By: Katelin Tellechea, HTL (ASCP)CM QLS CM
I had been working in Histology for over 10 years when my husband and I decided to start our family. I work in a small clinical lab, performing all tissue processing tasks from grossing to changing reagents. I knew I needed to identify the reproductive hazards in my lab and determine what modifications needed to be made to protect my baby. I immediately notified my supervisor of my condition and together we developed a plan for safety: I would wear a mask and refrain from changing any chemical reagents until I had reviewed the chemical Safety Data Sheets (SDS) and thoroughly researched and discussed the potential hazards of each chemical with my physician. I am so fortunate to work for a company that makes safety a priority.
I started reviewing SDS and I quickly realized that while the clear majority list health hazards, they note almost nothing regarding pregnancy. Out of 22 SDS in my lab only 5 include Reproductive Toxicity statements. Three of these are from alcohol based solutions that refer only to developmental toxicity when alcohol is ingested during pregnancy. The formalin SDS includes the statement “may cause genetic defects” within the Hazard Statement section. The SDS for hematoxylin is the most thorough, stating that the components have been shown to cause developmental delays and defects. What shocked me the most was that the SDS for xylene did not include any reproductive hazard information.
Though my lab has always registered well below the Permissible Exposure Limits (PELs) for xylene and formaldehyde, I contacted OHSA to ask if there were PELs set for pregnancy. Not only are there none but I also learned that OSHA acknowledges that its PELs are outdated and inadequate, even for healthy workers.
When I contacted NSH for information, the Health and Safety Committee provided me with material regarding hazardous chemicals but had nothing specific to pregnancy. I then turned to internet forums and listservs and found numerous anecdotal stories from women saying that they worked in histopathology while pregnant and that their babies had turned out just fine. But what kind of labs were they in? Were they grossing? Were they at a microtomy station far away from laboratory chemicals? These responses seemed to indicate that no additional safety precautions were needed; however, I couldn’t come to that conclusion with no additional details regarding the specifics of those labs or without other, verifiable research.
In addition, I read about techs who didn’t want to lose their jobs or inconvenience their co-workers by altering their job duties. Protecting the health of an unborn baby is not a burden; there are laws to protect pregnant women in the lab and workplace. I wondered about other techs who perhaps questioned whether the chemicals they were exposed to had affected their pregnancies. Were there histotechs who had experienced birth defects or who didn’t want to put their stories online, afraid for their families or jobs? Did information exist that substantiated these fears?
When I asked questions to supervisors, they overwhelmingly responded that they let their techs do whatever they are comfortable with. I couldn’t find any labs that had a policy regarding pregnancy. If the OSHA PELs and chemical SDS are inadequate how can labs create policies regarding pregnancy? If pregnant techs are to be responsible for performing only the tasks we are comfortable doing, how do we determine which tasks are safe for our babies? What we need, as histotechs and supervisors, is something more than online forums and SDS sheets; we need to create an evidence based a culture of safety for our pregnant workers.
A review of research needs to be done and it needs to be shared amongst our community. I want any tech to have ready access to the research studies available, so that they can immediately implement safety modifications when they are pregnant. With the support of my company, I submitted “Pregnancy in the Histology Laboratory: A review of safety considerations” as a poster topic for the 2016 Annual NSH Symposium/Convention. My abstract was accepted, and you can find my poster here.
Reviewing research studies, I found new evidence demonstrating that formaldehyde molecules can pass through the placenta to the fetus. Formaldehyde exposure is also documented to increase chances of having fertility problems or miscarriage, and can be absorbed by the skin. I learned that xylene can be absorbed by the skin and that exposure (by breathing vapors or skin contact) increases the chances of having a miscarriage, stillbirth, preterm birth, a low birth weight baby, and birth defects, including neural tube disorders.
I discussed my findings with my physician and we determined that I should wear a proper respirator (not a mask) and full Personal Protective Equipment (PPE) during grossing and changing the alcohols. I would have no exposure to xylene, hematoxylin, or aldehyde neutralizing powder.
When I presented my poster for the 2016 Annual NSH Symposium/Convention I met a lot of wonderful histotechs and listened to a great deal of pregnancy stories with very positive outcomes. I met techs whose labs offer temporary transfer to safer jobs during pregnancy, then rotate them back in after their return from maternity leave. Then I met a tech who had reproductive complications while working in the lab but was able to have children after she left. She returned to work in histology and always wondered if the chemicals in the lab contributed to her difficulties. I heard from a tech who had two babies with neural tube disorders; she was unaware (at the time) of any link between xylene and neural tube defects and therefore did not limit her exposure during pregnancy. I was contacted by people in research who understood the need for more research and hoped to be able to conduct studies of their own. I met Connie Warren who encouraged me to join the NSH Health and Safety Committee and published the text of my poster in the Fall 2016 issue of the Mikro-Graf (the official publication of the Michigan Society of Histotechnologists). NSH also interviewed me about my poster and you can listen to the podcast here: https://www.podbean.com/media/share/pb-s59am-645605.
The response to my poster has been overwhelming and positive. I have had so many requests for the poster and references and have also created a short document based on my poster with the references listed.
I hope that the interest in this topic reaches our histology community and that we move forward with more research on the safety of the chemicals we are working with every day; that we can take this small research project and further it to encompass fertility (for both men and women) and breastfeeding. I want to become an advocate for OSHA to create new, accurate PELs for all chemicals. I hope that we can protect our reproductive health with up to date findings that are effortlessly obtainable to all histology workers.