Background: Oncology nurses are routinely exposed to cytotoxic drugs, making appropriate use of personal protective equipment (PPE) an essential component of occupational safety. Despite established safety recommendations, adherence to PPE precautions remains inconsistent, potentially increasing the risk of occupational exposure and related health consequences.
Objectives: This systematic review aimed to identify, categorize, and synthesize the barriers to consistent PPE use among oncology nurses.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, SID, Magiran, IranDoc, and IranMedex for studies published from January 2011 to December 2024. The review was conducted in accordance with the PRISMA 2020 statement. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Findings from 17 eligible studies were synthesized using thematic analysis based on Braun and Clarke's framework.
Results: Barriers to PPE use were grouped into three main domains: individual and psychosocial factors, including inadequate knowledge and low self-efficacy; organizational factors, including insufficient training, high workload, and limited managerial support; and environmental and structural factors, including inadequate workplace design and limited availability of PPE. Overall, the included studies demonstrated moderate to high methodological quality, although reliance on self-reported measures was a common limitation.
Conclusion: PPE non‑adherence among oncology nurses reflects the interaction of individual, organizational, and environmental barriers rather than a single behavioral deficit. Strategies to improve PPE adherence should therefore extend beyond education alone and address workplace conditions, ongoing competency‑based training, PPE accessibility, and organizational and managerial support.