For more information on this testimony, contact Michelle Nawar, Labor Education/Communications Specialist, at (202) 651-7122.

Good Afternoon, Chairman Hoekstra, Vice Chairman Norwood, and members of the Oversight Committee. My name is Susan Wilburn, Senior Occupational Health and Safety Specialist for the American Nurses Association (ANA). I am here today representing the 2.5 million registered nurses, and on behalf of the coalition of unions representing healthcare workers, to support OSHA's Technical Information Bulletin: Potential for Allergy to Natural Rubber Latex Gloves and Other Natural Rubber Products.

As a member of NIOSH's National Occupational Research Agenda (NORA) Advisory Committee on Allergic and Irritant Dermatitis, I have been working together with the FDA and OSHA on this problem since 1996. I have participated as a member of the planning committee and speaker for the FDA teleconference last May on Natural Rubber Latex Allergy.

ANA is an advocate on this issue because we have seen a dramatic increase in reports of RNs being affected, and sometimes permanently disabled, by latex allergy. Over the past five years, this occupational illness has reached epidemic proportions among health care workers.

It is now more dangerous to work in the healthcare industry than in mining or construction. According to the Bureau of Labor Statistics, there were 700,000 reports of occupational injuries and illnesses to healthcare workers in the last year. This does not include the estimated one million needlestick injuries per year. Given that research shows that only 10-30% of work-related illnesses are reported, it is more likely that there are at least two million incidents per year.

Latex allergy is a growing concern for RNs and health care workers. Up to 200,000 RNs in the U.S. are allergic to latex. The prevalence rate of latex allergy among healthcare workers using gloves is consistent across industrialized nations such as Canada, the United Kingdom, Germany, and Finland. The German government recently implemented a low-protein and powder-free requirement in all healthcare facilities due to the exorbitant costs of compensation for disabled healthcare workers with latex allergy, and powder-free gloves are the standard in Britain. This allergy can be a debilitating and career ending illness for nurses. Chronic exposure to latex in an allergic worker can lead to permanent pulmonary and cardiac diseases and premature death.

The data shows that latex allergy is a real and serious threat, not only to healthcare workers, but to the patients we care for. Evidence of the increasing prevalence and severity of the problem is the purchase of Medic Alert bracelets. In 1985, there were 20 requests for latex allergy identification bracelets. As of March 8, 1999, there have been over 10,000 requests for the bracelets which each cost $70. Latex allergy is not an "imagined" disease. For example, approximately 51% of children with spina bifida develop latex allergy from repeated exposure to latex products from their numerous necessary corrective surgeries. Nurses who work in emergency and operating rooms are the most concerned because patients often come to them unconscious, in anaphylactic shock, and unable to communicate.

Oftentimes, patients do not even know they have a latex allergy until they are in shock. In the case of nurse Cheryl Mohrbacher, Cheryl was at work when she had an asthma attack brought on by exposure to powdered gloves. She died in the emergency room where the physicians and nurses in that small Oregon community hospital used latex gloves while treating her respiratory arrest.

Powdered latex gloves are the biggest threat to nurses because the latex protein attaches to the powder. When a healthcare worker puts on a glove, that protein powder sprays into the air settling on equipment and into the ventilation system where it can be carried around the building. Nurses wear up to 50 pair of gloves a day.

So, how do we solve latex allergy?

By exclusively using powder-free or non-latex gloves, we can save lives and prevent healthcare workers and patients from developing latex allergy. ANA and other organizations have been urging medical facilities to take these simple steps to protect healthcare workers and patients. In 1997, the American Academy of Allergy, Asthma and Immunology together with the American College of Allergy, Asthma and Immunology issued a joint statement that no powdered latex products be used in the provision of healthcare. In 1998, the American Academy of Dermatology also called for the elimination of glove powder in their position statement. These three organizations represent the medical specialists who treat patients with latex allergy.

Clearly, latex allergy is largely preventable. There are powder-free and non-latex alternatives such as vinyl, nitrile, neoprene, elastryn and other synthetic polymers. These gloves have been determined by the CDC and the FDA to provide an adequate barrier to protect healthcare workers from bloodborne exposures. It is inaccurate to assume that switching to powder-free gloves is always more expensive. For example, when the Mayo clinic decided to protect their patients and healthcare workers by switching to powder-free gloves, they saved approximately $200,000 in the first year by a competitive bidding process.

Several leading U.S. healthcare facilities have switched to powder-free gloves. In addition to the Mayo Clinic, these include Kaiser Permanente's 700 clinics and hospitals, the Allina Healthcare System, and the four Sisters of Providence hospitals in Oregon. Also, two large teaching hospitals on the cutting edge of research, the Brigham and Women's Hospital in Boston, affiliated with Harvard University, and Emory University Hospital in Atlanta, both switched to powder-free gloves after RNs and surgeons in the operating room became ill from latex allergy.

Despite the systemic changes made by these cutting edge institutions to create a latex-safe environment, experts paid by the latex glove industry will testify that these changes are neither practical nor scientifically sound. Some may discuss studies funded by the latex industry using CDC data that has not been analyzed by unbiased scientists independent of the industry. How many years did the tobacco industry sponsor "studies" that claimed that cigarettes were not hazardous.

ANA supports Assistant Secretary Jeffress and OSHA's direction on this issue. Under the Occupational Safety and Health Act of 1970 signed by President Nixon, OSHA is charged with ensuring a safe and healthful workplace. If this bulletin is prevented from immediately going forward, essential and life-saving information will be denied to healthcare facilities and healthcare workers across this country.

ANA believes there should be a Latex Allergy Standard. However, we are not discussing a Latex Allergy Standard today. We are discussing a technical information bulletin, which is the bare minimum needed to protect healthcare workers. I respectfully request your support for the immediate publication of this OSHA bulletin that is critical to protect the health and safety of millions of nurses, physicians and other healthcare workers, not only in your districts, but throughout the country.

Healthcare workers need this bulletin not only to protect themselves but to protect their latex allergic patients. Thank you for giving me the opportunity to speak with you today. I am happy to answer any questions you may have.

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