The information related to health risks to foetuses due to the handling of chemotherapeutic agents by nurses during pregnancy is limited. The risks involved can be reduced significantly if nurses adhere to standard safety precautions while handling cytotoxic drugs. Nurses in patient areas where chemotherapy is administered are at constant low-level risk of exposure. The authors tried to gather evidence in this article from the recent literature to help to formalise policies for pregnant mothers working in these settings. How safe is it for pregnant health-care professionals to handle chemotherapy drugs?
Polovich M. Exposure risks can be greatly reduced through staff education and an investment in equipment such as external ventilation systems and personal Hazarrs equipment. Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. Many pregnant women are able to adjust their job duties temporarily, or take extra steps to protect themselves. Functional abnormalities may result during this phase, manifesting as physiological or intellectual abnormalities [ 1 ].
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The information related to health risks to foetuses due to the handling of chemotherapeutic agents by nurses during pregnancy is limited. The risks involved can be reduced significantly if nurses adhere to standard safety precautions while handling cytotoxic drugs. Nurses in patient areas where chemotherapy is administered are at constant low-level risk of exposure.
The authors tried to gather evidence in this article from the recent literature to help to formalise policies for pregnant mothers working in these settings. How safe is it for pregnant health-care professionals to handle chemotherapy drugs? The answer to this question is not straightforward. We attempted to look at the current literature to assimilate the evidence involved with answering this important question. Chemotherapy services have expanded over recent years. Mothers remain concerned about the safety of their unborn babies while handling hazardous materials.
How toxic they can be during pregnancy is not absolutely clear. Unfortunately, the information is scanty. The handling of these chemicals by pregnant nurses may be risky. However, the risk may be negligible if one adheres to standard safety precautions [ 1 ]. There is a possibility of at least skin exposure in this environment. Therefore, people who handle chemotherapeutic drugs are at constant risk of exposure. This may be true for nurses who administer chemotherapy. This risk of exposure can be minimised by personal protective equipment PPE , a needle-less system, and ventilation cabinets.
However, this may not eliminate all possible risks [ 4 ]. Exposure to such chemicals can lead to growth abnormalities in the foetus. Pregnancy has three phases: embryogenesis, organogenesis, and foetal growth. The effects on the foetus are different during each phase.
Embryogenesis kicks in at fertilisation and ends on the 14th day. Cell damage in this phase usually leads to foetal death. During organogenesis, the foetus forms different organs and body systems. This lasts to the end of the 12th week. Damage can result in spontaneous abortion or malformation. The last phase starts at the 12th week and ends at birth. Functional abnormalities may result during this phase, manifesting as physiological or intellectual abnormalities [ 1 ].
The rapid expansion of chemotherapy services throughout the world has raised serious concerns regarding exposure by pregnant mothers to cytotoxic drugs. Much of the information is patchy. A recent study, published in the American Journal of Obstetrics and Gynecology [ 6 ], has looked at pregnant nurses involved in the handling of hazardous materials. It has shown a relative increase in rates of spontaneous abortion among mothers who handle chemotherapy.
They did use PPE and were not involved in obvious exposure. This means that they were unknowingly exposed to constant low levels of exposure during their pregnancy [ 6 ]. This study has brought the working conditions of oncology nurses into the limelight. A recent article in the Seattle Times raises similar concerns [ 7 ]. Historically, nurses were found to be less adherent to guidelines while handling chemotherapy drugs. Scientific evidence is seriously lacking in this field [ 8 ]. A recent study among Greek oncology nurses showed a lack of adequate use of PPE during pregnancy [ 9 ].
Similarly, another study among Turkish Oncology Nurses highlighted a lack of protection during pregnancy with widespread non-adherence to standards set by national and international labour organisations [ 10 ]. A safe working environment is essential for pregnant mothers. General guidelines are available, but they are not completely sufficient to protect unborn babies. Individuals and society are both responsible for maintaining the health of future generations.
Every staff member has the responsibility for her own safety. One should keep reviewing safe working conditions constantly. Breast feeding or pregnant nursing staff who wear PPE should consider themselves safe even while administrating chemotherapy, cleaning up bodily fluids, or handling pre-mixed drugs.
The use of PPE has been shown to reduce the risk of exposure significantly [ 3 ]. Studies have shown drugs being excreted into breast milk.
Similarly, the American society of Heath-System Pharmacists has feared environmental contamination by these drugs from BSCs onto the gloves, the final product, or into the air [ 3 ]. In another study, two infants who were fed on breast milk from mothers exposed to cyclophasphamide were found to be neutropenic [ 14 ].
Ethically, it is not possible to run studies to see the effects of exposure of drugs on infants of lactating mothers. According to the American Academy of Paediatrics cytotoxic drugs in the breast milk were found to interfere with cellular metabolism in infants [ 15 ]. These drugs can cause bone marrow suppression including neutropenia and growth retardation. This information is normally written on the material safety data sheet provided with the drug.
