In 1988, Barbara Zucker-Pinchoff, MD, went into anaphylactic shock during the C-section delivery of her second child. The anesthesiologist thought she was allergic to the fentanyl used in the epidural, but she was diagnosed two years later with an allergy to latex.

"Like most people, I heard 'allergy,' and I thought switching to non-latex gloves and taking some antihistamines would bring the allergy under control," Dr. Zucker-Pinchoff says.

But achieving a truly latex-free environment is nearly impossible in a healthcare facility.

In 1997, on the day that turned out to be her last in medicine, she went into anaphylactic shock on the job.

"I was wheezing, despite being on antihistamines," she says. "Four people popped latex gloves out of the box, and I anaphylaxed. I realized that this is not safe for an anesthesiologist. You can't just say, 'I have to go.' It's not safe for patients," she says.

Dr. Zucker-Pinchoff left medicine and is now on full disability. She is a self-employed jeweler in New York City, her medical career torpedoed by the starch that latex gloves are powdered with to make them easier to slip on and off.

Silent and invisible threat
For Dr. Zucker-Pinchoff, 50, and others who suffer from latex allergy, the stakes are very high. The symptoms can range from a simple dermatitis to asthma to conjunctivitis to full-blown anaphylactic shock, and there can be little to no distance in between.

"This is not a cat hair allergy where you just itch and sneeze," she says. "It's more like a peanut allergy where you anaphylax and die."

What about your facility? Are you and your staff at risk for inhaling life-threatening latex allergens? Regardless of whether any of your staffers have developed latex allergy, the risk always looms.

Every time powdered gloves are snapped on and off, the starch becomes airborne, carrying the proteins in the natural latex with it. Once inhaled, the body quickly absorbs those proteins. When you consider how many times you change surgical gloves each day (10? 20? 30?) and that you become more sensitized with each additional exposure to latex, it's not surprising to hear that an estimated 10 to 17 percent of U.S. healthcare workers are sensitive to latex.

And what about your patients? They may not know they have latex allergy until they have an overwhelming exposure or until a caregiver takes an adequate history to uncover sensitivity to latex. Dr. Zucker-Pinchoff's latex sensitivity is so great, she feels endangered by such everyday activities as going to a restaurant, the beauty parlor, the dentist or a child's birthday party. "If they ever take me to an ER," she says, "I'm dead."

In this article, we asked experts for steps you can take to assess your facility's commitment to protecting your staff and patients from latex allergy.

Exposure increases risk
The good news is that awareness of latex allergy is on the rise. In a survey of facility managers published last August in Outpatient Surgery, nearly 80 percent of respondents said they've become more concerned in the past five years. The bad news is that change is slow. Some experts say that healthcare facilities are not doing all they can to minimize the risk to employees.

"This allergy is iatrogenic. No one is born with it. It has everything to do with exposure, and if healthcare workers are exposed to latex proteins day in and day out, then they are at risk," says Elizabeth Borel, DMD, a past director of ELASTIC, the Education for Latex Allergy/Support Team & Information Coalition.

Many medical products besides surgical and examination gloves are made from latex (bandages, dressings, IV access ports and bags, and anesthetic masks and connectors). "It's difficult for facilities to know what is latex-safe. It depends on the individual, and many individuals who are sensitized to latex are not symptomatic," says Mary Beth Bollinger, MD, the director of allergy at the University of Maryland, who oversaw a system-wide study of latex allergy in healthcare workers.

It starts with you
Is making your facility latex-safe high on your list of priorities?

"Unless you've had a personal experience with latex allergy, or know someone directly who is highly sensitized, it's hard to grasp what this is all about," notes Dr. Borel. "Latex allergy can be devastating and it's entirely preventable. Trouble is, it's difficult to recognize who will be affected and when."

Dr. Borel's own story illustrates her points. While practicing dentistry, she noticed a mild dermatitis, which she attributed to powder from her latex gloves. She switched to a powder-free, hypoallergenic latex glove, but her health went downhill -and fast. She had a severe systemic reaction and spent five days in the ICU. Today, Dr. Borel, 48, wears a pacemaker and no longer practices dentistry.

Although Dr. Borel's case is severe, experts say that it could happen to anyone who is repeatedly exposed to latex protein - which means virtually every healthcare worker in virtually every facility in the United States. Surgery center personnel are at even higher risk because latex gloves are preferred by so many surgeons.

"In our study, we found that 8 percent of our employee population were sensitized to latex, but about half of those people were asymptomatic. They didn't know they were sensitized, so they did not avoid latex exposure," says Dr. Bollinger.

The cost of latex allergy is high. Dr. Bollinger's study estimated that the typical disability cost for one healthcare worker is $10,000 - if the worker could return to work. If the employee could not return to work, costs were estimated at $1,163,740 plus medical expenses (based on estimates to cover the average nurse salary).

Sensitivity screening
Although screening for latex sensitivity is not yet standard practice, the study done by Dr. Bollinger shows that it can be done with positive results for the facility. She and her colleagues at the University of Maryland devised a screening program for new employees and offered the screening to current employees, too. The purpose was to identify people at risk for latex allergy, then place them in latex-free units of the hospital.

In 15 months, Dr. Bollinger and colleagues evaluated nearly 1,800 respondents. They were categorized as patient care or non-patient care personnel and presented with a clinical questionnaire about any previous signs of sensitivity (rhinitis, asthma and eczema).

