Assessing risks can target reproductive hazards
Employee questionnaire asks sensitive questions
Monitoring the hospital environment for reproductive hazards such as radiation and waste anesthetic gases may not be enough to ensure employee safety. By categorizing employees by risk level, employee health professionals can target educational interventions and conduct medical surveillance, says Larry Lindesmith, MD, FACOEM, FCCP, medical director of employee health and safety at Gundersen Lutheran Medical Center in La Crosse, WI.
Lindesmith, who is drafting guidelines for the medical center occupational health section of the American College of Occupational and Environmental Medicine in Arlington Heights, IL, has developed a risk assessment model and medical monitoring questionnaire to help manage reproductive hazards.
Employees at high risk will be offered special educational programs and reminders that they can use extra protective equipment or request a temporary reassignment. Medical monitoring will enable Gundersen Lutheran, a community teaching hospital, to track any trends in miscarriages or birth defects.
"In looking at [our policies], we were aware that there is no good guidance as to what should constitute even an assessment for reproductive health hazards," says Lindesmith. "While there are various texts and guidelines, there is nothing that has helped direct an individual health care worker or institution, other than to say they should check into their reproductive health and try to protect them. We’re trying to make things a little more specific and provide some more specific guidance."
Risk identification provides framework
Identifying employees at greatest risk helps clarify the hazards and gives employee health professionals a framework for responding, says Lindesmith, who is revising the reproductive health hazard reduction policy at Gundersen Lutheran with colleagues Johanna Hargreaves-Kwong, RN, MSN, and Mary V. Lowell, RN, MSN, COHN-S.
Employees who have undergone a vasec-tomy or tubal ligation have no reproductive risk, regardless of exposure. Employees who are pregnant, trying to become pregnant, or who do not always use birth control are at high risk. Those who use birth control consistently are at low risk. The risk is also associated with the possibility of exposure to the hazards.
"You can start at the top category and work down as you have time and capabilities," he says. "The high-risk groups are the ones definitely exposed to known evidentiary agents that are known to cause reproductive problems and who are pregnant or attempting to get pregnant."
To assess risk, Lindesmith will ask employees in high-risk areas to fill out a reproductive health questionnaire. If employees move in or out of a high-risk job or if their reproductive health status changes, Lindesmith has asked them to notify the employee health department.
What safeguards should you provide for high-risk employees? Ultimately, it is up to individual employees to decide how they will respond to reproductive risks.
Lindesmith notes that the U.S. Supreme Court has ruled that workers can’t be required to change job duties because they are pregnant or trying to become pregnant. They simply must be informed of hazards and given options. Instead, Lindesmith focuses on hazard elimination and reduction, safe work practices, monitoring exposure levels, medical surveillance, and employee education. For example, Lindesmith makes sure periodic monitoring occurs to detect waste anesthetic gas wherever an anesthesia machine is in use. Daily checks of the scavengers are conducted to prevent gas from escaping into the work environment.
Knowing who is at high risk — such as employees who are pregnant or trying to become pregnant — helps Lindesmith develop focused educational sessions. For example, a group class on protecting against radiation hazards might offer a question-and-answer period for employees and emphasize taking extra precautions.
"We may counsel someone in the radiation area to be sure they’re watching out for stray radiation from the floor from below," he says. "You have to be sure they’re wearing the longer protective lead aprons."
Lindesmith documents badging efforts and results, training and education sessions and materials, the use of surveillance and follow-up of any identified concerns, and the offering of personal protective equipment and of engineering and administrative control efforts.
Hospital to track miscarriages
As delicate as it is to ask people about whether they are trying to conceive and whether they regularly use birth control, the most unique aspect of Lindesmith’s reproductive health plan may be the medical monitoring. He wants to know whether hazards may create an increased likelihood of poor reproductive outcomes.
While any individual miscarriage or birth defect could be tied to factors completely unrelated to work environment, Lindesmith will be looking for any trends or significant variation from expected rates.
Lindesmith acknowledges that such surveillance is rare, outside of research institutions. "In the literature, I haven’t found much in the way of good data that measures outcomes showing that the safety measures we’re using around the country actually work," he says. "This is designed to try to allow some data collection in regular patient care institutions as opposed to research institutions."
On an annual basis, perhaps at the same time as tuberculosis testing, employees in high-risk areas will respond to questionnaires, providing information on any miscarriages or birth defects. Information will be collected from men about their wives or partners, as well as from women. Over time, Lindesmith hopes to compare such data to national norms.
"This is not going to give us day-to-day information, but it will allow us to monitor what’s happening at our institution on a long-term basis," he says.
Lindesmith doesn’t yet know whether employees will agree to complete the questionnaires, which are voluntary and confidential. He notes that employees in high-risk areas such as the post-anesthesia recovery unit are aware of the hazards and open about the issues involved. The questionnaires will be kept separate from regular medical records.
"Our feeling is that most [employees] will not feel threatened by this," he says.
[Editor’s note: Information for employees about reproductive health hazards is available from the National Institute of Occupational Safety and Health in these publications: "The Effects of Workplace Hazards on Female Reproductive Health" (DHHS/ NIOSH Pub. No. 99-104) and "The Effects of Workplace Hazards on Male Reproductive Health" (DHHS/NIOSH Pub. No. 96-132). Telephone: (800) 35-NIOSH. On-line: www.cdc.gov/niosh/99-104pd. html and www.cdc.gov/niosh/malrepro.html.]
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