Allergy symptoms continue despite powder-free gloves
Education and nonlatex are ultimate solutions
Restricting the use of powdered latex gloves is only the first step in solving the problem of latex sensitivity among health care workers, say occupational health researchers. Additional steps, such as a strong education component and avoidance of all latex products, are necessary.
Researchers at the University of Connecticut Health Center in Farmington used a Centers for Disease Control and Prevention HCW glove use survey form to which they added five questions on latex glove-related symptoms. The scannable questionnaires were mailed to all 3,116 health center employees, and 1,073 responded (34% response rate). Data were collected between February and April 1998.
Findings were presented at recent conferences of the Association of Occupational Health Profes sionals in Healthcare1 and the American College of Allergy, Asthma and Immunology.2
Objectives of the cross-sectional survey were threefold: to determine the prevalence of glove-related symptoms, to measure the effectiveness of a one-year-old policy limiting powdered latex glove use, and to increase HCWs’ awareness about latex allergy, says Marcia Trapé, MD, medical director of the employee health service and an assistant professor of clinical medicine with the Department of Medicine’s Division of Occupational and Environmental Medicine.
The glove policy in place for a year prior to the survey recommends use of latex-free or powder-free latex exam gloves for nonsterile procedures.
"We wanted to see how people were doing in utilizing the recommended gloves, or if they were still using powdered latex gloves, and also to see the prevalence of self-reported symptoms associated with latex glove use," Trapé tells Hospital Employee Health.
Survey questions asked workers about skin symptoms, including redness, chapping, rash, and itching on hands while wearing latex gloves; hives or urticaria; respiratory or mucous membrane irritation such as tearing eyes, sneezing, runny nose, wheezing, shortness of breath, and chest tightening; and how many pairs of latex gloves were worn per day.
Employee categories indicating the greatest percentage of latex glove use were surgical medical staff, nonsurgical medical staff, clinical dental staff, phlebotomist/IV team, nursing staff, clinical lab technicians, and housekeepers. (See table, at left.)
On analyzing the data, Trapé found that employees in the high-exposure categories were more than 12 times as likely to develop skin symptoms as the low-exposure groups (laundry, transport, clerical, security, researchers, maintenance, and engineering).
Data showed that 24% of all respondents (1,073) reported skin symptoms. However, 40.3% of all respondents wearing latex gloves reported skin problems. (See graph, below.) Urticaria was reported by 3.2% of the general survey population, but the rate for those wearing latex gloves was nearly three times higher, at 9.2%.
Respiratory or mucous membrane symptoms were reported by 7% of the general population, but the rate among latex glove users was 23.6%, more than three times higher.
Fifty-one percent of respondents were still wearing latex gloves, either powdered or powder-free. (See graph, p. 57.)
Two of the most revealing findings were that more than 16% of latex users were still wearing powdered latex despite the institution’s policy, and that 84% of workers who reported skin problems were still using latex gloves even though nonlatex gloves were readily available.
"We recommended that workers not use powdered [latex gloves], but those gloves were not eliminated from the health center," Trapé says. "Even though we had the policy for one year, people still were not changing behavior. Behavior is very hard to change. The majority of people who were still using powdered gloves were doing so out of habit."
Getting workers to "think twice" instead of continuing accustomed behaviors requires additional education, she says. "We really had to invest more in the educational component of the policy. We added more training in latex allergies, how to avoid latex and use other options."
Even so, emphasizing education and the use of powder-free latex gloves are just the first steps toward preventing latex allergies among HCWs, Trapé says.
"Once you go powder-free, you decrease sensitization through aerosolized particles, but still so many people have broken skin. If they continue to use powder-free latex, latex particles are going to sensitize the broken skin, so eventually even those individuals can become sensitized to latex," she explains.
The ultimate solution is to use nonlatex gloves, "but it’s an area in which we have to respect the professionals because most were trained in an era of latex as the ideal glove," she notes. "It can be very difficult for surgeons or other people doing delicate procedures to adapt to a different feeling and texture of a different type of glove. Those considerations should be kept in mind as well."
Meanwhile, latex gloves should be used as little as possible, Trapé says. Higher rates of latex exposure mean higher rates of symptoms and sensitization. In her study, HCWs with more symptoms were wearing powdered latex more frequently. Workers wearing any type of latex gloves more frequently had a chance of developing skin problems three times greater than that of workers who avoided latex gloves.
Longer tenure linked with more symptoms
The survey also found that HCWs in their profession for five or more years were more likely to report skin symptoms than workers with fewer years in the profession. In addition, employees with more than three years at the institution were twice as likely to report skin symptoms as employees with less tenure. Trapé says both findings probably indicate that those workers have had more latex exposure and therefore a greater chance to become sensitized. She also notes that the reported skin symptoms may or may not have been caused by latex exposure.
The overall rate of latex allergy at her health center is low, she adds.
"All of our [allergic] workers have been able to stay at work. They are latex-free and [working] in environments that are powder-free, and they are doing well with those measures. They take all the precautions — carry an epinephrine pen at all times, wear a medical ID bracelet, and they’re told to call me immediately if they have any reactions."
References
1. Association of Occupational Health Professionals in Healthcare. 18th annual national conference. Poster session. Orlando; Oct. 21-24, 1998.
2. American College of Allergy, Asthma and Immunology. 1998 annual meeting. Poster session. Philadelphia; Nov. 6-11, 1998.
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