Occupational exposure risk assessment for cytotoxic drugs among clinical nurses in oncology care settings:...

To develop a scientific and systematic occupational exposure risk indicator system for cytotoxic drugs (CDs) among clinical nurses and to provide an evidence-based basis for institutional risk management and targeted occupational protection strategies.

This methodological study used a mixed-methods consensus-building design. Based on the work breakdown structure-risk breakdown structure (WBS-RBS) framework, an initial risk matrix was constructed through literature analysis, policy and guideline review, and semi-structured interviews. Three rounds of Delphi consultation were conducted with 16 experts in oncology nursing, nursing management, pharmacy, and occupational protection/infection control. Indicators were screened using a 5-point Likert scale, and weights were determined using the analytic hierarchy process (AHP).

The response rates for the three Delphi rounds were 80.00%, 93.75%, and 100.00%, respectively. The expert authority coefficients were 0.803, 0.856, and 0.891. In the third round, the coefficient of variation ranged from 0.000 to 0.264, and Kendall's coefficient of concordance was 0.265 (P<0.01). The final indicator system included five first-level indicators, 13 second-level indicators, and 33 third-level indicators. All AHP judgment matrices met the consistency requirement (CR<0.10).

The indicator system developed in this study integrates full-process clinical work links with multidimensional risk sources, providing a structured and quantifiable framework for early identification, prioritization, and targeted management of occupational exposure risks related to cytotoxic drugs among clinical nurses. It may serve as a practical decision-support reference for developing graded and precise occupational protection strategies, particularly in institutions without centralized intravenous admixture services.