An attempt has been made to determine the cost of latex sensitivity to
the health care system. The prevalence of latex allergy in health care
facilities varies between 5-10%. Information on the cases of latex and
rubber related problems provided by the Ontario Workers' Compensation
Board were reviewed. The first claims were reported in 1986 and the
number steadily increased with time. Including partial data in 1993, 60
latex rubber related claims were allowed. Twenty-five cases were from
health care facilities and eight had reactive airway disease. However,
the diagnosis of latex allergy was not provided with a computer code
until 1994. Therefore without proper coding and the elapsed time for
case allowance, the Workers' Compensation Board statistics are grossly
underestimating the true prevalence of latex sensitivity.
Fifteen hospitals (varying in size from small town facilities to
municipal hospitals with up to a 650-bed capacity) were visited in
southwestern Ontario in 1993 to determine the scope of latex allergy.
Most hospitals did not have a clear understanding of latex
hypersensitivity. The prevalence of reported latex allergy in these
hospitals ranged from 0-5 workers. During these visits, a latex allergy
presentation was given to hospital employees. A formal follow-up study
was not done but one of these hospitals subsequently reported 19
additional confirmed latex allergic cases.
In assessing the total cost of latex allergy, it is important to stress
human cost disrupting the quality of employees' work and personal lives.
The problem is, however, that it also has financial costs - something
that has important ramifications for health care facilities.
The most obvious example of the cost of latex sensitivity is the Ontario
Workers' Compensation Board where the experience rating formula assesses
the direct cost of one latex claim at $215,000. Based on the size of the
facility, the employer could be accountable for 90% of this cost. For
example, when an employee develops occupational asthma due to latex
exposure and cannot be accommodated within the existing work place, it is
expected that the employer will be faced with a cost of $194,000.
An example of the effects of latex allergy costs is the experience of
the Hamilton Civic Hospitals. These two urban hospitals have more than
3,000 full time workers and 750 beds. At the Hamilton Civic Hospitals,
eight employees have been assessed as having significant latex allergy
and have temporarily been removed from the work place. However, two of
these claims were assessed as having severe latex allergic symptoms and
have been completely removed from their work place environment. In 1993,
latex allergy cases have been responsible for an additional $304,900 in
Workers' Compensation charges and the cost is growing.
The hospital is making every effort possible to accommodate allergic
employees, but there are limitations. To prevent employees with exposure
to latex from developing latex allergy each individual's degree of risk
must be assessed. The most direct approach is control of the work
environment. At this time, it is impossible to remove all latex
material. However, there are specific controls that may now be
implemented.
One control is to restrict the use of powdered high protein latex gloves
and/or replace gloves with vinyl. However, vinyl may not be an acceptable
alternative. Other suitable materials with lower protein presently have
an increase in cost. The volume of non-sterile bulk gloves is 3.6
million pair/year so an increase of a few cents will have a significant
overall cost implication.
In addition to the cost implications involved protecting employees in
health care facilities, there is a growing number of patients who have been
diagnosed as latex allergic. In fact, latex sensitivity was recognized as a
problem in the emergency and operating rooms long before this was
recognized as an occupational issue. Now all health care
facilities must address the implication of an increasing
percentage of the general population with latex
hypersensitivity. Family physicians, dentists, emergency
response teams, medical clinics and hospitals must recognize a latex allergy
patient in the general public could have an allergic reaction in their
facility. This would include possible anaphylaxis which, of course, is a
major concern.
Research is underway to determine the cause for the recent worldwide
increase in latex allergy over the past 10 years. However, health care
facilities presently are having to deal with the repercussions. The
potential cost impact on the whole health care system is overwhelming.
In a system such as ours where funding restraint is the order of the
day, it follows that latex allergy will have a serious impact on the
cost and type of health care services we can provide in the future.
