When you have pregnant staff, protect them and their fetuses from harm

Don’t put yourself at risk for sex discrimination — Follow suggestions

Several of your staff are in the first trimester of pregnancy. You’re thrilled for them, but you want to make sure they aren’t exposed to chemicals or radiation that might impair the fetus. One staff member brings in a note from her OB/GYN saying to follow guidelines for pregnant staff in the OR, but you can’t find any state or federal guidelines.

You wonder if you should change any of their job responsibilities or schedules, but you don’t want to be accused of discriminating. Discrimination against women on the basis of pregnancy is sex discrimination and is illegal under the federal Civil Rights Act and some state laws, according to a pregnancy guide published by the Washington Department of Labor and Industries in Olympia.1 Subjecting a pregnant woman to an unwanted transfer is an example of discrimination.1

You decide to get your administration, employee health staff, and human resources department involved, but other members of your leadership team dismiss your concerns and imply that you’re crazy for pursuing the issue.

And the concerns don’t end there. One surgical manager recently sounded this alarm on a listserv: What are we doing for the nurse who doesn’t realize she is pregnant? And when she learns the happy news, does she spend the next seven months terrified for her unborn because of exposures she unwittingly allowed?

There are many areas of potential reproductive risks in outpatient surgery, according to sources interviewed by Same-Day Surgery. A generic list for all workplaces from the Washington Department of Labor and Industries says risks include heavy lifting, working more than 40 hours per week, certain chemicals, radiation, anesthetic gases, some infectious diseases, stress and fatigue, and standing for long periods of time. Prolonged standing can be associated with preterm birth, says Barbara Grajewski, PhD, senior epidemiologist at the National Institute for Occupational Safety and Health in Cincinnati, OH. Additionally, an organizational atmosphere of high strain, or "high demand but low control over how fast and what you do, has been linked to some adverse reproductive health outcomes," Grajewski says. Schedule short breaks at least every two hours, and provide a place where women can rest on their breaks, suggests the Washington Department of Labor and Industries.

Don’t wait until you have a pregnant worker to put healthy policies and practices into place, the Washington agency advises. Consider these suggestions submitted by experts in the field:

• Protect staff from radiation.

When it comes to procedures involving radiation, "if there is any question about being pregnant, staff should always go the safest route: Wear a wraparound apron," says Kathie Bailey, LVN, CST, materials manager at Lakeview Surgery Center in West Des Moines, IA. At Lakeview, female staff sign a form letter for declaring pregnancy that addresses the health risks. [Editor’s note: A copy of this form is available with the on-line version of Same-Day Surgery. If you’re accessing your on-line account for the first time, go to www.ahcpub.com. Click on the "Activate Your Subscription" tab in the left-hand column. Then follow the easy steps under "Account Activation." If you already have an on-line subscription, to go www.ahcpub.com. Select the tab labeled "Subscriber Direct Connect to Online Newsletters. Please select an archive." Choose "Same-Day Surgery," and then click "Sign on" from the left-hand column to log in. Once you’re signed in, select "2006" and then select the May 2006 issue. For assistance, call Customer Service at (800) 688-2421.]

Lakeview has a variety of lead aprons available, Bailey says. "The younger females prefer wraparound, full-protection gowns." The advantage of the wraparound aprons is that if staff members have their backs to the field, they are protected, sources say.

However, pregnant women should be aware that lead aprons may be uncomfortable and can cause upper back and neck problems, cautions Laura Welch, MD, adjunct professor of environmental and occupational health at George Washington University in Washington, DC, and director of Silver Spring, MD-based Occupational and Environmental Medicine at the Center to Protect Workers Rights, which focuses on the construction industry.

Grajewski advises outpatient surgery managers to ensure that all machines that emit radiation, including portable X-rays, are within specifications for shielding and protection, "and make sure there’s not undue scattering of radiation happening, especially with portable units."

Nina Johnson, RN, CNOR, OR coordinator at Mankato (MN) Surgery Center, says her big worry is for the nurse who doesn’t realize she is pregnant. "My nurses know when one of us is trying to become pregnant’ because that nurse starts wearing the maternity lead [apron] before she knows for sure," Johnson says. "Once pregnancy is confirmed, we monitor with the additional fetal radiology exposure badge."

• Monitor exposure limits for radiation.

At Lakeview, employees who are pregnant have the option of signing a declaration of pregnancy. Once signed, that form is placed in the employee’s file, and exposure limits are monitored, Bailey says. If an employee does not declare her pregnancy, then no occupational exposure limits can be placed, according to Lakeview’s policy. Pregnant employees may ask for a fetal monitoring badge to be worn under an X-ray apron, the policy says.

• Waste anesthetic gases not a danger with recovery systems.

The American Society of Anesthesiologists says that there is no evidence that trace concentrations of waste anesthetic gases causes adverse health effects of people working where scavenging of waste anesthetic gases is carried out.2 "It is safe to try to become pregnant or work when pregnant in these locations," the ASA says.2

Waste anesthetic gases are one of the most well-studied reproductive toxicants, Welch reports. With anesthetic recovery systems, there no release of anesthesia into the staff members’ breathing zone, she says. While many studies focused on specific older anesthetic agents such as nitrous oxide, Welch isn’t comfortable saying the newer ones are safe. "Use best available practices, and control any exposure," urges Welch, referring to anesthetic recovery systems.

• Avoid exposure of pregnant staff to some infectious diseases.

According to the March of Dimes, women should avoid all possible sources of HIV infection before and throughout pregnancy, including contact with needles, razors, or other items possibly contaminated with the blood of an infected person.3

Also, pregnant women who are not immune to chickenpox should avoid anyone with the disease and anyone who has had contact with someone with the disease, according to the March of Dimes.4 An infected person is contagious before he or she develops the disease, the association says.

If a pregnant woman is not immune to rubella, she should avoid anyone who has this illness, according to the March of Dimes.5 There is no effective treatment for rubella during pregnancy, and there is no effective way to prevent rubella in a susceptible woman who is exposed to the illness, the association says.

References

  1. Washington Department of Labor and Industries. How to be a Pregnancy-Friendly Workplace. Olympia, WA. Accessed at www.lni.wa.gov/Safety/TrainTools/Online/Courses/Default.asp?P_ID=157.
  2. American Society of Anesthesiologists Committee on Occupational Health of Operating Room Personnel. Information for Management in Anesthetizing Areas and the Postanesthesia Care Unit (PACU). Accessed at: www.asahq.org/publicationsAndServices/wasteanes.pdf.
  3. March of Dimes. Quick Reference: Fact Sheets — HIV and AIDS in Pregnancy. Accessed at www.marchofdimes.com/pnhec.
  4. March of Dimes. Chickenpox. Accessed at www.marchofdimes.com/pnhec.
  5. March of Dimes. Quick Reference: Fact Sheets — Rubella. Accessed at www.marchofdimes.com/pnhec.

Resources

A publication and video/DVD titled Waste Anesthetic Gases: Information for Management in Anesthetizing Areas and the Postanesthesia Care Unit (PACU) is available from the American Society of Anesthesiologists. To access the free publication, go to www.asahq.org/publicationsAndServices/wasteanes.pdf. The video/DVD version is available for $10 plus $6 for shipping. Contact:

  • American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, IL 60068. Telephone: (847) 825-5586, ext. 134. Fax: (847) 825-1692.

For more information on reproductive risks in outpatient surgery, contact: