Research into the effect of many occupational exposures is limited and by no means concrete, but there are some prudent precautions that can help safeguard the health and wellbeing of pregnant veterinary staff and their unborn children. The Control of Substances Hazardous to Health (COSHH) Regulations 2002 require employers and the self-employed to assess risks to health from harmful substances, including micro-organisms, and to take steps to prevent or control those risks. The Management of Health and Safety at Work Regulations 1999 require employers and the self-employed to further assess any risks which affect pregnant women specifically. But what might these be?
Veterinary working conditions while pregnant
Working hours: Consider any increased risks associated with long days or missed breaks. It’s important to ensure adequate hydration and nutrition, and a requirement to provide additional rest breaks for pregnant staff when requested. Long periods of standing or sitting can increase risk of musculoskeletal pain or injury, or thrombosis.
Shift work: While it might seem sensible (or perhaps just appealing) to avoid night shifts or on-call duties while pregnant, there is actually no lawful restriction that prohibits pregnant women from doing so. This is unless they are advised to avoid such work by a doctor or midwife, in which case written advice should be provided for the employer.1 If it is the case that night work should be avoided, then an employer should offer alternative, daytime equivalent work or if that is not available, suspend the pregnant employee on full pay.
It is a requirement that suitable rest facilities should be provided for pregnant or breastfeeding mothers, including a place to sleep where appropriate.
On call: Discuss the risks associated with the OOH rota, not just in the workplace, but also commuting when tired. A contingency plan is strongly advised should any changes be required at short notice. This is especially true for ambulatory practice, where some premises may present higher risk during pregnancy.
Lone working: Assess whether there are any increased procedural risks associated with working alone and whether they might viably be mitigated by support from another vet, a veterinary nurse or student.
Manual handling: The pregnant abdomen and additional strain on the back and pelvis also increase risk of injury. Hormone changes during pregnancy cause laxity of the ligaments increasing the risk of musculoskeletal injury. Lifting heavy items, operating heavy equipment (e.g. cattle crushes), and animal handling can pose an increased risk during pregnancy.
Toxic chemicals: The use of and exposure to chemicals that are particularly hazardous to pregnant personnel, including cleaning agents and medications including hormones, cytotoxic drugs and inhalational anaesthetics, should be discussed and considered. Exposure limits set by the practice should already allow for the possible exposure of pregnant workers, but this is an opportune moment to check that precautions are observed. More on this below.
Ionisation
Contrary to popular belief, as long as the standard procedures and rules are followed then there should be no need to vastly change practices when it comes to radiography in practice. The foetus is most susceptible to radiation in the first 12 weeks of pregnancy and some advocate the avoidance of partaking in radiography altogether during this time if possible, although this is not a legal requirement.2
Exposure at work through X-ray, CT, gamma scintigraphy, radiotherapy and brachytherapy should be below the permitted limit (1mSV) for a foetus, but it may be an appropriate time to check that working practices meet requirements. 1mSv is about the amount that would be incurred through natural radiation during pregnancy from the environment. Normal limits are set at 20mSv/year, with those receiving over 6mSv deemed ‘classified persons’ and requiring dose monitoring, which should be easy to achieve in general practice.2 Pregnant women should be supported if they choose not work with ionising radiation.
Pregnant employees should keep as far away as practicable from the patient and the X-ray tube while it is on, preferably behind a protective lead screen. If they have to be outside a protective screen during exposures, they must wear a lead apron that is comfortable to wear, fastened properly and covers their abdomen.2 Specific lead aprons are available for pregnant women. Employers need to check that protective measures do not create other risks such as back problems. Although it is not a legal requirement, some employees may be reassured by being provided with an active dose monitor.
Anaesthetic gases
The jury is still out on the exact risks of exposure to anaesthetic gases during pregnancy, but there are potential teratogenic effects and a higher risk of abortions at high concentrations. Reduced weight and size of the foetus at lower concentrations have been reported for many anaesthetic gases3. However, many of the studies were either conducted in animals, or took place in the 1970-80s when the use of scavenging systems was still variable, and prior to the use of more modern agents such as desflurane and sevoflurane. Nitrous oxide use in the absence of scavenging systems has been shown to increase risk of spontaneous abortion5.
It is essential that anaesthetic scavenging is used and that regular safety checks are carried out on the equipment to ensure a leak-free system. Face mask induction should be avoided, so it’s sensible it is to have another vet or within Schedule 3 provisions a veterinary nurse, on standby to take over an induction in case this is deemed necessary. Where an induction chamber is used (e.g. for gaseous induction of rodent anaesthesia) the system must be completely closed and thoroughly flushed with oxygen prior to opening.
In general, the following measures should be applied; regular checking and maintenance of anaesthetic machines and circuits for leaks; waiting to turn on anaesthetic gases until the patient is connected and the circuit is complete; minimising gas flow rates to the lowest possible level; flushing the system through with oxygen prior to disconnecting the patient; use of an anaesthetic gas scavenging system. Workplace exposure limits to anaesthetic gases and details on how to measure them are available in the COSHH regulations.
Chemicals
Pregnant employees should not handle griseofulvin, corticosteroids, prostaglandins or cytotoxic drugs and should avoid handling any hormones and parasiticides. They should consider asking a colleague to inject animals with hormones or administer parasiticides on their behalf. If it is necessary to apply parasiticides such as spot-on products, employees should do so wearing gloves and be in a well-ventilated room, although it is better to avoid this altogether. The data-sheet information should always be read before handling any drug.
