Probing technical knowledge on preparation and administration of chemotherapy drugs: A cross-sectional study focusing nurses of Dhaka, Bangladesh

Probing technical knowledge on preparation and administration of chemotherapy drugs: A cross-sectional study focusing nurses of Dhaka, Bangladesh | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Probing technical knowledge on preparation and administration of chemotherapy drugs: A cross-sectional study focusing nurses of Dhaka, Bangladesh Nasrin Akter, Bilkis Banu, Farhana Faruque Zerin, Nusrat Hossain Sheba, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7141786/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Nurses are the largest medical professional groups handling cancer patients. They are responsible for safely preparing and administering chemotherapy drugs (CDs), managing side effects, and educating patients and their families about the adverse effects of chemotherapy. In this regards their knowledge regarding cancer chemotherapy is pivotal for safe handling of cancer patients. Objectives This study aimed to assess the level of technical knowledge regarding the preparation and administration of chemotherapy and associated factors among the nurses of Bangladesh. Methods This was a cross-sectional study conducted among randomly selected 105 nurses working in cancer units of a selected tertiary level hospital in Dhaka city, Bangladesh. Data was collected by semi-structured questionnaire through face-to-face interviews. A binary logistic regression model was used for analytical exploration. Adjusted and Unadjusted Odds Ratio (OR) with 95% confidence intervals (95% CI) were calculated for the specified setting indicators. A Chi-square test was used to observe the association. Participants scoring ≥ 80% were classified as having good knowledge, while those scoring < 50% were categorized as having poor knowledge, based on prior studies in LMICs. Ethical issues were maintained according to the Declaration of Helsinki. Results The result showed that a majority (58.1%) of the nurses were from ≤ 32 years of age group among whom 90.5% of the respondents did not get any training on cancer patient management. It is significantly revealed that respondents (77.1%) who had a poor basic knowledge of cancer and chemotherapy were found to have poor technical knowledge (55.2%) of chemo preparation and administration (AOR/p = 6.58/0.01; 95% CI: 1.29–21.78). In addition, poor knowledge of chemo preparation and administration was also observed as statistically significant among the diploma nurses (AOR/p = 3.91/0.01), who completed their nursing education from a private organization (AOR/p = 4.57/0.01) and had a minimum of working experience in cancer unit (AOR/p = 4.73/0.04). Conclusion The negative portrayal regarding knowledge of chemo preparation and administration among the nurses is alarming for the quality of health care in cancer management. Continuous knowledge upgradation is needed for using safety measures and following guidelines in every step of the work with the concern of proper policies. Technical knowledge nurses preparation and administration of chemotherapy Bangladesh Figures Figure 1 Figure 2 Figure 3 What is already known on this topic Previous studies emphasize the importance of technical knowledge in chemotherapy administration for safe oncology practice. However, recent findings regarding nurses’ knowledge of cancer and chemotherapy in Bangladesh, indicates concerns for both nurses and cancer patients regarding safe handling and administration. What this study adds: The outcome of this study adds a new insight regarding knowledge of chemotherapy drug preparation and administration among the nurses of Bangladesh. Nurses in the country mostly do rotational duties in the cancer unit despite having inadequate knowledge. How this study might affect research, practice, or policy: The outcome of this study might help to develop new approaches and strategies toward a safe health service regarding cancer treatment management in Bangladesh. In addition, this study will guide future large-scale nationwide studies to generate more scientific evidence for effective utilization in successful implementation policies in cancer patient management training among the nurses. 1 Background A critical component of cancer treatment is the nursing workforce, one of the largest medical professional groups handling cancer patients [ 1 ]. Over the last decade or so, there have been major changes to the extent of practice, more complex treatment regimens, novel chemotherapeutic and supportive care agents, and more intricate healthcare systems that have impacted the role of oncology nurses in the safe administration of chemotherapy. They are responsible for safely preparing and administering chemotherapy drugs (CDs), careful patient assessment, managing side effects, educating patients and their families about the adverse effects of chemotherapy, and providing emotional support through the process. However, the distinct pharmacological characteristics of CDs, which obstruct cell division, are recognized to make them potentially dangerous [ 2 ]. These drugs have toxic properties and can have teratogenic, mutagenic, and carcinogenic effects [ 2 , 3 ]. Due to the prolonged and repeated exposure to chemotherapy drugs, nurses may be at risk of exposure through improper hygiene practices such as eating, drinking, or smoking. This exposure can occur through direct skin or ocular contact or inhalation of droplet aerosolization [ 4 – 7 ]. They can also lead to cancer, abortion, fetal malformations, infertility issues, and genetic alterations in offspring, as noted by the Occupational Safety and Health Administration (OSHA) [ 3 , 8 ]. Recent studies have revealed a troubling rise in the potential dangers linked to occupational exposure to CDs which is particularly significant for healthcare providers [ 9 , 10 ]. Therefore, the oncology nursing society strongly recommended the educational qualification of nurses in chemotherapy drug perpetration and management at the workplace. The rate of hazardous exposure depends on their depth of knowledge and skill [ 11 , 12 ]. The more knowledge they acquire, the more they adhere to safety measures when treating patients, thereby enhancing the chances of a healthy life. According to a study, nurses' understanding of managing chemotherapy is mediocre; yet, they seem to face challenges when it comes to using personal protective equipment, keeping a biological safety cabinet, following protocols, medical monitoring, and training [ 2 , 3 , 13 , 14 ]. Another study indicates that there has been an increase in the use and availability of gloves, but at the same time, a decrease in other essential personal protective equipment, such as protective garments, face masks, and respiratory shields, when handling chemotherapy [ 8 ]. Among oncology nurses in tertiary hospitals, a study revealed that attitude is the most significant aspect of their chemotherapy administration competencies, while knowledge is the weakest [ 14 ]. As a result, nurses had a limited grip on the exact guidelines of chemotherapy drug management although having good knowledge [ 15 ]. That is why, it was observed that while nurses had sufficient knowledge of safe chemotherapy administration, their practices were not up to standard. Hence, in-service training might help them increase their level of knowledge through hands-on learning [ 2 ]. There are existing guidelines for handling chemotherapy drugs from different organizations like the National Institute for Occupational Safety and Health (NIOSH), Oncology Nursing Society (ONS), American Society of Clinical Oncology (ASCO), American Society of Health-System Pharmacists (ASHP) etc [ 3 ]. However, there is still a lack of routine medical monitoring for employees exposed to chemotherapy, and the monitoring procedures do not consistently adhere to the guidelines established by OSHA [ 8 ]. In Bangladesh, nurses have limited knowledge and skills for handling CDs. Most significantly, oncology nurses require comprehensive in-service training in the safe management of chemotherapy medications and understanding of related risks and contamination, and adequate facilities for personal protection, as their knowledge and awareness are vital in cancer care [ 3 ]. Therefore, the study was conducted to assess technical knowledge of the preparation and administration of chemotherapy drugs among the nurses working in tertiary-level hospital settings in Bangladesh. The results of this study could serve as a roadmap for future research into training for oncology nursing and for advocating that healthcare facilities with oncology units offer evidence to inform policy implementation. 2 Methods 2.1 Study design A quantitative cross-sectional study was carried out followed analytical approach from 05 July to 10 January 2024. Semi-structured data were collected in this study for obtaining the information on socio-demographic characteristics, professional characteristics, basic knowledge on cancer and chemotherapy and technical knowledge on chemo preparation and administration among nurses working in a tertiary-level hospital with existing and actively functioning cancer units in Dhaka city. 2.2 Study participants, sample size and sampling This study included a total of 105 nurses from Kurmitola 500 Bed General Hospital of Dhaka, Bangladesh. Quantitative information of this study was collected from the respondents’ identified as currently active nurses during the data collection period, signified as working in the cancer unit on a rotational basis and provided their consent to participate in this study. Initially a potential standard sample size was assumed as 100 calculated by using the formula “n= ‘Z 2 pq/d 2 ” where Z (standard normal deviate) considered as 1.96; p (knowledge on one of the components of chemo drug administration 93.9%) was considered as 0.93 [ 16 ] and margin of error was considered as 0.05. With a minimum calculated sample 100, an additional 5% was added as cushion to take into account non-response and considering data cleaning and initial management and the final samples were 105. Initially, six tertiary-level hospitals in Dhaka, the capital of Bangladesh, were targeted due to their significant availability of cancer units [ 17 ]. Kurmitola 500 Bed General Hospital in Dhaka was randomly selected for this study. Kurmitola 500 Bed General Hospital was selected based on its active oncology unit, logistical feasibility, and administrative clearance. Though single-site data collection may limit generalizability, this government facility is representative of typical tertiary-level public hospitals in urban Bangladesh. Concentrating on one hospital allows methodological consistency and minimized institutional bias. Future research should consider multi-center designs to enhance external validity. A systematic random sampling technique was used to select participants from a list of 140 nurses assigned to rotational duty in the cancer unit during the study period. This list, provided by the hospital’s nursing administration, served as the sampling frame. With a required sample size of 105, the sampling interval was approximately 1.33. One nurse was randomly selected from the first three names on the list using a lottery method to determine the starting point, after which every nurse at the calculated interval was selected. ‌2.3 Data collection Quantitative data was collected from the nurses by using a pre-tested and semi-structured questionnaire through the interviewer-administered method. Respondents were interviewed according to their convenience from 01 September to 07 October 2023. The interviewer took only 10 to 15 minutes to complete the survey. All authors had access to the collection and preserving participants’ information during or after data collection. The survey was administered in the Bengali language with the utmost support of the hospital administrative authority. 