With the recognition that hepatitis and HIV viruses are able to be transmitted by
bodily fluids, the delivery of safe care in medical institutions changed dramatically in the
mid-1980's. In an attempt to protect workers, the concept of universal precautions was
instituted. Since that time, the latex glove industry and the healthcare field has encountered
a new crisis. This crisis involves sensitization to natural rubber latex protein which has
affected numerous patients and healthcare workers. This has resulted in a dramatic need for
another change in the care of patients as well as healthcare workers throughout the world.
In order to effectively deal with a growing number of patients and healthcare providers with
latex allergy, each institution must develop guidelines to reduce the risk to these subjects.
One of the most effective means of instituting safe practice has been the development
of institutional task forces, or committees, that oversee issues around latex allergy. These
issues include care of the individual patient, prevention of sensitization of patients at high
risk of developing latex allergy, prevention of sensitization of healthcare workers, and care
of the already sensitized healthcare worker. Because there is no standard documented best
approach, each institution must develop their own guidelines.
The task force should be multi-disciplinary and include a mix of physicians, nursing,
and other medical personnel. The doctors involved should include an allergist, surgical
specialist, ambulatory, and administrative physicians. In addition, nurses from all
departments must be represented. Representatives from occupational health, respiratory
care, risk management, and materials management are also necessary in order to effectively
carry out the tasks of this committee. Achieving excellence through team work has been
quite successful in our institution and others across the country.
The Chair of the committee must be able to understand all the issues involved and
coordinate multiple disciplines. The first and foremost duty of this task force is to define
guidelines for the care of a latex-sensitive patient. This may include practices such as no
exposure to latex from the time of birth for individuals that have spina bifida to the
screening of every individual who requires surgery or procedures. Other groups at higher
risk of latex allergy include those with multiple surgeries or frequent exposure in their
occupational setting. In order to prevent any untoward reactions, a standard screening
questionnaire is useful for patients undergoing procedures.
Identification of medical products which may cause an allergic reaction is necessary.
The vast majority of reactions will occur with examination and surgical gloves and possibly
intravenous systems with inline latex valves. Although many products contain natural
rubber latex parts, they are rarely responsible for allergic reactions; this would include
medication vial tops, mechanical ventilators, and other such equipment. Some important
devices causing reactions would include Foley catheters and latex tubing that may come in
contact with mucous membranes. Each hospital should define potentially problematic
products by writing to the manufacturer to obtain a product content. The committee can
effect this through the Materiels Management Officer.
Even more important, the protection of healthcare workers to sensitization from
latex has become the primary responsibility of these committees. They need to examine
barrier protection issues and make an informed decision about exposure to
potentially allergenic gloves. Low allergen gloves and gloves that are powder-free
appear to be the standard to be emulated in the industry at this time. Hospitals should
aggressively seek out companies who can provide these high quality gloves and
institute a policy of using powder-free gloves in their facilities. Numerous reports
of the allergenicity of gloves have been published. Natural rubber latex gloves
should never be utilized for a patient with latex sensitivity as they may react to this
substance despite the low allergen content.
In addition to these functions, quality improvement opportunities should be
monitored by this group for patients and employees. All untoward events should be
monitored by this committee and reported to the Food and Drug Administration. The
development of this collaborative program is necessary to protect the patient and the
healthcare worker.
