Occupational exposure to hazardous drugs (HDs) is a serious safety concern for healthcare workers, particularly nurses involved in drug administration and patient care. Hazardous drugs are defined as agents that exhibit characteristics such as genotoxicity, carcinogenicity, teratogenicity, or reproductive toxicity. For pregnant nurses, the primary risk is teratogenicity—the potential for these substances to cause structural or functional defects in a developing fetus. Avoiding exposure is especially important during the sensitive first trimester when fetal organs are forming. Protecting the unborn child requires understanding which drugs are hazardous and how exposure occurs in the workplace.
Identifying High-Risk Drug Categories
The National Institute for Occupational Safety and Health (NIOSH) maintains a comprehensive list of hazardous drugs, classified due to their inherent toxicity. Nurses who are pregnant should avoid handling any drugs classified in the three main NIOSH tables without robust protective measures.
Antineoplastic (chemotherapy) agents represent the highest occupational risk because they are designed to target and destroy quickly dividing cells. Examples of agents that should be strictly avoided include methotrexate, a known human teratogen, and drugs like daunorubicin and idarubicin, which are associated with fetal malformations even after the first trimester.
The second category includes hormonal agents that can disrupt normal endocrine function and fetal development. These agents include certain estrogen and testosterone products, specific contraceptives, and drugs like finasteride, which are considered hazardous because of their potential for reproductive harm.
A third category consists of other hazardous drugs, including specific antiviral agents, immunosuppressants, and certain teratogenic antibiotics. Examples include ribavirin or mycophenolate mofetil, which carry specific warnings for reproductive health. Nurses should consult their facility’s specific hazardous drug list, based on NIOSH guidance, to identify all concerning medications, as the risk is not limited to oncology units.
Routes of Occupational Exposure
Nurses encounter hazardous drugs through several distinct pathways. The most common route is dermal absorption, which occurs when a drug solution or powder contacts the skin during administration or disposal. This can happen from small leaks, residual drug on the outside of vials or IV bags, or contact with contaminated surfaces.
Inhalation is another significant route, particularly when drugs are handled in a manner that creates aerosols or dust. Tasks such as crushing tablets, opening ampules, or expelling air from a syringe can release microscopic drug particles into the air, which are then breathed in.
Ingestion, though often indirect, is a third mechanism of exposure that occurs through hand-to-mouth transfer. This happens if a nurse touches a contaminated surface and then inadvertently touches their mouth, eats, or drinks before washing their hands. Accidental injection or needle-stick injuries represent a fourth, more acute exposure route, delivering a drug directly into the body.
Exposure also extends to handling patient excreta, including urine, feces, and vomit. This risk lasts for up to 48 hours after a patient has received certain HDs, as the drugs are metabolized and excreted.
Essential Handling and Safety Protocols
Protecting pregnant nurses from hazardous drug exposure relies on a layered approach combining engineering controls, personal protective equipment, and clear administrative policies. The most effective strategy is the implementation of engineering controls. This includes the mandatory use of biological safety cabinets (BSCs) for drug preparation and the use of closed system transfer devices (CSTDs) for drug administration, which minimize the opportunity for drug escape through aerosols or spills.
Proper personal protective equipment (PPE) acts as a second line of defense against unavoidable contact with HDs. Nurses must utilize chemotherapy-rated gloves and non-absorbent, coated gowns when administering or handling hazardous materials. All PPE must be correctly donned, doffed, and disposed of immediately after use to prevent cross-contamination.
Administrative controls are equally important and include clear policies on handling and disposal. Workplaces should have established spill kits and decontamination procedures. All staff must receive regular training on the risks and proper handling techniques.
For pregnant nurses, professional guidelines from organizations like NIOSH and the American Nurses Association strongly recommend offering an alternative duty assignment. This reassignment allows the nurse to avoid all tasks involving the handling of high-risk medications. A formal, non-punitive policy ensures the nurse can protect the fetus. Even with all safety controls, the risk of exposure cannot be completely eliminated, making work modification the most certain protective measure during pregnancy.