Medical Environment Update—Healthcare workplace may pose hazards to reproductive health

By: October 26th, 2008 Email This Post Print This Post

Although it might not be the next topic featured in a most-dangerous-job reality TV show, a healthcare occupation comes with significant risks.

Some of those risks are potent drugs, which can work wonders when targeted toward patients’ ills but also present occupational hazards to caregivers, including adversely affecting the reproductive systems of those exposed.

With more healthcare being delivered outside of hospitals, workers in ambulatory settings are certainly not immune to workplace reproductive hazards.

Many fields in healthcare are affected by potential exposure to reproductive hazards, says William Buchta, MD, MPH, medical director of Employee Occupational Health Services at Mayo Clinic in Rochester, MN, and recent chair of the Section on Medical Center Occupation Health for the American College of Occupational and Environmental Medicine. Oncology with the use of chemotherapy usually comes to mind first, Buchta says, but areas such as rheumatology, gastroenterology, dermatology, and the care of transplant surgery patients employ hazardous pharmaceuticals that carry reproductive warnings on drug labels.

Reproductive effects from hazardous drugs include increased fetal loss, congenital malformations depending on the length of exposure, low birth weight and congenital abnormalities, and infertility, according to the NIOSH publication Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings.

The effect of hazardous drugs on the reproductive system is not just a concern for female healthcare workers. NIOSH identifies hazardous drugs as an occupational risk to female and male reproductive health.

Workers are usually immediately aware of an exposure incident involving bloodborne pathogens, but the reproductive effects of hazardous drug exposure play out on workers who might not know they are exposed, Buchta says.

Employees know what to do and what to expect when an acute exposure occurs; it’s covered in the material safety data sheet. It is the long-term, low-dose exposure that goes unnoticed or unreported by workers and might present the greatest reproductive risks in occupational settings, Buchta adds.

Engineering controls such as the use of biosafety cabinets, work-practice controls (which include adherence to wearing personal protective equipment), and worker education offer the most direct protection, Buchta says. But those types of controls, he warns, are certainly not foolproof. Environmental monitoring and medical surveillance might be needed to fill in the safety gaps.

For more on reproductive hazards in healthcare, see the October issue of Medical Environment Update.

How is your workplace taking precautions to prevent exposures to reproductively-harmful drugs and chemicals? Do your co-workers ask or worry about these potential hazards. Does management support or resist safety efforts on this matter? Leave a comment below.


By Bill Buchta, MD on October 27th, 2008 at 11:23 am

David did an excellent job of representing my views on this challenging aspect of occupational & environmental health. While the number of actual case reports of personal harm from healthcare-related occupational toxicant exposures are quite small, there is great potential for missed attribution of cause-and-effect for multiple reasons. While medical monitoring has the appearance of efficacy, most of us “in the business” have been frustrated with the lack of sensitivity or specificity of this costly and time consuming endeavor. I see the primary role of such monitoring as an opportunity to educate our workers as to the reality of the hazards in the workplace and to remind them of the value of reports of significant exposures.

By Bruce Cunha RN MS COHN-S on October 30th, 2008 at 9:58 pm

Glad to see Dr. Buchta added a bit to this article. This is one of the more frustrating ones for a healthcare safety professional.

As far as I am aware, there are no labs in the US that do wipe sample testing for Chemotherapy agents. So if you can’t test to see if chemo agents are present in the work environment, how do we assure PPE is working? This makes it very difficult to assure that exposures are not happening. As Dr. Buchta pointed out, normal medical monitoring is difficult to do. What do you look for? What organs will be affected by the large number of chemo agents we now have? If I study any one population of employees would I not expect to find some abnormalities over time? How do you then tell if the medical issues are related to the work.

I have one pet pieve with the various reports on the hazards to employees. We all know that working with chemo agents without ppe and handling/use protocols can cause medical issues. Problem is, the majority of the science on this topic was done prior to implementation of current PPE and handling/use protocols. To date, I have not seen a new good scientific study that shows employees are actually suffering the medical issues that are documented in the above article.

By Bill Buchta, MD on October 31st, 2008 at 11:02 am

I cannot agree with Bruce more. The recent NIOSH Hazard Alert does not make a compelling scientific case for medical monitoring, and the environmental tools we might use, such as wipe tests, are not readily available, nor are there biological equivalents of harm from work exposures to this date. However, the potential risk is so high that those of us in occupational health would be remiss to completely divorce ourselves from a surveillance and educational role, as limited as it might be at this time. There is the old adage in clinical medicine: Be careful what you test for if you will have difficulty interpreting the results. I would suggest baseline testing and then periodic survey questions with further lab testing only for documented excessive exposures or significant medical history deviations.


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