Biogel Skinsense N: surgical glove management for latex allergies

Healthcare staff with a high occupational exposure to latex gloves, such as those who work in the operating theatre, have a higher than average incidence of latex allergies. Certain patient groups are also known to be considered "high risk" for latex allergies. When wearing gloves, staff allergic to latex and those working with patients allergic to latex must wear latex-free gloves to protect themselves and their patients. Of all the different types of gloves available--examination, medical or diagnostic--surgical gloves have to meet the highest standards, offering both protection and comfort. However, latex-free surgical gloves have previously lacked some of the "comfort" qualities of natural latex. This article describes appropriate glove management for latex allergies and looks at the new generation of latex-free surgical gloves.     

Latex allergy in health care workers. What are the risks?

Individuals with a history of atopy are at increased risk of becoming latex allergic. Specific food allergies also cross react with latex. It is important to choose products low in allergen content and powder free to minimize exposure when use of latex products is essential. Using nonlatex products whenever possible is essential. Education of health care workers, clients, and their families about latex products, latex allergy, and substitutions for latex products needs to be current and ongoing. Development of clear guidelines related to working with health care workers with latex allergies encourages management to consider the seriousness of latex allergy and ways to avoid it.     

An evaluation of the risk for latex allergy in prehospital EMS providers

Hospital health care providers are increasingly being diagnosed as latex sensitive or allergic. Little is established on incidence or risks to prehospital health care providers. A written survey of EMT-DCs and EMT-Ps was done anonymously using established risk stratification questions to identify factors that indicate higher potential for developing latex allergies. There were 666 surveys distributed with 580 (87%) returned completed. Of the respondents, 533 were male (91%) with 510 (87%) reporting more than 5 years of field experience. Of the survey participants, 435 (75%) were EMT-DC level and 145 (25%) were EMT-P level. We found that latex sensitivities and allergies are present in our population, with an 8% incidence of latex allergies in EMT-DCs and 18% in EMT-Ps. A greater number of respondents report having factors that have been established to be associated with increased risk for latex allergies, indicating the need for more vigilant monitoring for the development of such reactions.     

The appropriate use of gloves to reduce allergies and infection

Twenty years ago, the wearing of gloves for non-sterile procedures was viewed as insulting to the patient as it made him/her feel 'unclean'. Today, gloves are worn for all procedures and are often wastefully used. There must be a fine balance between inappropriate and appropriate use of gloves and between the use of latex gloves for comfort and fine movements vs the potential for latex allergies. This article will review the use of synthetic and latex gloves and examine some of the related issues.     

Latex allergy: are you at risk?

The prevalence of latex allergies in healthcare workers has significantly increased over the past 2 decades. Increases in exposure to latex products in healthcare environments are related primarily to the use of gloves for barrier protection. In the early 1980s, with the implementation of universal precautions and appropriate healthcare worker protection, latex glove use dramatically rose in many countries. Manufacturing techniques and additional factories for latex gloves were developed to meet the tremendous demand. As a result of new "fast-track" production processes, some of the latex gloves had variant amounts of powder and allergen content. Synthetic materials, such as polyvinyl, polyurethanes, nitrile, and neoprene, are being used to manufacture medical gloves. Some hospitals and clinics have adopted the use of these alternatives to provide a "latex-free" healthcare environment. Risk reduction and prevention strategies are being implemented in many countries. Latex sensitivity and allergy can present as variable clinical reactions including contact dermatitis, rhinoconjuctivitis, asthma, and anaphylaxis. Some healthcare providers who have coexisting risk factors, such as atopy and food allergies (chestnuts, bananas, avocados, passion fruit, celery, potatoes, and peaches), are at an even greater risk for severe allergic reactions following repeated latex exposure. This journal course will provide an overview of the information available related to latex allergy in healthcare workers.     

Latex allergy update.

