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Hospitals alert to reproductive hazards
Educate employees, consider job change
As the use of chemotherapeutic agents and hazardous drugs becomes more commonplace, hospitals are placing a new focus on identifying potential reproductive hazards.
The National Institute for Occupational Safety and Health (NIOSH) is updating its list of hazardous drugs, which now includes about 120 agents and encompasses drugs used in areas outside of oncology.
Reproductive hazards have been a key concern as NIOSH has issued alerts and guidance documents on medical surveillance, engineering controls, personal protective equipment, and other means to reduce exposures, says Thomas Connor, PhD, a research biologist at NIOSH in Cincinnati who specializes in chemotherapeutic agents and hazardous drugs.
"We have not developed recommendations on more specific considerations pertaining to reproductive health, but we plan to seek public input on this issue in the near future," he says.
NIOSH advises hospitals to have a medical surveillance program to look for signs and symptoms of adverse effects due to drug exposure. But hospitals also are becoming more proactive to help protect employees from potential reproductive hazards.
Most importantly, hospitals need to educate health care workers about the hazards and protections. "We should make the workplace healthy for everyone, even those who don't know they're pregnant," says William G. Buchta, MD, MPH, medical director of the Employee Occupational Health Service at Mayo Clinic in Rochester, MN.
Mayo considers safety issues involving pregnant employees on a case-by-case basis. "We don't have a policy to automatically restrict pregnant workers from those environments as long as they're using personal protective equipment and patients are properly isolated," he says.
Assessing risk and reassuring
The University of Connecticut Health Center in Farmington takes a proactive approach and encourages employees who are pregnant or trying to become pregnant to come in for a risk appraisal. Not surprisingly, most of the employees who seek advice already are well into their first trimester, when the fetus is undergoing rapid development.
"We don't see people early enough in this process," acknowledges John Meyer, MD, MPH, associate professor of Occupational and Environmental Medicine who also has worked in obstetrics and gynecology. However, the facility's approach places an emphasis on identifying and controlling reproductive hazards for everyone, he says.
University of Connecticut Health Center uses a five-page pregnancy risk questionnaire that asks employees about their exposures to chemical and biologic agents and radiation, as well as other potential hazards at work or outside work. The hospital also has a "pregnancy risk" hotline for anyone with questions about reproductive hazards.
The questionnaire provides an opportunity for education and to reinforce the importance of personal protective equipment when working with hazardous substances, says Sandra A. Barnosky, APRN, FNP-BC, COHN-S, a nurse practitioner with the hospital's employee health service.
"We encourage employees to notify us when they're pregnant, and then we'll take extra precautions with them," she says, noting that pregnant radiation technicians have their monitoring badges checked more frequently.
Much of what Meyer does involves reassurance. He discusses safe lifting with the employees. He reviews their vaccination records in case they need any updates. In rare cases, an employee may have a temporary change in their work environment. For example, working with certain disinfectants, such as ethylene oxide, may be a risk that employees need to avoid altogether, and the employee may be temporarily reassigned.
Meyer is aware of the need to provide protections but maintain the ability of the employee to stay on the job. "Unemployment is probably more hazardous than being around controlled exposures [with adequate protection]," he says. Without a job, "you don't have a salary; you don't get benefits or health insurance. All of those are detrimental to pregnancy as well."
In fact, employers who restrict pregnant women from certain duties may be on sticky legal ground. In 1991, in Automobile Workers v. Johnson Controls Inc., the U.S. Supreme Court found that Pregnancy Discrimination Act bars "sex-specific fetal-protection policies." A pregnant woman or woman of childbearing age cannot be excluded from work duties "unless her reproductive potential prevents her from performing the duties of her job," the court held. (Editor's note: See http://laws.findlaw.com/us/499/187.html.)
No gender gap
Some reproductive hazards affect men as well as women, notes Evie Bain, RN, MEd, COHN-S, FAAOHN, associate director and coordinator of the health and safety division of the Massachusetts Nurses Association in Canton, and many women don't realize they are pregnant until several weeks into their first trimester. "The workplace should be safe at all times for all people," she says.
Yet employers may accommodate workers who are concerned that the engineering controls and personal protective equipment don't completely eliminate risk. "There are some special circumstances where a pregnant worker may be at some perceived increased risk," says Buchta. "We need to take that as seriously as real risk, because that affects their ability to function in the workplace."