2.4 Ethical considerations This study was approved by the Ethical Review Committee of the Department of Public Health of Northern University Bangladesh (NUB/DPH/EC/2023/29) and conformed to the Declaration of Helsinki. Participation of the respondents was anonymous and voluntary. Written informed consent was taken from the respondents at the beginning of the survey. Participants could withdraw from the survey at any time and their autonomy has been ensured. 2.5 Questionnaire design The questionnaire was pre-validated by two independent reviewers and pre-tested among five respondents. The quality of the questionnaire addressed the responses of the pre-test. To ensure content validity, a panel of five experts in oncology, pharmacy, and public health reviewed the draft questionnaire for relevance, clarity, and contextual fit. Their feedback informed revisions to several items, ensuring alignment with the clinical and cultural context of the study setting. The pivotal components of the questionnaire were: (i) Socio-demographic and professional characteristics: age, professional education, type of educational institution, working experience in nursing, working experience in cancer unit, training on cancer patient management; (ii) Basic knowledge on cancer and chemotherapy: concept, types, treatment types & stages of cancer, chemotherapy, immediate health hazards of chemotherapy; (iii) Technical knowledge on chemotherapy drug preparation or administration: use of isopropyl alcohol, standard operating procedure, specially dedicated room for chemotherapy, chemo preparation place (in nursing station), drop and time calculation of intravenous chemo, closed system drug transfer devices (CSTD). Each correct response was scored as one point, and total knowledge scores were converted into percentages. Participants scoring ≥ 80% were classified as having good knowledge, while those scoring < 50% were categorized as having poor knowledge and 50–79% were considered as moderate knowledge. The use of an 80% cut-off for this binary classification (good vs. moderate/poor knowledge) was based on established precedents in similar studies conducted in low- and middle-income countries [ 22 , 23 ] and was reviewed by oncology nursing experts. In the context of Bangladesh, where no national benchmark currently exists, this cut-off provides a pragmatic and interpretable standard. It also strengthened regression modeling by clearly delineating at-risk subgroups, thereby informing targeted training and policy strategies. Although the 80% cut-off may not offer optimal sensitivity and specificity in a diagnostic context, it reasonably reflects the threshold at which limited knowledge may compromise safe chemotherapy handling in resource-constrained settings. No patients or members of the general public were involved in planning, execution, reporting, or distribution of our study. 2.7 Data analysis Collected data was checked and analyzed employing the Statistical Package for the Social Sciences (SPSS) software. Study characteristics were subjected to descriptive statistics (frequency and proportions) to summarize the obtained data. Relevant continuous data were categorized followed mid values of the percentage scores as cut points [ 18 ]. A binary logistic regression analysis was performed followed by a modeling procedure considering a backward elimination process, including pre-specified confounders i.e. age, professional education, type of educational institution, working experience in nursing, working experience in cancer unit, training on cancer patient management and basic knowledge on cancer and chemotherapy. Odds ratios with 95% confidence intervals with respect to technical knowledge on chemotherapy preparation or administration (good and poor) were calculated for the specified exposures. Study instrument was peer-reviewed by the authors and experts in the oncology & nursing arena. In addition, to test the reliability, the internal consistency of the questionnaire was assessed by Cronbach's alpha coefficient and alpha greater than 0.71 was considered satisfactory [ 19 ]. The validity was tested through Pearson’s Correlation Coefficient analysis. Considering the degree of freedom at the two-tailed test as (N-2 = 105-2 = 103) at 95% Confidence Interval (CI) the obtained value (0.333) was found greater than the critical tabulated value (0.138). The outcome suggests the significant validity of the instrument. All odds ratios (ORs) were presented with corresponding 95% confidence intervals (CIs) to indicate the precision of the estimates. Multicollinearity among independent variables was assessed using Variance Inflation Factor (VIF), and all VIF values were below 2.5, indicating no significant multicollinearity. Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test, and the non-significant result (p > 0.05) suggested a satisfactory model fit. Although all key statistical assumptions were met, we recognize that certain contextual variables such as organizational support, workload, or unit-level supervision were not included in this model. However, the inclusion of key covariates and use of a structured modeling approach enhance the validity of the reported associations. Future studies with larger samples should explore interaction effects and additional variables to further strengthen causal inference. 3 Results 3.1 Participant’s characteristics This study included a total of 105 respondents among whom the majority (58%) were from ≤ 32 years of age group. More than half of the respondents had a diploma education while 17.1% and 31.4% had basic BSc and post-basic in nursing respectively. Most of the respondents completed their nursing education from the government institution (66.7%) and had ≤ 10 years of working experience (68.6%) in the nursing profession. However, a bulk of them were working in the cancer unit for only ≤ 1 year (86.7%) and did not have any training on cancer patient management (82.9%) while all of them had to work in the cancer unit by rotation. Most alarmingly, the study also revealed a huge number of respondents (77.1%) had poor basic knowledge of cancer and chemotherapy among them. (Table 1 ) Table 1 Background characteristics associated with the level of technical knowledge regarding chemotherapy drug preparation & administration among the respondents (n = 105) Characteristics Number of participant n (%) Level of technical knowledge on chemotherapy preparation & administration Good n (%) Moderate/Poor n (%) ꭕ 2 /p-value (≤ 0.05) Age (in years) ≤32 61 (58.1) 17 (16.2) 44 (41.9) 5.36/0.02* >32 44 (41.9) 22 (21.0) 22 (21.0) Professional education Diploma 54 (51.4) 12 (11.4) 42 (40) 15.18/0.01* Basic BSc in nursing 18 (17.1) 6 (5.7) 12 (11.4) Post basic in nursing 33 (31.4) 21 (20) 12 (11.4) Type of educational institution Government 70 (66.7) 34 (32.4) 36 (34.3) 11.75/0.01* Private 35 (33.3) 5 (4.8) 30 (28.6) Working experience in nursing (in years) ≤10 72 (68.6) 20 (19.0) 52 (49.5) 8.60/0.01* >10 33 (31.4) 19 (18.1) 14 (13.3) Working experience in cancer unit (in years) ≤1 91 (86.7) 30 (28.6) 61 (58.1) 5.09/0.02* >1 14 (13.3) 9 (8.6) 5 (4.8) Training on cancer patient management Yes 18 (17.1) 12 (11.4) 6 (5.7) 8.11/0.01* No 87 (82.9) 27 (25.7) 60 (57.1) Basic knowledge of cancer & chemotherapy Good 24 (22.9) 16 (15.2) 8 (7.6) 11.62/0.01* Moderate/Poor 81 (77.1) 23 (21.9) 58 (55.2) Table 1 Footnote: Data are presented as frequency (n), percentage (%); *Statistical significance at p value ≤ 0.05. Chi-square test was used to observe the association Fig 1. Distribution of technical knowledge among respondents (n = 105) regarding chemotherapy drug preparation and administration, including key gaps in six safety-related components. 3.2 Status of technical knowledge regarding chemotherapy drug preparation & administration among the respondents The crucial outcome of the study is the technical knowledge regarding chemotherapy drug preparation & administration among the respondents. The majority of the respondents had poor (62.90%) technical knowledge regarding chemotherapy drug preparation & administration while only 37.10% showed good knowledge regarding chemotherapy drug preparation & administration. This knowledge was assessed considering some pivotal components regarding chemo drug preparation and administration. Components include knowledge of adequate use of isopropyl alcohol, standard operating procedure, an especially dedicated room for chemotherapy, chemo preparation place, drop and time calculation of intravenous chemo, and closed system drug transfer devices (CSTD). The most prominent components responsible for overall poor technical knowledge were knowledge of chemo drug preparation place (in nursing station: 46.70%), standard operating procedure (inadequate knowledge: 45.70%), and Closed System Drug Transfer Devices (CSTD) (no knowledge: 41.9%). (Fig. 1) 3.3 Association between basic knowledge on cancer, chemotherapy and technical knowledge on chemo drug preparation, administration Another crucial outcome of this study portrayed a strong statistical association (ꭕ2/p = 11.62/0.01) between basic knowledge of cancer, chemotherapy, and technical knowledge of chemo drug preparation, and administration. It was observed that nurses who had poor (81/77.1%) basic knowledge of cancer and chemotherapy, they found to have poor technical knowledge of chemo drug preparation and administration (58/55.2%). (Fig. 2 ) 3.4 Respondent’s Characteristics associated with the level of technical knowledge on chemotherapy preparation & administration The outcome of bivariate cross-tabulation analysis is delineated in Table 1 mentioned in this article. It was observed that nurse’s knowledge of chemo drug preparation and administration is significantly associated with their age (p = 0.02), professional education (p = 0.01), educational institution (p = 0.01), working experience in nursing (p = 0.01) and cancer unit (p = 0.02), having training on cancer patient management (p = 0.01) and their basic knowledge on cancer, chemotherapy (p = 0.01). In other words, poor knowledge was significantly higher among ≤ 32 years of aged nurses (44/105) who had diploma education (42/105) only from private institutions (30/105) and less working experience in nursing (52/105) and cancer unit (61/105). In addition, poorly knowledgeable nurses did not have any training (60/105) on cancer patient management and they also had poor basic knowledge (58/105) on cancer and chemotherapy. 