Are you at risk for latex allergy? Here's what you need to know
ED nurses must take the lead and protect both themselves and their patients from latex allergy
Almost every ED has been affected by latex allergy. On one occasion, an emergency nurse in a Boston suburb was rushed to the ED after a serious reaction to latex and was treated by a nurse who was also latex-allergic, says Gail Pisarcik Lenehan, RN, EdD, CS, a Boston-based emergency nurse and editor of The Journal of Emergency Nursing. "She was taken care of by an ED nurse with swollen lips and red streaks on her face, who had grabbed a pair of latex gloves to do a procedure because she couldn't find any non-latex," she reports. "The nurse had a relatively mild yet systemic reaction, yet didn't want to take Benadryl because she had to work for the next seven hours."
Research has shown that 8-17% of health care workers are latex allergic.1-3 "When you've got those kinds of numbers, it's every bit as serious as any epidemic we were wearing the gloves to protect," Lenehan argues.
ED nurses should act immediately to protect themselves against latex allergy, says Lenehan. "Nurses might be at higher risk than physicians because they tend to wear gloves more due to the hands-on nature of their role and their more frequent handling of bodily fluids," she adds.
Ironically, latex allergy is largely caused by gloves that protect clinicians from HIV and other infectious agents. "Over the last 10 years, it's been drilled into our consciousness to wear gloves," says Lenehan. "It's hard for nurses to fathom that the gloves that protected us from something are quite possibly a greater danger."
Products made by being dipped in liquid latex are most allergenic, such as gloves, balloons, and condoms. "For purposes of preventing sensitization, those have to be looked at first," says Lenehan. "If we could simply eliminate the danger from gloves, it would really mean a dramatic decrease in the amount of latex protein on surface and in the air."
Powdered latex gloves are a source of increasing concern. "The powder binds with the latex proteins and brings them into the air to be breathed by patients and staff," Lenehan explains. "Latex-allergic individuals may be in danger if they are working with others wearing latex gloves."
New FDA requirements will make it easier to identify products containing latex. As of September 1, 1998, any device that comes into contact with humans must have a warning label if it contains latex. "Many people feel that at this point we also need labeling of non-medical devices," says Lenehan. "With a pair of shoes, or carpeting, it's difficult to know whether you're looking at a synthetic or natural latex rubber product."
ED clinicians tell their stories
In addition to severe reactions, latex allergy has forced many ED nurses to stop clinical practice. "There are so many nurses with 10 or 20 years of experience who have had to simply walk out the door, who are now working telephone or desk jobs, and don't come into contact with the clinical area," says Lenehan.
Too often, latex-allergic ED nurses are given inaccurate information about their condition. "When I realized I couldn't wear latex gloves, I was told I should just switch to vinyl gloves and everything would be okay," recalls Emilie Goudey, RN, BSN, CEN, a former ED staff nurse (and current employee) at Berkshire Medical Center in Pittsfield, MA. "No one ever told me I shouldn't be around any amount of latex, so I wore latex gloves over vinyl gloves during procedures."
Suddenly, Goudey began suffering from respiratory problems and tightness in the chest. "It was progressive," she recalls. "The first time it occurred, it took four hours for me to react, then it only took two hours, then an hour and a half." The condition had been getting progressively worse even though she had no symptoms for years, she explains.
Goudey had her latex allergy documented by an allergist and informed her nurse manager about her condition. "I was told I'd have to work in a latex-free environment, but there was none in the hospital, so I had to walk off and leave my job," she says. "I will work at any facility that can guarantee me a safe area, but right now no one is able to tell me that. I'd been a nurse for 20 years, and it was a job I loved. It's very sad when something attacks you when you're helping people."
If a hospital isn't safe for latex-allergic clinicians to work, it's also not safe for them to be treated in. "I was not only an employee, I am also a patient, and the hospital has to be able to treat me and others who have this problem," Goudey says.
Without that assurance, the risk of death from being treated with latex products always looms. "Patients with a latex allergy shouldn't have to worry about the safety of emergency equipment when they are in a life-threatening situation," Goudey emphasizes.
Once latex allergy has progressed to a certain point, nurses can find themselves virtually housebound. "I had to walk out of four different restaurants one day because they used latex gloves to prepare food," says Goudey.
When facilities don't act to protect clinicians and patients, it's up to clinicians to do so, says Dale Long, DO, an emergency physician at Robinson Correctional Center (IL) who has been latex-allergic for 15 years. "To protect yourself from being sensitized, you must not only use latex-free products yourself, there must be no one else in the environment using powdered latex products," he stresses. "Latex proteins leach into the powder and the powder flies everywhere, landing on everything."
Because of continued exposure to latex, Long's reactions became progressively worse. "I've had anaphylaxis more times than I can count," he says. "I used to get itchy, then have trouble breathing, and then go into shock. Now it goes right to the bad stuff, and doesn't respond to epinephrine like it used to." The problem is exacerbated in the prison health care environment, since guards often wear latex gloves, he notes.
Often, ED clinicians are reluctant to admit they're latex allergic for fear of retribution, Long emphasizes. "I know many people who are allergic but wouldn't admit it, because they were afraid they'd lose their jobs," he says. "I came out of the closet when I needed emergency spinal surgery and was sure they would kill me by using latex equipment." After surgery, Long faced another hurdle when he had to undergo rehabilitation in which clinicians also used latex products.
Many facilities are reluctant to switch to latex-free products because of the increased cost, he notes. "A good-sized hospital probably spends upward of $150,000 to half a million dollars a year on gloves, and powder-free ones often cost twice as much," says Long. "You've got to convince administrators it's a life-and limb issue. Sometimes they won't believe it until there are lawsuits or the body count stacks up."
References
1. Pennsylvania Allergy and Asthma Association. Latex hypersensitivity: White paper presented by an ad hoc committee of the Pennsylvania Allergy and Asthma Association. April 1996.
2. Arellano R, Bradley J, Sussman G. Prevalence of latex sensitization among hospital physicians occupationally exposed to latex gloves. Anesthesiology 1992:77:905-908.
3. Yassin MS, Lierl MB, Fisher TJ, et al. Latex allergy in hospital employees. Ann Allergy 1994;72:245-249.