Don't be at risk for latex allergy suits

Home care hasn't been hit - yet

Although patients have initiated most litigation over latex allergies, focusing on manufacturers of latex products and devices, lawsuits by home health workers against their employers are clearly on the horizon.

As with the litigation directed at tobacco companies, plaintiffs have argued that manufacturers of products that contain latex have known about the potential dangers for some time but have failed to take appropriate action. It has also been suggested that manufacturers have not provided proper warning of the potential dangers of latex exposure.

Home health agencies are also vulnerable.

As justification for their suits, home health workers may rely upon requirements of the Occupational Safety and Health Administration (OSHA) that agencies provide safe working environments. An employee may also seek compensation under state workers' compensation programs.

The extent of the potential problem of latex allergies did not become apparent until the late 1980s when fifteen patients died as a result of anaphylaxis caused by latex balloon-tipped catheters used in barium enema procedures. The number of cases of allergic reactions to latex undoubtedly increased at even a faster rate after the Centers for Disease Control and Prevention called for the use of universal precautions to prevent the transmission of HIV infection. These universal precautions include the use of protective gloves, often containing latex. Now it is estimated that there are approximately 18 million people in the United States, or 6% of the population, that can be described as latex sensitive.

The problem for health care workers, including home care personnel, is compounded by the fact that many products and devices commonly used by staff contain latex. For example, adhesive tape, catheters, blood pressure cuffs, intubation tubes, enema tips, baby bottle nipples, tourniquets, drug administration devices, rubber banks, syringes, vial stoppers, and injection ports often contain latex.

The difficulty posed by latex sensitivity or allergies is further compounded by the fact that workers do not have to actually touch latex in order to have an allergic reaction. If the allergen in latex becomes airborne, it is often sufficient to cause a reaction. Latex can become airborne with the pop of a balloon or the snap of a glove, especially a powdered glove.

A wide variety of symptoms

Workers who are sensitive or allergic to latex can experience a wide variety of symptoms. These symptoms may include itching, swelling, and blistering of the skin, difficulty breathing, hives, and red, watery eyes. They may also include anaphylactic shock, a life-threatening condition. The greater and more frequent the exposure, the greater likelihood that symptoms will become more severe.

Other risk factors among home care workers may include:

· a history of food allergies, especially to milk products, fruits, vegetables, grains, and nuts;

· a history of hay fever or other allergies;

· dermatitis on the workers' hands that becomes more severe as a result of wearing latex gloves.

Because so many products used by home care workers contain latex, it is probably unrealistic to attempt to manage this risk by eliminating all products that contain latex. A more realistic goal for home care agencies is probably to strive for a latex-safe environment.

Providers may wish to establish an interdisciplinary committee to study existing information on this issue. The task force may also wish to identify specific products that contain latex and attempt to identify products that can be substituted that do not contain latex.

Agencies also might develop policies and procedures to protect employees. Such policies and procedures may include elimination of latex gloves that do not include powder since powder can increase exposure. It may help to prohibit the use of hand creams and lotions before putting on gloves containing latex since the use of these products seems to enhance exposure to the latex allergen. Directors might require workers to wash their hands immediately after removal of gloves contain latex or use of other products containing latex in order to minimize exposure.

Directors may also seek information from all current and prospective employees regarding a history of latex allergies and their risk factors for latex allergies. When employees confirm some of the high-risk factors described above or a definitive history of latex sensitivity, agencies may wish to offer allergy testing at agency expense.

It's a good ideal to educate all staff about latex allergies and to document that such training has occurred. Such training may include information about the symptoms of allergic reactions and ways to limit exposure as described above. Periodic updates should be provided, especially in view of the fact that knowledge regarding this problem and how to manage it will clearly increase in the future.

Report all adverse reactions to latex to the Food and Drug Administration and the Centers for Disease Control and Prevention.

Assign one or more staff to be responsible to monitor developments in this emerging area.

There is no doubt that home care providers are under fire these days as a result of implementation of provisions of the Balanced Budget Act and other federal and state initiatives. Agencies should not, however, lose sight of the fact that this "firestorm" will end and that the future of home care is still bright. Agency managers must be careful to continue to find the resources to plan to manage some of the long-term problems in home care.

Suggested Reading

1. American Nurses Association. Latex allergy: Protect yourself, protect your patients. Workplace Information Series WP-750 M 6/96. Washington, DC; June 1996.

2. Barton EC. Latex allergy: Recognition and management of a modern problem. Nurse Practitioner 1995; 18:54-58.

3. Blaylock B. Latex allergies: overview, prevention and implications for nursing care. Ostomy/Wound Management 1995; 41:10-15.

4. Culver JB. Latex sensitivity in healthcare workers part II: A risk reduction model. Journal of Hospital Occupational Health 1995; 15.