi: Nil.
19. Hosen MS, Hasan M, Saiful Islam M, Raseduzzaman MM, Tanvirul Islam M, Tazbiul Islam M, et al. Evaluation of knowledge and practice of handling chemotherapy agents by nurses: A multicentre study in Bangladesh. International Journal of Community Medicine and Public Health. 2019; 6(10): 4175-4181. doi: 10.18203/2394-6040.ijcmph20194471
20. Asefa S, Aga F, Dinegde NG, Demie TG. Knowledge and practices on the safe handling of cytotoxic drugs among oncology nurses working at tertiary teaching hospitals in Addis Ababa, Ethiopia. Drug Healthcare and Patient Safety. 2021; 13: 71-80. doi: 10.2147/DHPS.S289025
21. Sargidy AAW, Yahia A, Ahmad M, Abdalla A, Khalil SN, Alasiry S, et al. Knowledge of safe handling, administration, and waste management of chemotherapeutic drugs among oncology nurses working at Khartoum Oncology Hospital, Sudan. PeerJ. 2022; 10: e14173. doi: 10.7717/peerj.14173
22. Mamdouh ZM, Mohamed AS, Mohamed DG. Oncology nurses’ knowledge and practices regarding safe administration of intravenous chemotherapy. Egyptian Journal of Health Care. 2022; 13(1): 1218-1231. doi: 10.21608/EJHC.2022.225111
23. Zaman T, Zaman N, Ahmad I. Nurses’ knowledge and practices regarding safe handling of chemotherapeutic agents. Journal of Health and Rehabilitation Research. 2024; 4(3): 1-5. doi: 10.61919/jhrr.v4i3.1314
24. Ibrahim N, Al Mutairi M, Al Onazi M. Assessment of oral chemotherapeutic agents safe handling among healthcare professionals in Saudi Arabia. Global Journal of Medical Therapeutics. 2019; 1(2): 14-19. doi: 10.46982/gjmt.2019.104
25. Sheikh YA. Knowledge and practice on safe handling of cytotoxic drugs among health care workers at Kenyatta National Hospital [thesis]. Nairobi (Kenya): University of Nairobi; 2016. Corpus ID: 78698156.
26. Mohamed AFM, Sharaf AY. Safe handling of cytotoxic drugs: Oncology nurses’ knowledge and practices. IOSR Journal of Nursing and Health Science. 2019; 8(2): 89-100. doi: 10.9790/08020689100
27. Lawson CC, Johnson CY, Nassan FL, Connor TH, Boiano JM, Rocheleau CM, et al. Antineoplastic drug administration by pregnant and nonpregnant nurses: An exploration of the use of protective gloves and gowns. The American Journal of Nursing. 2019; 119(1): 28-35. doi: 10.1097/01.NAJ.0000552583.69729.51
28. Martin S, Larson E. Chemotherapy-handling practices of outpatient and office-based oncology nurses. Oncology Nursing Forum. 2003; 30(4): 575-581. doi: 10.1188/03.ONF.575-581
29. Uddin MM, Rahman MM, Rafi IK, Khandaker MS. Health problems in Bangladesh: A struggle for equitable and accessible healthcare. Mediterranean Journal of Medicine and Medical Sciences. 2025; 1(1): 1-7. doi: 10.5281/zenodo.15606021
30. Hashad SS, Etayari HM, Mejrab EM. Assessment of staff knowledge level and evaluation of medical staff for the prevention of central-line-associated bloodstream infections. Mediterranean Journal of Medical Research. 2025; 2(4): 186-195. doi: 10.5281/zenodo.17487415
31. Paul SK. Assessment of knowledge and attitude of adverse drug reactions among healthcare professionals in Bangladesh. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2025; 5(2): 70-78. doi: 10.5281/ zenodo.15275065
32. Ahmad MB, Shamoun S. Knowledge and attitudes of safe handling of chemotherapy drugs among oncology nurses at a teaching hospital. Asian Pacific Journal of Cancer Prevention. 2025; 26(9): 3331-3337. doi: 10.31557 /APJCP.2025.26.9.3331
33. Sreekumaran J, Goyal H, Sharma R, Javeth A. Perceived barriers and risks of safe handling of chemotherapeutic agents: A cross-sectional study. Journal of Infusion Nursing. 2025; 48(3): 214-222. doi: 10.1097/NAN. 0000000000000593

Citation :

Salama RM, Elfakhri RM. Knowledge, handling practices, and systemic challenges regarding safe chemotherapy management among Libyan healthcare workers in Benghazi. Mediterr J Pharm Pharm Sci. 2026; 6(3): 22-32. [Article number: 258]. https://doi.org/10.5281/zenodo.21719557