When latex allergy and the high-risk populations were first recognized at Children's Hospital, it was imperative to develop nursing
policy and procedures specific for the care of the latex allergic
patient and the patient at high risk for developing the allergy. As
perioperative nurses in a pediatric center, we were seeing many
patients with hypersensitive reactions to latex. The majority of these
patients had spina bifida or a severe urologic anomaly, such as cloaca
or extrophy of the bladder. Along with the formation of nursing
guidelines, an all inclusive master list of latex-containing and latex-free products was developed.
Patients are exposed to latex on a much higher level during surgical
procedures. The knowledge about the serious effects from latex allergy prompted the formation of the Latex Committee at our hospital.
This committee consisted of representative individuals from multidisciplinary units. The work ahead of this committee at its commence-
ment seemed overwhelming, as there were many questions surrounding the issue of latex allergy and the implementation of guidelines.
We needed a policy that would be practical and universally accepted
by every discipline in the hospital.
Dr. Robert Holzman and Dr. Navil Sethna of our Anesthesia
Department kept statistics on the number of latex allergic reactions
that were occurring in our operating room suites. Their findings,
along with others in the literature, concluded that the spina bifida and
congenital urological anomaly groups were indeed at high risk for
latex allergy. To date we have had 40 latex allergic patients return for
a total of 62 surgical procedures. Latex precautions were implemented without any prophylactic medication given, and no incidents of
latex allergic reactions were evident.
This evidence aided in the formation of our hospital-wide guidelines,
to include all spina bifida and congenital urologic anomaly patients
to be treated with latex precautions in order to decrease their exposure to latex. We consider patients with a history of latex allergy
"latex allergic," and they are labeled as such in their record, with an
allergy ID band, a sign on their O.R. room doors, the inpatient room
door and on the bed.
The two high-risk groups (spina bifida and congenital urological
anomaly patients) are labeled "latex alert," and treated with the same
latex precautions as the labeled latex allergic patient. Even though
the history for latex allergy may be negative, the risk is too great
to expose these groups to latex. Spina bifida patients have been
known to have up to 50% incidence of latex allergy.
Communication is very important regarding the existence of a latex
allergy or the risk for the allergy. Knowledge of the need for latex
precautions prior to the preparation of the surgical case is mandatory,
as many alterations in the set up for the procedure must be made.
In our quest to make up the perfect all-inclusive list of latex and
latex-free items, we have found it a challenge to keep it updated.
Research is done on each item, including lot and product numbers.
Manufacturers have the right to change the product content without
any notification of the alteration. Health care providers must remain
aware of any changes, and companies should realize the repercussions of such changes.
We consider the implementation of our Latex Policy and Procedure a
success thus far, with thorough patient histories and assessments,
communication, and in-house teaching being the necessary prerequisites for such success. It is still a new phenomenon to many, and education about latex allergy is essential to prevent serious, life-threatening reactions due to latex exposure.
