Foundations of Practice

by Susan Wilburn, MPH, BSN, RN

ANA Spearheads Latex Allergy Movement

Anita Wolf, RN, (see "Vital Signs", below) is just one of thousands of nurses and other health care workers affected by latex allergy. The National Institute for Occupational Safety and Health (NIOSH) reports that between 8% and 12% of all health care workers are sensitized to latex. It is i mportant that nurses recognize the signs and symptoms of latex allergy for their own personal health-- and to protect their patients.

Allergy to natural rubber latex (NRL) is a serious threat to health care workers and patients. Latex allergy develops from exposure to NRL, which comes from the Hevea brasiliensis tree and is used extensively to manufacture medical gloves, other medical devices, and numerous consumer products.

At least three types of reactions can result from sensitivity to latex products: irritant contact dermatitis, allergic contact dermatitis (delayed hypersensitivity reaction or chemical sensitization), and latex allergy. Irritant contact dermatitis, caused by direct skin irritation from gloves or handwashing, is indicated by drying, scaling, and cracking skin. Allergic contact dermatitis results from accelerators used in glove manufacturing and manifests as itching, papules, blisters, fissures, and crusting of the skin. Latex allergy, which is often confused with the first two conditions, is a progressive disease caused by direct contact with NRL proteins or from breathing cornstarch glove powder containing the protein. Allergic reactions to latex range from skin disease to asthma to anaphylaxis and can result in chronic illness, disability, career loss, hardship, and death. There is no treatment for the allergy except complete avoidance of latex.

The American Nurses Association urges immediate intervention to reduce the risk of latex sensitization. It issued a position statement on latex allergy in September 1997 recommending that all health care facilities establish a multidisciplinary latex allergy task force to develop patient care and occupational health guidelines to ensure that workplace and patient care environments are free of contamination by latex and other substances carried by glove powder. Health care institutions need to identify latex-sensitized patients, employees, and those at risk; instruct them about self-care; and deliver latex-safe care in accordance with recommended practice guidelines.

Institutions should also conduct a complete inventory of all latex-containing medical products. Some of the products that contain NRL include: sphygmomanometers, urinary and barium enema catheters, Penrose drains, and rubber stoppers on medication vials. The effort to identify all latex- containing products will be assisted by the September 1998 implementation of the FDA rule for labeling latex medical products. (See "Washington Watch," December 1997.) This rule also will ban the use of the misleading term "hypoallergenic" from all medical gloves.

Following guidelines in a joint statement of the American College of Allergy, Asthma, and Immunology and the American Academy of Allergy, Asthma, and Immunology, the ANA is calling for the elimination of powdered latex products and the implementation of low-allergen, powder-free latex gloves in all health care settings. Institutions may then need to clean the heating, ventilation, and air conditioning systems to remove latex aeroallergens attached to glove powder. The ANA's position is supported by the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogen Standard that calls for employers to provide appropriate alternatives to latex gloves for sensitized workers . Alternatives to latex gloves include vinyl, nitrile, neoprene, tactylon, and elastryn.

Testimony by the ANA and others in 1996 resulted in latex allergy being prioritized for research by NIOSH in the National Occupational Research Agenda and in the publication, "NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Workplace." Later this year, OSHA will publish "Hazard Information Bulletin: Potential for Sensitization/Allergy and Life Threatening Reaction to Natural Rubber Latex Gloves and Other Products."

Susan Wilburn is the occupational safety and health specialist at the American Nurses Association.

If you suspect that you are allergic to latex, seek advice from your health care provider and report to your institution's employee health services for screening and diagnostic referral. Also, make sure that any allergic reaction, including asthma, is recorded on the OSHA 200 health and safety logs kept by your employer. In addition, report allergic events related to latex medical devices to the FDA MedWatch Program, at (800) FDA-1088, or fax, (800) FDA-0178.