Taking Off the Gloves
With about 10 percent of nurses allergic to rubber gloves, a challenge is posed to facilities to go latex-free

By Beth Berk
January 13, 2003

In the mid-1980s, Barb Fritchie, RN, scrubbed-in daily in a Colorado cardiac cath lab and wore latex gloves for most of the workday. Throughout the next few years, she developed hand dermatitis. Sometimes, she would arrive at work and start to feel awful. It all came to a head on Memorial Day 1990.

"We were doing an emergency procedure in the middle of the night," Fritchie said. "I got very sick to my stomach, very lightheaded and felt like I was going to pass out." She broke scrub, went into the back room and lay down on the floor. "I actually went into anaphylaxis and had to have epinephrine and airway and everything. From that day on, I didn't work in the hospital."

With asthmalike symptoms and hives, she sought the help of an allergist. Office testing confirmed that Fritchie had both a skin reaction to latex and a severe allergy to latex proteins. It changed her life. "I was actually off work for a year and a half," she said. "I had been to several different occupational evaluators and was told I would not be able to work anywhere." Fortunately, the allergist she saw appreciated Fritchie's nursing skill and agreed to make his office latex-free. She's been working there ever since.

It's been more than a decade since Fritchie developed her latex allergy. Although more people today know about the potential effects of latex exposure, nurses in many hospitals are still running into obstacles as they try to protect themselves.

Serious problem

Nurses who wear rubber gloves and find that they have sore, cracked or itchy hands may have an irritant contact dermatitis or allergic contact dermatitis. Both are reactions to chemicals used in processing latex. But a true latex allergy is a reaction to the proteins in natural rubber latex. Symptoms occur within minutes of exposure and may include skin rash, hives, flushing, itching, asthma or some of the more serious signs of anaphylaxis that Fritchie described.

Although the allergy has been reported since the 1920s, it wasn't until the late 1980s-when health care workers began massive use of gloves to fight HIV and other bloodborne disease transmission-that the number of latex allergies began to rise.

Experts now estimate that less than 1 percent of the general population is allergic to latex, while 8 percent to 12 percent of health care workers are sensitive to the protein, according to Susan Wilburn, MPH, RN, senior specialist for occupational safety and health at the American Nurses Association.

"And up to 17 percent of the worker groups that are highly exposed-like operating room personnel or L&D nurses-are sensitive. People who have about 30 glove changes a day," she said.

Wilburn said the problem is serious. "There are 2.5 million working nurses. Ten percent of that is 250,000. That's a horrendous number of people who are sensitive to the protein and, as a result, potentially can't work safely until changes are made in their work environment," she said.

Powder keg

Latex can be difficult to avoid. In the hospital, it might be found in everything from rubber stoppers to catheters. But the majority of the allergy problem is traced to rubber gloves. "Examination gloves are probably 90 percent of the problem," said Diane Flanagan, president of the Milwaukee-based American Latex Allergy Association (ALERT). "The thing we have to be careful to avoid is high-protein, powdered latex examination gloves in the hospital environment. Their time is up. They have to go," she said.

Powder is used to make it easier and faster to pull the gloves on and off, but it is also efficient at sending latex proteins into the air, where they can be inhaled. Respiratory mucous membranes allow for easy entry of the glove allergens. Continued exposure to allergens increases sensitization and makes allergic reactions worse.

According to an American Nurses Association survey in 2001, with almost 5,000 responses, 39 percent of respondents said their hospitals were still using powdered latex gloves. "That was four years after the American College of Allergy, Asthma and Immunology published a position statement saying that we should be eliminating powder," Wilburn said.

After ICU nurse Heidi Kohout, RN, developed a latex allergy in 1995, she was given special vinyl gloves. "I had to take my own box from place to place. But even if you're using a different kind of glove, what other people are using gets into the air. People snap gloves on and off all around you. Everybody else in the ICU was using latex," she said.

Kohout ended up leaving her hospital job and finding a job with the Visiting Nurses Association.

Protect yourself

If you think you might be sensitive to latex, the first thing you should do is try to get away from it. "Listen to what your body is telling you and start learning about it, not putting the blinders on like so many nurses do, like I did," Kohout said. "You think you can handle it or just take your antihistamine and it will go away. But it doesn't go away."

The next step is to find an expert in allergy and immunology who has experience with glove chemical sensitivity and latex allergy, in order to get a diagnosis. Then report any problems to your employee health unit. If the exposure was work-related, you may need to document it for a possible workers compensation claim.

Wilburn suggests that all nurses-even those without latex sensitivity-contact their employee health unit or occupational health provider to find out what kinds of gloves are being used at work. If the employer doesn't seem amenable to finding alternatives to latex gloves, Wilburn suggests contacting a local union representative or state nurses association.

"There's no place that you have to have a latex glove," Wilburn said. Alternatives, such as nitrile gloves, can provide adequate barrier protection, she said.

Nurses who must-or who choose to-work in latex gloves can reduce their risk of reaction by washing and drying their hands thoroughly after removing the gloves, and by avoiding oil-based hand creams or lotions, which can deteriorate gloves, according to the National Institute for Occupational Safety and Health. Hypoallergenic latex gloves won't reduce the risk of allergy, but they may reduce allergic contact dermatitis from exposure to chemical additives in the latex.

Unfortunately, no federal regulation requires that hospitals and other health care employers become latex-safe. The Occupational Safety and Health Administration does have a standard requiring that employers select the most appropriate glove for an application, and its bloodborne pathogens standard requires glove alternatives be provided, Wilburn said.

Allergy experts at ALERT say that nurses have been key players in getting hospitals to think about glove selection and become latex-safe. Annie Calteaux, RN, who helped form the association, knows firsthand.

She developed a latex allergy 10 years ago. She agreed to stick with her hospital and manage a new emergency department clinic, if the hospital made the clinic latex-free. "Some employers aren't as gracious as my employer. But now with the nursing shortage, I think that will be changing," Calteaux said.

"The great thing about nursing is that there are thousands and thousands of different jobs that you can have when you're an RN," she said. "You will find something you will be able to do, even with a latex allergy."

Contact Beth Berk at berk2@prodigy.net