Several years ago, our community hospital became concerned about latex sensitivity. More of our patients were mentioning that they were allergic to latex, a few of our employees had developed sensitivity to it, and we'd begun to hear much more about it in the healthcare community. At the time, we didn't really have a system to handle either latex-sensitive staff or patients-when a latex-sensitive patient would arrive, for example, our entire OR would rush to find latex-free gloves, bandages, catheters and other products. Before this relatively minor problem grew into a big one, we decided we needed to take action.

We soon discovered that other departments in the hospital and our affiliated rehabilitation facility had become aware of this problem and were starting their own latex programs. We decided that it would be most efficient to form a network-wide committee to tackle the problem facility-wide. Here's a step-by-step description of what we did.

The first priority: Gloves
Just about everyone was compiling lists of products that might contain latex, so we put our notes together to compare. Here in the OR we were looking at any product that contained or had the potential to contain latex, for example:

• Gloves (sterile and non-sterile)
• All types and sizes of stretchy bandages
• IV tubing
• EKG pads
• Catheters
• Syringes
• Instruments containing nipples or diaphragms
• Surgical caps, hats
• Drapes

Our committee determined that switching from powdered latex gloves to powder-free latex surgical gloves should be our first priority. There were two reasons for this: First, powder actually binds to latex protein and helps distribute it through the air. Second, gloves were something we used every day, for every case. Although switching to powder-free, latex-free gloves was an option, we decided to keep latex gloves as our standard variety because latex, despite its allergy-causing properties, is an excellent barrier. We were able to find three different brands and ran a trial with them.

The trial was challenging for two reasons. First, the surgeons, who were accustomed to the fit and feel of powdered, latex gloves, were reluctant to change. Second, powder-free gloves were in limited supply and quite expensive-$1.15 per pair, as opposed to $0.37 per pair for standard gloves. It wouldn't have surprised anyone if our network had thrown up its hands at the expense and the complaints and just continued to use powdered gloves. Fortunately, we had some resolute individuals who believed the switchover was an important priority. We ended up selecting a brand that offered a number of sizes and thicknesses and had the least latex protein content. After we had decided on the brand, we banished powdered latex gloves from our facility.

Surgeons and staff who do not want to use powder-free latex may use synthetic gloves, which we had always kept in stock for latex-sensitive patients. These gloves were and continue to be about the same price as the powder-free latex variety-$0.95 to $1.15 a pair. We also keep synthetic, powder-free unsterile gloves as our standard exam gloves that are worn outside the OR.

An overall system
While we were on a quest for new gloves, we also were working to replace many latex-containing products or provide alternatives. This involved a great deal of phone calls and research, as the vendors and manufacturers were not yet as aware of this problem as we were. Since we started, however, manufacturers have made tremendous strides in producing latex-free products-just about everything has a latex-free alternative.

We developed a purchasing protocol for the entire network that specifies asking: "Does this product contain latex?" If the answer is yes, our staff will ask: "Do you offer an alternate product that does not contain latex?" It took us about a year to painstakingly develop a list of latex-free products and their suppliers. Each department then developed a list of which products it would need, and how many.

In the OR, we joined forces with the anesthesia department to develop a cart with latex-free items to use with latex-sensitive patients. The cart contains the following items:

• Latex allergy warning signs (we hang these on the OR door when the patient is in the OR, or we put them in the patient's room to warn staff not to use latex products in the area)
• Sterile and exam gloves
• Bandage-type products
• IV tubing with non-latex tips
• Catheters
• IV tourniquets
• Epidural kits
• Syringes
• ECG pads
• Endotracheal tubes

We also developed a cart to travel with a latex-sensitive patient throughout the facility. This cart contains the following latex-free items:

• Latex-sensitive signs and stickers
• Sterile and nonsterile gloves
• Tourniquets
• Microport tape
• Plastic stethoscope
• Catheters
• Oral airway

Attitude adjustment
Once we were able to provide the staff with non-latex products, we found that training was not a big concern. Most of these products are used the same way the previous, latex-containing products were used.

Staff education about latex-sensitivity is important. Unless a person is latex-sensitive or has worked with someone who has developed a latex allergy, it's difficult to take this issue very seriously. From surgeons on down, we held meetings and initiated discussions wherever possible.

The four key points that helped us get the message across include:

• Anyone can develop latex sensitivity, not just people who have a history of allergies.
• Latex sensitivity increases with exposure to latex, so all healthcare workers are at risk.
• Once a healthcare worker develops this sensitivity, he or she will need to accommodate it very carefully. Some health professionals can no longer practice in a setting where they could be exposed to latex.
• Latex-sensitive patients cannot be exposed to even a hint of latex. The allergy can quickly progress to anaphylactic shock in sensitized individuals.

To a large degree, we're talking about an attitude adjustment. Just as facilities and staff are dedicated to maintaining sterile environments ? no matter what the cost, effort or special equipment ? they can become dedicated to a latex-free (or at least greatly minimized!) environment.

Now that our network has been dedicated to this goal for several years, it's more "second nature" than conscious effort. We have an environment that minimizes the use of latex products, and we have established policies and procedures that protect patients and staff. When a latex-sensitive patient arrives, we know exactly what to do to ensure that patient's well-being. And we're proud to know that our employer values the staff's health enough to make the necessary commitment of time and money. n

Ms. Moser is OR Patient Care Manager for Paoli Memorial Hospital, Paoli, Pa. The hospital is part of the Main Line Health Network.