Use Of Latex Gloves Research Articles

Inhaled latex allergen (Hev b 1)

Background: IgE-mediated responses to natural rubber latex allergens have become a major health problem among recognized risk groups. Objective: The purpose of this investigation was to measure the amounts of Hevea brasiliensis latex allergen (Hev b 1) inhaled and deposited on surfaces when latex or vinyl gloves were worn and compare the results with the conventional measures (breathing zone samplers) of occupational exposure. Methods: Hev b 1 exposure was measured by nasal sampling and breathing zone sampling. Latex allergen exposure was generated by having each subject don a pair of powdered latex examination gloves and continuing his or her normal daily activity for 30 minutes. By means of adhesive tape, surface dust samples were collected from the surfaces of gloves, the subject's hands, and work areas. Sampling was performed with subjects wearing no gloves, subjects wearing powdered vinyl gloves, subjects wearing powdered latex gloves, and nearby colleagues wearing latex gloves. All samples were assayed through use of the HALOgen assay (Inhalix, Sydney, Australia) with a Hev b 1–specific mAb. Particles transporting latex allergen were identified by a surrounding immunostain halo, and these were quantified and reported as total numbers of particles inhaled, airborne, or found on surface areas evaluated. Results: Study subjects inhaled 26 times more allergen when powdered latex gloves were worn than under the “no glove” and powdered vinyl glove conditions. During the same period, Hev b 1 particle levels measured in the ambient air through use of the breathing zone sampler increased by 24-fold. The median numbers of particles carrying Hev b 1 allergen per square centimeter on the surface of the hands after the wearing of latex and vinyl gloves were 1964 and 5, respectively. Latex allergen was physically associated both with cornstarch granules and with larger dust particles having a darker, more irregular appearance. Conclusion: In a laboratory where gloves are worn for protection, the use of latex gloves resulted in a 26-fold increase in inhaled latex allergen over background levels measured while vinyl gloves were worn as controls. Low levels of latex exposure also occurred when vinyl gloves or no gloves were worn; the reasons for this are under investigation. (J Allergy Clin Immunol 2002;109:701-6.)

Self-Reported Skin and Respiratory Symptoms Related to Latex Exposure among 5,087 Hospital Employees in Norway

Background: Latex allergy has become prevalent among health care workers. Objectives: To determine the prevalence of self-reported symptoms related to latex exposure among hospital personnel. Methods: Questionnaires addressing symptoms and risk factors for latex allergy were distributed to all employees (n = 5,087) at Haukeland University Hospital. Results: Symptoms associated with latex exposure were reported by 23.8% of the participants. Skin symptoms were most frequently reported – flushing/itching/hives: 21.0%, hand eczema: 11.8% – while systemic and respiratory symptoms were reported by 1.4 and 1.2%, respectively. Approximately twice as many women than men reported symptoms (odds ratio 2.55, confidence interval 2.04–3.18). Symptoms were reported by 33.7% of those with atopy and by 20.0% of those without. The occurrence of symptoms increased significantly with the frequency of use of latex gloves but was unrelated to age, years of exposure or number of surgical procedures. Conclusions: The occurrence of self-reported symptoms was associated with the frequent use of latex gloves, atopy and female gender.

POPULATION DIFFERENCES IN PREVALENCE TO Hev B 1 OR Hev B 6.02 ARE NOT DEPENDENT ON DERMAL PENETRATION

Health care workers (HCW) and spina bifida (SB) patients comprise two populations, which are particularly affected by latex allergy and demonstrate different profiles of sero-reactivity to individual latex proteins, with SB patients more frequently having antibodies to Hev b 1 and 3 and HCW to Hev b 5, 6, and 7. Given that HCW have extensive dermal exposure to latex proteins through the use of latex gloves, these studies were conducted to evaluate the percutaneous penetration of Hev b 1 and Hev b 6.02 as a potential factor in the divergent antibody responses observed in HCW and SB patients. Hairless guinea pig skin was used in in vitro flow through cells for percutaneous penetration studies and for immunohistological evaluation of protein localization in the skin. Skin samples were separated into intact and abraded exposure groups based on barrier integrity as measured by a 3H2O barrier test, and radioactive counts were determined for both skin and receptor fluid. Little protein penetration (less than 3%) was observed into or through intact skin samples following exposure to either protein. As expected, the degree of penetration through abraded samples was found to correlate significantly with the degree of abrasion for both proteins. Minimal disruption of the stratum corneum (less than 4% 3H2O penetration) was required to permit up to 50% Hev b 1 penetration. This was in contrast to the relationship observed for Hev b 6.02 where abrasion resulting in greater than 8% 3H2O penetration was required to permit more than 40% penetration of Hev b 6.02. Immunohistochemistry revealed Hev b 1 and Hev b 6.02 localized primarily in the stratum corneum when skin samples were intact and extending into the viable epidermis when abraded. These studies demonstrate that greater than 40% of Hev b 1 and Hev b 6.02 penetrate abraded skin with less abrasion required to achieve a higher degree of penetration with Hev b 1. Other factors including the amounts of individual proteins in latex products and physiological factors other than bioavailability through the skin must be considered in understanding the divergent antibody responses in HCW and SB patients.

