Infection control precautions for the pregnant health care worker

Health care workers (HCWs), especially women of child-bearing age, are aware that, in the course of caring for their patients, they are likely to be exposed to a variety of infectious agents that have the potential to cause fetal damage when a primary infection is acquired during pregnancy. Implementation of standard precautions, an understanding of the modes of transmission and adherence to pre-exposure and post-exposure interventions prevent the vast majority of infections and adverse fetal outcomes. Infections that may be acquired nosocomially and are of concern to pregnant HCWs may be classified as follows. (1) Transmission-based or standard precautions are the only preventive measures: cytomegalovirus, hepatitis C, parvovirus B19 and tuberculosis. (2) Post-exposure chemoprophylaxis is effective: human immunodeficiency virus, syphilis. (3) Pre-exposure immunizations are protective: hepatitis B, influenza, measles, rubella and varicella. Herpes simplex and toxoplasmosis may cause devastating disease in the fetus but are not likely to be acquired nosocomially. This review provides specific facts that may be used to educate pregnant HCWs and to allay their fears.