While previous studies have found that about 10 percent of healthcare workers are sensitized, 8 percent of this sample was sensitized to latex. A higher percentage (8.6 percent) was found in the patient care group, versus the non-patient care group (5.6 percent). Approximately 57 percent of sensitized respondents reported symptoms of latex allergy, primarily when using powdered latex gloves.

In an article about the study published in Annals of Allergy, Asthma and Immunology, Dr. Bollinger's team found:

• some respondents reported symptoms, but tested negative on the blood test for latex allergy;
• some respondents reported no symptoms, but were positive on the blood test;
• about 25 percent of respondents who were positive on the experimental skin-reactivity test were negative in the blood test;
• and that an FDA-approved skin-reactivity test for latex allergy is needed.

Armed with information from the study, the team was able to make recommendations for placement of new and current employees. Those with symptoms of latex sensitivity and/or positive results of the blood or skin tests were advised to use synthetic gloves at all times in their work. An allergist evaluated those with respiratory symptoms, and some employees were assigned to latex-free units.

The cost of the screening program, about $60,000, is prohibitive for all but large institutions. But even small facilities can devise a simple screening program that includes questions about latex exposure and symptoms of latex sensitivity. You can train your staff to recognize signs of latex allergy.

What's your response?
Experts say that facility managers are key to making changes. Deborah Qualey, MD, an anesthesiologist who is allergic to latex, recalls a period in which six nurses and two physicians at her former place of employment developed severe latex allergy.

"We had one physician who was in charge of selecting new products, and he took the bull by the horns. He put a latex task force in place, and in 10 days we went from full latex glove usage to latex-free, nitrile gloves in every OR," she says.

"It's more difficult to change over surgical gloves," admits Dr. Bollinger. "Part of the problem was to find a glove that was acceptable and safe. We also needed time to educate, and do a glove trial. It's a long process."

Sharon Kurtz, RN, who oversaw a latex safety program at Henry Medical in Center in Stockbridge, Ga., suggests that your plan should do four things:

• Minimize exposure by identifying all products that might contain latex and then switching to latex-free alternatives, or at least having them available to use.
• Educate staff about the signs of latex sensitivity, and encourage them to report these immediately when observed.
• Screen staff and patients for sensitivity, using the questions described above in the University of Maryland study.
• Establish protocols for at-risk staff and patients. Staff members who are already latex-sensitive should avoid latex exposure by using latex-free gloves and gowns with latex-free cuffs. You may need to provide an entirely latex-free OR for latex-sensitive staff and patients.

It's the gloves
Not to oversimplify a serious medical condition like latex allergy, but the evidence is clear that the greatly expanded use of latex gloves since the late 1980s is the culprit in sensitizing so many healthcare workers. From the standpoint of latex allergy, the sooner you can convert to latex-free gloves, the better.

"For healthcare staff, the major contact with latex is gloves. We went to vinyl and nitrile gloves for exam gloves. Nitrile was more expensive, but now the prices have come down and the price difference (as compared to latex) is not as great as it was," says Joan White, RN, who headed the latex task force at Cooper Medical Center, in Camden, N.J.

Perils of powder
If you can't convert to latex-free gloves, perhaps you can change to powder-free latex gloves. Powder is a primary factor in latex sensitivity because it spreads latex protein throughout your facility.

Debra Adkins, RN, a co-founder of ELASTIC, cautions, "There are no powder-free latex gloves, just some with less powder. There must be some donning powder to prevent the latex from sticking." She and Dr. Borel agree that choosing latex gloves with less powder is better than doing nothing to minimize latex exposure.

Research has shown that natural rubber latex proteins may bind to the starch powder on gloves and become airborne. Once airborne, these proteins can be inhaled. Additionally, body sweat inside latex gloves may allow latex proteins to be absorbed from the glove, passing through the skin and sensitizing the wearer to latex.

Do you use the right glove for the job?
Experts say that surgery centers should reevaluate glove usage throughout the facility, and in doing so, may identify better glove choices that also reduce latex exposure.

"No one glove is appropriate for every healthcare provider in every situation," explains Barbara Gerwel, MD, the director of the New Jersey Occu-pational Health Surveillance Program. "The decision to use gloves, glove use and choices should complement the facility's latex allergy management protocols, as well as provide barrier protection from infectious and hazardous materials."

In a document distributed to every healthcare facility in the state, "Selecting the Right Glove for the Right Task in Health Care Facilities," Dr. Gerwel says that when choosing gloves, facility managers should consider:

• Barrier efficacy. All medical gloves must protect the skin from blood and other potentially infectious body fluids.
• Physical stress/durability. A glove is durable when it maintains barrier protection when subjected to physical stress. A deciding factor is the length of time needed to complete a procedure.
• Chemical resistance. If the glove will come in contact with disinfectants, sterilizing or chemotherapeutic agents, check with the chemical product manufacturer for recommended glove material.

Well worth the effort
Natural rubber latex is harmless to most people. But, like other things in nature - shellfish, bee sting venom, dairy products - it can cause health problems for some people. Though creating and implementing a latex safety program might seem like a lot of effort for the benefit of just a few, experts believe it's a necessity for every healthcare facility.

"The problem is that you don't know for sure who is or will become latex-sensitive. You could be protecting a highly valued staff member - or even yourself," says Dr. Borel, who believes that she would still be practicing dentistry if some of these steps had been taken prior to or when she first showed symptoms. "It's definitely worth it."