Patients

Assessment

Patients should be assessed to determine if they have a known latex allergy or are at high risk for a latex allergy and in need of an evaluation to determine the type of latex precautions or latex-free environment that may be needed. This might include might include the use of a latex-free products or procedure trays, latex-safe hospital room, or latex-free procedure or operating room. The development of latex allergy precautions in the health care settings involves a multidisciplinary approach to ensure that all diagnostic and therapeutic procedures and clinical care are provided in a latex safe environment.

Policies

Collaboration in developing these latex allergy precautions should include the medical and nursing staff, material management, operating room, laboratory, pharmacy, dietary and environmental services.

Documentation of allergy

There should be clear documentation of a patient’s latex allergy in the medical record, on the patient identification band, and other places where appropriate, e.g., signage in the patient’s room..

Sample policies

Two sample latex allergy precaution policies are provided that contain examples of approaches used in healthcare settings.  Avoiding exposure Individuals who are latex-allergic should avoid exposure to latex. Complete avoidance is the most effective approach to preventing any allergy, although this is difficult, if not impossible, to achieve. A more realistic approach is to reduce latex exposures. Strategies to reduce exposures include the use of non-latex gloves when there is little potential for contact with infectious materials (e.g., food preparation or housekeeping) and the use of reduced latex protein, powder-free

gloves when there is risk of contact with infectious materials. While there is insufficient clinical data to calculate the precise amount of extractable latex protein in a latex glove that will cause sensitization or a reaction, it is known that reduced levels of latex protein decrease the risk of sensitization. To support the identification of these gloves, the FDA permits label claims of reduced latex protein (for example, gloves with 50 micrograms or less of total water extractable latex protein per gram).

Environmental strategies

Other strategies include good housekeeping practices to remove latex-containing dust from the workplace through identification of areas contaminated with latex dust, and the scheduling of these areas for frequent cleaning (including upholstery, carpets, ventilation ducts, and plenums). Ventilation filters and vacuum bags should also be changed frequently in latex-contaminated areas.

Healthcare workers

Staff training

Workers should receive training and education about the risks associated with latex allergies, signs and symptoms of reactions, and methods to reduce risks of exposure. Essential strategies for preventing long-term, serious health effects include periodic screening of high-risk workers for symptoms of latex allergy and alterations in the work place to minimize or eliminate exposure to latex for symptomatic workers. The information obtained from periodic screening of workers and identification of workers with latex allergies should be used for evaluation and revision of current prevention strategies.

Latex-safe environment

Once a worker becomes allergic to latex, special precautions are needed to prevent exposures at work as well as during medical or dental care Many facilities maintain latex-safe areas for affected patients and workers by using non-latex gloves for workers and non-latex medical devices and supplies for patients.  However, avoid using terms such as “latex-free environment” or other terms that lead one to believe there is no latex present. Given the large number of items containing latex in hospitals, it is very difficult to maintain a completely latex-free environment. Many healthcare facilities seek to identify latex-free products in order to limit exposures to allergic individuals. See Premier’s Supply Chain Advisor (SCA).

When latex-sensitive employees are working in areas not designated as “latex-safe” and are potentially exposed to infectious agents, they must still wear synthetic gloves. Intact synthetic or latex gloves provide a barrier against exposure. However, some non-latex gloves (e.g., vinyl) have been shown to lose their barrier effectiveness from “break down” after rigorous use and/or contact with alcohol. To reduce the risk of exposing others to aerosolized latex protein allergens, non-latex allergic individuals should wear a non-latex (e.g., synthetic) glove with appropriate barrier protection or wear low-protein, powder-free latex gloves. Workers with systemic reactions to latex exposures may need to be reassigned to work areas with limited latex exposure. See discussion below for other considerations related to colored gloves.

Colored gloves

There currently are no standards, guidelines, or regulations regarding the color-coding of exam or surgeons’ gloves in healthcare. However, traditionally, latex examination gloves have been flesh- or bisque-colored. In an effort to differentiate between latex and non-latex gloves, manufacturers began offering the non-latex (for example, nitrile) gloves in bright colors like purple and green, a particular advantage for the worker with a latex allergy.   Some manufacturers may offer both latex and non-latex in multiple colors, including purple, lilac, blue, green, and pink. Although brightly colored latex gloves may have appeal, there is concern that it may have unintended outcomes for workers and patients with latex allergies who have relied on the color of gloves to distinguish between them.

Although the FDA requires labeling of medical products that contain latex, many workers may not read the label prior to glove use because they have relied on the color. Also, clinical staff may use gloves that have been removed from the original box and placed in a dispenser or gloves from a dispenser that covers the labeling on the box. There is also a serious risk for the patient with a latex allergy if the clinician mistakenly uses latex gloves during patient care.

Reduced risk of latex allergies associated with glove color

The issue of glove color needs to be addressed by each healthcare organization as it develops and revises its glove use and latex allergy prevention policies. Strategies and issues to consider include:

  • Type of gloves used in the facility, including the designated colors of both latex and non-latex.
  • Staff’s preferences of glove color.
  • Staff ‘s perceptions of which gloves are latex and non-latex based on the colors.
  • Reported allergic latex reactions in patients or workers because of selection of incorrect glove based on color.
  • User input on need for standardization throughout the facility/system of the color for each specific glove type.
  • Frequency and type of education needed for staff on any changes in glove colors and
  • assessment of the success of this education to reduce risk (consider staff turnover, contract/contingency workers, and visiting staff).
  • Inclusion of the criteria of glove color in all evaluations and selections of gloves.

