244 Implementing changes to protect workers from exposures to hazardous drugs

Abstract Hazardous drugs (HD) present a complex exposure problem within healthcare facilities whereby nursing, pharmacy and other staff are chronically exposed to low-levels of HDs via contaminated surfaces throughout pharmacies and clinical settings. Many of these drugs are designated as ALARA substances (reproductive toxins and/or carcinogens); exposures to unknown mixtures or cleaning agent reaction by-products may also occur but have been poorly characterized. There is a lack of health-based surface-OELs against which to benchmark exposures. Despite increased awareness of HD exposures and promotion of safe handling measures, surface levels of HD have plateaued over the last decade. New, collaborative approaches are needed to reduce environmental contamination of HD that contribute to exposures among healthcare workers and staff. We introduce a new approach involving a broad, collaborative, system-wide program based on social dialogue models that brings all parties (e.g., employees/unions, employers, scientists and regulators) together to work on a common goal (e.g., HD exposure reduction) in a collaborative manner that is evidence-based (e.g., surveillance data) that have been successfully implemented in Europe, and an embedded quantitative exposure assessment strategy that uses “hygienic guidance values” (HGV) in the absence of surface OELS. This HGV-based surveillance strategy provides key operational details to the user and also provides target performance levels (through HGV rather than OELs). This approach offers support for a quantified ALARA response, as an HGV approach can encourage measured and continual improvement (i.e., exposure reductions) over time, and centers on a continuous improvement paradigm.