3.5 Significant determinants against poor level of technical knowledge on chemotherapy preparation & administration The regression analysis of the study revealed a set of significant predictors associated with the poor level of technical knowledge on chemotherapy preparation & administration. Initially, unadjusted odds ratios were calculated through the binary regression analysis. For instance, higher Crude Odds Ratios (COR) of poor technical knowledge were observed among the nurses who had only diploma education (COR/p = 6.13/0.01) from a private institute (COR/p = 5.67/0.01), did not have any training (COR/p = 4.44/0.01) on cancer patient management and those nurses who had poor basic knowledge (COR/p = 5.04/0.01) on cancer and chemotherapy. In addition, significant odds of poor knowledge were also found among ≤ 32 years aged (COR/p = 2.59/0.02) who had less working experience in nursing (COR/p = 3.53/0.01) and cancer unit (COR/p = 3.66/0.03). After a model adjustment with the crude outcomes, the study revealed some ultimate determinants associated with poor technical knowledge among the study subjects by exploring the Adjusted Odds Ratios (AOR). Likewise, as the final predictor’s significant odds of poor technical knowledge were found among the nurses with poor basic knowledge (AOR/p = 6.58/0.01) who completed their only diploma (AOR/p = 3.91/0.02) education from a private institution (AOR/p = 4.57/0.01) and had a minimum (0-1year: AOR/p = 4.73/0.05) working experience in chemotherapy unit. Although with this poor background condition, they are pretended to their duty in the cancer unit by rotation which is alarming for the safe health care service among the cancer patients. (Fig. 3 ) 4 Discussion Nurses have a crucial role in the management of chemotherapy treatment, particularly in the safe preparation and administration of cytotoxic drugs, alongside other critical aspects of patient care. [ 2 ]. The level of knowledge of the nurses about the preparation and administration of chemotherapy drugs is not satisfactory, especially in low and middle-income countries (LMIs) [ 1 , 3 , 14 ]. The objective of this study was to evaluate the technical knowledge of the preparation and administration of chemotherapy drugs among nurses in Bangladesh The present study revealed that nurses aged ≤ 32 years accounted for over half of the study subjects. This feature coincides with numerous other studies [ 2 , 3 , 14 ], highlighting, and emphasizing young nurses and their technical knowledge on the preparation and administration of chemotherapy drugs. In addition, a robust outcome was found between the results regarding the educational attainment and work experience of nurses with diploma programs and findings from other studies [ 2 , 3 , 14 – 16 ]. Moreover, most of the nurses in this study did not have any training regarding cancer and chemotherapy while mostly trained subjects were identified in an Egyptian study conducted in different settings [ 2 ]. According to other studies, medication errors in chemotherapy centers were widespread (44%) because staff members lacked specialized knowledge and training in the preparation and administration of chemotherapy [ 3 , 15 , 20 ]. Research indicates that engaging in a training program resulted in a noteworthy improvement in knowledge levels [ 8 , 15 , 20 , 21 ]. Standard operating procedures and awareness of the location where chemotherapy drugs are prepared were found as the two main factors contributing to the overall lack of technical knowledge among the nurses in our study. The prevalence of harmful behaviors in the workplace and the mean knowledge scores by chemotherapy drugs preparation region did not differ significantly, according to the other studies [ 7 , 8 ]. The fact that 25% of respondents to another survey never prepared medication in a designated area raises concerns about environmental contamination. The preparation of the medications in approved treatment areas is a requirement for the safe handling of chemotherapy [ 15 ]. In our study, it is noteworthy that responders with low technical knowledge of chemo preparation and administration had a low basic understanding of cancer and chemotherapy. Similar results were found in another study in Bangladesh, which revealed most of the nurses had average knowledge of administering and preparing chemotherapy [ 3 , 21 ]. However, other studies in different demography and settings showed poor practice of handling chemotherapy although they had satisfactory scores of knowledge [ 2 , 8 , 9 , 14 – 16 ]. In our study, it was also discovered that diploma nurses with at least a little experience working in a cancer unit had significant odds of poor technical knowledge of chemotherapy which coincides with other studies conducted previously [ 3 , 15 ]. It is also indicated that the length of time a nurse has worked in an oncology unit may have an impact on their knowledge and skills. Years of experience working in the oncology unit were found to be statistically significantly associated with knowledge of chemotherapy (P < 0.005) [ 15 ]. Inadequate knowledge of the preparation and administration of chemotherapy was also shown to be statistically significant among the nurses who obtained their degrees from a private organization. Which does not account for the deficient practice of protective equipment during CD management [ 3 ]. A potential explanation for this finding may lie in systemic differences in curriculum structure, clinical exposure, and institutional support between diploma and degree programs. Diploma programs in Bangladesh often provide limited specialization and hands-on oncology training, which may contribute to weaker technical competency in chemotherapy preparation and administration. Early suggestions include providing insights into the factors influencing the periodic enhancement of nurses' knowledge and skills in chemotherapy drug management, emphasizing the necessity for stringent policy development, and highlighting the importance of facilitating the implementation of guidelines [ 3 , 15 , 20 , 21 ]. The majority of nurses in our study demonstrated limited technical knowledge in areas such as identifying appropriate chemotherapy preparation sites, calculating drop rate and infusion time for intravenous drug administration, and understanding the use and purpose of closed-system drug transfer devices (CSTDs).These competencies are essential for the safe preparation, administration, and disposal of hazardous drugs, and are explicitly emphasized in international oncology safety standards established by the Occupational Safety and Health Administration (OSHA), Oncology Nursing Society (ONS), and the National Institute for Occupational Safety and Health (NIOSH). The observed knowledge gaps indicate a significant misalignment with global safety protocols, particularly regarding the routine use of PPE, CSTDs, and adherence to safety-engineered controls (e.g., biological safety cabinets). These findings highlight an urgent need to align local training and practice standards with international recommendations to protect both healthcare workers and patients. The duration of our study was brief, which limited our ability to observe long-term knowledge retention or behavior change. Our study's ability to be generalized is constrained as it was conducted solely at one site which may not reflect practices across diverse healthcare institutions in Bangladesh. A larger sample size would bolster statistical robustness. Moreover, being a cross-sectional study, extending the observation period could yield more comprehensive insights. The use of a ≥ 80% threshold for knowledge categorization, although informed by empirical evidence and expert opinion, was not statistically validated and may limit precision in classifying knowledge levels. Nevertheless, despite these limitations, our study generated distinct findings that can contribute to shaping the future direction for enhancing nurses' knowledge and practices in cancer and chemotherapy management, thereby fortifying oncology services within the healthcare system. The findings of our study are reinforced by a prior investigation involving Bangladeshi nurses, enhancing the credibility and reliability of our results. Furthermore, the outcomes of our current study are presumed to be crucial additions to the existing knowledge base, particularly within the context of Bangladesh, where limited research has been conducted among nursing staff regarding their knowledge of the preparation and administration of chemotherapy drugs. 5 Conclusion This study revealed a crucial outcome regarding nurse’s technical knowledge of chemotherapy preparation and administration. The majority of the respondents had poor technical knowledge regarding chemotherapy drug preparation & administration which is significant among those nurses who had poor basic knowledge too. In addition, poor technical knowledge was also found significant among the diploma nurses with minimum working experience in the cancer unit who did not have any training on cancer & chemotherapy. The negative outcome of this study indicates an alarming scenario of poor healthcare service delivery among cancer patients in Bangladesh. To address the substantial impact of cancer there is a need for enhancements in the healthcare service strategies within cancer units across Bangladesh. A competency-based education/training strategies need to be implemented for the gradual improvement of nurses’ knowledge and skills regarding cancer treatment and management including chemo drug preparation and administration. Moreover, a nationwide survey following this approach needs to be conducted to yield a valid outcome for a sustainable intervention addressing the determinants of poor knowledge of chemotherapy drug management in cancer treatment. Considering our findings, it is advisable to integrate standardized chemotherapy safety protocols and competency-based modules into the national nursing curricula to strengthen foundational training. Additionally, establishing mandatory continuous professional development (CPD) requirements for nurses working in oncology units—such as regular refresher training and certification—could significantly enhance their preparedness and safety practices. These measures will ensure nurses remain up to date with evolving standards and contribute to safer cancer care delivery. Declarations Author Contribution Statement: Nasrin Akter: Conceived and designed the study; performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper. Bilkis Banu: Conceived and designed the study; performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper. Farhana Faruque Zerin: Conceived and designed the study; performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper. Nusrat Hossain Sheba: Performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper. Md. Tanzeerul Islam: Performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper. Rupali Akter: Performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper. Fatema Afrin: Performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper. Sarder Mahmud Hossain: Performed the study; contributed materials, analysis tools, or data; wrote and reviewed the paper. Source of funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of interest: None declared Ethics Declarations: This study involved human participants and required ethical approval and informed consent. The research was conducted in accordance with ethical standards and the Declaration of Helsinki. Consent of participants: Written informed consent was obtained from all participants before their inclusion in the study. Participation was voluntary, and participants were informed of their right to withdraw at any time without any consequences. Anonymity and confidentiality were