Based on this information, nurses involved in handling them should take extra precautions to reduce risks posed to them and their babies [ 1 ]. Due to this, many do not utilise the facility. Nurses are relatively at higher risk of adverse effects from cytotoxic drugs than their patients due to constant exposure. In , these effects were discussed in the ONS meeting in detail [ 17 ].
According to ONS, these drugs have effects on the reproductive system leading to menstrual dysfunction, infertility, miscarriage, foetal abnormalities, and premature labour. They can also lead to mental and physical disabilities in children. These devices should have external ventilation. PPE should also include a face fitting mask, two layers of chemotherapy approved gloves and impermeable gowns [ 1 ].
Contamination of floors, table-tops, phones, chairs, and devices are a common source of unrecognised hazard. Long-term studies are needed to evaluate the effects of low-level exposure to cytotoxic drugs by pregnant and lactating mothers. General guidelines are available [ 12 ]. Especially, during the first trimester, exposure should be limited as much as possible. During the second and third trimesters, work may be allowed if standard safety precautions are followed [ 21 ].
In brief, the responsibility lies with nurses to follow the guidelines [ 22 ]. At the very first indication of suspected exposure, they should try to remove themselves from the source [ 1 ]. The following recommendations are made to avoid exposure to foetuses and infants:. All staff involved in the handling and administration of cytotoxic drugs should be familiar with and adhere to local and national policies, and follow safe practice with cytotoxic drugs following standard operating procedures.
Pregnant staff should be given the choice to avoid work activity in an area with increased risk of exposure to chemotherapy agents. It is the responsibility of the nursing staff to inform the employer regarding their decision to conceive, when they become pregnant, or when they lactate. Nursing staff should avoid working in high-risk areas during the first 84 days of their pregnancy.
After 84 days of pregnancy, nursing staff can work in these areas if they adhere to standard precautions using PPE. All staff involved in handling and administering chemotherapy must undergo appropriate training and education for safe handling of cytotoxic drugs.
Employers should take responsibility to facilitate avoiding exposure and provide local guidelines. National Center for Biotechnology Information , U.
Journal List Ecancermedicalscience v. Published online Apr S Gilani and S Giridharan. Author information Article notes Copyright and License information Disclaimer. Correspondence to: Shahid Nazir Gilani. Received Feb 9. This article has been cited by other articles in PMC. Abstract The information related to health risks to foetuses due to the handling of chemotherapeutic agents by nurses during pregnancy is limited.
Keywords: chemotherapy, pregnant, nurse, health-care professional. Introduction How safe is it for pregnant health-care professionals to handle chemotherapy drugs?
Wider context The rapid expansion of chemotherapy services throughout the world has raised serious concerns regarding exposure by pregnant mothers to cytotoxic drugs.
Safe handling of chemotherapy drugs A safe working environment is essential for pregnant mothers. Conclusion Long-term studies are needed to evaluate the effects of low-level exposure to cytotoxic drugs by pregnant and lactating mothers. Recommendations based on current evidence The following recommendations are made to avoid exposure to foetuses and infants: All staff involved in the handling and administration of cytotoxic drugs should be familiar with and adhere to local and national policies, and follow safe practice with cytotoxic drugs following standard operating procedures.
Lactating mothers should also avoid working in high-risk chemotherapy areas. References 1. Albin K. Vet Tech. Administering chemotherapy: is it safe for pregnant or breast-feeding veterinary technicians? Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Pittsburgh: Oncology Nursing Society;
Epub Oct Noyola DE, et al. J Adv Nurs ;63 5 CDC has issued updated guidance on working with Zika virus in laboratories. It is not suitable for new mothers to use toilets for expressing milk.
Hazards for pregnant healthcare workers. Infectious agents
Unsafe working conditions contribute to health worker attrition in many countries due to work-related illness and injury and the resulting fear of health workers of occupational infection, including from HIV and Tuberculosis.
Protecting the occupational health of health workers is critical to having an adequate workforce of trained and healthy health personnel. The WHO Global Plan of Action on workers health calls on all member states to develop national programmes for health worker occupational health.
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Pregnancy can affect your safety as a worker. If you are pregnant, we encourage you to discuss possible job hazards with your employer, health and safety office at work if there is one , and doctor, as soon as possible. Many pregnant women are able to adjust their job duties temporarily, or take extra steps to protect themselves. Current occupational exposure limits were set based on studies of non-pregnant adults.
What is considered safe for you, may not be safe for you unborn baby. Section Navigation. Minus Related Pages. Pregnancy and Your Job Pregnancy can affect your safety as a worker. If you are pregnant and working you may have to consider that: Changes in your metabolism increase how quickly you absorb some chemicals e. Because of physical changes, the personal protective equipment that you could wear correctly before pregnancy may not fit properly, such as lab coats or respirators. When pregnant, changes in your immune system, lung capacity, and even ligaments can alter your risk of injury or illness due to some workplace hazards.