Natural rubber latex allergy after 12 years: Recommendations and perspectives

Natural rubber latex (NRL) allergy is a “new” illness whose prevalence reached epidemic proportions in highly exposed populations during the last decade. In children with spina bifida and in patients exposed to NRL during radiologic procedures, institution of prophylactic safety measures has had demonstrable effects in preventing allergic reactions. The risk of NRL allergy appears to be largely linked to occupational exposure, and NRL-associated occupational asthma is due almost solely to powdered latex glove use. Prevalence of NRL-allergic sensitization in the general population is quite low; several studies of young adults demonstrate rates of positive skin test results that are less than 1%. After occupational exposure, rates of sensitization and NRL-induced asthma rise dramatically in individuals using powdered NRL gloves but not in individuals using powder-free gloves. Airborne NRL is dependent on the use of powdered NRL gloves; conversion to non-NRL or nonpowdered NRL substitutes results in predictable rapid disappearance of detectable levels of aeroallergen. For these reasons, adoption of the following institutional policies designed to prevent new cases of NRL allergy and maximize safety is recommended: (1) NRL gloves should be used only as mandated by accepted Standard Precautions; (2) only nonpowdered, nonsterile NRL gloves should be used; and (3) nonpowdered, sterile NRL gloves are preferred for use. Low-protein powdered, sterile gloves may be used, but only in conjunction with an ongoing assessment for development of allergic reactions. (J Allergy Clin Immunol 2002;109:31-4.)

The effects of latex gloves on the kinetics of grasping

This study investigated the effect of the use of latex gloves on motor performance. In the first experiment ten participants performed sensory discrimination tests (a two-point discrimination and a Von Frey hair test) to assess the impact that varying layers of latex gloves (no glove, one, two or three layers of latex gloves) had on the tactile sensitivity of the index finger and thumb. Results showed that multiple layers of gloves impaired haptic sensitivity. To determine if impaired sensation affected motor control, in a second experiment participants picked up various masses (100, 150, 200 g) with their index finger and thumb in the same four glove conditions. Grip and load forces were recorded using a force transducer implanted in the target object. Results showed that more grip and load force was generated when participants were wearing multiple glove layers. However, it was also demonstrated that the gloves were more slippery than bare skin, suggesting that the increased grip forces observed when wearing gloves may have been related to lower friction between the object and glove surfaces. Relevance to industry The results of this study provide data on grip force production that can be used for designing tools and equipment and for potentially reducing the increased force production that is associated with repetitive strain injury.

Dental management of children with latex allergy.

This paper reviews the aetiology, epidemiology and dental management of children with latex allergy. The issue of latex allergy has serious consequences for the dental management of children with one or more of the following risk factors: spina bifida, atopy, first surgery before one year of age, history of multiple surgical procedures, congenital urologic abnormalities, gastrointestinal malformations, hydrocephalus internus, ventriculo-peritoneal shunts, spinal cord injuries, and family history of atopy. Management of latex allergy is based upon the diligent avoidance of latex exposure. Universal use of powder-free low-allergen latex gloves is recommended.

Assessment of the activity of antiperspirants added to surgical hand disinfectants: methodological aspects and first observations

Due to the risk of sensitization caused by glove powder, the use of unpowdered latex gloves is increasing. These unpowdered gloves need a special inner-surface layer which makes it easier for the applicant to put the glove on the hand and to remove it again. However, many users report difficulties with removing the gloves because of sweat production within the glove. Therefore, a method has been developed to evaluate the efficacy of antiperspirants which may be added either to the inner-surface layer of the glove or to hand disinfectants or to skin-care products used before the gloves are put on. The paper describes various trials to optimize this method.

Workers??? Compensation Claims From Latex Glove Use

Workers??? Compensation Claims From Latex Glove Use

Latex Sensitization in Health Care Workers and in the US General Population

Sensitization to natural rubber latex is a prerequisite to type I immediate hypersensitivity reactions (urticaria, angioedema, anaphylaxis, and allergic rhinitis) that result from subsequent latex exposure. This study examines occupations in which latex glove use is common to determine whether it is associated with increased prevalence odds of latex sensitization (measured by latex-specific immunoglobulin E antibodies) by using data from 5,512 adults aged 17--60 years from the Third National Health and Nutrition Examination Survey (1988--1991). After other factors associated with latex sensitization were controlled for, there was a nonsignificant association between longest-held jobs in health care and latex sensitization (odds ratio (OR) = 1.49, 95 percent confidence interval (CI): 0.92, 2.40). For current occupations, latex sensitization was not associated with health care work in which gloves were used (OR = 1.17, 95 percent CI: 0.51, 2.65) or with other occupations in which latex glove use is common (OR = 1.01, 95 percent CI: 0.49, 2.07) compared with other occupations. Current health care workers who reported not using gloves were at increased risk of latex sensitization, both among those without a history of childhood atopy (OR = 2.30, 95 percent CI: 1.04, 5.13) and those with such a history (OR = 28.04, 95 percent CI: 3.64, 215.97). This odds ratio heterogeneity suggests that subjects with childhood atopy may be at high risk of latex sensitization.

