Latex-safe Environment Research Articles

Guidelines in Practice: A Safe Environment of Care.

Creating a safe environment for performing surgical procedures is essential to achieve successful patient outcomes and protect the perioperative personnel who are providing care. Numerous factors challenge the provision of a safe environment of care and create a complex setting for perioperative nurses to manage. The updated AORN "Guideline for a safe environment of care" provides perioperative nurses with recommendations for establishing a safe environment for both patients and personnel. This article provides an overview of the guideline and discusses recommendations for implementing fire safety protocols, using warming cabinets, and creating a latex-safe environment. It also includes a scenario describing the care of a patient with an unidentified latex allergy who is undergoing a laparoscopic sleeve gastrectomy and hiatal hernia repair. Perioperative nurses should review the guideline in its entirety and implement recommendations as applicable in operative and other procedural settings.

Latex-safe: Children's center conversion

The paper describes how a tertiary children's medical center converted its pediatric-dominant operating rooms (ORs) to latex-safe environments without compromise in patient care or incurement of excessive costs. Latex sensitization and allergy continue to be problems especially with at-risk pediatric populations. Even when a latex allergy is identified for a patient, latex supplies still can be used mistakenly. Mayo Clinic used a methodical approach to identify the latex supplies used in the pediatric ORs, selected appropriate latex-free alternatives, and implemented a robust change management program to ensure a latex-safe environment for all pediatric surgical patients. After the change, the use of latex-containing supplies decreased by 93% in the pediatric ORs. This study showed not only that it is possible to convert to a latex-safe environment in a large medical institution but also that more work needs to be done to completely eliminate latex from the surgical environment.

Latex safe environment: report of two cases

Latex safe environment: report of two cases

Creating a latex-safe perioperative environment

Creating a latex-safe perioperative environment

The Final Steps in Converting a Health Care Organization to a Latex-Safe Environment

In a follow-up to a previous article, which described the approach at The Johns Hopkins Medical Institutions to establishing a latex-safe environment, subsequent efforts to convert all the sterile gloves to nonlatex products and thereby complete the implementation of a latex-safe program are reported. Before the complete conversion to nonlatex sterile gloves, operating room use had increased to approximately one-third of our total sterile glove use during the preceding four years. The final stages of the conversion involved both consistent follow-through with education, training, and personnel involvement at all levels and a change in the culture of the medical facility. New and improved nonlatex glove products were coming to the market, and their costs were decreasing because of increased supply and competition. Five synthetic neoprene or polyisoprene gloves-two from one manufacturer and three from the second manufacturer-were evaluated in glove trials. Overall, by manufacturer, a similar rate of acceptance among the various sterile nonlatex gloves (74.2% versus 78.1%) was found. However, to ensure that all users were satisfied, contracts were awarded to both vendors. The weekend before the conversion date of May 1, 2007, all old powdered sterile latex gloves were replaced with the new stock of nonlatex sterile gloves. Once financial and logistical concerns were addressed, conversion to a latex-safe environment entailed readying the organization for the change in organizational culture. Key factors were (1) general acceptance from all the chiefs of the surgical departments; (2) centralization for all purchases of medical supplies, including sterile gloves, through corporate purchasing; and (3) ongoing education and vigilance.

Anaphylactic reactions during cesarean section

Sensitization to latex seems to occur more frequently in women than in men. Obstetric and gynecological surgical procedures have recently been shown to be a common setting for latex anaphylaxis. We analyzed all the cases of anaphylactic reactions during 1240 cesarean sections in 2004; the patients were questioned for risk factors and underwent allergy testing for drugs and latex. Four patients had anaphylaxis under spinal anesthesia and in all cases it was due to latex allergy. Reported symptoms included facial edema, profuse sweating, itching, generalized erythematous rash and hypotension. Only one patient manifested a severe reaction which included bronchospasm, dyspnea, tachypnea and anaphylactic shock, requiring orotracheal intubation and epinephrine. Our data showed a high incidence (1:310) of intraoperative latex anaphylactic reactions in the one-year study period. This may be related to the very specific population (all women) in a very specific setting (obstetrics). To prevent anaphylactic reactions during obstetric surgery it is important to identify potential risk factors to include, for example atopy, adverse reactions to foods and latex items. If latex allergy is confirmed or strongly suspected, patients should be managed in a latex-safe environment. Premedication with antihistamines and steroids might be useful to further reduce the risk. After the delivery, specific desensitization may represent a good therapeutic option.

Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Context: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice.Case Presentation: A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time.Discussion: The patient’s presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work.Relevance to Clinical or Professional Practice: The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.

Institution of latex safe environment significantly improves RAST and Symptoms' score in health care workers: Six year follow up study in a tertiary care center

Institution of latex safe environment significantly improves RAST and Symptoms' score in health care workers: Six year follow up study in a tertiary care center

How health care organizations can establish and conduct a program for a latex-safe environment.

