Pregnancy H&S

RE: Pregnancy H&S

Tedders — Wed, 01 Mar 2017 14:38:45 GMT

[quote user="Michael Woodhouse"]

[quote user="Tedders"]There was a case up in Scotland where there were 3 miscarriages amongst staff and from memory that was put down to faulty scavenging [/quote]

Please be careful stating such things so authoritatively. It could add a lot of stress and anxiety to these pregnant ladies, where the real risk is very minimal. They still use it as an anaesthetic agent in pregnant women, where the exposure would be vastly greater than any 2nd hand dose in a vet practice.

I know it must be really difficult if you work in such an environment and suffer abortion, but you need to try and take emotion out of things and compare the relative risk of abortion if you were not a vet but just a 'normal' pregnant lady. There are studies showing similar risk profiles:

https://www.ncbi.nlm.nih.gov/pubmed/12608624

I don't think the message is to be reckless, but lets not try and place the blame on a single whiff of iso. Chances are that pregnancy was not going to continue anyway. The human abortion rate is way higher than I would accept in any dairy herd, although the medics seem pretty accepting of it.

[/quote]Apologies if I have worried anyone! I thought I had read the case in the Vet Times and that people would be aware of it, was certainly not trying to cause any alarm. I have been pregnant 3 times and once ended in miscarriage but did not believe at any point that iso was a factor... although I might have done had I worked in that practice described above where you could smell it!

RE: Pregnancy H&S

Michael Woodhouse — Tue, 28 Feb 2017 23:12:02 GMT

[quote user="Tedders"]There was a case up in Scotland where there were 3 miscarriages amongst staff and from memory that was put down to faulty scavenging [/quote]

https://www.ncbi.nlm.nih.gov/pubmed/12608624

RE: Pregnancy H&S

Tedders — Tue, 28 Feb 2017 21:08:14 GMT

Congratulations to you and also hope the original poster is doing well. Can't really answer your question hopefully someone can but you can get Burtons or someone to check the scavenging which would be a good idea I think if it hasn't been done recently as part on an annual service. There was a case up in Scotland where there were 3 miscarriages amongst staff and from memory that was put down to faulty scavenging so I can see why you would consider it but I would think the risk is very low with properly functioning equipment and wish you all the very best for a healthy pregnancy this time.

RE: Pregnancy H&S

Jill Butterworth — Tue, 28 Feb 2017 21:07:20 GMT

Your practice should be monitoring the iso levels occasionally (can't remember how often), but of course it won't allow for if someone forgets to replenish it or there is a gap at the top. IMO not as good as active scavenging. I had a pregnant nurse in single handed practice and we managed, and we were both OTT paranoid, as we both felt more comfortable with this. I always drew up extra indiction agent and started the anaesthetic just on oxygen, so that we were well and truly cuffed and stable before starting the gaseous anaesthetic. I coped with the odd exotic alone. We never had the X-ray machine on (because of fear of accidental discharge/malfunction)when she was in the room, but she did assist, by a pantomime of switching the machine on and off (which could be done from outside the room). We had a fabulous stainless steel hydraulic op table on wheels which went right to the ground, so there was never any need to lift, it could even be trundled to the freezer if need be. We kept all the doors open (wind tunnel effect from from to back of the building) to change the air after recovery and we had a good ventilation system.

Incidentally, an old study showed that the rate of miscarriage in the wives of op theatre workers was higher than average, so no room for complacency, boys ;)

RE: Pregnancy H&S

Nicola Cole — Tue, 28 Feb 2017 20:57:31 GMT

I believe the evidence for inhalant gases, properly scavenged (!), being problematic is fairly poor. However, I will admit that I only consulted during my pregnancy at my previous practice. Before I get one starred-the amount of iso leaks we had were ridiculous, you could smell it as soon as you walked into the room numerous times a week and numerous staff members had concerns about it (whether pregnant or not!)(leaking pipes or machine in some way, cuffed appropriately). I would have no such concerns at the practice I currently work at and would happily operate.

