Not asked to testify, experts speak out
All suggest avoidance of powdered latex gloves
To note who was absent from the invitees’ list to a recent hearing scheduled by the House Subcommittee on Oversight and Investigations is to give that panel’s name new meaning. Observers might wonder whether the omission of certain key organizations with experience and expertise in protecting health care workers from the hazards of latex exposure was indeed an oversight.
The subcommittee heard testimony recently both pro and con on the U.S. Occupational Safety and Health Administration’s latex technical bulletin.1 (See this issue’s cover story.) However, not called to testify were representatives from the National Institute for Occupational Safety and Health (NIOSH), which published a landmark latex safety alert in 1997 and is the arm of the federal Centers for Disease Control and Prevention charged with safeguarding workers; the American College of Allergy, Asthma, and Immunology (ACAAI), a professional organization that issued latex guidelines for health care facilities in 1996; and the American College of Occupational and Environmental Medicine (ACOEM), the largest organization of U.S. physicians specializing in worker health.
NIOSH guidelines are consistent with information contained in the OSHA technical bulletin, says DeLon Hull, PhD, deputy director of NIOSH’s division of surveillance, hazard evaluation, and field studies in Cincinnati and a lead author of the alert.
"Our recommendations are geared toward ways [for health care workers] to avoid becoming sensitized," he states. (See Hospital Employee Health, September 1997, pp. 97-101.)
He speculates that the greater level of opposition directed at the technical bulletin probably is due to the fact that OSHA is a regulatory agency while NIOSH is not. Nevertheless, powdered glove manufacturers were actively opposed to the NIOSH document as well, which, like the OSHA bulletin, advocates eliminating powdered gloves from the workplace.2
Similar conclusions reached
Hull emphasizes that the Food and Drug Administration also came out with a similar conclusion several months later in a medical glove powder report stating that the major adverse impact of glove powder appears to be its contributing role in natural rubber latex (NRL) allergies, that glove powder acts as an airborne carrier of natural latex proteins, and that exposure to airborne natural rubber latex allergens can be decreased most effectively by reducing both the level of natural latex proteins and the amount of powder on medical gloves.
For those reasons, the FDA suggests a possible ban on powdered medical gloves "at some predetermined time in the future."3
Guidelines issued by the Arlington Heights, IL-based ACAAI also advise against the use of powdered gloves to prevent HCW sensitization.4 (See HEH, January 1997, pp. 5-7.) They recommend that latex gloves be used only as mandated by universal precaution standards, and that latex gloves used should be low-allergen and powder-free.
Latex sensitivity can result from inhaling airborne particles of allergenic latex proteins in glove powder, as well as from direct contact with latex-containing products, says B. Lauren Charous, MD, chairman of ACAAI’s latex hypersensitivity committee and director of the allergy and respiratory care center at the Milwaukee Medical Clinic, where he treats numerous latex-allergic HCWs.
"As currently marketed, powdered gloves are the source of latex aeroallergens in the workplace," Charous says. "When you use powdered gloves, you get measurable latex aerosol levels, and when you stop using them, [the aerosol levels] go away. No matter how much anyone with an economic interest wishes that away, that’s the reality. The way you develop asthma is through aerosol respiration of an allergen, and the only way [HCWs] get [latex-related asthma] is from powdered gloves."
Physician organization concurs
In a statement issued by the medical center occupational health committee of the ACOEM in Arlington Heights, IL, occupational health physician members also suggest that powder-free gloves would help control latex sensitization among HCWs.5
"Studies have shown a reduction of symptoms of allergy correlated with the reduction of airborne NRL protein," ACOEM states. "The dispersion of allergens in an environment is frequently increased in the presence of particulates. There is no reason to believe the particulates in powder from gloves would not provide a vehicle for the dispersion of NRL."
Reducing particulates in the workplace would be beneficial, the physicians say, "and the substitution of powder-free gloves has been shown to reduce particulates."
OSHA’s technical information bulletin summarizes currently available information and contains reasonable recommendations, ACOEM states, adding, "Those who would suggest that OSHA does not have a legitimate responsibility to participate in educational and regulatory activities related to latex gloves do not appreciate OSHA’s mandate."
References
1. Occupational Safety and Health Administration. Technical Information Bulletin: Potential for Allergy to Natural Rubber Latex Gloves and Other Natural Rubber Products. Washington, DC: OSHA; April 12, 1999.
2. National Institute for Occupational Safety and Health. NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Workplace. DHHS (NIOSH) Pub. No. 97-135. Washington, DC: NIOSH; 1997.
3. Food and Drug Administration, Center for Devices and Radiological Health. Medical Glove Powder Report. FDA: Rockville, MD; September 1997.
4. Sussman G, Gold M. Guidelines for the Management of Latex Allergies and Safe Latex Use in Health Care Facilities. Arlington Heights, IL: American College of Allergy, Asthma, and Immunology; 1996.
5. American College of Occupational and Environmental Medicine. ACOEM Statement on OSHA’s Technical Information Bulletin on Allergy to Natural Rubber Latex. Arlington Heights, IL: ACOEM; 1999.
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