Whether they've read about it, heard about it or experienced it firsthand, surgery center managers are becoming more concerned about the threat of latex sensitivity and latex allergy. They face many hurdles in making their facilities latex safe, including meeting resistance from surgeons, searching for hard-to-find latex-free substitutes and squeezing their budgets to pay for these products. Nevertheless, most managers have taken some steps to make their facilities latex safe, and a few have practically eliminated latex products. That's the indication of a survey of 561 Outpatient Surgery readers. Ninety, or 16 percent, responded.

Increasing incidences, increasing concern
When asked to rate their concern about latex allergy on a scale of one to five, where one is "not at all concerned" and five is "extremely concerned," 90 percent of the respondents rate their concern at a level of three or above, and 33 percent give it a five. Seventy-eight percent say they've become more concerned in the last five years. Many respondents credit media stories, anecdotal reports and industry literature for heightening their awareness. "Increased knowledge and information that has come out has made me aware of how important an issue [latex allergy] can be," says Shiela Stewart, OR Manager at the Chippewa Valley Hospital in Durand, Wisc. Shirley Olson, OR Supervisor at Shelby County Myrtue Memorial Hospital in Harlan, La., concurs, noting, "You read about and meet so many people who have developed sensitivities in the health care field." Mark Krause, medical director at the Provident Hospital of Cook City in Arlington Heights, Ill., says that he has read about "catastrophic occurrences," that have prompted him to take steps to make his facility latex safe.

Others are focusing on latex allergy because of more direct or even personal experience. Geri Werkman, the director of surgical services at Flaget Memorial Hospital, in Bardstown, Ky., is one of many respondents reporting that more staff are presenting with latex sensitivity and latex allergy. In fact, 67 percent of our respondents have experienced some level of reaction to latex personally or have seen it in their staff. The most common reaction, reported by 64 percent of our respondents, is irritant contact dermatitis, characterized by dry, itchy irritated areas on the skin, usually the hands, caused by latex gloves or handling latex products. Fourteen percent of respondents state that they have seen full-blown cases of latex allergy, involving an immediate reaction to latex from skin redness to anaphylactic shock. Constance Hillman, clinical director at the Palms Wellington Surgical Center in Palm Beach, Fla., was involved in such a worst-case scenario. "I have seen a near-fatal anaphylactic reaction from latex and have also seen health care workers unable to work in jobs they love due to latex allergies," she says.

"We are seeing more and more patients with latex allergy," says an OR Manager at a Michigan-area hospital, and she's not alone. Fifty-nine percent of respondents report seeing latex sensitivity of varying degrees in their patients, and 30 percent say they have cared for patients who are allergic to latex. To pinpoint susceptible patients, 73 percent of respondents say that they've updated their screening policies in the last five years. Some simply ask the question "Are you sensitive or allergic to latex?" on a pre-op questionnaire or phone call. Many respondents recognize, however, that patients may be unaware that they have this condition, so they ask about related allergies, including reactions to shellfish, avocados and bananas. According to Ms. Werkman, one question that has helped her identify several latex-sensitive patients is "Do your lips ever swell when you blow up a balloon?" In many cases, if the patient's answers seem to suggest a latex sensitivity, many facilities have him or her fill out a follow-up questionnaire to gauge its severity.

Some freestanding surgery facilities have made it a policy not to handle latex-sensitive or allergic patients. The facilities that do proceed with caution. "We have a latex-free kit that follows a patient with latex allergy throughout their stay," says Veronica Thomas, director of surgical services at an ASC in Hannibal, Mo. Ms. Hillman's facility handles patients with known latex allergies as the first surgeries of the day, to minimize the chances that latex proteins will be present in the ORs.

Taking steps toward safety
For the most part, managers seem to be successful in finding latex-free alternatives for many products, including anesthesia masks, IV access ports, anesthesia circuits and exam gloves. Seventy-seven percent of respondents say they use at least some latex-free supplies and equipment; 14 percent say they have eliminated latex altogether.

Traditionally, the one area where it's difficult to find a substitute for latex's comfort, strength and durability is in surgical gloves, and while many facilities have cut down on their use of latex gloves, most aren't ready to give them up completely.

Fifty-four percent of respondents elect to minimize the chance that the latex proteins will become airborne by choosing powder-free latex or low-powder latex gloves. In some cases, the switch cuts back or eliminates latex issues. "Since we went to powder-free, we are not seeing problems with staff," notes Linda Larson, director of surgical services at an Iowa health center. Eighty-three percent of respondents state that they are using fewer gloves containing powder, latex or both than they did five years ago, and 21 percent of respondents report that they now use powder-free, latex-free gloves most of the time. But many managers note that surgeons, especially, insist on latex varieties. "Most surgeons still prefer latex gloves," says the CEO of a South Dakota surgery center. "They will only wear latex-free if the patient is sensitive."

In many cases, convincing surgeons and staff to switch to gloves containing less powder, latex or both wasn't exceptionally difficult. Forty-seven percent state that this was "easy," while 30 percent say it was "moderately difficult." Respondents found different strategies for making the switch, ranging from the gradual and collaborative to the quick and dictatorial:

• The medical director of a North Carolina hospital ran a "blind" test, where he brought in five or six different latex free gloves, had everyone try them, and then chose the most popular. Several other facilities mentioned that they trialed latex-free and powder-free sample gloves for a period of weeks or months before deciding on one or a few brands.
• Ms. Werkman took care to screen and find a similarly feeling tactile glove before she asked her surgeons and staff to demo it.
• The OR manager at an Ellsworth, Maine, hospital solicited the help of the glove sales representative to discuss the benefits with the staff and surgeons. Fifty-six percent of respondents took a similar approach by soliciting the help of industry experts or gathering information themselves to present formal educational sessions on latex sensitivity issues.
• Anthony Johnson, MD, Medical Director of Carolina Eye Associates in Greenville, SC, employed a more direct approach