Latex protocol aimed at preventing allergies
October 1, 1998 4 minutes read
Latex protocol aimed at preventing allergies
Policy designed to prevent and manage exposures
By Dorothea T. Silk, MA, RNC
Staff Development Coordinator
Joanna Glattly, RN, CIC
Employee Health/Infection Control Coordinator
New England Sinai Hospital and Rehabilitation Center
Stoughton, MA
Latex gloves have prevented the spread of infection and protected health care workers from dreaded diseases such as AIDS and hepatitis. However, the advent of universal/standard precautions and the widespread use of latex gloves and other latex-containing products have caused a serious health problem for both patients and HCWs: the development of allergic reactions to latex, ranging from contact dermatitis to anaphylactic shock and death. At our facility, we have researched the causes of this epidemic and implemented education and prevention programs to minimize the effects and development of latex allergies.
Sinai, a 212-bed long-term and rehabilitation hospital located in a Boston suburb, employs approximately 700 workers.
In December 1994, the coordinator of infection control and employee health recommended to the hospital's quality management committee (HQM) that latex allergy be considered a quality improvement (QI) priority. HQM and the leadership group approved, and the responsibility for implementation was delegated to the product improvement committee (PIC).
PIC members selected for the task force were the infection control/employee health coordinator, who was named chairperson; the coordinator of staff development; and the central supply room registered nurse. The goal was to develop guidelines for latex allergy management for both patients and staff.
Literature review aided education
The infection control/employee health nurse had first-hand experience with Sinai employees manifesting symptoms of severe dermatitis, with four individuals definitely identified as latex- sensitive. She had attended educational programs about latex allergy and subscribed to Latex Allergy News and Hospital Employee Health newsletters. Her first assignment was to educate other task force members and staff about the severity of the problem. This was accomplished by a literature review (see selected bibliography on p. 124) and coordination of two educational programs presented by medical experts.
The task force surveyed all departments, catalogued latex-containing products used in the hospital, and researched nonlatex substitutes. They developed a list of latex products and suggested alternatives, and circulated it among department heads and managers. A cart containing only nonlatex equipment was stocked for any latex-allergic patient admitted.
Gloves represented the most commonly used latex product. Research into the cost and effectiveness of vinyl and other synthetic gloves revealed a potential savings of $10,000/year in 1996, while maintaining infection control safety. Glove trials were conducted, and by June 1996, the hospital had discontinued the use of latex gloves for general use and had substituted vinyl and other synthetic gloves in all departments.
The task force then developed guidelines for managing patents and staff with potential and/ or actual latex allergy. After review by the leadership team, these guidelines became the framework for a hospitalwide/interdepartmental policy.
Employee health protocol established
The employee health department established a protocol for prevention and treatment for staff with suspected latex allergy. Prevention efforts focus on:
· educating staff about universal/standard precautions and using gloves only when necessary;
· instructing staff in proper hand-washing techniques with emphasis on drying hands thoroughly.
Guidelines for staff manifesting dermatitis symptoms are:
· substitute vinyl or other synthetic gloves;
· use glove liners;
· follow any medical interventions prescribed;
· monitor progress weekly;
· place in modified duty positions when indicated.
For staff diagnosed with latex allergy, the protocol states:
· avoid any exposure to latex products;
· carry a syringe prefilled with epinephrine at all times;
· wear a Medic-Alert bracelet;
· place in modified duty position;
· advise to consider career change options.
Prior to formation of the latex allergy task force, several employees had been screened and treated for hand dermatitis. Approximately 40 cases had been reported. Of those, nine were referred for special allergy testing. Four were determined to have latex allergy, two had chemical allergies, and three had eczematous dermatitis.
During the final stages of protocol development, a facilitator was assigned to the task force to monitor progress and help with communication with hospital administration. A storyboard was created highlighting latex allergy statistics and the task force's work. This was used to educate leadership and staff.
Once the department of medicine and administrators approved the latex allergy policy, the task force scheduled educational programs. At the first meeting in June 1996, department heads and managers received copies and an explanation of the policy. In July, a program for all hospital employees was presented, at which information was provided on the history and prevalence of latex allergy and Sinai's response to the problem. The nonlatex product cart was displayed, but the most impressive part of the program was the story of how latex sensitivity affected the life and career of one of our staff nurses.
Since implementation of Sinai's latex allergy policy, 13 employees have been treated for hand dermatitis, and one has been diagnosed with latex allergy. However, latex allergy as a result of exposure to latex products may not manifest immediately. For this reason, the employee health nurse monitors any suspicious symptoms.
Latex-allergic reactions will continue to be a concern for HCWs. The key to stopping latex allergy is to limit latex exposure. By identifying nonlatex alternatives and promoting their use, employee health and staff development professionals will increase staff awareness, thereby reducing the incidence and seriousness of this problem.
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