Latex policies return allergic workers to jobs
Latex policies return allergic workers to jobs
Hospital implements swift, sweeping changes
In less than a year, an Indiana hospital's fast and thorough response to the first signs of latex allergies among its employees has allowed 74 of 75 affected workers to remain in their jobs or be accommodated in new positions.
Last June, a physician at the hospital was diagnosed with latex allergy. A couple of months later a unit nurse suffered breathing difficulties she thought were related to her asthma. After using her inhaler several times with no relief, she ran to the emergency department, where she went into full-blown anaphylaxis, says Debbie McGuire, RNC, COHN, CCM, employee occupational health services manager at the 5,000-worker Methodist Hospital of Indiana in Indianapolis.
After intubation and several days in critical care, the nurse recovered. An allergist's evaluation revealed she, too, was allergic to latex.
"From that point on, our employee health department started becoming much more aware of these allergies and educated about them," McGuire says.
Distributing an educational brochure for employees was "like opening up Pandora's box," she states. "We started having more and more employees coming down [to employee health]."
At around the same time, some 30 to 40 latex-allergic patients were admitted to the hospital. The combination of employee and patient problems spurred formation of a multidisciplinary latex committee, which, in less than a year, has recommended and implemented changes that have helped make the hospital "as safe as possible so we can get our employees back to work and keep them here," McGuire says.
Powdered gloves banned in ORs
One of those changes is almost unprecedented. While a number of U.S. hospitals have removed latex examination gloves from their premises (see Hospital Employee Health, September 1996, pp. 109-115), almost none has banned powdered latex surgical gloves from operating rooms and other areas.
At Methodist, not only were all powdered latex gloves eliminated from the ORs, but the rooms were completely cleaned -- floors, ceilings, and equipment -- to remove traces of airborne particles. Surgeons and other OR personnel now wear either latex surgical gloves that are unpowdered and low-protein or synthetic surgical gloves. This has allowed latex-allergic OR nurses to return to work.
"When our head of surgery found out he had five nurses with this allergy and that three of them weren't able to come back into the unit, he realized he had a problem," McGuire says. "He knew how much it was going to cost to retrain those nurses and to take care of them, and he decided he was really going to get his OR cleaned up."
Many hospitals will say they are latex-safe, she adds, but they have not tackled the OR.
"The OR is always the last place to go. It's the hardest place to get cleaned up because the surgeons have worn those [powdered latex] gloves since they've been residents. It's difficult to tell a surgeon he can't have his gloves," she says.
Top administrators have supported all efforts to make the hospital safer for latex-sensitive workers. In addition to the surgical glove changes, all examination gloves used throughout the hospital are synthetic. Housekeepers and dietary personnel are not permitted to wear latex gloves, either. Balloons have been banned. This involves notifying area florists, as well as the clowns who entertain pediatric patients by making balloon animals.
In addition, a latex-allergy support group for employees meets regularly, and a list of products containing latex is periodically updated and made available.
Inservices are offered throughout the hospital for managers and staff to educate them about latex-avoidance measures. Articles have been published in the hospital newsletter and community newspapers. Public education spots have even been presented on local television stations, and a one-day workshop was provided for occupational health professionals and the public.
"We're trying to educate not only in our building, but also to get the word out in our community and across the state, too," McGuire says.
"Our goal has been to be proactive in identifying employees with this allergy so we can catch them early, so we can keep them at work, and so they don't end up developing anaphylactic reactions," she explains. "If we catch them early and educate them about latex avoidance, not only here at work but also at home and at play, we're hoping we can keep them in their jobs and their professions."
So far, 75 workers have been diagnosed as latex-allergic. When employees report to the EHS with symptoms, they fill out a work accident report form and a questionnaire. After evaluation by an EHP, they may be tested with the AlaSTAT Latex-Specific IgE Allergen Test Kit. (See related story in Hospital Employee Health, May 1995, pp. 66-68.) Lab results are evaluated by the occupational medicine physician, who might refer them to an allergist for an ability-to-work evaluation.
Of the 75 affected workers, five were identified with systemic symptoms such as hypotensive bronchospasms and urticarial reactions. All but one have been returned to work in the hospital, most at their previous jobs. The one who has not returned is working outside the hospital, but McGuire says a job within the hospital soon will be found. Positions were created for several workers with systemic symptoms. Those include patient and transplant education coordinator jobs for nurses, and another nurse has been charged with developing and maintaining nursing policies and procedures for the hospital.
Questionnaires monitor employees' health
McGuire sends a monthly questionnaire to all workers diagnosed with latex allergies (weekly for those with systemic symptoms) to monitor their health. (See form, p. 58.)
"We have found that just switching the gloves has made such a difference in their health. There was a big difference just within the first month. Many are off their medications and feeling so much better from getting the powder out of the environment," she says.
A hospital can never be latex-free, McGuire notes. She has contacted medical device manufacturers to determine which products contain latex, a tedious process that would be unnecessary if the U.S. Food and Drug Administration in Rockville, MD, would require content labeling for natural-rubber latex in medical devices, she adds.
Despite all her efforts, McGuire worries that the full scope of the latex allergy problem among health care workers is yet to be uncovered.
"I think we really just hit the tip of the iceberg," she says. "If you look at the statistics, anywhere from 10% to 20% of health care workers have a latex allergy. I have 5,000 employees, and I've identified only 75 [with latex allergies], so what does that tell you? Part of my concern is that people are out there who have this allergy and are probably afraid to come forward for fear of losing their jobs and having to be placed somewhere else. That's really threatening to a lot of employees."
She hopes to keep the hospital environment "as clean and safe as possible" so that employees who are not coming forward at least might not develop more serious symptoms. "That's the scary part of this allergy -- we really don't know what the progression is," she says.
Making a hospital latex-safe is an ongoing process that requires attention to detail, McGuire states. The latex committee has recently created a "glove patrol" to check areas such as code carts for any remaining latex gloves.
"We want to see if we can find any latex gloves that were missed or that people are hoarding or hiding somewhere. We know that there probably still are some out there because that's just the way we are as human beings; we are going to try to hold onto our gloves. We've heard reports that people have hidden some or brought some in from outside areas," she notes.
"It's been difficult from my standpoint as an occupational health nurse because not many other people are going to this extent in the city or in the state or even in the country," she adds. "When I went to do the OR, they wanted to know what other ORs were doing about this. I called around trying to find out. People would say to me, 'We're latex-safe,' but everybody has a different definition of that. Our definition is to get latex content as low as possible, knowing that we can never be completely latex-free. We're still working on it ourselves. It's an ongoing challenge."
[Editor's note: McGuire says she would be glad to share information with other Hospital Employee Health readers. To learn more about how to help make your hospital latex-safe, contact Debbie McGuire, RNC, COHN, CCM, employee occupational health services manager, Methodist Hospital of Indiana, I-65 at 21st St., P.O. Box 1367, Indianapolis, IN 46206. Telephone: (317) 929-8494.] *
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