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Latex allergy update: Is powder-free carefree?
Fewer problems reported with improved gloves
With low-protein, powder-free latex gloves available, has the issue of latex allergy been resolved? For some hospitals, changes in products have reduced new employee sensitivities almost to zero. Other hospitals are still seeking alternatives to latex to create a latex-safe environment.
Here are the experiences of several hospitals as they address the problem of latex allergy:
• Disbanding the latex task force.
At Tampa (FL) General Hospital, about 100 employees a year once complained of sensitivities to latex gloves. Some of them developed latex allergies, either with skin or respiratory reactions. But the switch to powder-free, low-protein gloves, even in the operating room, virtually has eliminated the problem.
"Now I have maybe one employee a year who has a true latex allergy," says JoAnn Shea, MSN, ARNP, director of employee health and wellness. "They’re not severe. It’s usually more of a dermatitis." Shea involved both staff and doctors in the glove decisions. Her task force included managers, staff nurses, educators, and infection control. "I probably had about 30 people look at the gloves and decide what to evaluate," she says.
Price was an important consideration because the hospital uses about 105,000 boxes of latex gloves a year. A drop in price in the powder-free latex as well as nitrile gloves enabled the hospital to make the switch. The hospital is eliminating vinyl exam gloves because of concerns about durability and will use only latex and nitrile.
With the elimination of powdered gloves, a latex allergic surgical tech was able to return to the operating room, Shea notes. Employees with asthma reported that their symptoms improved, and fewer employees complained of dermatitis. A few employees have reacted to accelerants in the latex, but they are able to wear the gloves with cotton liners or with a different brand, she says.
The change in gloves also fit in with an overall evaluation of latex use in the hospital, explains Shea. The hospital has sought latex-free products and has exam carts with latex-free items for use with allergic patients.
Tampa General continues to evaluate new employees for latex allergy, but the latex task force has disbanded. Going powder-free "has made a remarkable difference," Shea says. "We don’t meet anymore because we resolved our issues."
• Moving toward a latex-free environment.
When Baystate Health System in Springfield, MA, set up a latex allergy task force in 1997, the long-term goal was to shift from latex to nitrile gloves. "Each year, we look at the numbers and reassess the situation," says James Garb, MD, director of occupational health and safety.
Every year, some employees are newly identified as allergic to latex, despite the hospital’s use of low-protein, powder-free gloves. In 2003, eight employees became latex-allergic. In the first half of 2004, two employees were identified with latex allergy. The three-hospital system has 6,000 employees. "As a percentage it’s not great, but it has a huge impact on these people’s lives for the ones who do develop allergies," Garb says.
With the dropping cost of nitrile, he was able to request a switch from latex gloves, a change that will cost an additional $134,000. About 90% of exam gloves would be nitrile, while some employees would be able to continue to use latex. The hospital system also uses a small proportion of vinyl exam gloves.
Garb expects some employees will have sensitivities to the accelerants used in nitrile gloves. "We’ll try to have some glove options that have different type of chemicals. If you have a problem with one glove, you’ll try another one just like with hand soaps." As more hospitals use nitrile, the cost likely will continue to decline, he adds. "I think we should be trying to minimize exposure to latex even though the gloves are better [quality] than they were years ago."
• Staying on the (latex allergy) alert.
Mayo Clinic in Rochester, MN, considered disbanding its latex allergy task force. After all, years of coordinated efforts virtually had eliminated new cases of latex allergy.
"We just don’t get complaints anymore, but we’ve decided to keep the vigilance up," says William Buchta, MD, MS, MPH, medical director, employee/occupational health service.
With no federal standards on allowable protein levels in latex gloves, the Mayo Clinic set up its own testing of the allergenicity of the gloves. More recently, Mayo has favored neoprene and vinyl exam gloves. "We encourage the synthetic," Buchta notes. Employees aren’t always pleased with the switch. "It was a culture change. People like the feel of latex. It feels more natural," he says.
Surgeons have been allowed to continue to use powder-free latex gloves within some parameters, as they aim to use only products with low latex antigen. "We just try to limit the number of types so we have some control over the product," Buchta adds. "It used to be that any surgeon could order whatever glove they wanted. We can’t allow that."
He still sees cases of contact dermatitis, but often that is caused by repeatedly taking the gloves off and washing the hands. He also screens new employees for latex allergy.
Meanwhile, the task force meets quarterly to talk about latex allergy issues related to both employees and patients. "We try to keep the awareness up that this is always going to be an issue," Buchta says. "We just have to keep it under control."