strictly maintained throughout the study. Name of the IRB or Ethics Committee: This study was approved by the Ethical Review Committee (ERC) of the Department of Public Health, Northern University Bangladesh, under approval number NUB/DPH/EC/2023/29. The committee reviewed and approved all study procedures in accordance with national and international ethical guidelines. Author Details: Nasrin Akter , Lecturer, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail: [email protected] ; Phone: +88-01675746599. Bilkis Banu, Associate Professor, Department of Public Health, Independent University, Bangladesh, Dhaka, Bangladesh; E-mail: [email protected] ; Phone: +88-01716245245. Farhana Faruque Zerin, Research Fellow (remote), Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail: [email protected] Nusrat Hossain Sheba, Lecturer, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail: [email protected] ; Phone: +88-01727454135. Md. Tanzeerul Islam, Research Fellow, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail: [email protected] ; Phone: +88-01716409109. Rupali Akter , Research Fellow, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail: [email protected] ; Phone: +88-01680132549. Fatema Afrin , Research Fellow, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail: [email protected] ; Phone: +88-01762353418. Sarder Mahmud Hossain , Professor and Head, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail: [email protected] ; Phone: +88-01914893676. References Al-Ruzzieh MA, Ayala de Calvo LE, Bigirimana JB, Burg A, Buswell L, Challinor J, Cummings G, Day SW, Galassi A, Houlahan K, Nevidjon B. Strengthening the oncology nursing workforce in low-and middle-income countries to address the growing cancer burden. Int Soc Cancer cases. 2015;5:1–6. Mamdouh Zakaria M, Mohamed Alaa S, Mohamed Desoky G. Oncology Nurses' Knowledge and Practices regarding Safe Administration of Intravenous Chemotherapy. Egypt J Health Care. 2022;13(1):1218–31. Hosen MS, Hasan M, Saiful Islam M, Raseduzzaman MM, Tanvirul Islam M, Tazbiul Islam M, Motaher Hossain M, Nafiujjaman M, Nishat TR, Jahidul Hasan M. Evaluation of knowledge and practice of handling chemotherapy agents by nurses: a multi-centre studies in Bangladesh. Int J Community Med Public Health. 2019;6(10):4175. Ensslin Angela S, Huber R, Angelika P. Biological Monitoring of Hospital Pharmacy Personnel Occupation ally Exposed to Cytostatic Drugs: Urinary Excretion and Cytogenetic Study. Int Archives Occupa tional Environ Health. 1997;70(3):205–58. 10.1007/s004200050208 . Vollono C, Badoni G. Petrelli Risk Perception and Self-Assessment of Exposure to Antineoplastic Agents in a Group of Nurses and Pharmacists. Giornale Italiano di Med del Lavoro ed Ergonomia. 2002;24(1):49–55. Sessink PJ, Wittenhorst BC, Anzion RB, Bos RP. Exposure of Pharmacy Technicians to Antineoplastic Agents; Reevaluation after Additional Protective Mea sures. Arch Environ Health. 1997;52(3):240–4. 10.1080/00039899709602893 . Nygren E, Lundgren C. Determination of Platinum in Workroom Air and in Blood and Urine from Nursing Staff Attending Patients Receiving Cisplatin Chemotherapy. Int Archives Occup Environ Health. 1997;70(3):209–14. 10.1007/s004200050209 . Chaudhary R, Karn BK. Chemotherapy-knowledge and handling practice of nurses working in a medical university of Nepal. J Cancer Therapy. 2012. Krstev S, Perunicic B, Vitakovic A. Work-practice and some adverse health effects in nurses handling antineoplastic drugs. Med Lav. 2003;94(5):432–9. Dranitsaris G, Johnston M, Poirer ST, Milliken D, Green E, Zanke B. Are health care providers who work with cancer drugs at an increased risk for toxic events? A systematic review and meta-analysis of the literature. J Oncol Pharm Pract. 2005;11(2):69–78. Kosgeroglou N, Ayranci U, Ozerdogan N, Demirustu G. Turkish nurses’ information about, and administration of, chemotherapeutic drugs. J Clin Nurs. 2006;15(9):1179–87. Shahrasbi AA, Afsar M, Shokraneh F, Monji F, Noroozi M, Ebrahimi-Khonji M, et al. Risks to health professionals from hazardous drugs in Iran: A pilot study of understanding of healthcare team to occupational exposure to chemotherapy. EXCLI J. 2014;13:491–501. Kubilay G, Fesci Erdem H. Evaluation of the Status of the Nurses Preparing and Administrating CDs. Oncol Nurses’ Association. 1997;6:7–15. Khan N, Khowaja KZ, Ali TS. Assessment of knowledge, skill and attitude of oncology nurses in chemotherapy administration in tertiary hospital Pakistan. Open J Nurs. 2012;2(2):97. Nwagbo SE, Ilesanmi RE, Ohaeri BM, Oluwatosin AO. Knowledge of chemotherapy and occupational safety measures among nurses in oncology units. J Clin Sci. 2017;14(3):131–7. Kapucu S, Özkaraman AO, Uysal N, Bagcivan G, Şeref FC, Elöz A. Knowledge level on administration of chemotherapy through peripheral and central venous catheter among oncology nurses. Asia-Pacific J Oncol Nurs. 2017;4(1):61–8. Hospital Service Management. Government of the people’s Republic of Bangladesh. http://hospitaldghs.gov.bd/list-of-2ndary-tertiary-level-hospital/ Banu B, Chowdhury SH, Akter N, Islam KR, Hossain SM, Amin MR. Preventive Behaviors to Mitigate COVID-19: Urban-Rural Disparities of Densely Populated Country like Bangladesh. J Environ Sci Public Health. 2021;5(4):433–50. Kottner J, Streiner DL et al. Internal consistency and Cronbach's alpha: A comment on Beeckman. (2010). International journal of nursing studies. 2010;47(7):926-8. Winn A, Afolabi EK, Bifarin M, Avwioro T, Alatise OI, Kingham PT, Barton-Burke M. Knowledge, Attitudes, and Practice of chemotherapy management among nurses at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Asia-Pacific J Oncol Nurs. 2024;11(3):100371. Abdullah DA, Rasheed OH. Nursing staff knowledge regarding safe chemotherapy administration at oncology center in Kirkuk City. Kirkuk Univ J. 2018;13(1):144–55. Iliyasu G, Dayyab FM, Habib ZG, Tiamiyu AB, Abubakar S, Mijinyawa MS, Habib AG. Knowledge and practices of infection control among healthcare workers in a Tertiary Referral Center in North-Western Nigeria. Ann Afr Med. 2016;15(1):34–40. Tekle T, Wolka E, Nega B, Kumma WP, Koyira MM. Knowledge, attitude and practice towards cervical cancer screening among women and associated factors in hospitals of Wolaita Zone, Southern Ethiopia. Cancer Manage Res 2020 Feb 11:993–1005. Additional Declarations No competing interests reported. Supplementary Files Dataset.xls Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7141786","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488513356,"identity":"a35bcfb7-190a-40e2-aafa-0a551ec9e1a1","order_by":0,"name":"Nasrin Akter","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYLCCBAYGxoYDzAeATAkZUrSwJYC08BBtEVALjwGIQViLOfvxZx8e7mCQ7Tt+5vOrGzUWPAzsh49uwKfFsifHeEbiGQbjmWdyt1nnHAM6jCct7QY+LQYHcpgZEtsYEjfc4N1mnMMG1CLBY4Zfy/nnj6FaeJ4Z5/wjRsuNBGOYFubHuW1EaXkD0iIB9EuaGXNunwQPG0G/nE9/zPizzQYYYocff875VifHz374GF4tUCABItggJBHK4YD5AymqR8EoGAWjYOQAANzESc9xmcJIAAAAAElFTkSuQmCC","orcid":"","institution":"Northern University Bangladesh","correspondingAuthor":true,"prefix":"","firstName":"Nasrin","middleName":"","lastName":"Akter","suffix":""},{"id":488513357,"identity":"f1c113ab-318c-4105-a200-466db6fd0c3a","order_by":1,"name":"Bilkis Banu","email":"","orcid":"","institution":"Independent University","correspondingAuthor":false,"prefix":"","firstName":"Bilkis","middleName":"","lastName":"Banu","suffix":""},{"id":488513358,"identity":"dcc6c62f-a188-4d00-9ec1-e81461289d3f","order_by":2,"name":"Farhana Faruque Zerin","email":"","orcid":"","institution":"Northern University Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Farhana","middleName":"Faruque","lastName":"Zerin","suffix":""},{"id":488513359,"identity":"8923258b-fc75-4286-9910-22560e309a91","order_by":3,"name":"Nusrat Hossain Sheba","email":"","orcid":"","institution":"Northern University Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Nusrat","middleName":"Hossain","lastName":"Sheba","suffix":""},{"id":488513360,"identity":"cbc797a3-96ff-42d8-854f-1057144d6d61","order_by":4,"name":"Md. Tanzeerul Islam","email":"","orcid":"","institution":"Northern University Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Md.","middleName":"Tanzeerul","lastName":"Islam","suffix":""},{"id":488513366,"identity":"503fba1d-be86-44fd-ac6e-1096ca9469a8","order_by":5,"name":"Rupali Akter","email":"","orcid":"","institution":"Northern University Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Rupali","middleName":"","lastName":"Akter","suffix":""},{"id":488513368,"identity":"d65908ab-790c-42d7-b2f4-8100a79e8bc6","order_by":6,"name":"Fatema Afrin","email":"","orcid":"","institution":"Northern University Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Fatema","middleName":"","lastName":"Afrin","suffix":""},{"id":488513369,"identity":"b5208b90-567a-46c2-b4a0-60474d3a40a5","order_by":7,"name":"Sarder Mahmud Hossain","email":"","orcid":"","institution":"Northern University Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Sarder","middleName":"Mahmud","lastName":"Hossain","suffix":""}],"badges":[],"createdAt":"2025-07-16 15:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7141786/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7141786/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87383917,"identity":"c495926f-b252-43a7-83b0-71d90f9eb168","added_by":"auto","created_at":"2025-07-23 08:43:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":67082,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of technical knowledge among respondents (n=105) regarding chemotherapy drug preparation and administration, including key gaps in six safety-related components.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7141786/v1/14a280ae2014554f1bfcf9d2.png"},{"id":87383918,"identity":"1860059f-d971-4b91-b7da-c04e3f18f0f7","added_by":"auto","created_at":"2025-07-23 08:43:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":147477,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociation between technical knowledge of chemotherapy preparation and administration and basic knowledge of cancer and chemotherapy among respondents (n=105), showing that poor basic knowledge is linked to poor technical competency.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7141786/v1/e7209986d31bf4136ca89592.png"},{"id":87383920,"identity":"ba7b6f65-6f0e-4163-8c77-24cde9f64364","added_by":"auto","created_at":"2025-07-23 08:43:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":84187,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePredictors of poor technical knowledge of chemotherapy preparation and administration among nurses (n=105), shown by crude and adjusted odds ratios (COR and AOR), with 95% confidence intervals.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFigure 3 Footnote: Statistically significant predictor is considered at p ≤0.05. Reference category for age is \u0026gt;32 years, for professional education is Post Basic in Nursing, for type of educational institution is Government institution, for working experience in nursing is \u0026gt;10 years, for working experience in cancer unit is \u0026gt;1 years and for training on cancer patient management is Yes and lastly for basic knowledge of chemotherapy is good. (Regression Analysis).