临床护士乳胶手套过敏的现状调查及危险因素分析

目的 了解临床护士中乳胶手套过敏的发生率及其危险因素.方法 采用自行设计的问卷对湛江市4家综合性医院的临床护士进行乳胶手套过敏情况调查,并用logistic回归分析其危险因素.结果 在1469名护士中,248名占16.9%出现乳胶手套过敏症状.过敏组的年龄、工龄明显大于非过敏组,且过敏性疾病家族史和个人史阳性率明显增加.主要危险因素为过敏性疾病家族史、过敏性疾病个人史、药物或其他物质过敏和房间内工作时间,而每天平均使用手套数为保护因素.结论 临床护士属于乳胶过敏的高危人群,过敏体质是导致乳胶手套过敏的主要危险因素.     

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 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.     

A laboratory-based study to assess the performance of surgical gloves

The inherent tear resistance and elasticity of latex and the touch sensitivity it provides has made it the traditional material of choice for surgical gloves, protecting both health care workers and patients from the transmission of bloodborne infections. Although increased incidence of latex allergy has led to increased use of nonlatex surgical gloves, the effectiveness of these gloves as a barrier to infection has not been examined thoroughly. This laboratory-based study compared the performance of latex and nonlatex surgical gloves in a simulated stress protocol. The propensity of surgical gloves to fail was dependent on glove material, manufacturer, and stress. Nonlatex neoprene and nitrile gloves were comparable to latex and can provide a good alternative to latex for allergic patients and health care workers. In this study, isoprene was found to be inferior to latex and other nonlatex materials. The presence or absence of glove powder had no significant influence on the probability of glove failure. AORN J 71 (April 2003) 772-779.     

American Nurses Association. Position statement on latex allergy

Natural rubber latex allergy is a serious medical problem for a growing number of patients and a disabling occupational disease among health care workers. Latex allergy develops from exposure to natural rubber latex, a plant cytosol that is used extensively to manufacture medical gloves, other medical devices, and numerous consumer products. Allergic reactions to latex range from skin disease to asthma and anaphylaxis that can result in chronic illness, disability, career loss, hardship, and death. There is no treatment for latex allergy except complete avoidance of latex. Patients and health care providers must be assured safety from iatrogenic sensitization and allergic reactions to latex. Therefore, the American Nurses Association supports immediate interventions to reduce the risk of latex sensitization and ensure safe outcomes for latex-sensitized patients and personnel in all health care settings. Successful interventions will require collaboration between health care providers and administrators, with support from the research community, government agencies, manufacturers, professional organizations, sensitized patients, and patient advocacy groups.     

American Nurses Association position statement on latex allergy

Natural rubber latex allergy is a serious medical problem for a growing number of patients and a disabling occupational disease among health care workers. Latex allergy develops from exposure to natural rubber latex, a plant cytosol that is used extensively to manufacture medical gloves, other medical devices, and numerous consumer products. Allergic reactions to latex range from skin disease to asthma and anaphylaxis that can result in chronic illness, disability, career loss, hardship, and death. There is no treatment for latex allergy except complete avoidance of latex. Patients and health care providers must be assured safety from iatrogenic sensitization and allergic reactions to latex. Therefore, the American Nurses Association supports immediate interventions to reduce the risk of latex sensitization and ensure safe outcomes for latex-sensitized patients and personnel in all health care settings. Successful interventions will require collaboration between health care providers and administrators, with support from the research community, government agencies, manufacturers, professional organizations, sensitized patients, and patient advocacy groups.     

3种头孢菌素类药物皮肤过敏试验必要性的临床观察

[目的 ]观察头孢唑啉、头孢拉定、头孢哌酮皮肤过敏试验的临床意义。 [方法 ]将注射使用 3种头孢菌素类药物的住院病人 42 0 5例 ,分为皮试组和非皮试组 ,观察用药后不良反应发生情况。 [结果 ] 3种药物皮试阳性率无显著差异 ,平均为 2 .42 % ;有青霉素过敏史、其他物质过敏史和无过敏史人群皮试阳性率分别为 19.85 %、12 .12 %和0 .65 % ;皮试阴性后用药组过敏反应和总不良反应发生率显著低于非皮试组 ,尤其有过敏史的病人 ,不良反应的减少更为显著。 [结论 ]过敏史是影响 3种头孢菌素类药物皮试阳性率和不良反应发生的最重要因素 ,建议在用药前对有过敏史者要以拟用药作皮试。     