Reduction of use of latex gloves in food handlers: an intervention study

Frequent latex glove use is a risk factor for the development of latex allergy. With the increase in latex glove use, latex allergy has become more prevalent. There are a number of occupational groups in which the use of latex gloves is both inappropriate and even hazardous, including food handlers, where the hazard relates particularly to their latex-sensitive customers. The aim of this study was to assess both the use of latex gloves by food handlers and the impact of an intervention study on reducing latex glove use. This was done at the Queen Victoria Market in Melbourne, Australia. We found that 10 out of 30 stalls (33%) used latex gloves, and that following a short education program, this was reduced to 1 stall (3%, p=0.006). The potential to reduce latex glove use by using this intervention study was 93% (95% confidence interval of 54%-100%). We recommend that food handlers be educated during their training, not only about hygiene issues, but also about the appropriate type of glove to wear, in order to prevent both the development of a new occupational group at risk of becoming allergic to latex, but more importantly to protect their latex-sensitive customers.

Emergence of a new threat: Latex allergy - A case report

Allergy is by far one of the most common diseases affecting about 10% of the population. Allergy to latex appears to be a relatively new and increasingly frequent problem. The reason for this is not clear, but includes increased use of latex gloves over the past decade and changes in the manufacture of latex products. In this particular case an eighteen year old lady who was given restorative treatment for multiple carious teeth, reported with complication of contact dermatitis- days after the treatment. On through investigations for all the allergens the allergy was found to be from latex gloves.

Latex gloves use and symptoms in health care workers 1 year after implementation of a policy restricting the use of powdered gloves

Background: Latex sensitization related to glove use is a complex problem, and glove use policies that restrict exposure to powdered latex gloves alone may not provide adequate safety. This study explored health care workers’ (HCWs’) latex glove use and reports of related health symptoms 1 year after implementation of the latex glove replacement policy. Methods: Two cross-sectional surveys. One was a population-based survey of HCWs at the institution (National Surveillance System for Hospital Health Care Workers); the second, a detailed survey of HCWs stratified by exposure to latex gloves (Latex Symptom Survey). Results: The prevalence of symptoms of dermatitis reported by latex glove users was 40.3% (National Surveillance System for Hospital Health Care Workers) and 50.0% (Latex Symptom Survey). Symptom reports increased as exposure to latex gloves increased (pairs used per day, occupations with more glove use, working in higher exposure areas, more tenure, and more hours of use per day). Aerosol symptoms and urticaria related to latex glove use were reported much less frequently than were rash, chapping, itching, or redness. HCWs, even those with skin symptoms, continued to choose latex gloves in more than 80% of the cases. Conclusions: Stepwise preplacement evaluation at employee health clinics is recommended to identify and protect employees sensitized to latex. The medical community needs more understanding and education about latex gloves, latex sensitization, and available alternatives. (AJIC Am J Infect Control 2000;28:352-8)

Passive dispersion of latex aeroallergen in a healthcare facility

Prompted by worsening asthma in a dental assistant with latex allergy and occupational asthma while under personal latex precautions, we confirmed continuing latex aeroallergen exposure. To determine the source of latex aeroallergen and ascertain the effects of site-wide substitution of nonpowdered low allergen latex glove in a health care site. Using a volumetric sampler, baseline latex aeroallergen levels were measured in rooms where she worked and nearby rooms, as well as shared X-ray, laboratory, and waiting rooms. Allergen levels were measured in upholstery fabric samples, ventilation duct dust, and latex gloves. Alterations in aeroallergen levels following change of glove types were prospectively determined. Baseline latex aeroallergen levels ranged from 6 to 25 ng/m3 in the patient's work areas and in other rooms from 29 to 90 ng/m3 during work hours. Latex antigen was found in three brands of powdered latex gloves (chi = 1,156 microg/g) used in the nearby opertories and the hygiene room, and in upholstery fabric, carpet dust, but not ventilation duct dust. In the absence of any other control measures, airborne latex became undetectable (<5 ng/m3) with exclusive use of nonpowdered latex gloves. Latex aeroallergen is primarily generated by active glove use; carpeting and fabric upholstery can serve as important aeroallergen repositories. Site-wide substitution of nonpowdered latex gloves eliminates detectable latex aeroallergen.