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7141786/v1/c56f087e55a1fb87554d2316.png"},{"id":87467073,"identity":"c587c158-088a-4787-99c0-b314cb9a590d","added_by":"auto","created_at":"2025-07-24 07:55:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1762237,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7141786/v1/832a649f-2917-4a64-813b-8e69de00bdc0.pdf"},{"id":87385003,"identity":"cfa6bf04-a3cd-4bb8-af5e-4965a3479104","added_by":"auto","created_at":"2025-07-23 08:51:54","extension":"xls","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":112091,"visible":true,"origin":"","legend":"","description":"","filename":"Dataset.xls","url":"https://assets-eu.researchsquare.com/files/rs-7141786/v1/b5953e0ce2a1dbcec3221203.xls"}],"financialInterests":"No competing interests reported.","formattedTitle":"Probing technical knowledge on preparation and administration of chemotherapy drugs: A cross-sectional study focusing nurses of Dhaka, Bangladesh","fulltext":[{"header":"What is already known on this topic","content":"\u003cp\u003ePrevious studies emphasize the importance of technical knowledge in chemotherapy administration for safe oncology practice. However, recent findings regarding nurses\u0026rsquo; knowledge of cancer and chemotherapy in Bangladesh, indicates concerns for both nurses and cancer patients regarding safe handling and administration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe outcome of this study adds a new insight regarding knowledge of chemotherapy drug preparation and administration among the nurses of Bangladesh. Nurses in the country mostly do rotational duties in the cancer unit\u0026nbsp;despite having inadequate knowledge.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHow this study might affect research, practice, or policy:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe outcome of this study might help to develop new approaches and strategies toward a safe health service regarding cancer treatment management in Bangladesh. In addition, this study will guide future large-scale nationwide studies to generate more scientific evidence for effective utilization in successful implementation policies in cancer patient management training among the nurses.\u003c/p\u003e"},{"header":"1 Background","content":"\u003cp\u003eA critical component of cancer treatment is the nursing workforce, one of the largest medical professional groups handling cancer patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Over the last decade or so, there have been major changes to the extent of practice, more complex treatment regimens, novel chemotherapeutic and supportive care agents, and more intricate healthcare systems that have impacted the role of oncology nurses in the safe administration of chemotherapy. They are responsible for safely preparing and administering chemotherapy drugs (CDs), careful patient assessment, managing side effects, educating patients and their families about the adverse effects of chemotherapy, and providing emotional support through the process. However, the distinct pharmacological characteristics of CDs, which obstruct cell division, are recognized to make them potentially dangerous [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These drugs have toxic properties and can have teratogenic, mutagenic, and carcinogenic effects [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Due to the prolonged and repeated exposure to chemotherapy drugs, nurses may be at risk of exposure through improper hygiene practices such as eating, drinking, or smoking. This exposure can occur through direct skin or ocular contact or inhalation of droplet aerosolization [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. They can also lead to cancer, abortion, fetal malformations, infertility issues, and genetic alterations in offspring, as noted by the Occupational Safety and Health Administration (OSHA) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Recent studies have revealed a troubling rise in the potential dangers linked to occupational exposure to CDs which is particularly significant for healthcare providers [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, the oncology nursing society strongly recommended the educational qualification of nurses in chemotherapy drug perpetration and management at the workplace. The rate of hazardous exposure depends on their depth of knowledge and skill [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The more knowledge they acquire, the more they adhere to safety measures when treating patients, thereby enhancing the chances of a healthy life. According to a study, nurses' understanding of managing chemotherapy is mediocre; yet, they seem to face challenges when it comes to using personal protective equipment, keeping a biological safety cabinet, following protocols, medical monitoring, and training [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Another study indicates that there has been an increase in the use and availability of gloves, but at the same time, a decrease in other essential personal protective equipment, such as protective garments, face masks, and respiratory shields, when handling chemotherapy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Among oncology nurses in tertiary hospitals, a study revealed that attitude is the most significant aspect of their chemotherapy administration competencies, while knowledge is the weakest [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As a result, nurses had a limited grip on the exact guidelines of chemotherapy drug management although having good knowledge [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. That is why, it was observed that while nurses had sufficient knowledge of safe chemotherapy administration, their practices were not up to standard. Hence, in-service training might help them increase their level of knowledge through hands-on learning [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. There are existing guidelines for handling chemotherapy drugs from different organizations like the National Institute for Occupational Safety and Health (NIOSH), Oncology Nursing Society (ONS), American Society of Clinical Oncology (ASCO), American Society of Health-System Pharmacists (ASHP) etc [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, there is still a lack of routine medical monitoring for employees exposed to chemotherapy, and the monitoring procedures do not consistently adhere to the guidelines established by OSHA [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In Bangladesh, nurses have limited knowledge and skills for handling CDs. Most significantly, oncology nurses require comprehensive in-service training in the safe management of chemotherapy medications and understanding of related risks and contamination, and adequate facilities for personal protection, as their knowledge and awareness are vital in cancer care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, the study was conducted to assess technical knowledge of the preparation and administration of chemotherapy drugs among the nurses working in tertiary-level hospital settings in Bangladesh. The results of this study could serve as a roadmap for future research into training for oncology nursing and for advocating that healthcare facilities with oncology units offer evidence to inform policy implementation.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design\u003c/h2\u003e\u003cp\u003eA quantitative cross-sectional study was carried out followed analytical approach from 05 July to 10 January 2024. Semi-structured data were collected in this study for obtaining the information on socio-demographic characteristics, professional characteristics, basic knowledge on cancer and chemotherapy and technical knowledge on chemo preparation and administration among nurses working in a tertiary-level hospital with existing and actively functioning cancer units in Dhaka city.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Study participants, sample size and sampling\u003c/h2\u003e\u003cp\u003eThis study included a total of 105 nurses from Kurmitola 500 Bed General Hospital of Dhaka, Bangladesh. Quantitative information of this study was collected from the respondents\u0026rsquo; identified as currently active nurses during the data collection period, signified as working in the cancer unit on a rotational basis and provided their consent to participate in this study.\u003c/p\u003e\u003cp\u003eInitially a potential standard sample size was assumed as 100 calculated by using the formula \u0026ldquo;n= \u0026lsquo;Z\u003csup\u003e2\u003c/sup\u003epq/d\u003csup\u003e2\u003c/sup\u003e\u0026rdquo; where Z (standard normal deviate) considered as 1.96; p (knowledge on one of the components of chemo drug administration 93.9%) was considered as 0.93 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and margin of error was considered as 0.05. With a minimum calculated sample 100, an additional 5% was added as cushion to take into account non-response and considering data cleaning and initial management and the final samples were 105.\u003c/p\u003e\u003cp\u003eInitially, six tertiary-level hospitals in Dhaka, the capital of Bangladesh, were targeted due to their significant availability of cancer units [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Kurmitola 500 Bed General Hospital in Dhaka was randomly selected for this study. Kurmitola 500 Bed General Hospital was selected based on its active oncology unit, logistical feasibility, and administrative clearance. Though single-site data collection may limit generalizability, this government facility is representative of typical tertiary-level public hospitals in urban Bangladesh. Concentrating on one hospital allows methodological consistency and minimized institutional bias. Future research should consider multi-center designs to enhance external validity. A systematic random sampling technique was used to select participants from a list of 140 nurses assigned to rotational duty in the cancer unit during the study period. This list, provided by the hospital\u0026rsquo;s nursing administration, served as the sampling frame. With a required sample size of 105, the sampling interval was approximately 1.33. One nurse was randomly selected from the first three names on the list using a lottery method to determine the starting point, after which every nurse at the calculated interval was selected.\u003c/p\u003e\u003cp\u003e\u003cb\u003e\u0026zwnj;2.3 Data collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eQuantitative data was collected from the nurses by using a pre-tested and semi-structured questionnaire through the interviewer-administered method. Respondents were interviewed according to their convenience from 01 September to 07 October 2023. The interviewer took only 10 to 15 minutes to complete the survey. All authors had access to the collection and preserving participants\u0026rsquo; information during or after data collection. The survey was administered in the Bengali language with the utmost support of the hospital administrative authority.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Ethical considerations\u003c/h2\u003e\u003cp\u003e This study was approved by the Ethical Review Committee of the Department of Public Health of Northern University Bangladesh (NUB/DPH/EC/2023/29) and conformed to the Declaration of Helsinki. Participation of the respondents was anonymous and voluntary. Written informed consent was taken from the respondents at the beginning of the survey. Participants could withdraw from the survey at any time and their autonomy has been ensured.