Early detection can save money, lost productivity
A screening program designed to identify latex-sensitive health care workers at the University of Maryland School of Medicine in Baltimore has realized annual savings of at least $80,000 by enabling the school to accommodate these employees, often through the use of synthetic gloves.
Early identification of such workers is critical, says Mary Beth Bollinger, DO, director of allergy and assistant professor at the medical school. The fact that the facility had already decided to transition from latex gloves did not lessen the need for screening, she says. "Latex is something we are all exposed to every single day, and a lot of people have allergies," says Bollinger, noting that such allergies can significantly impact job performance.
"We had six workers identified in 1997 who had significant allergies — they missed an average of 50 days of work before we could get them back into the workplace. Some had to work in another area of the hospital, and two have such sensitivity that they developed occupational asthma."
Sensitive individuals often report skin reactions, such as rashes or itching, or even systemic hives or rash, says Bollinger. Upper respiratory problems such as sneezing, itchy noses, or lower respiratory problems such as coughing, chest tightness, wheezing, or shortness of breath also are seen.
In addition, she observes, latex-sensitive workers can develop serious anxiety about entering certain areas of the hospital. "We wanted our employees to work in a safe environment," Bollinger says, underscoring the motivation for both the transition and the screening. "If you continue to ignore even mild symptoms, in the next month or year, a person could have severe symptoms." Some health care workers become so symptomatic, she notes, that they have had to leave the profession altogether.
Putting things in motion
Following the identification of the six aforementioned cases, a multidisciplinary task force was formed that included the departments of allergy, occupational medicine, human resources, employee health, risk management, administration, patient support services, materials management and nursing. They developed a four-phase, five-year plan to eliminate natural rubber latex (NRL) gloves.
The screening program was developed by the employee health department, and in February 1998 was made mandatory not only for all new incoming employees but for existing employees who wished to transfer into patient care services. It also was made available to all employees who volunteered for NRL allergy evaluation.
A formal study was conducted over a 15-month period from April 1998 to July 1999. The screening involved both a clinical history questionnaire and a blood test for the NRL-specific IgE antibody. A total of 1,795 employees were screened. Of that group, 8%, or 144, were NRL-specific IgE antibody-positive by blood test and/or skin test. Of this group, 57.3% reported symptoms with powdered NRL glove exposure. Most of the NRL-sensitized workers were given synthetic gloves and were able to continue working in the same positions.1
The financial results also were positive. "When we first did our cost projections of converting to powder-free examination gloves, we projected it would cost $100,000 a year on a million-dollar glove budget," notes Bollinger. "This would be offset by what we would have paid in workers’ comp. When we did make the conversion, the materials management department realized that people all over the hospital had been using many different glove manufacturers. By limiting our purchases to just one manufacturer, we actually saved $80,000 per year."
Once you’ve decided to go latex-free, says Bollinger, your work has only begun. There are a number of products on the market from which to choose. "We used scoring sheets, filled out by representatives from nursing, physicians, and materials management," she recalls. The systematic glove evaluation and selection process involved criteria such as ease of putting and taking the gloves on and off, dexterity (staff tried to pick up tiny metal objects while wearing the gloves), drawing blood, slippage, smell, and even color. Then the committee got together and made the final decision based on the surveys. The nitrile gloves were selected, not only because of staff reaction, but because nitrile has in some cases been shown to provide an even more effective barrier against bloodborne pathogens than latex, which is not true of some vinyl products.
The task force initially wanted to convert immediately, but there were not enough gloves available in adequate supply and at reasonable cost, says Bollinger. This actually worked in their favor. "During the transition process, they came up with better gloves with textured fingertips," she notes. "We also felt we had more time to educate our employees by doing it in a staged process. Besides, whenever you make a change in health care, there’s going to be resistance."
The toughest employees to convince were the surgical staff, who are very particular about what they use. They also had to be educated about the glove, because it’s not as stretchy as latex, and if you try to shove your hand through it, you will poke a hole in it.
Finally, says Bollinger, a total conversion away from latex may not be financially or logistically feasible in your facility, so compromises may have to be made. On the other side of the spectrum, a place like The Mayo Clinic can even test different lots of gloves, and based on the amounts of antigen-emit-ted assign them to the most appropriate workers. "Mayo offers multiple choice because they couldn’t do a complete transition," Bollinger explains. "Our compromise was not to go totally to nitrile at first, but to transition gradually. The ultimate plan today is to switch everyone at once, but not too many people have been successful at doing that."
[For more information, contact: Mary Beth Bollinger, DO, Director of Allergy, University of Maryland School of Medicine, MSTF 319, 10 S. Pine St., Baltimore, MD 21201. Telephone: (410) 706-2443. Fax: (410) 706-0694.]
Reference
1. Bollinger ME, Mudd K, Keible LA, et al. A hospital-based screening program for natural rubber latex allergy. Ann Allergy Asthma Immunol 2002; 88:560-567.
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