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In Practice NO V EM B ER/ DEC EM B ER 2008 573

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AFETY

LEGALITIES

Once an employer has received writ-

ten notification from an employee

that she is pregnant (or that she has

given birth in the previous six months

or that she is breast-feeding), then by

law a specific risk assessment must

be conducted relating to that indi-

vidual. According to the Health and

Safety Executives guidance (HSE

2006), there are five straightforward

steps to be undertaken in the formu-

lation of a risk assessment:

Identify the hazards;

Decide who might be harmed

and how (this article specifically

considers the risk to the pregnant

employee and her unborn child);

Evaluate the risks and decide on

the precautions;

Record your findings and imple-

ment them;

Review your assessment and

update if necessary.

Remember, a hazard is anything

with the potential to cause harm. A

risk is the likelihood of the harm

occurring, plus an indication of the

severity.

IDENTIFYING THE

HAZARDS

The tables (right, and on page 574

and page 575) give examples oftypical hazards that may be faced

by farm animal vets in three cat-

egories: physical, biological and

chemical. It will also be necessary

to consider generic factors imposed

by the working conditions that cre-

ate increased levels of risk for the

pregnant worker, for example, inad-

equate facilities (including rest

rooms), excessive working hours

(such as night work), unusually

stressful work, lone working or trav-

elling, and other difficulties relating

to posture or standing.

EVALUATING RISKS

It is very important for there to be

a measured evaluation of the risks,

considering both likelihood and con-

sequence. This will help employers

target the issues where the risks are

greatest and help prioritise action.

Remember that the objective is to

focus on significant risks trivial

risks can be ignored.

Dont overlook anything

It is well publicised that preg-

In Practice (2008)30, 573-575

Health and safety considerations

for pregnant farm animal vets

nant women should avoid contact

with lambing ewes due to the risks

associated with enzootic abortion.

Indeed, the consequences of expo-

sure to Chlamydophila abortus,

Toxoplasma gondii, listeria or Q

fever are potentially very severe

and, certainly in the case ofC abor-

tus and Q fever, the microorganisms

are reported as being highly infec-

tious to humans. However, the actual

number of cases correctly diagnosed

is low, with approximately 70 cases

of Q fever in men and women and

only one or two cases of C abortus

reported in pregnant women in the

FARM animal work will inevitably expose vets to

a variety of different hazards and risks. It is the

legal duty of all employers to assess the risks tothe health and safety of their employees arising

from these hazards and to do what is reasonably

practicable to control the risks. With more female

veterinary staff than ever before, employers

are increasingly being faced with situations in

which pregnancy has an impact on the running of

their business. Fiona Lovatt and Alastair Mitchell

highlight some of the issues that employers may

need to consider when preparing a risk assessment

relevant to the work of a pregnant farm animal vet.

FIONA LOVATT AND ALASTAIR MITCHELL

EXAMPLES OF PHYSICAL HAZARDS

Hazard Source Consequence

Getting kickedby livestock

Cattle not restrained properly,particularly when injectinginto the rump or standingalongside to perform anoperation such as a caesarean

Shock or physical injury thatmay lead to miscarriage

Getting bargedby livestock

Moving cattle or rams intohandling facilities

Shock or physical injury thatmay lead to miscarriage

Getting attacked

by livestock

Being in the pen with a bull or

newly calved cows

Shock or physical injury that

may lead to miscarriage

Manual handling(eg, lifting heavyweights or usingawkward postures)

Turning sheep, calving cows orreplacing a prolapsed uterusin a cow

Musculoskeletal injury

With suitable facilities, a pregnant farm vet remains auseful member of the team

Fiona Lovattgraduated fromBristol in 1995 andwas awarded a PhD inconservation genetics

from Durham in2008. She works inthe farm departmentof a large mixedpractice based atBarnard Castle,County Durham,and is an activemember of the SheepVeterinary Society.With two smalldaughters, she hastwice been involvedin developing riskassessments fora pregnant farmanimal vet.

