Our associate is pregnant and wants to wear a respirator in surgery.  Is this a good idea?

In a word....no.  There are three problems with this scenario:

1) OSHA expects the practice leadership to use “engineering controls” and “procedural controls” to solve safety problems BEFORE they resort to the use of Personal Protective Equipment. That means there must be an effective scavenging system in place that removes the waste anesthetic gasses and the anesthetic machine must be checked for leaks before each and every procedure. Following these engineering and procedural controls, the exposure to the employee in the operating room should be virtually non-existent. The combination of effective WAG scavenging systems and strict procedural controls is normally very adequate to virtually eliminate the exposure in the operating room altogether. So when there is no real risk for exposure, the use of any PPE would not notably improve the health of the employee or the affect the progress of the pregnancy.

2)   The real chance for exposure is during the recovery portion of the procedure when the proper safeguards are observed in the operating room. Patients give off measurable amounts of anesthetic gasses in respiration during recovery. Normally, with good general ventilation in the recovery room, there is little exposure to the employee because the gasses are “diluted” with the room air to the point that they negligible. However, this is still the time when most staff members are exposed to the gas. The employee would have to wear the respirator throughout their entire work shift if they wanted to avoid exposure to all anesthetic gas concentrations but this is just not practical. A better solution for poor general ventilation would be to install an exhaust fan in the recovery area to ensure the air is “turned over” at least 4 to 6 times an hour.

3) When a respirator is used in the workplace to control a hazard, even voluntarily, the practice must comply with the very strict rules set forth in the Respiratory Protection Standard (1910.134), which include such provisions as medical evaluations of employees required to use respirators, specific procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding, and otherwise maintaining respirators, and of course, specific employee training. There is a provision in the regulation that allows “voluntary use of respirators by employees when the employer has determined that respirators are not required.

Section (c)2 of the regulation states:

“An employer may provide respirators at the request of employees or permit employees to use their own respirators, if the employer determines that such respirator use will not in itself create a hazard. If the employer determines that any voluntary respirator use is permissible, the employer shall provide the respirator users with the information contained in Appendix D to this section ("Information for Employees Using Respirators When Not Required Under the Standard"); and In addition, the employer must establish and implement those elements of a written respiratory protection program necessary to ensure that any employee using a respirator voluntarily is medically able to use that respirator, and that the respirator is cleaned, stored, and maintained so that its use does not present a health hazard to the user.”

So, even when the use of the respirator is voluntary, the business must still comply with many of the rules of the RPS.

Of course, the concern by the employee must be taken seriously by the practice leadership. Alleviating the concerns of the staff member is as important as alleviating the actual hazards! Naturally, it’s best to avoid any hazard when possible, but if it’s not practical, then the way to address those safety concerns is to take the same track as one would with a medical case: assess the physical conditions, perform laboratory tests to determine the exact level of the problem (click here for our Suggested Source Sheet for waste anesthetic badges) and then prescribe a course of action (procedural controls).

 

 

Did You Know...?

In 2008, 65.6% of first time mothers worked during their pregnancy.

Source: Department of Labor

https://www.dol.gov/wb/FirstTimeMothers-508-July2015REV.pdf