Feb 14

Pregnancy in Healthcare Workers in Aged Care

A Safety Guide for Healthcare Workers in Australia and New Zealand

Working in aged care is a physically and emotionally challenging profession. In Australia and New Zealand, thousands of nurses, health care assistants (HCAs), and non-clinical staff provide essential support to our aging population. However, when a healthcare worker becomes pregnant, the workplace introduces a unique set of occupational hazards.

From infectious diseases to hazardous medications and industrial chemicals, understanding these risks is vital for safeguarding both the mother and the developing foetus. This blog compiles the essential safety information every pregnant aged care worker needs to know.

Regulatory Legislation

Both Australia (under Safe Work Australia) and New Zealand (under WorkSafe and Health NZ) have strong legislation safeguarding pregnant workers. Employers must provide a safe working environment by law. If a "safe job" cannot be found, workers in Australia may be eligible for "Paid No Safe Job Leave," while New Zealand workers can access specific "Special Leave" and parental protections.

Infectious Diseases and Immune Status

Residents in aged care facilities often live closely together and, due to age, may have weakened immune systems, making them more vulnerable to infections. For a pregnant worker, the risk is doubled: the severity of illness for the mother and the potential for transmission to the foetus.

  • Cytomegalovirus (CMV): Possibly the most underrated risk. CMV can be found in bodily fluids such as urine and saliva. A primary infection during pregnancy can result in congenital CMV, which may cause hearing loss or developmental delays in the baby.
  • Respiratory Viruses (Influenza, COVID-19, RSV): Pregnancy alters a woman’s lung capacity and immune response. These viruses increase the risk of maternal pneumonia and have been associated with higher rates of preterm birth.
  • Varicella (Chickenpox) and Rubella: If a worker's serology indicates they are not immune, exposure to these can be disastrous, resulting in congenital rubella syndrome or severe maternal illness.
  • Gastroenteritis (Norovirus): Although usually short-term, severe dehydration from vomiting and diarrhoea can reduce placental blood flow and lead to premature labour.


The Strategy: Ensure your vaccinations are up to date before becoming pregnant or early in pregnancy. If an outbreak occurs in your facility or wing, request an immediate transfer to an unaffected or "clean" area.

Hazardous Medications: The "Dust" Hazard

The way medications are handled in aged care - particularly crushing tablets for residents with dysphagia - creates a significant inhalation risk. Even skin contact with certain drug residues can be hazardous.
  • Cytotoxic Drugs: These are not only for cancer. Medications like Methotrexate (Methoblastin) are commonly used for Rheumatoid Arthritis in aged care. They are powerful teratogens that can cause miscarriage or foetal malformations.
  • Hormonal Agents: Drugs used for prostate enlargement, such as Finasteride (Proscar) or Dutasteride (Avodart/Duodart), can affect the development of a male foetus’s reproductive organs if the mother touches a broken tablet (subcutaneous absorption) or inhales the dust.
  • Immunosuppressants: Drugs like Azathioprine (Imuran) or Leflunomide (Arava) are often used for chronic autoimmune conditions but pose significant risks during pregnancy.
  • Topical agents: Creams like Efudix (Fluorouracil), used for skin cancers or sunspots, are cytotoxic and should never be applied by a pregnant worker without double-gloving.


The Strategy: Avoid the "Medication Round" if it involves crushing hazardous pills. Use a sealed-pouch system (such as a Silent Knight) if crushing is unavoidable and always wear a P2/N95 mask to prevent inhaling the dust from the crushed medication.

Chemical Exposure and Environment

Industrial cleaning is a regular part of aged care to uphold hygiene standards. However, the chemicals involved can be harsh.
  • Sterilants and High-Level Disinfectants: Chemicals containing glutaraldehyde or formaldehyde (used in some medical equipment cleaning) are toxic and should be completely avoided.
  • Bleach and Ammonia: When used in small amounts in poorly ventilated residential en-suites, the vapours can cause respiratory distress and nausea, which may worsen morning sickness or cause fainting.
  • Pesticides and Strippers: Be aware of facility maintenance schedules. Floor stripping agents and professional pest control chemicals can often contain organic solvents or neurotoxins, which should not be inhaled during pregnancy.


The Strategy: Always review the Safety Data Sheet (SDS) provided for any chemical used in the facility. Check for "Hazard Statement H360" (May damage fertility or the unborn child). If present, the task must be allocated to someone else.

Physical Demands and Ergonomics

Although not a biological "poison," physical strain is a significant risk factor during the third trimester of pregnancy.
  • Manual Handling: Hormonal changes (relaxin) soften ligaments, increasing the risk of injury to the lower back and pelvis.
  • The "Boosting" Risk: Manually sliding a resident up in bed or performing solo transfers should be strictly avoided.
  • Heat Stress: Pregnant women tend to have a higher baseline body temperature. Working in heavy PPE in poorly ventilated areas can cause overheating and dizziness.

Creating Your Pregnancy Action Plan

To manage these risks, a proactive approach is essential. Don't wait for a "near miss" to raise concerns.
  1. Notification: Inform your manager early. Provide a medical certificate that lists specific restrictions (e.g., "no heavy lifting," "no exposure to cytotoxic medications").
  2. The Risk Audit: Arrange a meeting to review the residents on your floor. Identify who is on "Hazardous Meds" and who has active infections.
  3. PPE Upgrades: If you need to work in somewhat risky environments, make sure you have access to high-quality PPE, including long-sleeved gowns and N95 masks, rather than just standard surgical masks.

  • Task Adjustment: Negotiate a change in duties. You may be able to transition from high-intensity personal care to more administrative or lower-risk positions. Recommend that pregnant workers be excluded from terminal cleans, recurrent spill responses, and areas undergoing chemical treatments.

Key Points

  • Infections of Concern – measles, rubella, chickenpox, shingles, emerging viruses
  • Risk Assessment and modified duties
  • Employer Obligations vs. Personal Responsibilities
  • Supporting staff without stigma
  • Ensure pregnancy is included in IPC risk assessments and workforce planning. Involve the IPC Lead in this assessment and risk review.
  • Refer to local policy for specific IPC risk assessments and appropriate controls, e.g., PPE.
  • Clarify that pregnancy is an important consideration in personal risk assessments and outbreak management plans.

Conclusion

Pregnancy doesn't mean you can't work in aged care, but it does mean that the "business as usual" approach needs to be adjusted. By recognising the specific risks - from the CMV in a resident’s room to the Methotrexate on the med trolley - you can keep your pregnancy safe.

In both Australia and New Zealand, the law supports you. Make use of your facility’s Safety Data Sheets, rely on your Health and Safety Representatives, and never hesitate to delegate a task that puts you or your baby at risk. Professionalism in healthcare involves recognising your limits and prioritising the health of the next generation.

For more information on this topic, and others, see the HUB or ask EVE, our multilingual bot. Alternatively, our staff can help you: support@infectioncontrol.care

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Take advantage of our expertise in IPC. See the HUB for policies, resources and courses relating to this very important subject. Ask EVE for a quick answer to your question.

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