Alastair Mitchelljoined the Health andSafety Executive (HSE)in 1991, in Worcester.In 2004, he movedto the HSEs PolicyGroup (agricultureand food sector),where he works inthe health, educationand chemicalssection. His otherareas of responsibilityinclude vocationalqualifications,manual handling andveterinary matters.

This article does not attempt

to provide a model risk assess-

ment as each practice is differ-

ent, with veterinary surgeons

undertaking a variety of work

with different animals on

different types of farm.


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In Practice NO V EM B ER/ DEC EM B ER 2008574

UK annually. The advice that preg-

nant women should avoid any con-

tact with ewes at lambing time is due

to the very serious consequences,

even though the likelihood of infec-

tion is low.

Acknowledging the risk of con-

tact between pregnant women and

lambing ewes, however, should not

allow employers to overlook the

risks presented by other more com-

mon hazards. A poorly considered

risk assessment might prevent the

pregnant vet doing any work with

sheep, but still allow the same indi-

vidual to perform an emergency

caesarean on a Limousin heifer on a

farm with inadequate handling facil-

ities. So look beyond the obvious.

Any activity that involves the

vet working at the rear end of an

unrestrained cow should be very

carefully considered and avoided if

possible. Most vets have been kicked

in this situation at some time in

their careers, which demonstrates

that there is a reasonably high risk.

The consequences of a kick to the

unborn child of a pregnant employee

are potentially very severe and life-

threatening, so determining the rela-

tive importance of risks is an essential

element in risk assessment. While

there is no general formula for rating

risks, a number of simple techniques

have been developed to assist in the

decision making process. Assessing

relative risk involves some means of

estimating the likelihood of occur-

rence and the severity of a hazard.

Scoring a hazard

All tasks should be considered sepa-

rately and the likelihood and con-

sequence of each hazard should be

evaluated. This can be done on a

numerical basis so that likelihood

and consequence are both rated on

an arbitrary scale of 1 (low chance)

to 5 (high chance). The scores for

likelihood and consequence are then

multiplied together, giving a total

score that allows risks to be com-

pared and contribute to establishing

risk control priorities. For example,

in theory, entering a pen with a wild,

unrestrained bull would score 5 for

likelihood of injury and 5 for poten-

tial consequence/severity of injury.

The resulting total score of 25 is

extremely high and this would be an

activity that should be avoided by all

vets, pregnant or not.

A pregnant vet performing a clini-

cal examination on a ram may score

12 if the ram is not restrained (3 for

likelihood of being butted in the

abdomen and 4 for consequence of

injury), which would be unaccept-

able. However, if the ram was well

restrained, the score might reduce

to 4 (1 for likelihood and 4 for con-

sequence) and this would become an

acceptable activity for a pregnant vet.

These examples present the most sim-

plified method of estimating relative

risk, and practices will need to devise

systems suited to their own needs.

Colour coding

The outcomes of such an approach

can be recorded using a colour-coded

This cattle crush has been modified by the addition of an extraadjustable post so it can be used to restrain cattle undergoing acaesarean section, reducing the risk of the veterinary surgeonbeing kicked

EXAMPLES OF BIOLOGICAL HAZARDS

Hazard Source Route Consequence Notes

Chlamydophila

abortus

Birth fluids, placenta,abortion products, faeces,skin of neonates of sheep orgoats; soiled workwear

Oronasalinhalationof aerosolcontaminatedwith agent

Severe systemic illness inmother, miscarriage orstillbirth

Very few reports in humans fewer than five cases peryear in the UK. One report ofmaternal death in 1980 (HealthProtection Agency [HPA] 2008a)

Toxoplasma

gondii

Soil, hay or feed contaminatedwith cat faeces; abortionproducts of sheep or goats

Cuts on skin oringestion

Miscarriage, stillbirthor congenitalmalformation of thefetus

Toxoplasmosis affects 02%of pregnancies in the UK.Transmission to the unbornbaby occurs in less than half ofthese cases, and when it does,90 to 95% of babies have nosymptoms