Zoonoses
The protozoan parasite, Toxoplasma gondii can cause miscarriage, stillbirth, brain and other organ damage if contracted during pregnancy. It can be transmitted through broken skin or orally after handling infected cat faeces, new born lambs or consuming raw or undercooked meat, unwashed fruit or vegetables or unpasteurised goat’s milk and its products7. A blood test can be requested from the GP to check toxoplasmosis antibody status, however a positive result only indicates prior exposure. A rising titre would be required to indicate recent infection.
Other diseases that can be contracted from animals that pregnant women need to be careful not to contract include Salmonella, Campylobacter, Cryptosporidia and Escherichia coli. Although many of these will not directly harm the foetus, they may cause severe gastroenteritis for the mother or lead to more severe complications than would otherwise be the case, which can obviously also have severe consequences for the foetus indirectly.
Chlamydiosis is an infection caused by Chlamydophilia abortus – the agent of enzootic abortion in ewes (EAE). It can cause serious disease in the unborn child, leading to stillbirth or abortion. Q fever, caused by Coxiella, is also a cause of sheep abortion and can be zoonotic. Listeria monocytogenes is widely distributed in the environment, including soil, decaying vegetation and fodder such as silage, in which the bacteria can multiply. Consumption of foods contaminated with L. monocytogenes is the main route of transmission to humans, but infection can be acquired directly from animals, although cases are rare. Listeriosis is thought to account for around 1-2 % of ovine abortions. Pregnant women are particularly susceptible and should not handle animals that could be infected. Contact with aborting cows, sheep and goats, those at risk of abortion, dead newborn animals and placentae should be avoided by pregnant vets8.
Leptospirosis can cause developmental abnormalities or foetal death, and pose a significant threat to the health of the mother due to her compromised immune system. While contracting the disease from dogs is rare due to vaccination, vets are at a higher risk due to their increased contact. Leptospirosis can affect most mammals including sheep, cattle and pigs, so large animal vets need to be particularly vigilant. Humans mainly acquire infection by direct contact with infected urine through mucous membranes, eyes, or cuts and abrasions. Infection can also occur indirectly through contact with water, soil or foods contaminated with urine from infected animals. Pregnant women should not deal with any animals that could be affected by leptospirosis.
Pregnant women should also ensure their tetanus vaccination is up to date – it is safe to have the vaccination during pregnancy.
This is by no means an exhaustive list of specific risks and potential zoonoses – pregnant women should seek further advice regarding their specific risks and necessary precautions.
Further information on zoonoses and appropriate control measures can be found on the HSE website. This includes links to information on many zoonoses and the 1997 publication Infection risks to new and expectant mothers in the workplace – a guide for employers, by the Advisory Committee on Dangerous Pathogens (ref: ISBN 0-7176-1360-7). Further information on the infection risks to pregnant women from cattle, sheep and goats that have given birth is available on the PHE website. Tommy’s, the baby charity, produces comprehensive guidance on Toxoplasmosis which is available at : http://www.tommys.org/Page.aspx?pid=193
Animal Handling and physical activity while pregnant
Although there are no specific guidelines for pregnant mothers, standard procedures should be followed as well as applying common sense when it comes to handling animals during pregnancy and moderating physical activity. For small animal vets, it’s sensible to avoid handling fractious patients or lifting heavy ones. There’s usually someone around in the majority of practices to help with these situations, although large animal and equine vets may find avoiding them trickier (see box on special considerations for farm vets).
Special consideration should be given to avoiding situations that could result in getting kicked, squashed or barged. While we tend to have the type of personality that wants to get on with ‘business as usual’ during pregnancy, it is better to be safe than regret an injury which may have been preventable. Although this may seem impractical, there are usually ways around it, such as enlisting more help from the owner or farmer than you might usually request, or asking for the most suitable cases to be assigned to you. Practical measures to help best manage this aspect of the job while pregnant should be discussed and agreed with the employer when evaluating the risk assessment. All members of staff should be aware of which tasks are not suitable to avoid the scenario of a vet turning up at a farm only to find they are unable to carry out the job in question due to safety concerns.
Final note
Avoiding the many risks of veterinary practice is not an exact science, in many cases devoid of prescriptive guidelines or legal requirements. Each situation is also likely to be different, so openness, honesty and good communication between employer, employee and in some cases clients, is paramount when considering how best to ensure the health and safety of pregnant vets at work.
References:
- HSE regulations for new and expectant mothers that work. Accessed 12.02.2015 http://www.nhs.uk/planners/breastfeeding/documents/new%20and%20exp%20mothers%20who%20work.pdf
- http://www.legislation.gov.uk/uksi/1999/3242/contents/made
- Anesthetic Gases: Guidelines for Workplace Exposures | Occupational Safety and Health Administration (osha.gov)
- Waste Anesthetic Gases – Occupational Hazards in Hospitals – NIOSH Document Number 2007-151 (cdc.gov)
- Nitrous oxide and spontaneous abortion in female dental assistants – PubMed (nih.gov)
- Health and Safety Executive (2001). Working Safely With Ionising Radiation: Guidelines for Expectant or Breastfeeding Mothers, HSE: 3,6.
- Tommy’s Baby Charity (Date unknown). Toxoplasmosis problems in pregnancy
- Infection risk: https://www.gov.uk/guidance/pregnancy-advice-on-contact-with-animals-that-are-giving-birth
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2 responses to “Specific considerations for pregnant vets and their employers”
Terrific article
really useful thank you – used it myself as a leader and guided team members who are pregnant to read too