Nurses Perceptions of Occupational Reproductive Risks Associated with Severe Acute Respiratory Syndrome (SARS) and the Implications for Future Outbreaks.

Abstract

Introduction: The emergence of Severe Acute Respiratory Syndrome (SARS) in 2002-2003 and resulting outbreaks in Asia and Canada was the impetus for enhanced global and regional pandemic influenza planning. Health care workers represented a significant number of SARS cases, highlighting the occupational health risks of working as a responder during large-scale outbreaks. In Canada, the SARS outbreak represented two waves over several months. It is therefore reasonable to expect that during any infectious disease outbreak some responding health care workers will be pregnant or trying to conceive. The reproductive status of our medical response community may render them more susceptible to acute respiratory infections with important implications for their role in outbreak response. Methods: Five focus groups were conducted between November 2005 and February 2006, with Canadian emergency and critical care nurses, nursing managers, infection control specialists and union representatives from Ottawa, Toronto, Vancouver and Halifax as part of the Caring About Health Care Workers as First Responders: Enhancing Capacity for Gender-Based Support Mechanisms in Emergency Preparedness Planning project, funded by the federal CBRN Research Technology Initiative (CRTI). The number of participants in each focus group was: Ottawa (n=10, n=25); Toronto (n=15); Vancouver (n=27); and Halifax (n=23), for a total of 100 participants. Qualitative analysis of the focus group data was conducted by a team of four researchers, who coded the field notes from each session within the context of instrumental, informational and emotional supports for health care workers. Emergent themes were established by consensus of three associates on the research team. Results: The focus groups provided an opportunity for nurses to discuss their experiences working during the SARS outbreak and their perceptions regarding preparedness and risk. Major reproductive themes included: pregnancy/fertility risks associated with SARS exposure; pregnancy/fertility risks associated with prophylaxis medications/vaccinations; need for occupational safety information related to pregnancy/fertility and SARS; and human resource issues related to redeployment of pregnant nurses during infectious disease outbreaks. Implications: The few case reports of outcomes in pregnant women infected with SARS or H5N1 (avian influenza) describe significant maternal morbidity and mortality with obstetric complications (miscarriage, preterm delivery and intrauterine growth retardation (IUGR)) compared to non-pregnant women infected with SARS. These outcomes support the concerns expressed by nurses regarding occupational risks of SARS and pregnancy. A reproductive risk assessment should therefore be required in all infectious disease outbreaks (e.g. SARS, H5N1) or pandemic influenza to provide pregnant women, in particular female healthcare workers, with guidelines regarding infection control, use of prophylactic antivirals and obstetrics management. Effective risk communication strategies and policies will provide essential tools to enable health care workers to respond safely to infectious disease outbreaks.