Workers' compensation claims from latex glove use: a longitudinal analysis of Minnesota data from 1988 to 1997.

Allergic reaction experienced by health care workers from latex glove use has increasingly become the focus of researchers evaluating occupational sources of injury in health care settings. Many studies have attempted to estimate the prevalence of latex sensitization among health care workers by using various methods, but the findings have been inconsistent and do not predict reactivity. This study used workers' compensation data from Minnesota from 1988 to 1997 to assess allergic reactivity rates, injury severity, and costs associated with latex allergic reactions. The average reactivity rate was 7.1 claims per 100,000 health care workers, and total cost associated with the claims averaged $0.295 per health care employee. Using empirical cost data from another study, it was found that it is not cost-beneficial for health care institutions to globally adopt latex glove-free policies solely on the basis of workers' compensation costs.

Effect of powder‐free latex examination glove use on airborne powder levels in a dental school clinic

Cornstarch powder on latex examination gloves acts as an airborne carrier of natural latex allergens resulting in cutaneous, conjunctival, and/or respiratory responses to latex, a particular concern in a dental school environment where concentrated use of latex examination gloves occurs. This study measured airborne powder levels associated with a trial substitution of powder-free latex examination gloves for powdered latex examination gloves in a dental school clinic. Secondary aims of the study were to assess user acceptance of powder-free gloves during the trial and to assess the financial impact of converting the entire dental school to a powder-free environment. Air was sampled from two areas (dispensary and treatment room) of a student clinic fifteen to thirty minutes before the beginning of normal clinic sessions and again about 1.5 hours into the clinic session. The samples were microscopically analyzed for particulate counts of cornstarch powder. A written survey instrument assessed user acceptance of the two types of gloves. Historical financial data were used to estimate the cost of converting the entire dental school to a powder-free environment. Both the dispensary and the treatment room showed significant reductions in airborne powder counts during use of powder-free latex gloves and a return to high powder counts with resumption of powdered glove use. During the weeks of powdered glove use, the powder counts were also significantly lower before the beginning of the clinic session and higher during the clinic session. User acceptance of the powder-free latex gloves was high. The increased cost per year to convert the entire dental school to a powder-free environment was estimated to be $13,943.

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.

Health care worker disability due to latex allergy and asthma: a cost analysis.

The reported prevalence of occupational allergy to natural rubber latex is 8% to 17%, and that of latex-induced occupational asthma is 2.5% to 6%. Conversion of medical facilities to "latex-safe" can reduce employee sensitization, impairment, and disability. The purpose of this study was to determine the cost of a latex-safe approach, compared with that of continued latex glove use, and to identify the level of worker disability required to make the latex-safe approach financially preferable to a health care institution. The costs of 2 strategies--latex-safe vs the status quo--were calculated from the perspective of 3 health care institutions. A break-even point was calculated for each facility. In all facilities, the cost of using nonlatex gloves exceeded the cost of using latex gloves. In all 3 facilities, however, 1% or fewer of those at risk would have to become fully disabled or fewer than 2% would have to become partially disabled for the continued use of latex gloves to exceed the cost of the latex-safe approach. Health care facilities, regardless of size, are likely to benefit financially from becoming latex-safe even if latex-related disability levels are extremely low.

The implications of latex allergy in healthcare settings.

Latex allergy is on the increase. This paper focuses on how sensitization can occur and the use of latex gloves. Implications for the healthcare setting are addressed and recommendations made focusing on glove usage.

日本の歯学部におけるラテックスグローブの使用による接触皮膚炎の発症頻度

日本の歯学部におけるラテックスグローブの使用による接触皮膚炎の発症頻度

Risky business: pre-powdered gloves or powder-free gloves in the operating suite?

Two of the emerging issues for the health-care sector in the 1990s are occupational health and safety, and iatrogenic issues. Both of these issues are implicated in the use of pre-powdered latex gloves. Hospital health-care workers are exposed to latex in many ways: gloves, intravenous sets, ventilator circuits, dental products, resuscitation equipment, anaesthetic equipment. Post-operative complications, delayed wound healing, scar formation, and the potential for misdiagnosis, in the presence of starch powder, have been well documented in the literature with the need for through glove rinsing prior to surgery. Another route for glove powder to enter wounds is through a barrier breach. For an institution to ensure it provides the most durable and effective barrier for healthcare worker protection and patient safety, knowledge is needed regarding the various factors which lead to glove barrier failure. The primary aim of the study was to evaluate the in-use durability of the surgical gloves in current use against powder-free gloves. Descriptive statistics were used to analyse the data, in addition a cost analysis was calculated. The results of this study demonstrated clinically important differences between existing glove products in terms of barrier quality.