The advent of universal precautions brought about a dramatic increase in the use of natural rubber latex gloves, and reports of rubber latex allergies began appearing in the literature. In 1997 the Johns Hopkins Hospital created the interdisciplinary Latex Task Force to address the issue of creating, implementing, and evaluating a latex-safe environment. When suitable alternatives were available, all medical products that contained latex were to be removed from the hospital and nonlatex alternatives substituted. Latex medical gloves, especially powdered latex examination gloves, which were used in all patient care areas, were replaced by vinyl gloves. Yet because of the ongoing concern about strike-through and the minimal level of acceptance of fit with the vinyl gloves, the search for alternatives to the vinyl gloves continued. The task force recommended switching to nitrile examination gloves throughout the hospital. To facilitate the transition to another examination glove, new educational pamphlets about the nitrile gloves were developed. The switch to nitrile examination gloves was successfully completed, but conversion to nonlatex surgical gloves was less successful, with costs being the overwhelming impediment. Monitoring of latex-containing products and ongoing evaluations of alternatives are crucial in ensuring patient and health care worker safety.

Natural Rubber Latex Allergy

Abstract Natural rubber latex (NRL) allergy is discussed in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, in Section 8.5, Natural Rubber Latex Allergy, and refers to an IgE-mediated immediate hypersensitivity reaction to one or more protein allergens in latex devices, especially gloves. Among health care workers, NRL allergy is the most common cause of occupationally induced rhinoconjunctivitis and asthma, and clinical manifestations range from dermatitis and contact urticaria, allergic rhinoconjunctivitis, and asthma, to anaphylaxis. Evaluating physicians must be cognizant that a suggestive clinical history is necessary but not sufficient to diagnose NRL allergy, and FDA-approved NRL-specific IgE serum tests may have sensitivity as low as 75% and up to 27% false-positive results. No FDA-approved skin test reagent is available for testing. In evaluating impairment due to NRL allergy, evaluators should determine if the individual's problem can be resolved by avoidance of wearing latex gloves. Most patients who have asthma or air passage disruption impairment due to NRL have problems with bronchospasm only when they are exposed, and these patients may not necessarily have any ratable impairment due to NRL (but individuals who have atopic dermatitis may have ongoing symptoms due to pre-existing allergic rhinitis). Efforts to decrease the incidence of NRL allergy have been encouraging, and some patients diagnosed with NRL allergy may return to work in a latex-safe environment.

Allergic reactions occurring during anaesthesia

Allergic reactions occurring during anaesthesia

Dental Surgery in Pediatric Patients with Spina Bifida and Latex Allergy

Dental rehabilitation is a common outpatient pediatric surgical procedure. It requires the dentist to restore or extract the teeth of children with severe tooth decay or poor dental hygiene. Medical, physical, or emotional problems can make safe treatment in an outpatient setting impossible. These children require sedation or anesthesia for the dentist to gain access to their oral cavities. This article discusses caring for pediatric patients with spina bifida and latex allergy undergoing dental rehabilitation. Perioperative nurses must act as patient advocates in providing a latex-safe environment and also ensure quality care.

Risk of latex allergy from medication vial closures.

A latex allergy, like all allergies, is a serious matter that requires special precautions on behalf of patients and healthcare workers. The FDA final rule on the labeling of natural rubber-containing medical devices will assist in the creation of a latex-safe environment for latex-sensitive individuals. Currently, this ruling does not apply to medication vial closures that contain latex. Until further action by the FDA, the only way to determine whether a medication vial closure contains latex is by directly contacting the pharmaceutical manufacturer. Moreover, in order to rule whether special labeling should be mandatory for latex-containing medication vials, additional evidence is needed to clarify whether exposure to trace amounts of latex from a medication vial stopper can cause allergic reactions in individuals who are sensitive to latex.

Working in a latex-safe environment.

Working in a latex-safe environment.

Latex Allergy and the WOC Nurse

In Brief The WOC nurse is familiar with products used to manage skin care. Latex sensitivity and allergy is becoming epidemic in the United States and is being studied by the Centers for Disease Control and Prevention (CDC) because of its life-threatening consequences. Education and prevention from further exposure must be addressed by health care workers. With the wealth of information on manufacturers and their products, and a basic understanding of cellular immunology, the WOC nurse can facilitate the move toward either a latex-free or latex-safe environment for patients and health care staff. The potential role for the WOC nurse as a resource person for latex allergies is presented.