A recent challenge in the hospital environment is the care of patients with latex sensitivity. Since the introduction of universal precautions in the late 1980s, reports of latex sensitivity have soared. The sensitization process and development of latex allergy and its effect on the hospitalized patient are currently under much discussion. Medical personnel must stay abreast of new data and product information to provide up-to-date care for patients, as well as protection for themselves. Statistics have shown a dramatic increase in the incidence of allergy to latex-containing products. Depending on the source, the incidence is thought to range from 15% to 17% for health care workers, as opposed to 1% to 3% for the general population. Other high-risk groups report as much as a 73% incidence of latex allergies. This article explores the issue of latex allergy and its impact on patient care. Signs and symptoms, as well as the etiology of allergic reactions to latex are examined. The basics of the manufacturing and packaging processes are explored, along with elements of diagnosis and screening, with emphasis on the role of the peri-anesthesia nurse.     

Reducing the hazards of exposure to cornstarch glove powder

Latex allergy has received considerable attention during the past decade. The occurrence of latex allergy in health care workers is higher than in the general population. Latex gloves are the most frequent form of exposure that health care workers have to natural rubber latex; therefore, the relationship between gloves and latex allergies, has been well studied. Scientific evidence supports the link between glove powder and the occurrence of latex allergies, as well as the development of postoperative complications in surgical patients. This article describes how a multihospital system, which is the seventh largest not-for-profit health care corporation in the nation and includes 35 ORs, successfully eliminated powdered gloves from the environment.     

Children at risk: latex allergy and spina bifida.

A collaborative study conducted by nurse coordinators at five centers for children with spina bifida (myelodysplasia) identifies the increased incidence of allergies to latex products--gloves, balloons, and catheters--in this population. Reports from 185 families or adult patients with spina bifida on a questionnaire developed by the nurse coordinators describe the sample characteristics and history to allergies. Statistical analysis concludes that children with spina bifida have a higher incidence of allergies to latex products at 20.4% than the controls at 1.1%. Patient age and the presence of shunted hydrocephalus also correlated positively with latex allergy. The increased risk in this population for latex allergy and the life-threatening reactions (anaphylaxis) have implications for patient, family, and professional education.     

Hand dermatitis risk factors among clinical nurses in Japan

The purpose of this study was to establish hand dermatitis (HD) risk factors among Japanese nurses. A questionnaire was administered to 1,162 clinical nurses, from whom 860 replies were received (response rate of 74.0%). Their overall HD prevalence was 53.3%. Several risk factors were identified: using latex gloves (odds ratio [OR] 1.9), allergies in adulthood (OR 2.7), urticaria as an adult (OR 1.5), atopic dermatitis as an adult (OR 2.7), any allergies to latex products (OR 5.2), skin irritation following contact with latex (OR 4.1), contact dermatitis following contact with latex (OR 3.5), family history of hay fever (OR 1.6), and family history of atopic dermatitis (OR 1.9). The use of hand cream was associated with a 50% reduction in HD risk (OR 0.5). In this study, we found that Japanese clinical nurses suffer a significant occupational burden from HD. As such, it is essential that hospital managers consider interventions to reduce this troublesome occupational disease among clinical nurses in Japan, as elsewhere.     

