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(This was the winning entry in the Protecting Health Care Workers category in our 2001 Infection Control Innovation Awards. Look for more contest winners in upcoming issues of Hospital Infection Control.)
By Joanne Hudson, RN, CIC
Former Manager of Occupational Health/Infection Control (retired)
Clearfield (PA) Hospital
The problem of latex allergy and sensitivity for patients and employees in the health care industry became more apparent when articles containing this information began appearing in a large number of professional health care publications. When the National Institute for Occupational Safety and Health (NIOSH) published an alert in August of 1997, Preventing Allergic Reactions to Natural Rubber in the Workplace, it made me ask myself a couple of questions: Do we need to make changes here at Clearfield Hospital? Are we jeopardizing the health and safety of our patients and employees by using powdered latex products?
My first endeavor in an attempt to answer these questions was to gain more knowledge about the hazards of latex. I used every reference I could get my hands on. What an education I received. I never realized that more than 40,000 items used in our daily lives and more than 400 of the items used at Clearfield Hospital contained latex. The items used in our hospital could indeed pose a major problem, including causing anaphylaxis, for any patient or employee who had a true allergy to rubber products. As I stood in the middle of the storeroom among the mammoth amount of supplies, my thoughts were, "Where do I begin?"
I felt it best to start small with one widely used item effecting the majority of employees, so I decided to focus on powdered latex gloves (4 million used in 1997). Latex has always been the best protection against any exposure, but the powder in the gloves appeared to be the cause of the major problems. Numerous employees had complained of having dry, scaly, and sometimes bleeding hands. We always had felt this was due to soap. After learning what I had about latex powder, I began to question that rationale. Would switching our institution to powder-free latex gloves decrease staff complaints? Even though I had started with one item for employees, I realized that would not even begin to touch the surface of necessary supplies if we had a patient with a latex allergy admitted to our facility.
Now that I had a place to begin, my next challenge was to determine the best method to educate more than 700 employees. Ironically, about this time, the hospital education department approached me concerning the development of the infection control portion of the upcoming annual mandatory inservices for 1998. I knew I had a timely topic, but I wasn’t sure of my method. Keeping in mind that adults learn best when they can create a picture in their mind, my solution was the birth of "Latex Lucy," and the creation of a mobile latex-free supply cart.
I borrowed a Resusci-Annie mannequin, and renamed her "Latex Lucy." Lucy was outfitted to display a number of items used both in the home and the workplace that were made of latex. All hospital employees would attend this program, so this display needed to be applicable for every discipline. Lucy was placed on a bed that had rubber wheels and a rubber mattress. A latex balloon was tied to the IV pole. The IV and blood tubing hanging there had latex ports. All the items on Lucy, or lying beside her on the cart, contained latex in some manner. Even the fact that the room in which the educational programs were done was carpeted was used to prove my point.
Lucy was dressed with a shower cap, name band, Band-Aids, endotracheal tube, Ambu bag, EKG monitor buttons, colostomy bag and belt, T-Tube, adhesive tape, Foley catheter, blood pressure cuff and stethoscope, tourniquet, leg bag, and slippers. Next to Lucy was a rubber ball, rubber bands, syringe, Laerdal mask, pencils, condoms, and diaphragms. Finally, Lucy was reading a copy of Medicines Deadly Dust by Richard R. Erlich, MD, PhD. The cost of assembling the "Latex Lucy" display was approximately $50. I had asked the storeroom employees to save outdated items for me, and I borrowed other items where possible to keep the cost at a minimum.
When I rolled my sheet-covered display into the classroom, it looked like a dead body. Every-one laughed, but as the inservice continued, everyone realized how serious this topic was and the impact it could have. The visual display certainly enhanced the topic being discussed.
My presentations began with the rubber tree in Malaysia and ended with stories of personally known allergic or sensitive individuals, and how this problem had dramatically changed their lives.
During the presentation, participants were questioned to assess their knowledge of latex sensitivity/allergy. Candy was the reward for correct answers, except for one individual who received a "latex" balloon. At the end of the program, I explained how that balloon could have been detrimental to the recipient’s health if she indeed had an allergy to latex. At the end of the inservice, each employee completed a questionnaire to determine personal latex sensitivity/allergy. Five were found to be at risk and were referred for additional testing. One was found to have a true latex allergy. Counseling on methods for adjusting work environment and personal habits prevented potential serious complications for this employee.
I was able to reach more than 700 employees over a six-week period. One hundred percent of the written program evaluations rated the presentation as either above average or outstanding.
Eleven months later, I still received positive feedback. During our mandatory inservices in 1999, one question asked was: "Where is the latex-free supply cart located?" One hundred percent of the 460 hospital employees asked knew the answer. Follow-up assessments revealed staff were more aware of latex sensitivity/allergy, and all patient care departments added this to their patient assessment processes.
The hospital’s powder-free latex glove representative was so impressed with the presentation that she spread the word in her region about "Latex Lucy." Two hospitals in Pittsburgh contacted me and requested more information about "Latex Lucy" to adopt the concept for their facilities.
The use of our mobile latex-free supply cart started the day our "Latex Lucy" inservices were completed. We also have since found it more efficient to keep latex-free operative supplies in the operating rooms. We were the second hospital in the northwest Pennsylvania region to become a latex powder-free facility. We have admitted 13 latex-allergic patients to our facility since the inservices were held. Prior to this program, many negative occurrences could have affected these patients, including delayed procedures, increased costs, transfer to another facility, and inconvenience. If that allergy had not been detected, it would have added days to the hospitalization and potentially increased the cost of care by thousands of dollars.
For months, staff called me "Lucy." I even receive mail addressed to "Latex Lucy." I knew she remained alive and well in the minds of our staff.
Prior to sending this, I wondered if indeed "Latex Lucy" remained in the minds of our employees. Of the 102 employees I questioned, 100 of them recalled the inservice. I smiled as I walked away, because I was aware my goal was accomplished and my work had not been done in vain.