There's nothing like latex. Its strength, pliability and ability to convey tactile sensation have made it the gold-standard material for a plethora of medical products, from gloves to intravenous connectors. It's estimated that latex is used in 40,000 medical and non-medical products, so it's almost impossible to avoid.

That's no excuse, however, for throwing our (latex-glove clad) hands in the air and accepting latex sensitivity and allergies as just another workplace hazard. Although it may be impractical to make your entire facility latex-free, it is possible and affordable to make it latex-safe. And there are plenty of reasons to do so.

By some estimates, 8 to 12 percent of healthcare workers regularly exposed to latex develop sensitivity, and as many as 20 percent of operating room personnel may have already developed some form of latex sensitivity. Types of latex and glove-associated reactions include the following:

• Irritant contact dermatitis. A non-allergic skin reaction that causes persistent sore, red, dry and chapped hands.
• Allergic contact dermatitis. An allergy from exposure to chemicals used in the latex manufacturing process. Signs include red, raised bumps and cracked skin that appear slowly after exposure to latex.
• Latex allergy. Hypersensitivity to latex proteins that occurs when repeated sensitization to latex produces anti-latex IgE antibodies that stimulate mast cells, basophils and histamine release. An allergic reaction begins within minutes of exposure to latex and can start with dermatitis and quickly progress to respiratory distress and latex-induced anaphylaxis.

Few would argue the need to have latex-free supplies and policies in place to protect patients with a suspected or documented latex allergy. Even one latex-induced anaphylaxis incident is too many, which is why all healthcare facilities should have pre-operative screening questionnaires to identify at-risk patients (see "Patient Questionnaire for Detecting Latex Sensitivity" on page 58).

The tougher sell might be transitioning to a latex-safe environment and convincing staff, surgeons and management of the benefits of doing so, particularly if it means discontinuing the use of supplies (especially gloves) that surgeons and staff have become accustomed to. Here are some tips.

1 Pick your battles
Don't focus solely on switching to latex-free gloves, which is usually the most difficult and controversial part of a latex-safety initiative. Examine all your surgical supplies to find ways you can lower the overall latex load in your facility.

At our hospital, for example, we found latex covers on beds and OR tables that we could easily replace with latex-free varieties. We also purchased latex-free syringes, IV tubing, Penrose drains and other supplies. Some of these items, such as the Penrose drains, are a little less pliable and user-friendly than their latex counterparts, but the staff eventually became accustomed to them. Once you've made some successful switches, you'll be better prepared to move on to bigger issues - such as surgical gloves.

2 Avoid ultimatums and present the facts
Realize that most surgeons are accustomed to the feel of latex surgical gloves and they probably won't be amenable to a sudden switch. They might also consider the initiative to move to latex-free gloves to be somewhat superfluous, particularly if they've never personally experienced latex sensitivity. Therefore, introduce the idea of going latex-free gradually and produce plenty of data to support the switch, such as the number of latex-sensitive staff and surgeons in your facility and the potential cost of treating even one latex incident.

For example, a 1999 study in the American Journal of Public Health calculated the cost of total disability wage replacement for one employee with latex allergy at $108,917. The cost of partial disability for one employee was $61,988. When other factors, including decreased staff productivity and lost work time were considered, the latex-safe approach was more cost effective than using latex products.

3 Consider low-protein and powder-free gloves
Powder has been shown to increase the leaching of latex proteins and contribute to the aerosolization of proteins when gloves are removed. If you must keep latex gloves on hand, choose powder-free varieties.

4 Make latex- free products easily available
Make it convenient for staff and surgeons to use latex-free products by making them easily available in procedure packs, carts and surgical trays. Even if these items are the first things they reach for, have more traditional options on hand. At our hospital, we keep latex products in stock, including latex surgical gloves, which can be used if the patient has no latex sensitivity.

The good news is that manufacturers are producing better and better synthetic alternatives to latex products all the time, so eventually, the marketplace will provide solutions to the problem of latex exposure. In the meantime, avoid taking an all-or-nothing approach to latex safety. Realize that latex safety isn't a "sexy" issue, so it might take time to heighten awareness and institute changes, but in the end, your patients and staff will benefit.