Guidelines urge elimination of powdered latex gloves
EHPs charged with recognizing, reducing allergies
Hospital employee health services must take the lead in identifying, managing, and preventing latex-related problems among workers, according to new guidelines issued by the American College of Allergy, Asthma and Immunology (ACAAI) in Arlington Heights, IL.1
The guidelines, which were adapted from a Canadian document, outline recommendations for managing people who are exposed to latex in health care facilities. The use of powdered, high-protein latex gloves should be discouraged, the guidelines state. Other sections describe latex-allergic reactions, risk groups, patch-test methodology, and treatments. A latex allergy program is outlined, along with information on identifying high-risk employees (see questionnaire, p. 6), preventing exposures, and managing allergic workers.
Although the recommendations are not government-issued, "they do carry a lot of weight," says B. Lauren Charous, MD, director of the allergy and respiratory care center at the Milwaukee Medical Clinic and chairman of the ACAAI latex hypersensitivity committee.
In addition to the ACAAI, two other professional organizations the Canadian Society of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology also support the guidelines.
"All the North American professional organizations of allergists and immunologists who specialize in this disease have endorsed this," says Charous, whose practice includes many latex-allergic health care workers. "Latex allergy is a new problem, and there is a lot of confusion about what to do, how to address the problem, and how to educate health care workers about protecting both themselves and patients who are latex-sensitive. We attempted to provide a reasonable amount of information about what kinds of questions to ask [to determine possible latex allergy] and what kinds of procedures should be instituted within hospitals."
According to the 1996 Hospital Employee Health reader survey, 75% of hospitals employ workers with diagnosed latex allergies, up from 62% in 1995.
Recently, the U.S. Food and Drug Administra tion proposed a regulation requiring medical device manufacturers to label all devices containing natural-rubber latex and to remove hypoallergenicity claims from latex medical gloves and other latex medical devices. (See related story in Hospital Employee Health, November 1996, pp. 125-128.) The FDA’s action responded to more than 1,000 reports of allergic and anaphylactic reactions experienced by HCWs and patients since 1988, all associated with latex-containing medical devices.
When the proposed regulation becomes final, "it will go a long way to clarify what is safe and what isn’t," Charous adds. Meanwhile, the ACAAI guidelines are intended as a "framework" for health care facilities where frequent use of latex products may cause allergic reactions ranging from mild to life-threatening.
Contact dermatitis may increase allergy risk
The guidelines describe two categories of reactions caused by latex: contact dermatitis and immediate allergic reaction. The first category is the most common clinical reaction, and includes both irritant contact dermatitis (a nonallergic skin rash) and allergic contact dermatitis (a delayed hypersensitivity response). Although contact dermatitis is considered a mild reaction, it may be involved in latex sensitization.
"Irritant or allergic contact reactions reduce the barrier properties of the skin and allow absorption of larger amounts of chemicals or proteins. This is thought to increase the risk of latex sensitization. An increased frequency and progression through [allergic contact dermatitis] may precede the onset of latex allergy," the guidelines state.
An immediate allergic reaction (or IgE-mediated hypersensitivity reaction) results from latex proteins directly sensitizing a person and causing allergic symptoms. Those symptoms range from rhinitis, conjunctivitis, and urticaria to angio edema, asthma, anaphylaxis, and death.
Latex sensitivity can result from inhaling airborne particles of allergenic latex proteins in glove powder, as well as from direct contact with a latex-containing product. The prevalence of latex sensitization in HCWs is estimated at between 3% and 17%, according to the guidelines.
Because HCWs are in a high-risk group for latex sensitivity due to their increased level of exposure to latex-containing products, the ACAAI suggests using a questionnaire to help determine whether a worker may be developing sensitivity. However, Charous warns that the questionnaire is best used as a springboard for discussion and not a definitive diagnostic tool.
For example, people who have certain food allergies listed on the questionnaire also may have a coexisting latex allergy, but not all people with those food allergies will require latex avoidance. Similarly, not all people with latex allergies are allergic to those foods.
Establish task force
The guidelines say management of latex allergies in health care facilities should include formation of a latex allergy task force (with representation from occupational health, medical staff, nursing, administration, pharmacy, housekeeping, and central supply), development of appropriate facility policies, and initiatives aimed at latex allergy awareness and education.
They further propose that policies regarding occupational latex allergies address the following issues:
• measures to be taken for latex-related illness;
• procedures for reallocation of severely allergic employees;
• allowance of sick leave and workers’ compensation benefits.
Because latex gloves are the medical product most commonly implicated in latex allergies, the guidelines suggest that facilities review glove usage to determine whether latex gloves are being used unnecessarily.
"Non-powdered, low-protein gloves [or nonlatex gloves] should be the standard in a health care facility, with powdered, low-protein gloves available only on request and their use monitored," the recommendations state.
Health care facilities should provide a latex-safe environment for employees and patients, the guidelines continue. A latex-safe environment is defined as containing only nonlatex materials. Nonlatex medical products should be stocked on emergency carts in hospital wards and emergency departments.
The guidelines advise latex-allergic workers to use nonlatex gloves and other products. Other employees in the same work environment should use powder-free, low-protein gloves or, preferably, nonlatex gloves.
Additional occupational latex allergy guidelines include the following recommendations:
• The responsibility for hospital-related latex illness should be assumed by the employee health units, which should be represented on committees formed to manage latex-related hospital policies.
• Questionnaires should be administered to all new employees to determine the risk or presence of latex-related problems.
• Employees should be educated to recognize the signs and symptoms of possible latex allergy and encouraged to report the development of those symptoms.
• All high-risk employees (those who use gloves regularly, have existing allergies particularly to food or who have hand dermatitis or eczema) should have latex-allergy testing.
• Low-risk employees with a negative clinical history of latex reactions do not need allergy testing but should be evaluated if symptoms suggestive of latex sensitivity develop.
• Latex-allergic workers with positive histories and skin tests should be counseled on the risk of continued work in environments with high latex use and advised to use only nonlatex gloves and to avoid latex-containing products. They should have proper allergic identification (such as a medical alert bracelet) and always carry an epinephrine auto-injector device.
• Workers with irritant or allergic contact dermatitis should use cotton liners for protection under latex gloves or nonlatex gloves.
[Editor’s note: For a copy of the guidelines, contact the ACAAI, 85 W. Algonquin Road, Suite 550, Arlington Heights, IL 60005. Telephone: (847) 427-1200.]