Pregnancy is a contraindication for the administration of ribavirin as animal reproduction studies involving small animals such as rabbits and rodents have shown that it induced embryo death and teratogenicity (Kilham and Ferm [64]). Other small studies involving larger animals and humans did not demonstrate adverse effects, but due to the limited experience with ribavirin administration during pregnancy, concerns about potential effects on humans and in particular the developing fetus have been raised (Gladu and Ecobichon [46], Harrison et al. [49], Linn et al. [71], MHRA [78], Munzenberger and Walker [81]).

As previously noted, due to the potential teratogenic effects of exposure to ribavirin, healthcare workers who suspect or know that they are pregnant, who are breastfeeding or who are undergoing fertility treatment should not reconstitute or administer ribavirin or care for patients receiving it via nebulization. In addition, they should not enter the patient's room during administration of ribavirin by nebulization.

All staff involved in the direct care of patients receiving ribavirin therapy must have their names recorded on an administration record sheet (see Figure 21.10 for the record sheet used at the Royal Marsden) and this record must be kept and returned to occupational health within the Trust.

There has been one anecdotal report of ribavirin leaving deposits on contact lenses. Some staff may wish to wear glasses instead if they are reconstituting ribavirin.

People suffering from asthma are advised not to enter the room while ribavirin is being administered and for 15 minutes following the procedure (Donovan et al. [34]).

In order to ensure compliance with COSHH ([24]) and provide a written record of the control measures applied during the use of ribavirin, an administration record sheet should be completed for each patient receiving treatment (example in Figure 21.10). It is the responsibility of the ward manager and the nurse on duty to ensure that the administration record sheet (example in Figure 21.10) is completed each time a new patient receives ribavirin. All staff should record when they administer ribavirin to a patient (see Figure 21.10) in order to keep a record of exposure. This is because ribavirin should be regarded as a substance hazardous to health, and the risk of exposure should be reduced to as low a level as is reasonably practicable where use is indicated. Records of exposure are retained in occupational health (COSHH [24]).