Table 1.

Chemical hazards present in veterinary workplaces and recommendations for mitigation of risks to female reproductive health identified in the literature.

Hazard	Reproductive risk	Best practices to mitigate risk
Anesthetic gases	Spontaneous abortions20 and preterm birth21	Install scavenging and ventilation systems6,20–26 Operating rooms: 15 air changes/h, with a minimum of 3 air changes of fresh air/h Recovery rooms: 6 air changes/h, with a minimum of 2 air changes of fresh air/h25 Properly inspect and maintain anesthesia machines, breathing circuits, and waste-gas scavenging systems6,22,25,26 Inspect the anesthetic delivery system before each use for irregularities or breaks Fill vaporizers before or after (not during) the anesthetic procedure Fill vaporizers under a ceiling-mounted hood with an active evacuation system, if available Check the patient’s breathing circuit for negative pressure and positive pressure relief Turn on the room or local ventilation system Make sure the scavenging equipment is properly connected Start the gas flow only after anesthesia is induced and the endotracheal tube is placed with the cuff properly inflated Confirm that the endotracheal tube creates a completely sealed airway If a mask is used, make sure it fits the patient well Use an appropriate oxygen flow rate for the animal’s size Occlude the Y-piece if the breathing circuit must be disconnected during surgery Turn off the anesthetic gas before turning off the breathing system and flush the patient’s airway with oxygen before disconnecting Eliminate residual gases through the scavenging system before disconnecting a patient from the breathing system; empty the breathing bag into the scavenging system Perform a comprehensive maintenance inspection annually Train all workers in hazard awareness, prevention, and control of exposures to waste anesthetic gases25 Inform female veterinary personnel of the risks27–29
Carbon monoxide	Fetal anoxia leading to fetal death23	Do not enter a poorly ventilated, artificially heated area where animals may be ill or dying, because of a potential for carbon monoxide exposure23
Antineoplastic drugs and other hazardous pharmaceuticals	Reduced fertility, fetal loss, spontaneous abortion, preterm birth, and low birth weight30–32	Read and follow recommendations in the following publications: DHHS (NIOSH) 2010–15017 and other publications33–36 providing guidelines for safe handling of hazardous drugs in veterinary medicine, including receipt and storage, drug preparation, drug administration, waste cleaning and disinfection, drug transportation, spill control, and medical surveillance DHHS (NIOSH) 2004–165,16 which includes protection recommendations for health-care workers potentially exposed to hazardous drugs including chemotherapeutic drugs used in cancer treatment, antiviral drugs, hormones, and some bioengineered drugs DHHS (NIOSH) 2014–138,15 which provides a list of antineoplastic and other hazardous drugs Other prevention practices for handling antineoplastic and other hazardous pharmaceuticals include the following: Minimum precautions include use of gloves, mask, goggles, and a long-sleeved, water-resistant gown37 Pregnancy intention status is an important determinant regarding prevention behaviors in handling cytotoxic drugs and should be considered in training programs38 Practice institution-wide prevention strategies,37 develop written chemotherapy safety protocols,33 and communicate risk and prevention strategies to employees32,33
Ethylene oxide (gas sterilization)	Spontaneous abortion26	Ethylene oxide gas sterilization procedures should be avoided in general veterinary practice because of the challenges involved with safe use26 If ethylene oxide is to be used, consult OSHA guidance documents39 and OSHA standards document 29 CFR 1910.1047,40 and observe the following: Wear proper personal protective equipment when working with ethylene oxide; protective outerwear, chemically resistant gloves, and goggles or face shields should be worn26 Worker exposure to ethylene oxide should be limited to 1 ppm in air measured as an 8-hour time-weighted average. Worker exposure to the agent may not exceed the short-term excursion limit of 5 ppm averaged over any 15-minute sampling period Leave the sterilizer area during the exhaust cycle26 Use engineering controls and good work practices to reduce exposure Implement a written compliance program
Insecticides and other pesticides	Birth defects41 and spontaneous abortion29	Consult safety data sheets for the compounds42,43 Use appropriate protective measures to prevent or minimize exposure42 Avoid extralabel use42 Be aware that pesticide concentrates that require dilution pose a higher risk of exposure Avoid using materials that may absorb the compound and release it later43 Inform female veterinary personnel of possible reproductive effects of pesticide exposure29,44 Use extreme caution and biological monitoring to regulate occupational exposure to organophosphates41,43
Prostaglandins and other reproductive hormones (eg, GnRH analog, human chorionic gonadotropin, estrogen, progester one, synthetic progestin, testosterone, and oxytocin)	Spontaneous abortion, fetal death (PGF2α and its analog), prolongation of pregnancy (synthetic progestin), disruption of menstrual cycle (GnRH analog, synthetic progestin), and increased or decreased uterine bleeding (synthetic progestin)23,45	Pregnant women should not handle or administer prostaglandin products23,45 Avoid direct skin contact by wearing impervious gloves during drug handling; wash hands immediately after removing gloves; adhere to manufacturers’ safety warnings45 When specific warnings and guidelines are not provided, follow NIOSH guidelines15–17 If contact with skin occurs, wash the affected area immediately and seek medical attention45

DHHS = US Department of Health and Human Services. GnRH = Gonadotropin-releasing hormone. PG = Prostaglandin.