Management of workers with allergic reactions

Irritation

Determine and eliminate cause of irritation. Notify Employee Health Service:

  • Restriction from direct patient care may be recommended if hands have broken skin or open, draining sores. This reduces the risk of acquiring or transmitting infection until the skin heals.
  • Allow hands to heal. Steroid creams and moisturizes will repair the skin and reestablish integrity within two weeks (Note: Oil-based lotions may deteriorate gloves, and must not be worn under them.)
  • Initiate a handwashing regime to reduce skin irritation.
  • Consider glove liners, which may be beneficial.
  • If irritation is related to powder, consider powder-free gloves.
  • Glove option: Consider gloves which may have reduced chemical additives.

Allergic Dermatitis (Type IV)

Determine and eliminate cause of chemical-based allergic reaction. Notify Employee Health Service:

  • Restriction from direct patient care may be recommended if hands have broken skin; open, draining sores; or fluid-filled blisters This reduces the risk of acquiring bloodborne infection until the skin is healed.
  • Allow hands to heal.
  • Consider seeking consultation with a dermatologist or an allergist for specific diagnosis of the type of allergy and specific treatment of skin condition.
  • Initiate a hand-washing regime to reduce skin irritation.
  • Glove liners may be beneficial until hands heal.
  • Glove option:  If diagnosis is chemical allergy, consider vinyl or other synthetic gloves. There are gloves specially made for chemical irritation that may not have the same chemical additives. (Note: Vinyl and other synthetic gloves are also made with chemicals to which individuals with type IV allergies may also develop symptoms.)

Latex Allergy (Type I)

If a latex allergy is suspected:
Remove latex gloves and wash hands immediately. Notify Employee Health Service:

  • Restriction from direct patient care may be recommended if hands have broken skin; open, draining sores; or fluid-filled blisters. This reduces the risk of acquiring bloodborne infection until hands are healed.
  • Glove option: non-latex glove.
  • Have Employee Health Service assess work environment risk.
  • Seek diagnosis and medical management from a physician such as an allergist or immunologist.

Responsibilities of employers

Develop an institutional protocol for evaluating and managing personnel with suspected or known latex allergy:

  • Include mechanism for monitoring worker complaints and reported symptoms.
  • Survey personnel for symptoms suggestive of latex allergy during pre-employment and periodic evaluations.
  • Use information obtained from periodic screening of workers and identification of workers with latex allergies for evaluation and revision of current prevention strategies.
  • Refer workers with positive history to physician with expertise in latex allergies for diagnosis and medical management.
  • Consider active screening and allergy testing of high-risk workers.
  • Record serious latex reactions resulting in medical treatment or loss of work time on the OSHA 200 log.
  • Consider suspected or diagnosed case of “latex allergy” a significant event and investigate the cause of the exposure.
  • Require purchasing departments to consider barrier effectiveness and worker acceptance when
  • selecting gloves.
  • Provide workers with non-latex gloves to use when there is little potential for contact with infectious materials.
  • Consider targeted substitution of non-latex gloves (or low-protein, powder-free latex) in areas of the facility where use is high or in areas where large numbers of personnel have developed latex allergy.
  • If latex gloves are chosen, provide powder-free gloves with reduced latex protein.
  • Provide workers with a list of non-latex substitutes available in the organization.
  • Avoid the use of all latex products for personnel with a history of systemic reactions to latex.
  • Create a “latex safe” zone for highly allergic workers (and patients), such as specially designated areas where only non-powdered latex and non-latex gloves and medical devices are used.
  • Remove symptomatic workers from latex exposure as much as possible to prevent long-term serious health effects. Latex allergic individuals must wear non-latex (e.g., synthetic gloves) and coworkers should wear synthetic or low-protein powder-free latex gloves.
  • Provide education and training about risks associated with latex allergies, symptoms, and methods of prevention and exposure control.

Guidelines for workers with suspected latex allergies

For healthcare workers in high-risk groups or when testing has determined latex sensitivity without symptoms:

  • Become very familiar with the symptoms of latex allergy.
  • Reduce exposures to latex at work and at home as much as possible.
  • If skin rash is present, avoid contact with latex gloves.
  • Select non-latex gloves.
  • If latex gloves must be used, select low-protein, powder-free gloves.
  • Consider working in areas where other workers are using powder-free latex gloves.
  • Avoid contact with latex gloves and other latex-containing products in the work place and at home.
  • Avoid areas where the powder from latex gloves worn by other workers might be inhaled.
  • Tell employers and healthcare providers (physicians, nurses, dentists, etc.) about the latex allergy.
  • Consider wearing a medical alert bracelet.
  • Change protective clothing after any latex contact. (If someone in your family has a latex allergy, change your clothing before leaving work.)
  • Carefully follow physician’s instructions for dealing with allergic reactions to latex.

Additional precautions if latex allergy is confirmed and symptoms are present:

  • Avoid contact with latex gloves and other latex-containing products in the work place and at home.
  • Avoid areas where the powder from latex gloves worn by other workers might be inhaled.
  • Tell employers and healthcare providers (physicians, nurses, dentists, etc.) about the latex allergy.
  • Consider wearing a medical alert bracelet.
  • Change protective clothing after any latex contact. (If someone in your family has a latex allergy, change your clothing before leaving work.)
  • Carefully follow physician’s instructions for dealing with allergic reactions to latex.