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Questionnaire design\u003c/h2\u003e\u003cp\u003eThe questionnaire was pre-validated by two independent reviewers and pre-tested among five respondents. The quality of the questionnaire addressed the responses of the pre-test. To ensure content validity, a panel of five experts in oncology, pharmacy, and public health reviewed the draft questionnaire for relevance, clarity, and contextual fit. Their feedback informed revisions to several items, ensuring alignment with the clinical and cultural context of the study setting. The pivotal components of the questionnaire were: (i) Socio-demographic and professional characteristics: age, professional education, type of educational institution, working experience in nursing, working experience in cancer unit, training on cancer patient management; (ii) Basic knowledge on cancer and chemotherapy: concept, types, treatment types \u0026amp; stages of cancer, chemotherapy, immediate health hazards of chemotherapy; (iii) Technical knowledge on chemotherapy drug preparation or administration: use of isopropyl alcohol, standard operating procedure, specially dedicated room for chemotherapy, chemo preparation place (in nursing station), drop and time calculation of intravenous chemo, closed system drug transfer devices (CSTD). Each correct response was scored as one point, and total knowledge scores were converted into percentages. Participants scoring\u0026thinsp;\u0026ge;\u0026thinsp;80% were classified as having good knowledge, while those scoring\u0026thinsp;\u0026lt;\u0026thinsp;50% were categorized as having poor knowledge and 50\u0026ndash;79% were considered as moderate knowledge. The use of an 80% cut-off for this binary classification (good vs. moderate/poor knowledge) was based on established precedents in similar studies conducted in low- and middle-income countries [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and was reviewed by oncology nursing experts. In the context of Bangladesh, where no national benchmark currently exists, this cut-off provides a pragmatic and interpretable standard. It also strengthened regression modeling by clearly delineating at-risk subgroups, thereby informing targeted training and policy strategies. Although the 80% cut-off may not offer optimal sensitivity and specificity in a diagnostic context, it reasonably reflects the threshold at which limited knowledge may compromise safe chemotherapy handling in resource-constrained settings. No patients or members of the general public were involved in planning, execution, reporting, or distribution of our study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Data analysis\u003c/h2\u003e\u003cp\u003eCollected data was checked and analyzed employing the Statistical Package for the Social Sciences (SPSS) software. Study characteristics were subjected to descriptive statistics (frequency and proportions) to summarize the obtained data.\u003c/p\u003e\u003cp\u003eRelevant continuous data were categorized followed mid values of the percentage scores as cut points [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A binary logistic regression analysis was performed followed by a modeling procedure considering a backward elimination process, including pre-specified confounders i.e. age, professional education, type of educational institution, working experience in nursing, working experience in cancer unit, training on cancer patient management and basic knowledge on cancer and chemotherapy. Odds ratios with 95% confidence intervals with respect to technical knowledge on chemotherapy preparation or administration (good and poor) were calculated for the specified exposures. Study instrument was peer-reviewed by the authors and experts in the oncology \u0026amp; nursing arena. In addition, to test the reliability, the internal consistency of the questionnaire was assessed by Cronbach's alpha coefficient and alpha greater than 0.71 was considered satisfactory [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The validity was tested through Pearson\u0026rsquo;s Correlation Coefficient analysis. Considering the degree of freedom at the two-tailed test as (N-2\u0026thinsp;=\u0026thinsp;105-2\u0026thinsp;=\u0026thinsp;103) at 95% Confidence Interval (CI) the obtained value (0.333) was found greater than the critical tabulated value (0.138). The outcome suggests the significant validity of the instrument. All odds ratios (ORs) were presented with corresponding 95% confidence intervals (CIs) to indicate the precision of the estimates. Multicollinearity among independent variables was assessed using Variance Inflation Factor (VIF), and all VIF values were below 2.5, indicating no significant multicollinearity. Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test, and the non-significant result (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) suggested a satisfactory model fit. Although all key statistical assumptions were met, we recognize that certain contextual variables such as organizational support, workload, or unit-level supervision were not included in this model. However, the inclusion of key covariates and use of a structured modeling approach enhance the validity of the reported associations. Future studies with larger samples should explore interaction effects and additional variables to further strengthen causal inference.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Participant\u0026rsquo;s characteristics\u003c/h2\u003e\u003cp\u003eThis study included a total of 105 respondents among whom the majority (58%) were from \u0026le;\u0026thinsp;32 years of age group. More than half of the respondents had a diploma education while 17.1% and 31.4% had basic BSc and post-basic in nursing respectively. Most of the respondents completed their nursing education from the government institution (66.7%) and had\u0026thinsp;\u0026le;\u0026thinsp;10 years of working experience (68.6%) in the nursing profession. However, a bulk of them were working in the cancer unit for only\u0026thinsp;\u0026le;\u0026thinsp;1 year (86.7%) and did not have any training on cancer patient management (82.9%) while all of them had to work in the cancer unit by rotation. Most alarmingly, the study also revealed a huge number of respondents (77.1%) had poor basic knowledge of cancer and chemotherapy among them. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBackground characteristics associated with the level of technical knowledge regarding chemotherapy drug preparation \u0026amp; administration among the respondents (n\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNumber of participant\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eLevel of technical knowledge on chemotherapy preparation \u0026amp; administration\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eModerate/Poor\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eꭕ\u003csup\u003e2\u003c/sup\u003e/p-value (\u0026le;\u0026thinsp;0.05)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAge (in years)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (58.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (41.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5.36/0.02*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (41.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (21.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (21.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eProfessional education\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (51.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e15.18/0.01*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic BSc in nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (11.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost basic in nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (11.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eType of educational institution\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovernment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (32.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e11.75/0.01*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (28.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eWorking experience in nursing (in years)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72 (68.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52 (49.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e8.60/0.01*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (18.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (13.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eWorking experience in cancer unit (in years)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91 (86.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61 (58.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5.09/0.02*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (4.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eTraining on cancer patient management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e8.11/0.01*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (82.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60 (57.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eBasic knowledge of cancer \u0026amp; chemotherapy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e11.62/0.01*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate/Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (77.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58 (55.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003eFootnote: Data are presented as frequency (n), percentage (%); *Statistical significance at p value\u0026thinsp;\u0026le;\u0026thinsp;0.05. Chi-square test was used to observe the association\u003c/em\u003e\u003cb\u003eFig 1. Distribution of technical knowledge among respondents (n\u0026thinsp;=\u0026thinsp;105) regarding chemotherapy drug preparation and administration, including key gaps in six safety-related components.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Status of technical knowledge regarding chemotherapy drug preparation \u0026amp; administration among the respondents\u003c/h2\u003e\u003cp\u003eThe crucial outcome of the study is the technical knowledge regarding chemotherapy drug preparation \u0026amp; administration among the respondents. The majority of the respondents had poor (62.90%) technical knowledge regarding chemotherapy drug preparation \u0026amp; administration while only 37.10% showed good knowledge regarding chemotherapy drug preparation \u0026amp; administration. This knowledge was assessed considering some pivotal components regarding chemo drug preparation and administration. Components include knowledge of adequate use of isopropyl alcohol, standard operating procedure, an especially dedicated room for chemotherapy, chemo preparation place, drop and time calculation of intravenous chemo, and closed system drug transfer devices (CSTD). The most prominent components responsible for overall poor technical knowledge were knowledge of chemo drug preparation place (in nursing station: 46.70%), standard operating procedure (inadequate knowledge: 45.70%), and Closed System Drug Transfer Devices (CSTD) (no knowledge: 41.9%). (Fig.