Lois Schick MN, MBA, RN, CPAN, CAPA

Review the development diagnosis and current treatment of latex allergies

Describe each of the 3 types of human reactions to natural rubber/latex containing products

Identify currently available diagnostic tests and medical treatment options

National Institute for Occupational Safety and Health

Established under the 1970 Occupational Safety and Health Act

A division of the Centers fro Disease Control and Prevention (CDC)

Not OSHA In Ireland and Great Britain it is the NHS

June 1997 released-prevention oriented

Use the appropriate glove for the task at hand

Summarizes employer and worker info

Targeted towards hospitals, day care facilities, food service industry, environmental services

Cheryl was a 41 year old RN in Oregon Worked 3-11 Shift Cheri never came home from work one night Her Story:

◦ Visiting father in hospital and she develops a severe allergic reaction which required 3 days on a ventilator

◦ Carpets were being cleaned at hospital and her reaction was attributed to a reaction to the cleaning chemicals

◦ Had a second bout again when carpets were being cleaned at a hospital where she was employed

Cheri realized she was only having reactions when wearing Latex gloves

In 1994, Cheri was tested for and diagnosed with a latex allergy.

She switched to hypoallergenic gloves which are meant for those who suffer from dermatitis.

Some hypoallergenic gloves have been found to have 3000 times the latex protein as regular latex gloves making them more dangerous to latex sensitive nurses

Eventually she got latex-free gloves.

June 10, 1996 Cheri had a severe attack while at work.

She was rushed to the ED and told the staff there that she was latex sensitive.

At one point Cheri grabbed one nurse by the arm so hard that she left bruises and her last words to this nurse were:

“You’re just going to let me die. I’m not going to make it this time.”

Cheri was right – she did die in the ED that night.

Milky fluid derived from the rubber tree (Hevea Brasiliensis)

Two methods of treatment prior to use◦ Coagulate to solidify

Dry natural rubber i.e. tires, shoe soles◦ Ammonionate to prevent coagulation

Gloves, condoms◦ Proteins can cause range of

allergic reactions

Latex allergy affects 18 million Americans Increasing rates of sensitization

◦18-73% sensitization rate in children with Spina Bifida

◦33% sensitization rate in those having 3 or more surgeries

◦15% sensitization rate in RN’s

17% sensitization rate in ALL health care workers (2% have occupational asthma)

Increased sensitivity in operating room personnel from 2.95% to 15% in less than 10 years

Increased rates in dental personnel from 13.7% to 38% in 4 years

Congenital neural tube disorders

Urologic disorders requiring catheterizations

3 or more surgeries History of systemic

reactions to balloons, latex gloves, condoms, cosmetics, rocket handlers, Poinsettas

History of allergy to fruits with cross reactive proteins◦Hay fever, asthma, contact dermatitis

◦Food allergies to: bananas, avocados, passion fruit, kiwis, chestnuts, tomato, Celery, melon,

Delayed hypersensitivity◦Contact pruritus, erythema, uriticaria, eczema

Immediate hypersensitivity◦Rhinorrhea, conjuctival pruritis & edema, wheezing, bronchospasm, angina, tachycardia & progressively severe hypotension

Progresses in 15-20 minutes Resolves spontaneously over 1-2 hours Immediate, local and generalized

uriticaria, feeling faint, feeling of impending doom, angioedema, nausea, vomiting, abdominal cramps, bronchospasm, anaphylaxis

Anaphylaxis: Typically within 30 minutes after

exposure Cutaneous, GI, CV, Respiratory Laryngeal edema and CV collapse most

common cause of death Immunoglobulin & mediated systemic

reaction to the latex proteins that if untreated lead to fatality

Contact Dermatitis ◦Appears in 18-24 hours◦Resolves in 72-96 hours◦Redness & inflammation over exposed sites

◦Blister formation Allergic Dermatitis

◦ T-cell mediated delayed localized reaction to chemicals used in manufacture of gloves

GLOVES◦act as a vector for patient sensitization

◦Workers are at risk as a population from multiple exposures

◦5-6 million workers wear gloves regularly

◦117 million pairs of latex gloves were supplied to NHS in 1992

Latex gloves can cause contact allergic reactions◦itching, hives, vesicles, erythema, and eczema

◦Usually a delayed hypersensitivity reaction

◦Workers may have concurrent chemical sensitivities to additives in latex

40,000 consumer products that contain latex in their composition.

Makes it difficult to completely delete latex

Latex particles are suspended in indoor air in health care settings

Powder in gloves is the vehicle for latex particle aerosolization

Aeroallergens are higher in areas where workers frequently apply and discard gloves

When latex particles are inhaled, workers become sensitized

Gloves - sterile and exam Catheters IV injection ports Medication vials with needle access Ventilator, anesthesia, and respiratory

therapy equipment Latex tipped enemas, endoscopy parts Mattresses on stretchers Stethoscopes & blood pressure cuff tubing

Household gloves Diapers, bottle nipples, pacifiers Household insulation material, carpet

backing Newsprint, coupons, and magazines dusted

with latex coating Feminine sanitary pads, adult diapers,

condoms, diaphragms Clothing including elastic on underwear

Cutaneous & Mucosa◦ Gloves, dental equipment, surgical procedures,

food prepared by people wearing latex gloves, toys, clothing, sports equip.