If I was happy with the amount of iso exposure (ie. couldn't regularly smell it and didn't get banging headaches because of it) then I would happily operate whilst pregnant. So if you're happy that you're not regularly smelling it then risk (difficult to quantify) should be minimal as not getting exposed. I would however try and avoid the recovery room as much as possible as in a well scavenged, non leaking system that is when you are going to be exposed to highest levels of iso as the animal breathes it out. And I would avoid operating on animals with just a mask in place. A good friend of mine is a human anaesthetist and happily anaesthetised patients throughout her pregnancy.

Comes back to what I generally think on the topic-if appropriate health and safety protocols are in place then very little has to change due to pregnancy. If there are health and safety issues then really should be addressed whether pregnant or not (but generally people put their foot down more during pregnancy).

Very sorry to hear about your miscarriage. At the end of the day you have to do what you are comfortable with. Take care of yourself.

RE: Pregnancy H&S

An On MRCVS — Tue, 28 Feb 2017 20:29:48 GMT

I just want to bump this topic - not the original poster but also recently discovered pregnant after a miscarriage last year.

Is a flurosorber scavenger enough? Cannot find anything to say. Last time continued with surgery as one of the more experienced vets and it's concerning me iso may have been part of it even though could never smell it/checked for leaks/cuffed immediately etc. We do our own OOH as well so going to be challenging!

RE: Pregnancy H&S

Gillian Mostyn — Wed, 11 Jan 2017 12:36:44 GMT

[quote user="Iain Richards"]Gillian, if you practiced good hygiene and cleaned litter trays when fresh, too risk is very low as the oocyte need 2-3 days to sporulate before being infectious, so a negative too is not surprising. Pink lamb is a potentially greater risk. [/quote]

Absolutely - hence why the doctor's advice to 'avoid all cats' was so ridiculous! (I think gardeners and builders face a much greater threat. My dad, a builder, was constantly finding lumps in his sharp sand pile and therefore the mortar ..grim!)

RE: Pregnancy H&S

Iain Richards — Wed, 11 Jan 2017 11:30:05 GMT

Gillian, if you practiced good hygiene and cleaned litter trays when fresh, too risk is very low as the oocyte need 2-3 days to sporulate before being infectious, so a negative too is not surprising. Pink lamb is a potentially greater risk.

As to the Anon's request for information, the risk of radiation is well known though small in a properly run practice. The risk of Nitrous is recognised, that of iso is less certain. There are no studies showing an ill effect (see EMEA data) but I have seen one paper that gave a greater odds ratio for risk in theatre nurses. So being sensible about exposure - long, masked ops for instance - is a wise move - just for general health.

RE: Pregnancy H&S

CatherineThomas — Wed, 11 Jan 2017 05:55:32 GMT

I also told work before most of my family and friends. Just make sure everyone is aware that it's not common knowledge and shouldn't be mentioned on social media. I did have one nurse who took it upon herself to make sure everyone else in the practice knew before I had chance to tell them.

I was as careful as possible with iso but couldn't avoid masks etc completely because I work with exotics. I was very careful with birds and any booked in with respiratory signs or very ill I referred elsewhere. Made sure I was obsessive about washing hands etc. I also tried to avoid dentals particularly ones which had the potential to turn into marathons of tooth extractions, not fun when you are feeling sick and uncomfortable.

Working while feeling sick is not fun, why do they call it morning sickness? It's more like all day sickness. When I was really tired I would sometimes have a short nap in the on-call bedroom during lunch time which really helped me get through the long days.

RE: Pregnancy H&S

Gillian Mostyn — Tue, 10 Jan 2017 22:54:58 GMT

[quote user="David Mills"] Tell em asap and go nowhere near iso wormers steroids or methimazole in next 3m[/quote]

Can't say I completely agree with you there David.

Curious - why wormers??? Just use gloves....

Steroids and methimazole - don't inject yourself, and use gloves to count them. Ta da.

