Ribavirin exposure

[sugarmagnoliaRN]

I work on a unit that often gets patients with RSV and other viruses that require aerosolized Ribavirin treatment. In the past, our charge nurses assigned these patients only to men or women who are past child-bearing age (or are just done having kids). This rule recently changed to exclude only women who are currently pregnant or actively trying to get pregnant. I am young, female, have no children, and am in a serious relationship. I'm being put in the awkward position to 1) discuss my reproductive plans with my employer which isn't any of their business, and 2) let them know that I'm sexually active and accidents happen (again, none of their business). I don't feel like I should be assigned to these patients (but of course I was the very day the rule changed). There are other nurses on my unit who are more appropriate to take these patients, but the charge nurses aren't being very receptive to feedback on this. Does anyone have any articles about the dangers of ribavirin exposure that could be helpful in persuading them? I'm not really sure what to do here.

[classicdame, MSN, EdD]

I do not think you have the right to pick and choose your patients.

[sugarmagnoliaRN]

It's not that I want to pick & choose; I am legitimately concerned about exposure to a specific medication that is proven to cause birth defects.

[TraumaSurfer]

Your best piece of evidence is the consent form the patient or parents sign for the Ribavirin therapy. It should list all of the potential complications or long term effects of the medication which should also include the reproductive system. We are still waiting for the studies which hopefully are active on the many kids who got lots of direct Ribavirin exposure during treatment in the 80s and are now of child bearing age. Might be interesting for Neonatal RNs to watch for.

Are you working on an Oncology or HIV unit? These are about the only ones still using Ribavirin for RSV. If so, your employer could argue you handle several other medications which also have potential for health issues. But, there probably is a strict P&P for the handling of these meds just like there should be for Ribavirin. There are other nebulized meds which health care providers get exposed to frequently and are ignoring the risks involved with them although the studies are there also. ICU RNs also go through this with Nitric Oxide administration or even Flolan if not given properly with precautions in place. RNs who might have other health issues such as asthma, autoimmune or taking some immune suppressing drugs have also tried to avoid the patients taking these meds and other meds but the reply is generally you work in health care and should know the P&P to protect yourself.

In the meantime, adhere to the strictest exposure policy. Take the time to put on the proper mask, gown and gloves. Don't be a hero and rush in when Ribavirin is running or immediately after without proper protection. Wipe down the computer or anything you might touch even if it was covered and even if you have gloves on. Some people get exposed to a lot of things when they aren't mindful of how they remove their gloves which may have medication and other contaminants on them and come contact with their skin. Alcohol hand cleaner isn't going to help with medication exposure. Also, never wear your scrubs home. Remove and put in a plastic bag and not just in a backpack or gym bag without any protection. Don't touch the clothes when dumping into the washer. If so, wash hands. This should be the same for all scrubs worn in patient care areas.

[sugarmagnoliaRN]

Thanks TraumaSurfer! No, my unit is not heme-onc or HIV. Unfortunately, I don't have a choice about going into the room while the Ribavirin is running - it runs for 6 hours at a time, so it would be pretty hard to give that patient any care if I couldn't be in the room for 6 hours.

[nurseprnRN, BSN, RN]

You are quite right that any non-sterilized female of reproductive age could get pregnant regardless of marital status, and it's nobody's business. If there is an adequate precaution P&P, as TraumaSurfer outlines, then follow it to the letter.

I would consider enlisting the backing of the employee health department. You could point out that anyone could become pregnant, and that the previous policy (men, women past childbearing age, or sterilized by tubal ligation or hyst) was a good one from a hospital liability standpoint. It seems as if shifting that policy to put the burden or risk on fertile women to protect themselves would require a very, very strong P&P to do that, and the means to carry it out.

[TraumaSurfer]

I hope you are wearing a gown, N95 and gloves when you enter the room.

I can not imagine any other unit still using Ribavirin since it is now just used as a last ditch effort for those in Oncology or HIV. Peds determined it was ineffective at least 15 years ago. Those who advocate for it sometimes run it long enough (like 10 - 20 days) for the RSV or other viral infection to run its course but still claim the drug was responsible for the success.

Talk to the RTs. They probably have lots of resources since they go through this and some RTs don't have a choice about being the care provider even if pregnant due to the small size of their departments and "it being their job".

[OCNRN63, RN]

I found this:http://www.aft.org/pdfs/healthsafety/fs_ribavarin0806.pdf

Many years ago, I worked on a small peds unit. Back then, we ran tons of ribavirin. It was really exasperating working with one nurse. She wasn't pregnant/trying to get pregnant, but she'd refuse to take the ribavirin patients because, "I might want to get pregnant." It was a huge burden on the nurse working with her, because you'd usually have more patients and all of them sicker and requiring all of the precautions needed for ribavirin. I have to tell you, I resented her. It felt like she was just doing it to get out of taking those patients. It wasn't just the patient care...every time an IV beeped or a parent rang the call bell it meant the nurse taking those patients had to garb up yet again.

Did you do any research on your own?

[Esme12, ASN, BSN, RN]

Here are the OSHA recommendations does your facility have PPE available to you?

https://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html#5

[sugarmagnoliaRN]

I found this:http://www.aft.org/pdfs/healthsafety/fs_ribavarin0806.pdf

Many years ago, I worked on a small peds unit. Back then, we ran tons of ribavirin. It was really exasperating working with one nurse. She wasn't pregnant/trying to get pregnant, but she'd refuse to take the ribavirin patients because, "I might want to get pregnant." It was a huge burden on the nurse working with her, because you'd usually have more patients and all of them sicker and requiring all of the precautions needed for ribavirin. I have to tell you, I resented her. It felt like she was just doing it to get out of taking those patients. It wasn't just the patient care...every time an IV beeped or a parent rang the call bell it meant the nurse taking those patients had to garb up yet again.

Did you do any research on your own?

We only have 2 negative pressure rooms, so we have max 2 Ribavirin patients out of a 30-bed unit. TraumaSurfer, when I was reading up on this it was found that the RNs have much more exposure than the RT's - they generally don't stay in the room while the med is running. If I have to give a slew of IV abx (like I did with this patient, along with IVIG) I am going to be in there longer than the RT while it's going.

Our patients that are getting Ribavirin are usually old lung transplants that have contracted RSV.

GrnTea- you bring up a good point about the hospital's liability. I do wear the gown, gloves, and N100 mask but think it's worth discussing with the employee health department.

[meanmaryjean, DNP, RN]

I didn't think anyone was using ribavirin for RSV any more........

[sugarmagnoliaRN]

Thanks Esme! Yes, PPE is available.