Staff education vital to identifying, coping with latex sensitivity

Staff need to know symptoms of allergy, how to avoid exposure

Gloves, blood pressure cuffs, IV tubing ports, catheters, resuscitation bags — what do these things have in common? They’re all essential to quality patient care. And all may contain latex, a substance that can cause mild to severe reactions in patients and health workers. In the past several years, increased awareness of latex allergies has led to policies in which health care providers must identify people who are sensitive to latex and offer latex-free alternatives for medical equipment.

Educating your home health staff is essential in making sure their safety is assured so they can educate patients about the problem.

"We want our staff to be able to respond to patient questions in a very intelligent, informed, and practical manner so we can reassure the patients that we’re doing everything we can to have a latex-free environment," says Julie Seehafer, MSMT, in human resources development at Marshfield (WI) Clinic.

Proactive approach to a growing problem

Latex, the milky fluid derived from the rubber tree Hevea brasiliensis, is treated with chemicals to create a substance that contains about 2% protein. That protein appears to be at the heart of the reactions reported. The Occupational Safety and Health Administration (OSHA) reports that reactions to latex products first were recognized in the late 1970s, and the problem has grown, particularly among health care workers exposed to latex gloves or other medical products. OSHA estimates that 8% to 12% of health care workers are latex-sensitive. Their reactions to latex products can range from painful and annoying outbreaks of dermatitis to life-threatening episodes of anaphylaxis.

In addition to health care workers, some patients also are at risk for allergic reactions, particularly those who routinely use rubber catheters or latex gloves, children with spina bifida or congenital urologic anomalies, or other patients who have had multiple surgeries. This, of course, would include a large number of home health patients. "We’re mostly concerned about whether we know that a patient potentially has a latex sensitivity or an allergy, and how is this being communicated to us," says Dorothy Flees, MSN, RN-CS, quality improvement and staff education coordinator for Ministry Home Care in Marshfield, WI. "The second part of that is thinking about some of the equipment or the care supplies that we use. Do they in any way contain any kind of latex, and what do we do to adjust for that?"

Several years ago, Marshfield Clinic, Ministry Home Care, and St. Joseph’s Hospital worked together to create policies and education programs on latex sensitivity in an effort to get ahead of potential problems.

"We haven’t had significant problems" with latex, Seehafer says. "We really try to be very proactive on these things so we don’t have to wait until OSHA or some other accrediting agency mandates that we put this kind of training into place."

The joint committee drew up policies that addressed all the entities’ various needs. "The concerns really aren’t much different," Flees says. When the policy was done, she says, it was important for her to keep in mind how it affected the home care patient.

Employee education is important

Ministry Home Care requires all workers to undergo a yearly competency on latex sensitivity and how to protect health workers and patients. (See p. 108.) "All patient care staff [are included], which for us means occupational therapy, physical therapy, social work, speech/language pathology, nurses, volunteers — everybody," Flees says.

At Marshfield Clinic, education efforts include a self-study training package full of facts about latex sensitivity. "From an educator’s point of view, self-directed learning is good for people who aren’t always in the same place and on the same schedule," Seehafer says.

The clinic also offers additional training via a computer-based program networked to all of the facilities’ PCs. The program, which the clinic developed with help from Autumn Software in Plover, WI, allows employees to sign in at any computer, call up the training program at any time, and work through the information at their own pace. The computer uses employee ID numbers to keep track of who has progressed to what stage in the training and to record results of a post-test. Employees also can use the computerized training module as a reference.

Providing different alternatives for employee training has been a successful strategy for Marshfield Clinic, Seehafer says. "We always look at what are the different ways we can convey this information. The same method won’t be conducive for all people."

Latex sensitivity symptoms, interventions

Marshfield Clinic’s self-study packet explains the symptoms that could indicate sensitivity to latex, which include the following:

• complaints of unresolved or frequent dermatitis;

• repetitive respiratory symptoms with unknown causes;

• a history of swelling, itching, wheezing, conjunctivitis, or sneezing from latex rubber contact;

• unexplained anaphylaxis;

• oral itching after eating avocados, bananas, kiwi fruit, or chestnuts.

The information also explains the difference between the two most common forms of latex sensitivity.

In the relatively milder, Type IV reaction, contact with latex products can result in skin rashes, eczema, or other dermatological symptoms. These symptoms sometimes can occur days after contact, but they will recur consistently with continued exposure to latex. Type IV sensitivity is not classified as a true latex allergy because it is believed to be a reaction to the chemicals used in processing latex.

The more dangerous Type I allergic reaction usually sets in immediately on contact and can include congestion, conjunctivitis, wheezing, bronchospasm, facial swelling, tachycardia (abnormally rapid heart rhythm), nausea, swell ing of the larynx, hypotension, and flushing.

In these rarer but more serious cases, resuscitation may need to be administered immediately — with latex-free equipment.