Latex allergy in the prehospital setting

INTRODUCTION: Latex allergy first was recognized early in the 20th Century, but was not a matter of concern until the last decade of that Century. The reported incidence of latex allergy in different occupations varies considerably. It has been documented in dental workers, operating theater staff, anesthetists, and laboratory technicians. However, little data specifically related to those involved in patient care in the emergency prehospital setting are available. METHODS: A questionnaire was distributed to a sample of both volunteer and salaried first responders from St. John Ambulance Australia in South Australia and Western Australia, and the South Australian Ambulance Service. The first responders were surveyed to: (1) determine the incidence of latex allergy; (2) consider possible factors associated with its development; (3) compare characteristics of the surveyed groups; and (4) reinforce the development of an educational program. The study tool had predetermined statistical qualities. Data were collated and processed using standard statistical procedures. Surveys were collected anonymously. RESULTS: Of the 2,716 forms distributed, 1,099 were returned, resulting in an overall response rate of 40.5%. Atopy was identified in 14.9% of participants, hand dermatitis in 9.4%, and latex allergy in 6.4%. In the group of full-time ambulance officers, there was a significantly higher incidence of hand dermatitis and latex allergy. There also was a significant relationship between latex allergies and both dermatitis and glove usage (as measured by frequency and duration). CONCLUSION: In a group of first responders assessed by an anonymous, voluntary questionnaire, the subset of full-time, salaried ambulance officers was identified as having a higher incidence of hand dermatitis and latex allergy than their volunteer co-workers. These results require further assessment to substantiate the frequency of latex allergy and determine the predisposing factors. All personnel must learn about hand care. Non-powdered, natural rubber latex gloves should be supported for general use in this setting.     

Latex sensitivity in Washington State acute care hospitals. A needs assessment and survey of awareness of the issues.

Based on reports from the workers' compensation system and a sentinel health provider network, latex gloves may be one of the most prevalent sources of occupational skin disorders in Washington State's health care industry. To gather information to understand and address this problem, questionnaires were distributed to 105 acute care hospitals in Washington State. Employee health and infection control specialists were queried on their knowledge about latex allergy, the perceived extent of the problem, and the actions taken to address the problem. With 95 of the hospitals returning completed questionnaires (93% response rate), 30% reported having problems with latex allergies among employees in their facility, with most reporting two or fewer cases. Adequate knowledge was found about the causes and effects of latex allergies, but definite knowledge gaps existed. More than 60% of all of the hospitals surveyed had made some type of glove alternatives available to affected employees, 4% had designated latex free zones, 4% had cleaned to remove latex dust, and 7% had done nothing to address the issue.     

Latex glove allergy--dilemma for health care workers. An overview.

1. The prevalence of latex allergy in health care workers is estimated to be between 10% and 17%. 2. Reactions from wearing latex gloves can include irritant contact dermatitis, allergic contact dermatitis, and contact urticaria from latex proteins. 3. Individuals with a history of atopy, multiple surgeries early in life (particularly with bladder catheterization), or allergies to certain foods are considered at risk of latex allergy. 4. An early intervention protocol and documentation forms are offered for occupational health nurses faced with assessing potentially latex allergic employees.     

Latex allergies in the health care worker.

A dramatic increase in the incidence of latex allergies in health care workers followed the surge in latex glove use accompanying the rise of human immunodeficiency virus (HIV) in the early 1980s. This increase in latex glove use was driven by the release of Universal Precautions issued by the Centers for Disease Control (CDC) in response to the rise of HIV and other blood-borne pathogens. Efforts to stem allergic responses in the workplace have relied on the substitution of other materials for latex. Unfortunately, there is so much latex in everyday life that avoiding this allergen is exceedingly difficult once one is sensitized. Additionally, there are numerous cross reactants that are present in the environment. The situation is further confounded by the introduction of genetically manipulated foods and agricultural products that contain defense proteins genetically inserted to protect plants from pests and pathogens. Many of these defense proteins are antigens that will cross react with latex. Sensitivity reactions, once developed, may progress to the point at which the health care worker is excluded from working. This report provides an overview of rubber products and cross reactants, allergic reactions, and latex sensitivity for the health care worker.     

Neonatal sensitisation to latex: a hypothesis

The exposure of babies to latex gloves at birth may be behind the dramatic increase in childhood allergies in the past 40 years. Jennifer Worth explores this theory and calls for a ban on the use of pre-powdered latex gloves in maternity units.     

Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review

Summary.  Background: The reported diagnostic accuracy of the D-dimer test for exclusion of deep vein thrombosis (DVT) and pulmonary embolism (PE) varies. It is unknown to what extent this is due to differences in study design or patient groups, or to genuine differences between D-dimer assays. Methods: Studies evaluating the diagnostic accuracy of the D-dimer test in the diagnosis of venous thromboembolism were systematically searched for in the MEDLINE and EMBASE databases up to March 2005. Reference lists of all included studies and of reviews related to the topic of the present meta-analysis were manually searched for other additional potentially eligible studies. Two reviewers independently extracted study characteristics using standardized forms. Results: In total, 217 D-dimer test evaluations for DVT and 111 for PE were analyzed. Several study design characteristics were associated with systematic differences in diagnostic accuracy. After adjustment for these features, the sensitivities of the D-dimer enzyme-linked immunofluorescence assay (ELFA) (DVT 96%; PE 97%), microplate enzyme-linked immunosorbent assay (ELISA) (DVT 94%; PE 95%), and latex quantitative assay (DVT 93%; PE 95%) were superior to those of the whole-blood D-dimer assay (DVT 83%; PE 87%), latex semiquantitative assay (DVT 85%; PE 88%) and latex qualitative assay (DVT 69%; PE 75%). The latex qualitative and whole-blood D-dimer assays had the highest specificities (DVT 99%, 71%; PE 99%, 69%). Conclusions: Compared to other D-dimer assays, the ELFA, microplate ELISA and latex quantitative assays have higher sensitivity but lower specificity, resulting in a more confident exclusion of the disease at the expense of more additional imaging testing. These conclusions are based on the most up-to-date and extensive systematic review of the topic area, including 184 articles, with 328 D-dimer test evaluations.     

Perioperative care of patients with latex allergy

Initially identified in the pediatric population, latex allergy and sensitivity now are seen at increasingly higher rates in all age groups, and are especially prevalent in health care workers. Knowledge about the sources of latex in the environment, the signs and symptoms seen in latex sensitivity and allergic reaction, risk factors for sensitivity, and how to assess patients and those working in the health care profession for possible latex sensitivity is important for perioperative nurses.     

Natural Rubber Latex: A Matter of Concern for Nurses

DURING THE PAST 20 YEARS, the use of protective gloves in health care has increased, as have hypersensitivity reactions to the natural rubber latex (NRL) used in glove manufacture.A STUDY WAS CONDUCTED to determine what nurses who work in environments in which NRL is commonly used know about NRL, including their education about and experience with NRL-related allergies.NURSES REPLIED TO A QUESTIONNAIRE with 20 statements pertaining to NRL and NRL-related allergies. The results showed that the nurses had inadequate knowledge about NRL, but nurses in a specialty training program scored significantly higher than professionally active nurses. AORN J 88 (August 2008) 197-210. © AORN, Inc, 2008.     

Tackling latex allergies in patients and nursing staff

It has been known for some time that the latex contained in some medical equipment, such as gloves, can result in an allergic reaction. A new report from the National Patient Safety Agency (NPSA) looks into the response from NHS organisations to the threat from latex allergies and whether adequate measures have been taken to protect health care staff and patients.     

The use of latex gloves in the school setting.

In 1987, when the U.S. Centers for Disease Control and Prevention recommended the use of universal precautions in response to the HIV/AIDS epidemic, the demand for medical gloves dramatically increased. Unfortunately, the manufacturing techniques for the most widely-used gloves-natural rubber latex-also changed, in order to expedite production. These changes resulted in an increase in latex allergies, because excessive residual proteins that cause allergies remained on the gloves and became airborne with the gloves' high level of powder. This allergy concern is especially relevant in the school setting where school nurses are not only concerned about their own well-being, but the well-being of the children in their care. Today, latex gloves are still the most widely used of any medical gloves, but they have much lower levels of protein and are available in low- or no-powder. This article examines whether the current latex gloves indeed reduce the allergenicity of the gloves and how allergy and barrier protection data can assist school nurses in making informed glove choices.