Q fever Birth fluids or abortionproducts of sheep, cattle,goats or deer

Oronasalinhalation, tickbites or drinking

unpasteurisedmilk

Often asymptomaticin mother. Prematurebirth, low birth weight

or miscarriage

Infection can also occur frominhalation of spores (eg, viaventilation systems from

livestock sheds).Highly infective

Listeria Infected food; silage; abortionproducts and eye diseases ofsheep, cattle or goats

Ingestion Miscarriage orpremature birth.Septicaemia ormeningitis in thebaby, with 50 to 100%mortality

There are between 20 and30 cases a year in the UK. Itis not known how many areassociated with livestock(HPA 2008b)

Salmonella Infected food; faeces andabortion products from mostfarm animals

Ingestion Severe diarrhoea andfever

Campylobacter Eating infected food; faecesfrom farm animals, pets andpoultry; abortion products ofsheep or cattle

Ingestion Severe diarrhoea andillness

Escherichia coli Faeces from most farm

animals, pets and wild birds;contaminated workwear

Ingestion Severe diarrhoea,

possible kidney failure

Cryptosporidia Faeces from calves, sheep,deer and goats

Ingestion Severe diarrhoea,flu-like symptoms,abdominal pains


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In Practice NO V EM B ER/ DEC EM B ER 2008 575

system. A red activity would be

one that has either a high likelihood

of the hazard occurring or a high

consequence of that hazard. Red

activities should probably be avoided

by pregnant employees. If steps

can be taken to reduce either the

likelihood of the hazard or its con-

sequences then it becomes an

orange activity. Assuming suitable

precautions are put in place, then

orange activities are safe to be

undertaken by pregnant employ-

ees. Green category activities

are considered to be low risk, and

consequently those that a preg-

nant employee can safely perform.

Examples might include clinical

examination of cows, blood sam-

pling rams or tuberculosis testing

on farms where the practice knows

that there are good, secure handling

facilities that are well maintained

and used correctly.

CONTROL MEASURES

When risks have been analysed and

assessed, decisions can be made

about control measures. It is rec-

ognised that risk cannot always be

eliminated, but it must always be

reduced to the lowest level that is

reasonably practicable. There is a

hierarchy of control measures and

they must be applied in the follow-

ing order of priority.

Where possible, eliminate the

hazard completely (eg, shooting an

aggressive, dangerous bull rather

than attempting to capture it for

veterinary attention). Substitute the

dangerous with the inherently less

dangerous (eg, use less hazardous

substances or medicines).

If it is not possible to remove

the hazard, then the risks associ-

ated with it must be reduced. Peopleshould be prevented from coming

into contact with the hazard or a

safe system of work may be put in

place to control the risk (eg, ensur-

ing adequate restraint, using needle

guards on injection equipment and

training staff properly).

The final choice of control meas-

ure is the provision of adequate per-

sonal protective equipment (PPE)

(eg, gloves).

PRACTICAL SUGGESTIONS

All final decisions about risk

control measures must take into

account the relevant legal require-

ments and professional benchmark

standards that establish minimum

acceptable levels of risk prevention

or control. Here are some examples

of control measures that may be

appropriate in a risk assessment for

a pregnant vet:

Avoid contact with lambing or

aborting ewes, lambs up to two

weeks old or ewes up to two weeks

after lambing;

Avoid handling ewe abortion

products or materials potentially

contaminated with birth products;

Avoid handling prostaglandin

injections, live abortion vaccines or

any veterinary products for which

a specific risk to pregnant persons

has been identified. Where the use

of such products is unavoidable, del-

egate the task to other competent per-

sons under close supervision and only

when animals are well restrained;

Only handle cattle in a suitable

crush and insist on proper handling

facilities with sufficient competent

personnel in attendance;

Use an assistant to hold calves

and turn sheep or preferably use

well-designed restraint or turnover

crates to reduce the risk of manual

handling injuries;

Do not undertake high-risk

activities such as a cow caesar-

ean or replacing a uterine prolapse

alone when in the last trimester of

pregnancy;

Practise good personal hygiene at

all times;

Wear appropriate PPE when

handling pregnant ewes (outside the

two-week lambing period) or lambs

older than two weeks;

Wear gloves to handle faeces,

feed, hay or soil;

Wear gloves to handle live abor-

tion vaccines;

Wear gloves to calve cows orreplace prolapses.

