Make Your Facility Latex-Safe

Several years ago, I had never even heard of a latex allergy. Then, three of my colleagues became allergic to latex through constant exposure. One employee's condition became so severe that she was forced to leave the medical industry altogether. Going through this experience with our staff alerted me to the hazards of latex and spurred me to convert my hospital to a latex-safe facility.

Following, you'll find some advice that may help you start the process in your center.

1. Minimize exposure

A Brief History ...Before the early 1990s, we rarely encountered problems with latex allergies. Now hardly a day goes by where we don't see a latex-sensitive or allergic patient. This dramatic change is directly related to new measures comprehensively adopted by health care workers in the late 1980s. In response to the increase in HIV and hepatitis, the Centers for Disease Control and Prevention issued their Universal Precautions, recommending that health care workers wear gloves more regularly. The result was greater exposure to latex. As the volume of latex exposure increased for health care staff and patients, so did the incidents of latex sensitization. There are now more than 600 product liability lawsuits pending over latex allergies. Among the defendants are Johnson & Johnson, Baxter, Smith & Nephew and Ansell. Today, strict quality controls are in place. In 1999 the Food and Drug Administration released a proposed guidance document entitled "Medical Glove Guidance Manual," which recommended protein and glove powder limits. Today, many glove makers offer latex and powder-free gloves instead of or in addition to their latex gloves.

It's virtually impossible to make your center completely latex-free, since so many medical products contain latex. Your best strategy is to provide a latex-safe environment. One way to do this is to keep a supply of low-protein, powder-free latex gloves for non-allergic staff and patients.

The powder-free aspect is key, since latex proteins bind to glove powders and become airborne, where they can be inhaled by patients and staff.

Whenever possible, switch over to latex-free products. Naturally, if a latex-free product is available and cost and quality is comparable to the latex variety, choose the former. While it's still true that some latex-free products are more expensive than their latex counterparts (gloves are a good example), other latex-free products are actually less expensive. We've found this to be true of latex-free anesthesia circuits.

Even if the latex-free products are more expensive, don't cut corners in purchasing them. There are also other considerations when examining cost. You must consider the total expense in using the product. For example, powdered gloves should be rinsed with sterile water before use. Therefore the cost of water and other supplies must be added to the cost of the glove. Every facility should strive to have a latex-free alternative to every latex product in your facility.

Some companies provide latex-free procedure packs, but I don't recommend them. It's been my experience that it's more cost effective to replace the whole line (i.e. switch over to latex-free) whenever possible.

It's important to be selective when choosing which parents can stay with their children - if the parents are extremely upset or anxious, they may upset their children even more. If both parents are present, we try to choose the calmer one to be the escort; if neither is capable, we administer fast-acting sedatives to make the separation easy.

2. Keep a log
Keep a book that lists every product used in your facility, note the latex content of each, and list the latex-free substitute and its location in the facility to make it easy for your staff to find and use the products.

The top ten OR products that have the greatest potential to expose staff and patients to latex are:
- gloves,
- drains and catheters,
- IV tubing,
- anesthesia circuits,
- Eshmark bandages,
- Ace bandages,
- drapes,
- all surgical packs,
- gowns, and
- custom procedure trays.

3. Screen patients.
When taking patients' medical history, prompt them with specific questions.

For example, ask them what jobs they have held. Dental hygienists, for instance, run a greater risk of being allergic than patients who normally are not exposed to latex in their line of work. Also, query them on their known allergies; people with specific allergies, such as to tropical fruits, for example, tend to be latex-sensitive. The populations at greatest risk are:
- Patients with a history of multiple surgical procedures,
- Health-care personnel and other individuals with occupational exposure(such as food service employees who are required to wear latex gloves at work, et cetera.),
- Atopic individuals (e.g. people with a history of hay fever, asthma, etc.),
- Individuals with allergies to certain foods including avocado, kiwi, banana and chestnuts.

4. Establish protocols for at-risk patients and staff

If you do have occasion to care for a patient who is allergic to latex, take the following precautions:
- Schedule elective surgery for at-risk patients earlier in the day when there is less risk of latex protein floating around the environment.
- Before surgery, double-check all equipment to ensure that there are no latex products present.
- Display signs stating "Latex Allergy" on all OR doors during the procedure.

It's a given that if a member of your staff already is latex allergic or latex sensitive, they should avoid exposure completely. Allergic and sensitive staff members should use synthetic, non-latex material gloves as well as gowns with latex free cuffs. Care must be taken to limit these employees' exposure to latex products. It is not uncommon for these employees to require transfer from one area of the hospital to another.

To ensure the safety of your staff and patients, all that is required is a little planning and discipline. Since establishing these guidelines, we have not had any problems with latex allergies. I'm sure that if you adapt our suggestions for use in your facility, you will have positive results too.