牛奶过敏儿童接受百白破疫苗免疫接种的不良反应分析

目的 调查牛奶过敏患儿及无牛奶过敏的过敏性疾病患儿,接受百白破疫苗（DPTs）免疫接种的不良反应情况,为免疫接种提供参考意见.方法 收集2008年1月至2012年10月在我科就诊的2 ～84月龄的牛奶过敏患儿（试验组）,相同年龄的无牛奶过敏的过敏体质患儿（对照组）.所有患儿通过询问病史、牛奶皮肤点刺试验、血清牛奶特异性IgE检测和（或）牛奶口服激发试验来证实是否有牛奶过敏.通过现场调查问卷及电话问卷随访的方式调查患儿过敏性疾病病史、用药史及使用百白破疫苗的情况,观察两组患儿不良反应发生率的差异有无统计学意义.结果 试验组240例患儿中有43例出现不良反应,发生率为17.9％,其中33例（13.8％）为非变态反应性不良反应,20例（8.3％）为变态反应性不良反应;对照组663例患儿中有103例出现不良反应,发生率为15.3％,其中92例（13.9％）为非变态性不良反应,53例（8.0％）为变态性不良反应;两组间变态性、非变态性及总的不良反应发生率的差异均无统计学意义（P＞0.05）.所有不良反应均为轻度反应,予以对症处理即可缓解,不需要其他特殊处理或住院治疗.结论 牛奶过敏不增加百白破疫苗免疫接种的不良反应发生率.     

Latex allergy: an emerging problem in theatres

With the increasing use of natural rubber products, latex allergy is becoming a major health concern among patients and healthcare workers. The aim of this study was to determine the availability of a latex allergy protocol and essential latex-free products in theatres. The number of latex allergy complaints among patients and theatre personnel were also studied. Postal questionnaires were sent to theatre managers in 205 hospitals in England, Scotland and Wales, 120 (58.5%) of which were returned. Nearly two-thirds of the theatres did not have a latex allergy protocol. Overall less than one-third of theatres in the UK have latex-free products set aside for use. A total of 505 patients with latex allergy underwent surgery; of these, there were four deaths, 18 major anaphylaxes and 483 minor complaints such as skin rash; 239 theatre personnel reported latex allergic reactions and one had a severe anaphylactic reaction. The number of cases with latex-related complications might be reduced if all hospitals had a latex allergy protocol and a range of essential latex-free products.     

Adverse reactions to food and food allergy in young children in Iceland and Sweden

OBJECTIVE: To investigate the prevalence of adverse reactions to food and food allergy in Icelandic and Swedish 18-month-old children. DESIGN: Prospective multicentre comparative study. SETTING: Primary health care centres in Sweden and Iceland. SUBJECTS: A total of 324 children in Iceland and 328 in Sweden who attended for regular 18-month check-up. MAIN OUTCOME MEASURES: Adverse reaction to food according to questionnaire, and food allergy according to skin prick tests and double blind food challenge tests. RESULTS: Adverse reactions to food were reported in 27% of children in Iceland and 28% in Sweden. Food allergy was confirmed in 2.0% in both countries. Allergy among other family members was reported in 45% of the Icelandic children and 62% in the Swedish (p < 0.001). Indoor smoking was reported by 30% of the Icelandic families and 3% of the Swedish. Respiratory infections were reported significantly more often in Icelandic children than Swedish. CONCLUSION: Adverse reactions to food and food allergy were similar in Icelandic and Swedish children. At the age of 18 months one can expect to confirm food allergy in approximately one out of 15 children with reported adverse reactions to food.     

Latex protein allergy and your choice of gloves: a balanced consideration.

Natural rubber gloves have been acknowledged as the best protective devices available for protecting health care personnel and their patients against viral transmission and infectious fluids. Yet, with the adoption of standard safety precautions and the increase in the use of gloves, an increasing number of people are being affected with latex allergy. Negative publicity related to latex allergy has resulted in health care personnel deciding against using the highly protective natural rubber gloves. The relationship between natural rubber gloves and latex protein allergy needs to be better understood in order for health care professionals to make an informed choice in their selection of gloves.     

Integrity of vinyl and latex procedure gloves

In a series of experiments the integrity of vinyl and latex procedure gloves were tested under in-use conditions. Both types of gloves were tested by three methods: watertight (645 samples), bacterial penetration (50), and dye exclusion (90). Results of the watertight test demonstrated visible defects in 4.1% of vinyl and 2.7% in latex gloves. Twenty percent of latex gloves and 34% of vinyl gloves which had passed the watertight test allowed penetration of Serratia marcescens when worn by volunteers. A series of manipulations designed to simulate approximately 15 minutes of clinical activity in an intensive care unit resulted in failure rates as high as 66%. Using the dye penetration test, there was a statistically significant difference between vinyl and latex procedure gloves with full manipulations, with failure rates of 53% and 3%, respectively. Both types of gloves provided some barrier protection. However, latex gloves performed better when stressed.     

Allergic reactions to latex among health-care workers.