\u0026nbsp;1)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Association between basic knowledge on cancer, chemotherapy and technical knowledge on chemo drug preparation, administration\u003c/h2\u003e\u003cp\u003eAnother crucial outcome of this study portrayed a strong statistical association (ꭕ2/p\u0026thinsp;=\u0026thinsp;11.62/0.01) between basic knowledge of cancer, chemotherapy, and technical knowledge of chemo drug preparation, and administration. It was observed that nurses who had poor (81/77.1%) basic knowledge of cancer and chemotherapy, they found to have poor technical knowledge of chemo drug preparation and administration (58/55.2%). (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Respondent\u0026rsquo;s Characteristics associated with the level of technical knowledge on chemotherapy preparation \u0026amp; administration\u003c/h2\u003e\u003cp\u003eThe outcome of bivariate cross-tabulation analysis is delineated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e mentioned in this article. It was observed that nurse\u0026rsquo;s knowledge of chemo drug preparation and administration is significantly associated with their age (p\u0026thinsp;=\u0026thinsp;0.02), professional education (p\u0026thinsp;=\u0026thinsp;0.01), educational institution (p\u0026thinsp;=\u0026thinsp;0.01), working experience in nursing (p\u0026thinsp;=\u0026thinsp;0.01) and cancer unit (p\u0026thinsp;=\u0026thinsp;0.02), having training on cancer patient management (p\u0026thinsp;=\u0026thinsp;0.01) and their basic knowledge on cancer, chemotherapy (p\u0026thinsp;=\u0026thinsp;0.01). In other words, poor knowledge was significantly higher among \u0026le;\u0026thinsp;32 years of aged nurses (44/105) who had diploma education (42/105) only from private institutions (30/105) and less working experience in nursing (52/105) and cancer unit (61/105). In addition, poorly knowledgeable nurses did not have any training (60/105) on cancer patient management and they also had poor basic knowledge (58/105) on cancer and chemotherapy.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Significant determinants against poor level of technical knowledge on chemotherapy preparation \u0026amp; administration\u003c/h2\u003e\u003cp\u003eThe regression analysis of the study revealed a set of significant predictors associated with the poor level of technical knowledge on chemotherapy preparation \u0026amp; administration. Initially, unadjusted odds ratios were calculated through the binary regression analysis. For instance, higher Crude Odds Ratios (COR) of poor technical knowledge were observed among the nurses who had only diploma education (COR/p\u0026thinsp;=\u0026thinsp;6.13/0.01) from a private institute (COR/p\u0026thinsp;=\u0026thinsp;5.67/0.01), did not have any training (COR/p\u0026thinsp;=\u0026thinsp;4.44/0.01) on cancer patient management and those nurses who had poor basic knowledge (COR/p\u0026thinsp;=\u0026thinsp;5.04/0.01) on cancer and chemotherapy. In addition, significant odds of poor knowledge were also found among \u0026le;\u0026thinsp;32 years aged (COR/p\u0026thinsp;=\u0026thinsp;2.59/0.02) who had less working experience in nursing (COR/p\u0026thinsp;=\u0026thinsp;3.53/0.01) and cancer unit (COR/p\u0026thinsp;=\u0026thinsp;3.66/0.03).\u003c/p\u003e\u003cp\u003eAfter a model adjustment with the crude outcomes, the study revealed some ultimate determinants associated with poor technical knowledge among the study subjects by exploring the Adjusted Odds Ratios (AOR). Likewise, as the final predictor\u0026rsquo;s significant odds of poor technical knowledge were found among the nurses with poor basic knowledge (AOR/p\u0026thinsp;=\u0026thinsp;6.58/0.01) who completed their only diploma (AOR/p\u0026thinsp;=\u0026thinsp;3.91/0.02) education from a private institution (AOR/p\u0026thinsp;=\u0026thinsp;4.57/0.01) and had a minimum (0-1year: AOR/p\u0026thinsp;=\u0026thinsp;4.73/0.05) working experience in chemotherapy unit. Although with this poor background condition, they are pretended to their duty in the cancer unit by rotation which is alarming for the safe health care service among the cancer patients. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eNurses have a crucial role in the management of chemotherapy treatment, particularly in the safe preparation and administration of cytotoxic drugs, alongside other critical aspects of patient care. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The level of knowledge of the nurses about the preparation and administration of chemotherapy drugs is not satisfactory, especially in low and middle-income countries (LMIs) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The objective of this study was to evaluate the technical knowledge of the preparation and administration of chemotherapy drugs among nurses in Bangladesh\u003c/p\u003e\u003cp\u003eThe present study revealed that nurses aged\u0026thinsp;\u0026le;\u0026thinsp;32 years accounted for over half of the study subjects. This feature coincides with numerous other studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], highlighting, and emphasizing young nurses and their technical knowledge on the preparation and administration of chemotherapy drugs. In addition, a robust outcome was found between the results regarding the educational attainment and work experience of nurses with diploma programs and findings from other studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Moreover, most of the nurses in this study did not have any training regarding cancer and chemotherapy while mostly trained subjects were identified in an Egyptian study conducted in different settings [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to other studies, medication errors in chemotherapy centers were widespread (44%) because staff members lacked specialized knowledge and training in the preparation and administration of chemotherapy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Research indicates that engaging in a training program resulted in a noteworthy improvement in knowledge levels [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStandard operating procedures and awareness of the location where chemotherapy drugs are prepared were found as the two main factors contributing to the overall lack of technical knowledge among the nurses in our study. The prevalence of harmful behaviors in the workplace and the mean knowledge scores by chemotherapy drugs preparation region did not differ significantly, according to the other studies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The fact that 25% of respondents to another survey never prepared medication in a designated area raises concerns about environmental contamination. The preparation of the medications in approved treatment areas is a requirement for the safe handling of chemotherapy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, it is noteworthy that responders with low technical knowledge of chemo preparation and administration had a low basic understanding of cancer and chemotherapy. Similar results were found in another study in Bangladesh, which revealed most of the nurses had average knowledge of administering and preparing chemotherapy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, other studies in different demography and settings showed poor practice of handling chemotherapy although they had satisfactory scores of knowledge [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, it was also discovered that diploma nurses with at least a little experience working in a cancer unit had significant odds of poor technical knowledge of chemotherapy which coincides with other studies conducted previously [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It is also indicated that the length of time a nurse has worked in an oncology unit may have an impact on their knowledge and skills. Years of experience working in the oncology unit were found to be statistically significantly associated with knowledge of chemotherapy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Inadequate knowledge of the preparation and administration of chemotherapy was also shown to be statistically significant among the nurses who obtained their degrees from a private organization. Which does not account for the deficient practice of protective equipment during CD management [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A potential explanation for this finding may lie in systemic differences in curriculum structure, clinical exposure, and institutional support between diploma and degree programs. Diploma programs in Bangladesh often provide limited specialization and hands-on oncology training, which may contribute to weaker technical competency in chemotherapy preparation and administration. Early suggestions include providing insights into the factors influencing the periodic enhancement of nurses' knowledge and skills in chemotherapy drug management, emphasizing the necessity for stringent policy development, and highlighting the importance of facilitating the implementation of guidelines [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe majority of nurses in our study demonstrated limited technical knowledge in areas such as identifying appropriate chemotherapy preparation sites, calculating drop rate and infusion time for intravenous drug administration, and understanding the use and purpose of closed-system drug transfer devices (CSTDs).These competencies are essential for the safe preparation, administration, and disposal of hazardous drugs, and are explicitly emphasized in international oncology safety standards established by the Occupational Safety and Health Administration (OSHA), Oncology Nursing Society (ONS), and the National Institute for Occupational Safety and Health (NIOSH). The observed knowledge gaps indicate a significant misalignment with global safety protocols, particularly regarding the routine use of PPE, CSTDs, and adherence to safety-engineered controls (e.g., biological safety cabinets). These findings highlight an urgent need to align local training and practice standards with international recommendations to protect both healthcare workers and patients.\u003c/p\u003e\u003cp\u003eThe duration of our study was brief, which limited our ability to observe long-term knowledge retention or behavior change. Our study's ability to be generalized is constrained as it was conducted solely at one site which may not reflect practices across diverse healthcare institutions in Bangladesh. A larger sample size would bolster statistical robustness. Moreover, being a cross-sectional study, extending the observation period could yield more comprehensive insights. The use of a\u0026thinsp;\u0026ge;\u0026thinsp;80% threshold for knowledge categorization, although informed by empirical evidence and expert opinion, was not statistically validated and may limit precision in classifying knowledge levels. Nevertheless, despite these limitations, our study generated distinct findings that can contribute to shaping the future direction for enhancing nurses' knowledge and practices in cancer and chemotherapy management, thereby fortifying oncology services within the healthcare system. The findings of our study are reinforced by a prior investigation involving Bangladeshi nurses, enhancing the credibility and reliability of our results. Furthermore, the outcomes of our current study are presumed to be crucial additions to the existing knowledge base, particularly within the context of Bangladesh, where limited research has been conducted among nursing staff regarding their knowledge of the preparation and administration of chemotherapy drugs.