Iso - an individual choice I would have thought. If one of my vets hadn't wanted to operate, I would have happily modified the rota. Most vets at my practice prefer to be on ops anyway. (All consulting...) However, with active scavenging there should be very little risk. I do prefer pregnant ladies to stay out of the recovery ward though if possible.

I think that your approach could give the impression that we are in a high risk environment, and I would disagree. And having been pregnant, I found that long periods of time on my feet consulting, with the lack of help that you usually have in that environment, is much much harder on your body than operating!

As I said, the most important thing is that mum is happy! 8 months of being stuck in a consult room ... no thanks !!!

p.s. painful bladder kicks? That's the least of it....

p.p.s I lost faith in my doctor's advice when I was told at my first pregnancy appointment to stay away from all cats...!! I asked for a toxoplasma blood test... turned out to be negative! Certainly can't be that easy to catch from cats then!

RE: Pregnancy H&S

David Mills — Tue, 10 Jan 2017 20:06:53 GMT

Congrats. Tell em asap and go nowhere near iso wormers steroids or methimazole in next 3m (other half trainee gynaecology/obs).

Be prepared for a lot of consulting and painful bladder kicks.

Yours, modern man

RE: Pregnancy H&S

Gillian Mostyn — Tue, 10 Jan 2017 18:41:41 GMT

Congratulations!

Everybody else's advice all sounds very sensible really. Actually, due to the number of ladies of childbearing age in most practices, 'normal' precautions should be normal anyway!! If people are routinely being exposed to anaesthetics, x-rays etc, or expected to lift/wrestle large dogs alone, then the practice really needs to reassess their H+S policies!!!

The most important thing is that mum is happy and comfortable. Modifications can be irritating for other staff, but pregnancy only lasts a few months and, to be frank, the baby's and mum's health is more important than ANYTHING else.

Therefore, talk to your boss (my employees have told me immediately but often not their colleagues, as our normal system is sufficient on the whole) and keep the communication channels open throughout the pregnancy. If mum is happy, baby is happy. And if, god forbid, things don't go to plan, nobody (employee or employer) would ever want to think 'what if I hadn't ......'.

RE: Pregnancy H&S

Tedders — Tue, 10 Jan 2017 18:21:38 GMT

Congratulations!! Having read the other replies haven't really got anything to add except if you have moderate/severe morning sickness consider using up some holiday then to get over the first trimester, it can be tough working feeling dreadful and in veterinary practice you are either there and giving 100% or you are not, it is almost impossible to take it easy. Nothing to do with health and safety but beyond 32 odd weeks I think it can be hard grappling with large dogs in small animal practice when you are very big so I wouldn't plan to work too late (I know some people do!). Definitely take care of yourself and minimise every risk you can and hopefully you can relax a bit as the pregnancy progresses. Re the comment from Bob above, I heard about a nurse who refused to tablet any cats throughout her pregnancy in case she got bitten to the huge irritation I am sure of her colleagues as it affected the out of hours rota.

RE: Pregnancy H&S

bob lehner — Tue, 10 Jan 2017 17:58:31 GMT

Very much what others have said.

Sit down with your employer at the earliest opportunity and have a detailed risk assessment/discussion as to what they will let you do - and what you are prepared to do. You can obviously request strict confidentiality at that time if you wish. Both parties should keep a written record of the discussion.

Don't handle cytotoxics or repro hormone meds at all.

I'm often puzzled by the 'lifting' worry - how many mothers with a toddler become pregnant again quite soon - and spend half their pregnant life carting the older child about on their hip etc.?

I once had a pregnant vet employee who literally refused to pick a cat off the floor and put it on the table throughout her pregnancy. Seemed bonkers to me - if the pregnancy is really that fragile then I think sadly it wasn't meant to be.

RE: Pregnancy H&S

Nicola Cole — Tue, 10 Jan 2017 16:44:14 GMT

Congratulations.

I had a look a few years back and there wasn't much info on 'safe' levels of iso exposure-there may be something more recent but it would be hard to assess as you can't test it on pregnant ladies....

I also had very differing advice from 2 GPs as to what precautions should/shouldn't be taken.

