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Publish Date: October 10, 2007

RMV->)In Defense of Latex Surgical Gloves
Re: "Choosing Latex-free Supplies" (2004 Manager's Guide to Surgical Supplies, October 2004, page 22). I fully agree that latex allergy is a matter of concern, especially for sensitive individuals who should reduce their exposure to natural rubber latex products. However, I'd like to expand upon some important points noted in the article.

  • The 81 percent of irritant contact dermatitis and 26 percent of allergic contact dermatitis reported in the article aren't latex-induced reactions. They're caused by the presence of irritants and chemicals often used in the manufacture of gloves (both non-latex and latex). As such, choosing latex-free gloves alone won't necessarily eliminate these reactions in people who are affected by them.
  • There are indeed good reasons why surgeons are reluctant to use the non-latex (synthetic) alternatives. As correctly mentioned, they are "not as elastic as rubber gloves and can sometimes have a more slippery surface." More importantly, latex gloves are proven to provide excellent barrier protection against viral transmission and bloodborne pathogens that may lead to harmful diseases, as demonstrated by a number of studies comparing barrier performance of different types of commonly used medical gloves. The FDA recognizes latex as the barrier material of choice in the United States (FDA Glove Powder Report, 1997). In addition, many synthetic gloves lack the superior critical glove characteristics of latex, such as comfort, fit, high resistance to tear and tactile sensitivity. Failure in any of these qualities could compromise barrier protection the gloves provide.
  • The article rightly suggests that organizations consider going "low-allergen and powder-free." Latex glove manufacturers are now reducing the protein levels in gloves to help reduce latex-sensitization. A number of recent independent hospital studies in the United States, Canada and Europe have demonstrated that the use of low-protein/allergen latex gloves has vastly reduced the incidence of latex protein allergy. More importantly, they have shown that allergic individuals donning non-latex gloves can now work alongside their co-workers wearing these low-protein latex gloves and suffer no ill effects.

While allergic individuals should avoid latex and opt for synthetic gloves that provide adequate barrier protection, many organizations today recommend the use of low-protein/allergen latex gloves, especially when handling infectious materials.

Esah Yip, DSc
Malaysian Rubber Export Promotion Council
Washington, D.C.
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Billing for Anesthesia
Re: "Our Small Acts of Fraud" (June 2004, page 96). As a practicing anesthesiologist and lawyer specializing in healthcare compliance law, I wholeheartedly disagree with Dr. Dorin's contention that anesthesia time properly begins when you enter the operating room. The regulations Dr. Dorin cites specifically state that anesthesiologists may legally bill time during which we're "preparing the patient for anesthesia." This would include the pre-operative insertion of an intravenous but not the time we're evaluating the patient, which is included in the base units.

One could, in fact, take the position that failing to bill for IV insertion time before entering the OR constitutes a false claim punishable by civil and criminal sanctions.

Lorne B. Sheren, MD, JD
Assistant Professor
UMDNJ/New Jersey Medical School
Newark, N.J.
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Keep Up the Good Work
I get overwhelmed with publications but never throw away Outpatient Surgery. I pass it along to the managers in the perioperative department. Thank you for providing such useful information - I frequently use it as benchmarks when speaking to physicians and staff. I have always said this publication has the most useful tools for what is happening in current practice. Keep up the good work.

Maureen Spangler, RN, CNOR
Director, Perioperative Services
Lexington Medical Center
W. Columbia, SC
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Examine Similar Procedures, not Locations
Re: "Study Defends Safety of Office Surgery" (Dec. 27 E-Weekly). This study is incomplete in its scope.'A dermatologist doesn't have the expertise or experience to comment on plastic surgical procedures under general anesthesia.

Also, a paper comparing the performance of procedures in offices, outpatient centers and hospitals should'examine similar procedures, not just locations. For example, many office-based procedures are local anesthesia only and can't be compared with a more extensive body contouring procedure or facial rejuvenation.'

Steven J. Smith, MD, FACS
Parkwest Plastic Surgery
Knoxville, Tenn.
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For the Record
Scott Aronson is a principal at Russell Phillips & Associates, LLC, a fire and emergency management consulting firm for healthcare. We misidentified Mr. Aronson and his firm in "Lessons Learned from Three OR Fires" (December, page 46).

There was a typographical error in the telephone number for M'lnlycke Health Care in its ad appearing in the December issue. The correct number is (800) 882-4582.

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