With the emergence of the acquired immunodeficiency syndrome (AIDS) epidemic and the practice of protecting health-care workers from all body fluids, the use of rubber gloves has increased, as has occupational allergy to latex among health-care workers. During 1991, 49 Mayo Medical Center employees sought assessment and treatment of rhinitis, conjunctivitis, contact urticaria, contact dermatitis, asthma, or eczema thought to be related to exposure to latex. Most of these persons had a history of atopy and worked in areas where rubber gloves were used and changed frequently. Of the 49 subjects, 34 had positive results of skin tests to latex products, and the sera from 19 of 35 persons tested contained increased latex-specific IgE antibodies. Employees with sensitivity to latex (and co-workers in the immediate areas) should use vinyl gloves and should notify their own health-care providers of their sensitization. Changes in job assignment may be necessary for some persons.     

Medical gloves and glove materials

Latex gloves are widely used in health care, but latex allergy is increasingly becoming a problem. Nurses should be aware of the alternatives to latex gloves and when these can be used. Nurses should know their organisation's policy on glove use and latex allergy.     

Avoiding problems: evidence-based selection of medical gloves

Allergenic contact reaction to glove proteins and residual chemicals increased from 1980 onwards; circumstantial and technical evidence indicates that change from reusable to disposable latex gloves was a causative factor. Several protein fractions are potentially allergenic; if low protein gloves contain a dominant protein fraction, people with sensitivity may still have an adverse reaction. Use of chlorinated powder-free gloves reduces risk of allergenic reaction; other powder-free gloves may still pose a contact risk to patients. Adverse comparative tests of vinyl vs latex medical gloves may, in some cases, have used non-medical gloves without assessment of initial quality or involved an unrealistic test method; these have discouraged use of a non-allergenic alternative to latex gloves. Vinyl medical glove properties are reviewed. Nitrile examination gloves offer better protection than latex types when handling lipid-soluble substances and chemicals. Properties of medical gloves made from other materials are described.     

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.     

Anatomy of a defective barrier: sequential glove leak detection in a surgical and dental environment.

OBJECTIVES: a) To determine the frequency of perforations in latex surgical gloves before, during, and after surgical and dental procedures; b) to evaluate the topographical distribution of perforations in latex surgical gloves after surgical and dental procedures; and c) to validate methods of testing for latex surgical glove patency. DESIGN: Multitrial tests under in vitro conditions and a prospective sequential patient study using consecutive testing. SETTING: An outpatient dental clinic at a university dental school, the operating suite in a medical school affiliated with the Veteran's Hospital, and a biomechanics laboratory. PERSONNEL: Surgeons, scrub nurses, and dental technicians participating in 50 surgical and 50 dental procedures. METHODS: We collected 679 latex surgical gloves after surgical procedures and tested them for patency by using a water pressure test. We also employed an electronic glove leak detector before donning, after sequential time intervals, and upon termination of 47 surgical (sequential surgical), 50 dental (sequential dental), and in three orthopedic cases where double gloving was used. The electronic glove leak detector was validated by using electronic point-by-point surface probing, fluorescein dye diffusion, as well as detecting glove punctures made with a 27-gauge needle. RESULTS: The random study indicated a leak rate of 33.0% (224 out of 679) in latex surgical gloves; the sequential surgical study demonstrated patency in 203 out of 347 gloves (58.5%); the sequential dental study showed 34 leaks in the 106 gloves used (32.1%); and with double gloving, the leak rate decreased to 25.0% (13 of 52 gloves tested). While the allowable FDA defect rate for unused latex surgical gloves is 1.5%, we noted defect rates in unused gloves of 5.5% in the sequential surgical, 1.9% in the sequential dental, and 4.0% in our electronic glove leak detector validating study. In the sequential surgical study, 52% of the leaks had occurred by 75 mins, and in the sequential dental study, 75% of the leaks developed by 30 mins. In terms of the anatomical localization, the thumb and forefinger accounted for more than 60% of the defects. There were no differences in the frequency of glove leaks between the left and right hand. Leak rates were highest for the surgeon (52%), followed by the first assistant (29%) and the scrub nurse (25%). No false negatives were noted using the electronic glove leak detector; one false positive was seen out of 225 gloves tested (0.44%), as noted in our validation studies. CONCLUSIONS: Significantly high glove leak rates were noted after surgical and dental procedures, indicating that the present day latex surgical gloves can become an incompetent barrier once they are used. Unused latex surgical gloves demonstrated a higher rate of defects than allowed by the Food and Drug Administration standards, indicating substantial noncompliance of quality control standards by manufacturers as well as inadequate governmental oversight. Double gloving, or the use of thicker latex surgical gloves, would probably reduce the frequency of glove leaks. Latex surgical gloves should be tested for patency before use and during surgical and dental procedures.