Latex-allergic HCWs can keep their jobs

Precautions, synthetics create safe workplace

Latex allergy doesn’t have to cripple a health care worker’s career. New products and careful management of the work environment have allowed employees to continue working in clinical areas that once would have been rife with latex exposure. At Siloam Springs (AK) Memorial Hospital, a latex-allergic nurse works as director of the obstetrics unit. She dons synthetic gloves, while her co-workers wear nonpowdered latex gloves. Even though the nurse suffered an anaphylactic reaction years ago at a different hospital, she has been able to work at Siloam Springs with no ill effects.

"She is well aware [of the allergy risks] and certainly avoids situations where she would come into contact with latex," says Marian Parson, RN, CIC, infection control/employee health nurse at the 72-bed hospital. "She has not had a problem." Parson is latex-sensitive. Even a brief exposure to latex produces a skin rash. So she is especially attuned to the issue, even calling manufacturers to ensure that medication stoppers don’t contain latex. "There’s a lot more to this than I realized when I put the latex-free cart and protocol together," she says. "It was an overwhelming task to find out whether items have latex.

"Now all the syringes we use are latex-free. At one time, the plungers had latex," Parson adds.

Since 2000, the Food and Drug Administration (FDA) has required manufacturers to state in their labeling if a product contains natural rubber latex. The FDA is considering further labeling requirements that would state the protein and powder content of gloves.

"Our hospital has gone to all powder-free gloves," Parson says. "I expect that going completely nonlatex will be the next step in reducing the possibility of latex allergies in the hospital."

Better synthetic products and powder-free, low-protein latex gloves have made it easier to create a safe work environment for latex-allergic employees. A Type IV reaction, or allergic contact dermatitis, is related to chemicals used in the processing of the gloves and leads to itching, redness, blistering, and swelling. A Type I reaction, involving an allergic reaction to the latex proteins, can cause hives, respiratory symptoms, asthma, and in extreme cases, anaphylactic shock.

"For most of the patients that are found to be latex-allergic, especially if they haven’t had significant asthmatic symptoms, they can work well if the workplace is sensitive to their needs," says Wendy Huber, MD, dermatologist at Kaiser Permanente South Sacramento and lead physician for the latex-safe initiative for Kaiser Permanente Northern California.

Huber runs an occupational dermatitis clinic and chairs Kaiser’s national team that reviews glove choices and latex-alternative products. She offers this advice to employee health professionals who want to create a safe environment for latex-allergic and latex-sensitive employees:

• Eliminate powdered gloves.

Getting rid of powdered latex gloves and providing synthetic alternatives may be sufficient to allow allergic employees to continue working, Huber says. "There is the occasional patient who is so acutely sensitive or their airways are so reactive that they cannot go back to work. That is a very, very tiny minority. Most people are fine if their co-worker is wearing a latex glove as long as that co-worker doesn’t touch them."

Powder can produce reactions even in employees who aren’t allergic to latex, Huber notes. "Powder is responsible for a significant amount of asthma and airway problems," she says. "I make a distinction between powder vs. powder with latex in it. Powder is an irritant independent of the presence of latex."

• Seek latex-free products.

A "latex-safe" policy isn’t reserved just for a crash cart for allergic employees or patients at Kaiser. It’s an overall philosophy, Huber says. She always is seeking tubing, syringes, and other items that don’t contain latex. "If an item is of equal quality and the cost is the same, we’re going to take the latex-free one," she says.

Occasionally, there’s a product with no latex-free alternative. If a multiuse vial of medication has a latex stopper, Huber suggests piercing the stopper just once for use with latex-allergic individuals. The more often the stopper is pierced, the higher the likelihood of contamination with latex, she notes. "For the vast majority of cases, it is safe to poke the stopper one time, withdraw the medication and change the needle before you inject it into the patient," she says.

One study did find that latex stoppers can release enough allergenic proteins to produce skin reactions in latex-allergic individuals.1

• Refer suspect cases to a dermatologist or allergist.

In some cases, allergic reactions won’t be resolved by switching to latex-free gloves. Some synthetic products use the same accelerators used in latex gloves, Huber says. "In the patients I see who are latex-allergic, I always try to patch test them, especially if they’re having hand symptoms. I’ve had 6% to 9% of the [latex-allergic] people have a concomitant allergy to accelerators."

Huber has also seen cases of latex allergy that were difficult to diagnose, with initial blood tests registering negative while further tests came out positive. Yet early detection of symptoms is important, she says. "There’s always the possibility that a person’s symptoms can progress."

• Provide screening and education for staff.

Your screening program should include a questionnaire asking employees about risk factors, including multiple surgeries and allergies to foods such as chestnuts, bananas, and kiwis. New employees with risk factors should have further testing to determine if they are latex-sensitive or latex-allergic, and all employees should be aware of the symptoms of latex allergy.

Employees need to understand the protections required for their latex-allergic co-workers. "We’ve had a couple of instances where some people tried to bring powdered latex gloves back in. For whatever reason, they prefer the powder," Huber says.

Reference

1. Primeau MN, Adkinson NF Jr, Hamilton RG. Natural rubber pharmaceutical vial closures release latex allergens that produce skin reactions. J Allergy Clin Immunol 2001; 107:958-62.