Implementation Recommendations for Making Health Care Facilities Latex Safe

The problem of latex allergy is not limited to health care workers who provide direct patient care. Individuals in environmental services, dietary, engineering, and medical records departments have the potential for sensitization. Due to the significant liability that may arise from a latex-induced anaphylaxis or death, it is no longer prudent for health care facilities to ignore the problem. This article proposes practical recommendations for implementation of an institution wide latex-safe environment in health care facilities.

Latex-safe carts for bedside patient care.

The need to provide a latex-safe environment for patients with latex sensitivity continues to grow as the incidence of allergy increases. The unique approach of a mobile, latex-safe cart for use throughout the entire hospital is described, as well as the process used to develop the cart. A list of supplies for the cart is given to aid others who are faced with this task.

Overreaction to Latex Allergy

To the Editor: We read with great interest the case report by Vassallo et al. of a 16-year-old female with myelodysplasia who was presumed to have had an allergic reaction to latex from the stopper of a medication vial [1]. The patient had a history of anaphylaxis in the operating room associated with a strongly positive radioallergosorbent test for latex antigen. Because of this, she was premedicated with methylprednisolone prior to her last surgical procedure. This was prepared by pushing the stopper of a medication vial to mix diluent with powdered methylprednisolone, thereby placing the methylprednisolone suspension into contact with the stopper. Shortly after receiving the medication, she developed "marked erythema along the course of the corresponding vein." Vassallo et al. claim theirs "is the first reported case of an allergic reaction to latex from the stopper of a medication vial." We believe that there is another possible mechanism for this reaction. Although uncommon, allergic reactions to corticosteroids have been reported in patients [2,3]. These reactions include immediate or delayed responses occurring after the administration of a number of different steroids, most commonly methylprednisolone or hydrocortisone sodium succinate. There have been a wide variety of reported responses including but not limited to urticaria, bronchospasm, angioedema, and cardiovascular instability. The clinical investigation, in most cases, involved skin testing of the suspected agents, although some included reexposure. The vast majority of reports have implicated the steroid, not the agents used in the vehicle, including preservatives, as the offending agent. Some authors have postulated that because steroid molecules are small, the steroid acts as a hapten that combines with proteins in vivo to become antigenic. The actual mechanism of these allergic responses is not fully understood. In addition, the two suppliers of powdered methylprednisolone in a two-chambered vial, Abbott Laboratories and the Upjohn Company, have informed us that users of these products do not need to be concerned because the current and past formulations have not used latex in any way in their manufacturing process (Paul D. Rosen, Abbott Laboratories, personal communication, 1996; Vandana Slatter, PharmD., The Upjohn Company, personal communication, 1996). This case report prompted a letter to the editor of Anesthesia & Analgesia by Kearns and Norris about yet another case of presumed latex allergy, this time from the rubber in a syringe. They reported a case of urticaria localized along the course of a vein in a 29-year-old patient with spina bifida and known latex sensitivity after morphine was administered intravenously for postoperative pain from a syringe whose plunger contained latex [4]. Their report concluded that the localized urticaria from the postoperative morphine injection must have been caused by latex from the syringe because there was no response to morphine administered intraoperatively through the same injection site. We disagree with this conclusion and do not believe that there is sufficient evidence to show that latex from the syringe caused this urticarial reaction. Morphine is well known to cause histamine release. Localized urticaria is occasionally observed and may be related to multiple factors, such as the concentration and rate of medication administration, and perhaps may be masked by concurrent drug administration. Considering the above comments, we do not believe that the conclusion that latex caused the localized erythema in either of these cases is certain or even likely. Exposure to latex in medication vials or, for that matter, in disposable syringes has not been proven to cause reactions in latex-sensitive patients. In fact, we have now administered anesthesia to more than 200 patients with known latex allergy using freshly prepared syringes containing rubber stoppers without adverse effects [5,6]. We have taken the precaution of not inserting needles through rubber stoppers, but it is unclear if even this is necessary. We do agree, however, with the recommendations of Vassallo et al. and others that creating a latex-safe environment has led to the successful management of latex-allergic patients. If a latex-safe environment is adhered to, prophylactic treatment with steroids and/or antihistamines and the use of glass syringes is unnecessary based upon our experience. In conclusion, we are concerned that the strong legitimate desire to avoid problems with latex-sensitive patients has led to a number of inconclusive reports of latex reactions to various medical devices. These reports may have the unfortunate effect of increasing the fears, costs, and medical-legal liability of caring for these already complex patients. Richard H. Blum, MD Mark A. Rockoff, MD Robert S. Holzman, MD Department of Anesthesia; Children's Hospital and Harvard Medical School; Boston, MA 02115-5737 John McDermott, RPh Department of Pharmacy; Children's Hospital and Harvard Medical School; Boston, MA 02115-5737 Lynda C. Schneider, MD Department of Allergy; Children's Hospital and Harvard Medical School; Boston, MA 02115-5737