Implementing a latex-free environment 

It’s no secret that natural rubber latex can cause severe reactions in some people, and those who come in constant contact with it—including OR nurses—are prone to develop lifelong allergies. Managers who hope to reduce this risk by eliminating most latex from the work environment have their work cut out for them. To be successful they need to work with several interdisciplinary groups and be committed for the long haul.

“In the mid-1990s, we formed a latex task force with the goal of making our entire institution latex-safe. It consisted of a wide range of people, including physicians, nurses, hospital purchasing, risk management, pharmacy, occupational health, security, and public relations staff,” said Robert H. Brown, MD, MPH, a professor in the Department of Anesthesiology and chair of the latex task force at Johns Hopkins Hospital in Baltimore.

The hospital recently announced the elimination of all latex gloves in the hospital and they continue to substitute non-latex medical products for the few remaining latex ones.

One member of the task force, Laurie Saletnik, MSN, RN, assistant director of Surgical Nursing at Johns Hopkins Hospital, added that starting small was key.

“My team worked over the course of a couple of years, incrementally taking on this project,” she said. “We began by having latex-safe ‘kits’ developed. If we had a latex-allergic patient coming to OR and we were aware of it, we could call our supply area to get a kit.”

AORN has a guidance statement that recommends the availability of special carts with non-latex gloves, syringes, and related contents so that patients can be treated in a latex-safe environment. These carts can be a good first step to reducing the risk of an allergic reaction.

Beyond a cart, however, many hospitals are announcing a move toward a latex-free standard.

“You have to make the decision based on your belief that it's the right thing to do for your staff and your patients,” said Bob Boebert, RN, CNOR, CCRN, administrative director of Surgical Services at William W. Backus Hospital in Norwich, Conn., another hospital that recently switched to latex alternatives.

Brown of Johns Hopkins Hospital in Baltimore concedes that a true latex-free environment is probably unattainable and unnecessary, but he says there is a lot that a hospital can do.

“I know we’ll have rubber bands and rubber erasers here, but I don't think they represent the big risks,” he says. “The idea is to remove the medical products that could potentially cause an allergic reaction.”

A first step is to identify areas for improvement.

“In the hospital, historically, two of the biggest problems with latex exposure have been powdered gloves and balloons,” says Anita Shoup, RN, RN, MSN, CNOR, a clinical nurse consultant with Molnlycke Health Care and a member of AORN’s Perioperative Environment of Care Committee. “Hospitals are responding by not allowing latex balloons, only Mylar ones. Their workers are also using powder-free gloves.”

Counting the costs
The decision to convert from latex products is one thing; paying for the conversion is another.

“We made the decision to remove latex products about a year ago, and it took us that much time to look at our budget and incorporate the changeover,” Boebert said.

His administration could justify the changeover costs in part by looking at what they were already spending to treat latex-sensitive patients. 

“Ideally, you know ahead of time if a patient has an allergy, but sometimes you don't know right away,” Boebert said. “If you’d already had a room set up, you’d have to throw everything away and start over again. There’s a cost involved in turning over rooms.”

Hospital personnel shopping for latex-free supplies can expect to pay a premium.

“The cost for a non-latex pair of surgeon gloves is a little under two dollars per pair, depending on the material,” Shoup said. In comparison, the cost for powder-free, low-allergen latex surgeon gloves is around one dollar per pair, she added.

“Prices vary, of course, depending on how many pairs a hospital purchases, the contracted price, and whether or not the hospital chooses just one glove supplier (to maximize volume discounts),” Shoup said.

Boebert’s team asked its vendors for the prices of suitable latex-free products, and then they created a budget. “I added the whole cost for the changeover into my OR budget,” he said. “Next year, each individual department will budget their own products into their annual budgets.”

Finding the right fit
An important factor for making a successful latex-free switch is finding substitute gloves that have the right feel and texture, particularly for surgeons.

“We anticipated that this would be one of our most difficult jobs, but we were able to head off that difficulty by engaging faculty and practitioners early on,” Saletnik said. “We kept them in the communication loop, and we brought in different gloves for them to try.”

Surgeons were asked to make written evaluations of different brands.

These trials occurred periodically for over one year, Saletnik said. “It wasn’t overnight, but in the end, it wasn’t as difficult as we anticipated.”

Because the Johns Hopkins surgeons favored two glove manufacturers, the hospital opted to buy both brands.

Of course, replacing surgeon gloves is only one element. In addition to finding the best surgeon gloves, expect to spend time searching for exam-glove substitutes, too.

“With exam gloves, you have a much larger group of people affected, including nurses, technicians, aids, security, house keeping and even workers in the cafeteria,” Brown said. “You have to spend more time educating and more time doing trials of the gloves to make sure they’re adequate for everyone’s job.”

In the end, latex-free gloves may not be the best choice for everyone.

“The two more common types are polychloroprene and polyisoprene,” Shoup said. These are synthetic materials, and there’s a chance someone could develop a sensitivity to them.

There are other concerns as well. 

“A lot of people don’t realize it, but oil is used to make these gloves,” Shoup said. “It’s a non-renewable resource, and the price is very volatile.” 

Rather than use synthetic materials, another option is to adopt a latex-safe policy.

“You can use articles that are made of natural latex, but they’re powder-free and low-allergen,” Shoup said.

There are likely to be more latex-safe and latex-free products in the near future. Any hospital looking to change its latex policy needs to build flexibility into its plan, and any new product will need to be evaluated for effectiveness.

“As time goes on, we’ll see how many of our staff members develop allergies compared to the national averages,” Boebert said. If his hospital’s averages are lower, he’ll know he’s on the right track.

For more information on latex allergies visit:

www.osha.gov/SLTC/latexallergy/index.html

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