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Mary Ann Hellinghausen When Marshfield Clinic in Marshfield, Wis., implemented latex controls "everybody thought we were nuts," said Bruce Cunha, MS, RN, manager of employee health and safety at Marshfield. "They didn’t think it could be done." Now Cunha gets calls from safety managers at facilities across the country trying to establish latex protocols. Experts say as many as 17 percent of healthcare workers—especially those who frequently wear gloves, such as OR and ob/gyn nurses—could be allergic to latex. "There’s a need to make changes in every hospital around the country," said Susan Wilburn, MPH, RN, a senior specialist in occupational health and safety for the American Nurses Association. "They’re slowly becoming more proactive, but there’s a tremendous need for more change." Natural rubber latex, which is favored for surgical use because of its flexibility and resistance to tears, contains proteins that cause allergies. Powder inside the gloves exacerbates the problem. Reactions, which stem from direct contact with or inhalation of the proteins, can include hives, asthma, anaphylactic shock, and even death. Since the national Centers for Disease Control and Prevention recommended universal precautions in 1987, the increased use of latex gloves has led to greatly increased exposure—and reactions—to latex products. Between 1988 and 1992, the Food and Drug Administration (FDA) received more than 1,000 reports of adverse health effects from latex exposure, including 15 deaths. Creating protocols One of the first steps in creating a latex protocol is identifying all latex products in a facility, according to the Occupational Safety and Health Administration (OSHA). All medical products containing latex are required to be labeled as such—consumer products are not. One facility identified 20,000 items that contained latex, Wilburn said. OSHA also recommends that facilities allow latex products as a choice only in situations requiring protection from infectious agents. When latex products are necessary, only products that are powder free and have a low protein content should be used, according to the agency. Marshfield Clinic implemented latex controls after a cardiovascular surgeon at the facility experienced a serious allergic reaction. "Many facilities are making great progress and others are struggling. It’s a tough issue," Cunha said. Shriners Hospital for Children in Sacramento is now 98 percent latex free after implementing latex controls about two years ago. The move was prompted in part because the facility has a number of patients at risk for latex sensitivity, said Star Deppe, assistant administrator. "We get a lot of spina bifida patients, who tend to be at high risk because they have a lot of surgeries," she said. Shriners began by inventorying all products to see how many contained latex and then held a vendor fair, allowing vendors to show nurses and other staff their latex-free products. "They had all day to come down and play with latex-free products," Deppe said. A product review committee identified areas with the most critical need for latex-free products and worked with staff and vendors to find alternative products. Everything in the hospital’s storeroom that contains latex is now labeled with a bright orange sticker. The staff has supported the changes, Deppe said. "Everybody just knew this was the right thing to do. It’s been one of the easiest conversions we’ve gone through." Making the switch Gloves are the largest source of latex in most facilities, and using synthetic alternatives can significantly lessen latex exposure. Frequent glove changes increase the risk. Marshfield employees use either nitrile or vinyl exam gloves and have tried synthetic gloves for surgical use. "We had problems with holes [in the synthetic gloves], so we’ve gone back to nonpowdered latex gloves [for surgery]," Cunha said. He hopes that a hybrid latex glove being developed—which is coated on the inside so that latex does not contact the skin—can be used in the future. Marshfield also has replaced latex tourniquets with disposable synthetics and purchased nonlatex blood pressure units as they are replaced. "It’s not a simple transition. You need to educate employees on why changes are needed," Cunha said. Not everyone’s convinced Still, many healthcare workers resist latex controls. "Most believe [latex allergies] won’t happen to them," said Alwilda Scholler-Jaquish, PhD, RN, assistant professor at Texas Tech University Health Sciences Center School of Nursing in Lubbock. "When I first started researching this three years ago, [latex allergies and protocols] were the best kept secret in the United States." She believes many healthcare administrators fear an increase in workers compensation lawsuits if more health workers become aware of latex problems. The American Hospital Association (AHA) isn’t convinced, either. The group says there is still too much confusion on the issue to warrant a wholesale ban on latex. "Hospitals and health systems are concerned about and frustrated by the amount of conflicting information swirling around the issue of how to effectively reduce the risk of latex exposure to those with latex allergies," AHA spokesperson Laileni Kicklighter told a congressional committee in March. The AHA says allergies could be caused by chemicals used in the making of the gloves and not by the latex itself. "We must not mandate procedures that may not be scientifically valid, and we must not unnecessarily discourage the widely accepted use of natural rubber latex gloves that offer both patients and healthcare workers critical protection from HIV, hepatitis, and other infectious agents," Kicklighter said. But whatever the reason for the allergies, a basic fact remains: Healthcare workers should know whether they are using latex gloves and question their need to use them, said Lise Borel, national director for the nonprofit group Education for Latex Allergy/Support Team and Information Coalition (ELASTIC) in West Chester, Penn. "The days of glove innocence are over," she said. |
