Rubber meets the road: The push for latex safety
Rubber meets the road: The push for latex safety
Risk remains for allergic HCWs
It has been 10 years since Johns Hopkins Hospital in Baltimore created a latex task force to address the growing numbers of latex-sensitive employees. Now, the first hospital to use rubber surgical gloves they were developed at Johns Hopkins in 1894 has become one of the first to eliminate them completely.
Johns Hopkins isn't alone in taking a closer look at latex. Other hospitals are also seeking alternatives to latex products as a way to protect latex-allergic patients and employees.
Latex may have receded from the spotlight as an occupational risk to health care workers; powder-free, low-protein gloves produce far fewer new sensitizations. The risk to latex-allergic patients and employees remains a concern that has led some hospitals to remove as much latex as possible and become "latex-safe."
Improvements in alternatives to latex have enabled Johns Hopkins to replace its sterile latex gloves, which still were in use in the hospital's operating rooms, says Robert Brown, MD, MPH, professor in the departments of environmental health sciences and anesthesiology at the Johns Hopkins School of Medicine and chair of the hospital's latex task force.
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Can a shrub provide nonallergenic latex? FDA approves Yulex product for gloves Switching to latex-free surgical gloves requires a change in tactile feel, which can be disconcerting to some surgeons. But there may soon be a latex glove that is, somewhat paradoxically, latex-safe. The Food and Drug Administration has approved examination gloves made of latex from the guayule, a shrub native to the southwestern United States. The guayule plant naturally has a very low level of protein, says Robert Hamilton, PhD, professor of medicine and pathology at Johns Hopkins University School of Medicine in Baltimore, who conducted groundbreaking research on the allergenic properties of natural rubber latex. Hamilton now is on the scientific advisory board of Yulex Corp. of Maricopa, AZ, which is developing guayule products (www.yulex.com). "Essentially there's virtually no detectable protein in the final product," he says. Lab tests indicate that the guayule-based products will not trigger reactions in those allergic to the natural rubber latex (Hevea brasiliensis) proteins, he says. "If you're latex-allergic, there's every indication from in vitro testing there's no cross-reactivity between the hevea and guayule proteins," Hamilton says. "The protein drives the IgE-mediated allergic reactions." Some people may react to accelerator chemicals used in glove production, but those are Type 4 sensitizations that typically involve contact dermatitis and are rarely life-threatening, Hamilton says. Additional studies will need to demonstrate that people allergic to hevea latex can safely use the guayule product, he says. That would be especially useful for catheters, which must be flexible like rubber, for latex-allergic patients. "I think we're going to see the emergence of a variety of rubber products with Yulex entering the medical community," Hamilton says. |
"We felt the only way to do this was in a cultural change," he says. "We're going to be latex-safe throughout the institution."
Norton Healthcare in Louisville, which includes a children's hospital, still uses powder-free latex surgical gloves, but otherwise seeks nonlatex products wherever possible.
"I think we owe it to our employees to stay diligent on this," says Claire Rupert, RN, division director for value analysis and technology assessment at Norton Healthcare. "The question we ask our vendors when they come in with a new product is, 'Does it contain latex?'"
HCWs have a higher risk of allergy
Because of their greater exposure to latex, health care workers are significantly more likely to be sensitized or allergic. A recent meta-analysis of studies found that 4% of health care workers were latex-allergic compared to 1.37% of the general population, and latex exposure was linked to an increase in hand dermatitis, asthma and rhinoconjunctivitis in health care workers.1
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In January 2008, the U.S. Occupational Safety and Health Administration issued an updated Safety and Health Information Bulletin on latex sensitization and latex allergy (www.osha.gov/dts/shib/shib012808.html). In it, OSHA suggests the following measures to reduce health care worker exposure to latex:
- "If selecting natural rubber latex gloves for employee use, designating natural rubber latex as a choice only in those situations requiring protection from infectious agents.
- "If selecting natural rubber latex gloves, choosing those that have lower allergenic protein content. Selecting powder-free gloves affords the additional benefit of reducing response to environmental exposure.
- "Providing alternative suitable non-natural rubber latex gloves as choices for employee use (and as required by OSHA's bloodborne pathogens standard [29 CFR 1910.1030, paragraph (d)(3)(iii)] for employees who are allergic to natural rubber latex gloves)."
OSHA also recommends that hospitals identify all products that contain natural rubber latex and monitor the natural rubber latex content of incoming products. They also need a system for reporting, evaluating and managing latex-allergy cases among employees, the bulletin says.
The Food and Drug Administration requires labeling of medical devices that contain natural rubber latex. But keeping track of products that contain latex still can be difficult especially if the label is on the box rather than on individual items.
Those concerns prompted Premier Inc., a health care alliance and group purchasing organization based in Charlotte, NC, to publish a catalog for its members listing products that are latex-free. "Hospitals are still struggling with [the latex issue]," says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute. "We're still getting requests from hospitals about the latex content of products."
There's great variability in the way hospitals have addressed the latex issue, Pugliese says. Many have eliminated powdered gloves, which are associated with greater risk of sensitization. But about 10%-15% of latex glove purchases still are the powdered variety, usually due to surgeon preference, she says.
Norton Healthcare sought a specific list of latex-free products from Premier because of the identifying safe items. If a product doesn't mention latex, can you be sure that it doesn't contain any? "You're always a little on edge when you don't see that label that specifically addresses latex content," says Rupert.
In some cases, the health system decides to keep a product that contains latex because of its superior qualities but maintains latex-free versions for allergic patients and continues to seek better alternatives, says Rupert.
"A lot of manufacturers have been very proactive about eliminating the use of latex or natural rubber protein in their items. But we still are challenged by products that have to have a little bit of flex [such as pediatric nasogastric tubes]. In some cases, we don't have good latex-free options," she says.
Improvements in the quality of alternatives enabled Johns Hopkins to eliminate most latex. Brown estimates that 98% or 99% of the hospitals products are latex-free. "There are not many products left here that have latex in them," he says.
For example, polyisoprene surgical gloves have a feel that is similar to natural rubber latex and that surgeons are more willing to accept. "Clearly, it's a leap forward in terms of quality of glove," he says.
The switch to the new gloves occurred without complaint, Brown recalls. The hospital brought in both neoprene and polyisoprene gloves and asked operating room personnel to try them out including surgeons, nurses, anesthesiologists, techs, and invasive radiologists. The chairman of surgery was a champion of the process; she had a colleague who had been forced to quit surgery because of a latex allergy.
The new gloves are more expensive, and the change required some getting used to. But no one complained about the new product, Brown says. "It's easier than you think to be latex-safe," he says.
Reference
1. Bousquet J, Flahault A, Vandenplas O, et al. Natural rubber latex allergy among health care workers: A systematic review of the evidence. J Allergy Clin Immunol 2006; 118:447-54. Online publication July 3, 2006.
It has been 10 years since Johns Hopkins Hospital in Baltimore created a latex task force to address the growing numbers of latex-sensitive employees.Subscribe Now for Access
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