I think it very much depends on what you're comfortable with and if there are any pre-existing problems with health and safety at the practice eg. if the ops room stinks of iso on a regular basis and you've got leaking circuits then everyone should be avoiding that!

Everyone should be taking precautions to avoid problems at work anyway so as long as there are sensible rules in place then there is probably very little you can't do.

(Personally I would:

-avoid handling cytotoxic drugs (and urine of dogs on cytotoxics) and hormonal drugs (get someone else to give the injection). Wear gloves for dispensing.

-avoid filling the iso yourself and avoid the room for a while after, plus try and avoid room during recovery. If you're happy with the scavenging etc then personally I don't see the need to avoid operating (if you're not happy with scavenging/iso level in the room then this is a problem for all staff and should be adressed regardless!). Avoid mask induction/maintenance where possible.

-avoid being in the room for xraying, and probably leave room before machine switched on incase of malfunction (extremely rare but should be an easy enough precaution to take).

-during late pregnancy-probably avoid big bouncy dogs were possible-simply because fighting with an over exuberant dog rolling around on the floor isnt much fun when you're not as mobile or have pelvic symphaseal pain)...or just get someone into room to assist.

and enjoy it!

RE: Pregnancy H&S

Sammy82 — Tue, 10 Jan 2017 16:17:30 GMT

Congratulations!

I was in the same situation and told work before most of my friends and family, only my parents and my partner's mum knew earlier. It feels a bit wrong, but I don't know how else you would do it.

Personally I do not enter the x-ray room when the machine is connected (the warning light is lit). Of course there shouldn't be any radiation outside the actual exposure, but if the machine malfunctions there could be, potentially much higher than normal values. Legally you are allowed to keep x-raying as long as you wear an extra baby dosimeter which is checked monthly and the maximum permitted dose is 1mSv. Considering the stochastic radiaton effects (no safe dose) I am not taking the risk. This does not mean that we can't book x-rays. Usually I sedate the animal/help with positioning and discuss with the nurse which views we need. I then leave the room, the nurse switches on the machine and finishes setting up/taking the picture. There is a thread about x-rays and pregnancy somewhere on the forum.

There are certain drugs you have to be careful with, but common sense and our pharmacological knowledge/datasheets tell you. Generally I avoid all hormones (get another vet/nurse to do the injection), main injections I do not give are Alizin, Tardak, Oxytocin and Zycortal. A big no no in farm practice would be Estrumate. I try to avoid steroids, but think that they are not as dangerous as I think the tiny amount you might get from a needle stick is unlikely to have any effect. Always wear gloves to dispense loose tablets/liquids or handle injections. I operate only if the animal is tubed, tube has to be fitting well/cuffed, no masking.

My midwife.said that nowadays they are not so worried about lifting anymore. Heavy lifting is more likely to cause a sore back etc due to laxer ligaments, but is not thought to be a factor for miscarriage anymore. She said I could lift anything I feel comfortable with (which generally is 10kg in my case).

Not just the nurses but also the receptionist have to be aware what they can/can't book in for you to avoid award situations as you certainly don't want to tell all the clients yet.

RE: Pregnancy H&S

Joyce Whitehead — Tue, 10 Jan 2017 15:20:15 GMT

Congratulations! My colleagues also knew before most of my family, as I was working solo at a branch practice so had to tell the nurses so I didn't have to lift etc. I was pregnant in the bad old days of halothane and no scavenging, but we didn't know much about the risks then either. So I had to just be sensible and stay out of the room when X-rays were taken.

In in recent years we have had 2 pregnant vets and 2 nurses, they have all done some operating with sensible precautions, no mask procedures, scavenger on asap, cuff inflated and avoid the kennels whilst animals are recovering, as that has the highest concentration of exhaled gas. They all were happy to set up X-rays then leave the room before exposure. Gloves for any disoensing you have to do.

Please don't forget the risks of lifting, especially in the early weeks. And enjoy your pregnancy, hope all goes well and look forward to welcoming baby anon in another 8 months or so.