Inhalants◦ Anesthesia machines, powder from latex gloves,

balloons, car tires IV & Parenteral

◦ IV ports, tubing, burettes, bottles and syringes

Antihistamines - oral, IM, IV ◦ Chlorphenamine◦ Diphenhydramine

Steroids - inhaled, oral, IV Bronchodilators - inhaled, oral, IV Epinephrine - SQ & IV

Latex-safe preoperative and patient rooms

Latex-safe OR, PACU and anesthesia equipment

Latex-safe neonatal resuscitation equipment

Drugs must not be administered through latex ports, nor dwell in syringes with latex plungers

Schedule latex - safe cases first of the day to allow settling of latex dust overnight

Latex-safe anesthesia equipment Latex-safe respiratory equipment Latex-safe IV delivery systems Recognition of inadvertent latex

exposure

Latex-safe intubation & ventilation equipment

Latex-safe IV equipment Latex-safe gloves and monitoring

equipment Laminar air flow available for the

“exquisitely” sensitized

Screening criteria and diagnosis of latex allergy

Methods of allergy testing◦ RAST – RIA (invitro test IgE) with variable

sensitivity◦ AlaSTAT – ELISA testing ( IgE testing)◦ Skin Prick - Most sensitive but carries risk of

anaphylaxis

Non latex gloves for the employee Non latex for co-workers (Preferred) or

powder free Medications ( epi-pen, antihistamines,

inhalers, steroids) Education of co-workers Complete removal of latex sources

from work place

Remove latex sources from room Dust and vacuum with HEPA filters Mop all surfaces Label room with a “Latex Allergy”Sign Obtain non-latex medical equipment

(Cart) Reverse laminar air flow room if

possible

Non-latex exam and sterile gloves. NO Exceptions !◦ neolon, nitrile, & butadene-styrene

Latex-Free respiratory support equipment◦ Non-latex ambu bag, ETT, cannulas, &

masks readily available◦ Non latex anesthesia machine

components (Ohmeda, North American Draeger & Anesthesia Associates retrofits

Clave ( ICU Medical), Interlink ( Baxter), IVAC & Braun needleless IV tubings

Protective Plus (Johnson & Johnson) Insyte (Critikon), Abbocath, Clear-cath

Central lines-check with Arrow & Bard Heparin Locks - B. Braun and Abbot

Use needleless systems with latex free syringes or prefills◦ Abboject for most emergency drugs◦ Approved Wyeth-Ayerst blunt tip or tubex

drugs only Latex-free syringes - Terumo, Norm-

ject ( Air-tite) & Becton Dickinson DeRoyal Procedure Packs

Nursing, Laboratory, Pharmacy, Housekeeping & Food Service staff don fresh gowns when entering a latex-allergic person’s room to prevent latex glove residue on clothing from being introduced. All personnel wear non-latex gloves

Food prep done with non-latex gloves

Latex gloves Meds injected through latex topped

vials into latex IV ports Latex tipped enema catheters, urinary

catheters Respiratory and resuscitation

equipment

Sample of 79 Type I allergic response to latex◦ 49% RNs

Qualitative - Fears, Lifestyle changes, Job and family impact

Findings in a nutshell◦ Almost all respondents fear needing EMS

and Medical care◦ Denial of symptoms often results in

worsening

1. Identify those at risk as well as those who have had reactions.

2. Communicate information about the patient to all departments who have contact with the patient. Latex Precaution checklist

3. Admit patient to environment that reduces exposure to latex

4. Call for Latex Precautions cart. 5. Use Latex-free gloves for any patient

contact. Sterile & nonsterile. 6. Schedule surgeries/procedures as first

case of the day. 7. Protect patient from direct contact. 8. Follow physicians orders for pre and/or

post anaphylaxis medications. BE Prepared!

9. If appropriate, maintain a unit specific Latex Free “Tool Box”.

10. Educate the patient and the family-Refer cases to appropriate medical care, contact latex information networks.

LISTEN TO THE PATIENT!!!

Obtain latex free equipment before it is needed

Suspect every patient and any employee with symptoms

Resources:◦ Elastic - www.latexallergyhelp.com◦ Latex Cart Products List - Journal of

Emergency Nursing 1998; 24L58-61

◦Elastic - www.latexallergyhelp.com◦Latex Cart Products List - Journal of

Emergency Nursing 1998; 24:58-61◦http://www.cdc.gov/niosh/latexalt.html◦AANA: http://www.aana.com◦http://www.immune.com/allergy◦American college of Allergy Asthma

immunology: http:// www.acaai.org

See YOU in Seattle, WA. USA

April 3-7, 2011

Lois Schick MN, MBA, RN, CPAN, CAPA

12823 W. 3rd Place Lakewood, CO USA

80228 E- Mail:

Schickles@aol.com Home:303-989-2281

Cell: 303-475-9854