Hospitals take steps to become latex-safe

Action helps protect workers and patients

Current reports estimate that between 8% and 17% of health care workers suffer from latex sensitivity reactions ranging from chronic dermatitis to urticaria, asthma, and anaphylaxis.1-5 The precise cause of latex sensitivity remains unknown, but experts speculate that it is due not only to increased occupational latex exposure but also to changes in latex glove allergenicity. (See related stories in Hospital Employee Health, January 1997, pp. 5-7; November 1996, pp. 125-128; September 1995, pp. 109-115.)

With latex gloves identified as a main culprit in the epidemic of allergies among HCWs, hospitals are taking steps to eliminate latex gloves, as well as other latex-containing medical equipment. Action also is under way on political fronts.

Occupational latex allergy is one of the top priorities of the U.S. Occupational Safety and Health Administration (OSHA). No regulatory action is planned, but officials are in a "data-gathering phase," says OSHA spokeswoman Susan Fleming.

In Oregon, the state nurses’ association has introduced a bill in the House of Representatives (HB 3739) calling for an interim study on the issue of latex problems among hospital patients and workers. The bill is a compromise measure after recent defeat of a Senate bill that sought to ban powdered latex gloves in hospitals, says Pat Kabele, a lobbyist for the Oregon Nurses’ Association. The House bill has not received a hearing yet, and with the legislative session about to end, it may be shelved until next year.

But the real action is taking place in the trenches, with changes occurring as hospitals take steps to eliminate either powdered latex gloves or all latex exam gloves and to begin to substitute latex-free medical equipment for the more traditional brands.

"This is becoming more of an employee issue. Awareness of the problem has increased, but there are still pockets of ignorance and sometimes they’re very big. In general, the topic can’t be ignored any more, and health care facilities address it depending on how difficult the situation has become there," says Lisa Borel, DMD, executive director of the Education for Latex Allergy Support Team and Information Coalition (ELASTIC), a national organization for latex-sensitive HCWs and others, with chapters in 46 states.

"People are learning that it makes a big difference if you take some basic steps like getting rid of latex exam gloves, putting auxiliary services like housekeeping and food service in nonlatex, and when latex is used, it’s powder-free and low-latex-protein," adds Borel. She is a West Chester, PA, dentist whose extreme latex allergy ended her 10-year practice and plunged her into a nightmare of health problems, including lung and heart disease. "The importance of glove education is slowly being recognized."

Learning from patient care

Powdered latex exam gloves have been eliminated in favor of powder-free brands at Lovelace Health System in Albuquerque, NM, says Virginia Printz, RNC, CNOR, CNRN, MSN, clinical nurse specialist for the operating room, which also is 99% powder-free. Nonlatex exam and surgical gloves also are available, and the institution has had a latex policy and protocol in place for about five years.

As is typical of many hospitals, action was taken to reduce the possibility of latex reactions based on an incident involving a patient.

"The first incident I recall, and the reason we instituted a specific policy/protocol in the institution, was we had a 13-year-old female patient who had an anaphylactic reaction in the OR. So [latex allergy] hit us in the face as something we needed to look at and take care of," says Printz.

Latex sensitivity is not widespread among Lovelace employees, but Printz says several problems occurred in the past. An OR nurse began to develop skin problems from the elastic on a mask, then progressed to respiratory problems such as shortness of breath. A microbiology technician who worked in urgent care also developed skin and respiratory problems due to latex, and a licensed practical nurse in outpatient surgery had an anaphylactic reaction from balloons at another employee’s birthday party. All three workers were reassigned to more latex-safe areas.

The health system’s latex policy/protocol has been revised several times over the years as more information has become available. In addition, officials compiled an extensive list of latex-containing and latex-safe medical products throughout the hospital. (See editor’s note at end of article.) Many supply packs are tagged with information about which items contain latex.

Printz notes that the cost of powder-free gloves is comparable to powdered gloves, and in fact the overall cost of purchasing gloves has been reduced.

"It has been more economical for our institution because I bet we had about six different brands of gloves before. Now we have two," she says.

In addition to changing gloves, the health system is considering replacing all items on crash carts and perhaps throughout the system with latex-free versions.

"It’s becoming easier to get latex-free products," Printz says, "and many times the cost is not significantly different. Think about what the cost is to an institution if someone has an allergic reaction — an anaphylactic reaction, especially — and if someone has to go on workers’ comp because of being exposed, that’s no minor drop in the bucket either. It can be very expensive."

At Lancaster (PA) General Hospital, latex allergy awareness also increased as patients suffered problems. One of those patients was an employee, a trauma educator who was admitted with an acute illness.

"As we were taking care of her, we became more aware of what our needs were in becoming more latex-safe and could follow up easily afterwards," says Nancy McLaughlin, RN, staff development coordinator. "For example, at first we were using latex-free equipment on her, but we were not using it with another patient in the room, and that caused her problems. We learned from that."

Vinyl gloves now have been substituted for all latex exam gloves. Some employees complain about them, McLaughlin notes, "but no matter what gloves you have, they don’t suit everybody."

Latex-free and powder-free gloves are available in the operating room, and some powdered gloves remain there. "We’re still working on that," she says.

Other latex-containing equipment is being identified by asking manufacturers for that information; most are cooperative, she adds.

"Whenever we substitute products, we have our purchasing department tag that information to identify that the product was bought because it was latex-free and shouldn’t be substituted because of cost unless they can guarantee that the new product they bring in is latex-free as well," McLaughlin explains.

Lancaster began taking those steps three years ago, and has seen no greater expense from substituting exam gloves or equipment.

"This is an issue we need to be mindful of and work at to keep the problem from escalating," McLaughlin says. "As we became aware of our patients’ needs, we identified what we needed to do for our workers as well."

[Editor’s note: To obtain a copy of Lovelace Health System’s list of latex-containing and latex-safe medical items, contact Virginia Printz, RNC, CNOR, CNRN, MSN, clinical nurse specialist, operating room, Lovelace Health System, 5400 Gibson Blvd. SE, Albuquerque, NM 87108.

ReliaCare, a medical equipment company in Landover, MD, has just compiled a catalog of latex-free items. For a free copy, call Barbara Rosen at (800) 556-3210.]

References

1. Arellano R, Bradley J, Sussman G. Prevalence of latex sensitization among hospital physicians occupationally exposed to latex gloves. Anesthesiology 1992; 77:905-908.

2. Jacobelli A, McCullough J, Ownby D. The prevalence of latex allergy in high-risk medical personnel [abstract]. J Allergy Clin Immunol 1993; 91:216.

3. Lagier F, Vervloet D, Lhermet I, et al. Latex allergy in nurses. J Allergy Clin Immunol 1992; 90:319-322.

4. Sussman GL, Beezhold DH. Allergy to latex rubber. Ann Int Med 1995; 122:43-46.

5. Yassin M, Lierl M, Fischer T, et al. Latex allergy in hospital employees. Ann Allergy 1994; 72:245-249.