EVALUATION OF ENVIRONMENTAL SERVICES (EVS) WORKERS’ RISK FOR OCCUPATIONAL EXPOSURE TO ANTINEOPLASTIC DRUGS IN HOSPITAL SETTINGS

Purpose: This dissertation investigated the occupational exposure risk faced by EnvironmentalServices (EVS) workers, particularly their risk of exposure to hazardous chemicals, includingantineoplastic drugs (ADs). The study aimed to fill critical gaps in the literature by assessing therisk of occupational exposure to ADs, evaluating PPE use, and identifying factors influencingPPE compliance among EVS workers in hospital settings. Methods: The dissertation wascomprised of three manuscripts. The first manuscript (Chapter 2) presented a scoping review ofinternational studies to map the literature on occupational exposure to chemical substancesamong EVS workers. The second manuscript (Chapter 3) reported findings from observationaldata and survey methods assessing PPE use among EVS workers in hospital settings. The thirdmanuscript (Chapter 4) investigated factors influencing PPE use and evaluated training throughsurveys administered to EVS workers. Results: The scoping review revealed a spectrum ofadverse health outcomes associated with chemical exposure among EVS workers, highlightingdeficiencies in safety practices within hospitals. The assessment of PPE use indicatesdiscrepancies between self-report in a verbally administered questionnaireand observed compliance, underscoring the need for tailored interventions. The FactorsPredicting Use of Hazardous Drug Safe-Handling Precautions instrument scores showedinternal consistency, with several components correlated, yet regression analysis revealed nosignificant relationship between survey components and self-reported PPE use, although self-efficacy and perceived risk showed marginal trends. The findings regarding training on ADshighlight important gaps in knowledge and access to resources among EVS workers. While asubset of participants reported receiving training on ADs, a significant proportion did not,indicating a need for standardized training protocols across the facility where the study wascarried out. Discussion: The findings underscore the urgency of addressing occupationalhealth risks faced by EVS workers through targeted interventions. Collaborative efforts involvingpolicymakers, healthcare institutions, and EVS workers are essential for implementingevidence-based strategies to safeguard EVS worker health and well-being and to promote PPEcompliance and mitigate exposure risks. Conclusion: This dissertation advances ourunderstanding of the occupational health risks faced by EVS workers and provides actionablerecommendations for research and practice. By addressing gaps in the literature andadvocating for systemic changes, we can ensure a safer work environment for EVS workers anduphold their invaluable contributions to healthcare.