Prenatal Health Promotion at Vanderbilt
Babies and You

Planning for Child Care
Vanderbilt Child Care

Protecting Your Baby: A Health Care Worker's Guide

Vanderbilt Infection Control, Occupational Health, and Vanderbilt Environmental Health and Safety (VEHS) have safeguards to help you protect your unborn baby while you work at Vanderbilt.

When you learn of your pregnancy, you do not have to tell anyone. The trained professionals in Occupational Health and VEHS may be able to help you protect your baby if you decide to declare your pregnancy. As a pregnant worker, you could be reassigned to avoid hazardous chemicals or radiation. Each pregnant worker's duties are decided on a case-by-case basis.

CMV
Resistant Organisms
RSV
HIV
Parvovirus B19
Other Normal Precautions
Chemical Hazards
Radiation Hazards

CMV
CMV is a herpes virus that many health care workers of child-bearing age have already acquired.

Transmission of CMV requires direct contact with virus-containing secretions. Hand washing and using gloves are excellent ways to prevent infection.

The Centers for Disease Control and PRevention do not recommend any isolations for infants, children, or adult patients who are CMV positive. Approximately 1% of infants has the virus and can pass it on without the mother having any symptoms. Many hospitalized patients have already had CMV, and the surgery or hospitalization may cause their CMV infection to recur, causing these patients shed CMV. That is why Standard Precautions are recommended.

The CDC does not recommend excluding pregnant health care workers from caring for patients with known CMV infection. Health care workers should be careful with all patients they encounter.

Resistant Organisms
VRE (Vancomycin Resistant Enterocci) and MRSA (Methicillin Resistant Staph Aureus) are common in university-affiliated hospitals. However, Staph is normal flora on human skin and Enterocci are normal flora in the human bowel. Patients who have been hospitalized for long periods develop resistant organisms as a result of exposure to many antibiotics or the hospital environment. It is wise to note that resistant organisms are common in the community, and patients often bring them into the hospital.

Patients with these organisms are placed on Contact Precautions as recommended by the Centers for Disease Control. Health care workers are at no great risk for acquiring infection from these organisms. Instead, you can transmit these organisms to other patients if you do not wash your hands or change gloves between patients. There is no reason to exclude pregnant health care workers from caring for these patients.

RSV
Respiratory Syncytial Virus or RSV is one of the many cold-type upper respiratory infections that most of us acquire during the cold and flu season. For premature infants, infants with cyanotic or complicated congenital heart disease, bronchopulmonary dysphasia, or HIV, the infection could become very serious, even fatal.

RSV is transmitted by contact with secretions or contaminated environmental surfaces. RSV can survive on environmental surfaces for many hours. Infection among health care workers can occur by touching eyes or nose with contaminated hands.

Ribavirin treatment has been used as an aerosolized treatment. The drug RSV, when administered by nebulizer on a ventilated patient, poses no risk at all to visitors or health care workers. The drug, when administered as an aerosol, is usually administered in a head box to non-ventilated patients. This head box recovers 99% of the drug and should pose little if any risk to health care workers.

These patients are placed on Contact Precautions until their RSV cultures are negative.

HIV
Human immunodeficiency Virus can manifest as either HIV infection or Acquired Immunodeficiency Syndrome (AIDS). Health care workers are encouraged to use Standard Precautions on all body fluids from all patients.

The Needlestick Safety and Prevention Act 2000 and the Bloodborne Pathogen Standard CFR 1920.1030 mandates that health care employers offer safe needle and sharp devices. It is your duty to use them to take advantage of their safety. Pregnant health care workers can safely care for any HIV positive patient.

Parvovirus B19
Parvovirus B-19 infection is also known as Fifth Disease. About half of the adult population has had Parvovirus B-19 and are considered to be immune from getting the disease again. Parvovirus mainly infects children and can trigger aplastic or sicle cell crisis in children with these diseases. When hospitalized, these children can shed the virus for long periods of time. Non-immune healthcare workers who are pregnant should avoid patients with Parvovirus B-19.

Other Normal Precautions
All women of child bearing age are strongly encourage to receive immunizations for vaccine preventable disease before pregnancy. While pregnant, health care workers should still get their usual TB skin testing. Influenza vaccine is also important to prevent the flu, especially during the 2nd and 3rd trimesters.

Chemical Hazards
All workers, male and female, should be protected from toxic exposures at work. During your pregnancy you need to take all the precautions you would normally take to protect yourself. Chemicals that are reproductive hazards include:

• Ethylene oxide
• Antineoplastic and other hazardous drugs
• Inhalation anesthetic agents, particularly nitrous oxide

The exposure control plans for each of these agents is sufficient to protect all workers. Follow the safety procedures for storage and handling, and use personal protective equipment to handle these chemicals.

Radiation Hazards
The radiation dose to the fetus as a result of occupational exposure of the expectant mother should not exceed 500 mrem for the entire gestation period or 50 mrem/month. Overexposure could result in an increased risk of childhood leukemia and cancer. Radiation workers should complete a declaration of pregnancy form and submit it to Occupational Health. Download a form from Vanderbilt Environmental Health and Safety at http://www.safety.vanderbilt.edu. Once your pregnancy is declared, you will be monitored closely to keep you and your baby safe.

Health care workers caring for patients receiving radioactive treatments should be trained by Environmental Health and Safety to insure all appropriate precautions are in place. With these precautions, radiation exposure to health care workers is negligible.

• I-131 Health Care Workers' Risk