In the later stages of pregnancy

it is not appropriate for a preg-

nant farm vet to work alone out of

hours, so there should always be

a colleague available to be called

on. Whatever hazard or risk cat-

egorisation system has been used,

it is important that everyone in the

practice knows which activities

can and cannot be undertaken by

the pregnant vet. This allows sen-

sible allocation of jobs and avoidsembarrassment should the vet turn

up on the farm and find that she is

expected to do something that is not

safe.

INVOLVE STAFF

Although it is the employers respon-

sibility to undertake risk assess-

ments, it is helpful to involve staff

as much as possible in the process

so that workable solutions can be

reached. Dont forget that employers

with five or more staff are required

to record the significant findings of

their assessment. Maintaining risk

control measures also requires ade-

quate inspection, maintenance and

monitoring of procedures to ensure

that staff do actually comply with

the requirements. The assessment

will also need to be reviewed and

updated on a regular basis to ensure

that it is still valid.

What if risks cannot be

removed?

With regard to pregnant workers, if

the risks cannot be removed, the law

is very clear. First, the employer must

temporarily adjust the employees

working conditions and/or hours ofwork. If this is not possible, they must

offer her suitable alternative work

(at the same rate of pay) if available.

Failing that, they must suspend her

from work on paid leave for as long as

is necessary to protect her health and

safety and that of her child. As many

practices are small businesses work-

ing on tight budgets, it is clear that it is

in everyones interests to avoid reach-

ing this stage another good reason to

ensure that a thorough and balanced

risk assessment is carried out.

References andfurther readingHPA (2008a) Chlamydiosis(enzootic abortion of ewes)and risks in lambing season.

www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page

/1191942148907?p =1191942148907

HPA (2008b) Listeriosis andrisks in lambing season.www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733813002?p=1191942148384

HSE (1996) Workplace(Health, Safety and Welfare)Regulations 1992 ApprovedCode of Practice and Guidance.Sudbury, HSE Books

HSE (1997) Infection Risks toNew and Expectant Mothers

in the Workplace A Guidefor Employers. Sudbury,HSE Books

HSE (2000) Management ofHealth and Safety at WorkRegulations 1999 ApprovedCode of Practice and Guidance.2nd edn. Sudbury, HSE Books

HSE (2002) New and ExpectantMothers at Work A Guidefor Employers. Sudbury,HSE Books

HSE (2003) A guide for newand expectant mothers whowork. www.hse.gov.uk/pubns/indg373.pdf

HSE (2006) Five steps to riskassessment. www.hse.gov.uk/

pubns/indg163.pdf

Useful websites www.hse.gov.uk www.hsebooks.com www.hpa.org.uk

EXAMPLES OF CHEMICAL HAZARDS

Hazard Source/route Consequence

Prostaglandin injections(eg, cloprostenol[Estrumate or Planate,Schering-Plough; Cyclix,Virbac], luprostiol[Prosolvin; Virbac],dinoprost [Lutalyse, Pfizer;Enzaprost, Ceva; Noroprost,Norbrook])

Absorption viaskin or eyes,ingestion orself-injection

Miscarriage orpremature birth

Altrenogest (RegumateEquine, Intervet;Regumate Porcine,Janssen)

Absorption viaskin or eyes, oringestion

Disruption ofmenstrual cycle,prolongation ofpregnancy

Live ovine abortionvaccines (eg, Toxovax[Intervet], Enzovax[Intervet], CEVACChlamydophila [Ceva])

Absorption viaskin or eyes,ingestion orself-injection

Interferencewith normal fetaldevelopment(Toxovax) ormiscarriage(Enzovax or CEVACChlamydophila)

Note: when assessing risk, reference should always be made to theinformation provided by the manufacturer in the data sheet, which shouldgive specific warnings, instructions or prohibitions relating to use

AcknowledgementsThe author would like to thank KathrynDunn, Rachel Hayton and Peter Lovatt fortheir assistance in the preparation of thisarticle.

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