Kathy Sater, RN, MSN, director of education for Shriners Hospitals for Children Houston Hospital, sees many pediatric spina bifida patients who develop severe latex allergies as a result of repeated exposures to medical products containing the substance.

Because of the facility’s reputation for maintaining a latex-safe environment, it also has drawn some health workers who can’t work anywhere else because of their own latex allergies.

Sater says two major risk factors for increased latex allergy are the age of first latex exposure and the frequency of later exposures. Not everyone who has a milder, Type IV reaction early on will see those reactions become more severe, but Sater says it’s possible.

"You may never have it get any worse," she says. "That would be dependent on how many exposures you would have. Are you a person who tends to develop allergies? If you’re atopic [have a hereditary allergy disease] and you already have a history of allergy to other items, then you have a much greater chance of showing greater allergy over time."

New patients identified as latex-sensitive

At Ministry Home Care, identifying patients with latex sensitivity or allergy is easiest when the patients have been referred through Marsh field Clinic or St. Joseph’s Hospital, where awareness is high, Flees says.

"They use some special procedures for identifying a patient with latex sensitivity," she says. "There was special signage and special identifiers put on charts so it would come to somebody’s attention rather quickly."

For patients referred from elsewhere, it became important to educate intake workers to ask questions specifically aimed at identifying those who may be allergic.

"In several places, we’ve put reminders for people to ask specifically about that allergy," Flees explains. "You know, we always say to patients, Do you have any allergies?’ and of course the first thing they think of is probably medication. But you have to take it one step further and ask are there other environmental allergies, whether that be dust or mold or latex."

When a patient isn’t sure, he or she is asked about the symptoms that would indicate latex sensitivity, such as dermatitis problems or allergies to specific foods.

Because the most important method of prevention is avoidance of latex products, it’s important that employees and patients know what products contain latex and that they have access to alternatives.

Ministry Home Care provides a latex-safe kit, which contains the most commonly used products for home health patients, including several sizes of nonlatex gloves, stockinette, a silicone catheter, a selection of latex-free syringes, and plastic tape. When ordering supplies, staff use a supply catalog that has special coding for latex products to avoid mistakes. "That’s what’s most difficult — what is it hidden in?" Flees says.

Latex-free alternatives are easier to find and use than they were only a few years ago, Seehafer says. "It’s become much easier to replace those products because of a general push by the health care industry, which in turn pushes manufacturers to make more latex-free products."

Latex-free gloves, in particular, have improved tremendously — the best ones now fit better and allow the wearer more dexterity while providing comparable protection, she says. "Over the years, gloves have developed quite a bit, so the gloves you have now fit pretty well," she says. "You can work pretty well with them."

Alternatives to latex gloves available

The market now provides a number of glove alternatives, including vinyl and nitrite versions. Each has its drawbacks. Vinyl has a tendency to tear more easily and has limited dexterity. Nitrite is actually more puncture-resistant than latex, but it tends to tear upon puncture rather than forming a small hole as latex does. Nitrite gloves allow more dexterity and tactile sensitivity, but they are more expensive.

Sater says Shriners hasn’t had problems with the newer vinyl gloves, despite concerns that they wouldn’t be as sturdy as latex.

"We’ve not had a problem [with tearing], and we don’t have a practice of double-gloving, which initially was considered necessary. We haven’t found that to be the case. We have not had any big concerns."

Be aware of powdered latex

Flees says the most significant change at Ministry Home Care was to stop using powdered latex gloves. The powder is designed to make the gloves easier to put on and remove, but it picks up the proteins in the latex and disperses them into the air with every snap of a removed glove. From there, the proteins can be inhaled by sensitive patients and workers. Ministry Home Care now only uses nonlatex gloves, Flees says.

In addition to a complete education program on latex, the issue is addressed in a number of other inservices at Marshfield Clinic, Seehafer says.

"We went through this with blood pressure training," she says. "We were updating people on taking blood pressures, and our education program primarily focused on making sure everyone was doing it the same way, to standardize our procedure.

"A very small part of that was to be very much aware of patients with latex sensitivity and how to protect them from the blood pressure cuff and tubing, which may contain latex products," she says. "So we said that if you have someone with a known latex sensitivity, you put a very thin stockinette over the arm first. Then you can apply a blood pressure cuff, and you don’t have to worry if the tube brushes their arm."

That process of raising latex awareness repeats itself for every procedure, Seehafer says.

And that’s just the medical aspect of awareness. Marshfield Clinic now bans latex balloons in patient care areas because of sensitivity problems. "If someone goes out to buy a bunch of balloons for somebody’s birthday or anniversary, we remind them to make sure it’s latex-free," she says.

At Shriners, trouble came from an unexpected source at Christmastime. "We had a volunteer group that wanted to come decorate for Christ mas," Sater says.

"They put 250 poinsettias all over. Turns out poinsettias are potentially a latex allergy problem. If you break the plant and expose the skin to the white sap, there’s a problem. As long as no one was handling the plants, it was OK. But if they were to handle and break it, and had a true allergy, there could be a real problem."