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis study revealed a crucial outcome regarding nurse\u0026rsquo;s technical knowledge of chemotherapy preparation and administration. The majority of the respondents had poor technical knowledge regarding chemotherapy drug preparation \u0026amp; administration which is significant among those nurses who had poor basic knowledge too. In addition, poor technical knowledge was also found significant among the diploma nurses with minimum working experience in the cancer unit who did not have any training on cancer \u0026amp; chemotherapy. The negative outcome of this study indicates an alarming scenario of poor healthcare service delivery among cancer patients in Bangladesh. To address the substantial impact of cancer there is a need for enhancements in the healthcare service strategies within cancer units across Bangladesh. A competency-based education/training strategies need to be implemented for the gradual improvement of nurses\u0026rsquo; knowledge and skills regarding cancer treatment and management including chemo drug preparation and administration. Moreover, a nationwide survey following this approach needs to be conducted to yield a valid outcome for a sustainable intervention addressing the determinants of poor knowledge of chemotherapy drug management in cancer treatment. Considering our findings, it is advisable to integrate standardized chemotherapy safety protocols and competency-based modules into the national nursing curricula to strengthen foundational training. Additionally, establishing mandatory continuous professional development (CPD) requirements for nurses working in oncology units\u0026mdash;such as regular refresher training and certification\u0026mdash;could significantly enhance their preparedness and safety practices. These measures will ensure nurses remain up to date with evolving standards and contribute to safer cancer care delivery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contribution Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNasrin Akter:\u003c/strong\u003e Conceived and designed the study; performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBilkis Banu:\u003c/strong\u003e Conceived and designed the study; performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFarhana Faruque Zerin:\u0026nbsp;\u003c/strong\u003eConceived and designed the study; performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNusrat Hossain Sheba:\u003c/strong\u003e Performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMd. Tanzeerul Islam:\u0026nbsp;\u003c/strong\u003ePerformed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRupali Akter:\u003c/strong\u003e Performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFatema Afrin:\u003c/strong\u003e Performed the study; analyzed and interpreted the data; contributed materials, analysis tools, or data; wrote and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSarder Mahmud Hossain:\u003c/strong\u003e Performed the study; contributed materials, analysis tools, or data; wrote and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of funding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declarations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved human participants and required ethical approval and informed consent. The research was conducted in accordance with ethical standards and the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of participants:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants before their inclusion in the study. Participation was voluntary, and participants were informed of their right to withdraw at any time without any consequences. Anonymity and confidentiality were strictly maintained throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eName of the IRB or Ethics Committee:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethical Review Committee (ERC) of the Department of Public Health, Northern University Bangladesh, under approval number NUB/DPH/EC/2023/29. The committee reviewed and approved all study procedures in accordance with national and international ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNasrin Akter\u003c/strong\u003e, Lecturer, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail:\u0026nbsp;[email protected]; Phone: +88-01675746599.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBilkis Banu,\u003c/strong\u003e Associate Professor, Department of Public Health, Independent University, Bangladesh, Dhaka, Bangladesh; E-mail:\u0026nbsp;[email protected]; Phone: +88-01716245245.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFarhana Faruque Zerin,\u0026nbsp;\u003c/strong\u003eResearch Fellow (remote), Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail:\u0026nbsp;[email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNusrat Hossain Sheba,\u0026nbsp;\u003c/strong\u003eLecturer, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail:\u0026nbsp;[email protected]; Phone: +88-01727454135.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMd. Tanzeerul Islam,\u0026nbsp;\u003c/strong\u003eResearch Fellow, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail:\u0026nbsp;[email protected]; Phone: +88-01716409109.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRupali Akter\u003c/strong\u003e, Research Fellow, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail:\u0026nbsp;[email protected]; Phone: +88-01680132549.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFatema Afrin\u003c/strong\u003e, Research Fellow, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail:\u0026nbsp;[email protected]; Phone: +88-01762353418. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSarder Mahmud Hossain\u003c/strong\u003e, Professor and Head, Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh; E-mail: [email protected]; Phone: +88-01914893676.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAl-Ruzzieh MA, Ayala de Calvo LE, Bigirimana JB, Burg A, Buswell L, Challinor J, Cummings G, Day SW, Galassi A, Houlahan K, Nevidjon B. 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Preventive Behaviors to Mitigate COVID-19: Urban-Rural Disparities of Densely Populated Country like Bangladesh. J Environ Sci Public Health. 2021;5(4):433\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKottner J, Streiner DL et al. Internal consistency and Cronbach's alpha: A comment on Beeckman. (2010). International journal of nursing studies. 2010;47(7):926-8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWinn A, Afolabi EK, Bifarin M, Avwioro T, Alatise OI, Kingham PT, Barton-Burke M. Knowledge, Attitudes, and Practice of chemotherapy management among nurses at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Asia-Pacific J Oncol Nurs. 2024;11(3):100371.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdullah DA, Rasheed OH. Nursing staff knowledge regarding safe chemotherapy administration at oncology center in Kirkuk City. Kirkuk Univ J. 2018;13(1):144\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIliyasu G, Dayyab FM, Habib ZG, Tiamiyu AB, Abubakar S, Mijinyawa MS, Habib AG. Knowledge and practices of infection control among healthcare workers in a Tertiary Referral Center in North-Western Nigeria. Ann Afr Med. 2016;15(1):34\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTekle T, Wolka E, Nega B, Kumma WP, Koyira MM. Knowledge, attitude and practice towards cervical cancer screening among women and associated factors in hospitals of Wolaita Zone, Southern Ethiopia. Cancer Manage Res 2020 Feb 11:993\u0026ndash;1005.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Technical knowledge, nurses, preparation and administration of chemotherapy, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-7141786/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7141786/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eNurses are the largest medical professional groups handling cancer patients. They are responsible for safely preparing and administering chemotherapy drugs (CDs), managing side effects, and educating patients and their families about the adverse effects of chemotherapy. In this regards their knowledge regarding cancer chemotherapy is pivotal for safe handling of cancer patients.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eThis study aimed to assess the level of technical knowledge regarding the preparation and administration of chemotherapy and associated factors among the nurses of Bangladesh.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis was a cross-sectional study conducted among randomly selected 105 nurses working in cancer units of a selected tertiary level hospital in Dhaka city, Bangladesh. Data was collected by semi-structured questionnaire through face-to-face interviews. A binary logistic regression model was used for analytical exploration. Adjusted and Unadjusted Odds Ratio (OR) with 95% confidence intervals (95% CI) were calculated for the specified setting indicators. A Chi-square test was used to observe the association. Participants scoring\u0026thinsp;\u0026ge;\u0026thinsp;80% were classified as having good knowledge, while those scoring\u0026thinsp;\u0026lt;\u0026thinsp;50% were categorized as having poor knowledge, based on prior studies in LMICs. Ethical issues were maintained according to the Declaration of Helsinki.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe result showed that a majority (58.1%) of the nurses were from \u0026le;\u0026thinsp;32 years of age group among whom 90.5% of the respondents did not get any training on cancer patient management. It is significantly revealed that respondents (77.1%) who had a poor basic knowledge of cancer and chemotherapy were found to have poor technical knowledge (55.2%) of chemo preparation and administration (AOR/p\u0026thinsp;=\u0026thinsp;6.58/0.01; 95% CI: 1.29\u0026ndash;21.78). In addition, poor knowledge of chemo preparation and administration was also observed as statistically significant among the diploma nurses (AOR/p\u0026thinsp;=\u0026thinsp;3.91/0.01), who completed their nursing education from a private organization (AOR/p\u0026thinsp;=\u0026thinsp;4.57/0.01) and had a minimum of working experience in cancer unit (AOR/p\u0026thinsp;=\u0026thinsp;4.73/0.04).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe negative portrayal regarding knowledge of chemo preparation and administration among the nurses is alarming for the quality of health care in cancer management. Continuous knowledge upgradation is needed for using safety measures and following guidelines in every step of the work with the concern of proper policies.\u003c/p\u003e","manuscriptTitle":"Probing technical knowledge on preparation and administration of chemotherapy drugs: A cross-sectional study focusing nurses of Dhaka, Bangladesh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 08:43:49","doi":"10.21203/rs.3.rs-7141786/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8ee66138-f14d-4c9e-9553-1bfb27ff5447","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-22T09:53:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 08:43:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7141786","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7141786","identity":"rs-7141786","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}