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Lois Schick MN, MBA, RN, CPAN, CAPA

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1 Lois Schick MN, MBA, RN, CPAN, CAPA
Latex Allergy Lois Schick MN, MBA, RN, CPAN, CAPA

2 Latex Sensitivity Review the development diagnosis and current treatment of latex allergies Describe each of the 3 types of human reactions to natural rubber/latex containing products Identify currently available diagnostic tests and medical treatment options

3 NIOSH National Institute for Occupational Safety and Health
Established under the Occupational Safety and Health Act A division of the Centers fro Disease Control and Prevention (CDC) Not OSHA In Ireland and Great Britain it is the NHS

4 NIOSH Recommendations
June 1997 released-prevention oriented Use the appropriate glove for the task at hand Summarizes employer and worker info Targeted towards hospitals, day care facilities, food service industry, environmental services

5 June 1997 was too late for nurse Cheryl Maree Mohrbacker
Cheryl was a 41 year old RN in Oregon Worked 3-11 Shift Cheri never came home from work one night Her Story: Visiting father in hospital and she develops a severe allergic reaction which required 3 days on a ventilator Carpets were being cleaned at hospital and her reaction was attributed to a reaction to the cleaning chemicals Had a second bout again when carpets were being cleaned at a hospital where she was employed

6 Cheri’s story Cheri realized she was only having reactions when wearing Latex gloves In 1994, Cheri was tested for and diagnosed with a latex allergy. She switched to hypoallergenic gloves which are meant for those who suffer from dermatitis. Some hypoallergenic gloves have been found to have 3000 times the latex protein as regular latex gloves making them more dangerous to latex sensitive nurses Eventually she got latex-free gloves.

7 Cheri’s story June 10, 1996 Cheri had a severe attack while at work.
She was rushed to the ED and told the staff there that she was latex sensitive. At one point Cheri grabbed one nurse by the arm so hard that she left bruises and her last words to this nurse were: “You’re just going to let me die. I’m not going to make it this time.” Cheri was right – she did die in the ED that night.

8 Natural Rubber Latex (NRL)
Milky fluid derived from the rubber tree (Hevea Brasiliensis) Two methods of treatment prior to use Coagulate to solidify Dry natural rubber i.e. tires, shoe soles Ammonionate to prevent coagulation Gloves, condoms Proteins can cause range of allergic reactions

9 Latex Allergy 18-73% sensitization rate in children with Spina Bifida
Latex allergy affects 18 million Americans Increasing rates of sensitization 18-73% sensitization rate in children with Spina Bifida 33% sensitization rate in those having 3 or more surgeries 15% sensitization rate in RN’s

10 Latex Allergy 17% sensitization rate in ALL health care workers (2% have occupational asthma) Increased sensitivity in operating room personnel from 2.95% to 15% in less than 10 years Increased rates in dental personnel from 13.7% to 38% in 4 years

11 Suspected populations at risk
Congenital neural tube disorders Urologic disorders requiring catheterizations 3 or more surgeries History of systemic reactions to balloons, latex gloves, condoms, cosmetics, rocket handlers, Poinsettas

12 Suspected populations at risk
History of allergy to fruits with cross reactive proteins Hay fever, asthma, contact dermatitis Food allergies to: bananas, avocados, passion fruit, kiwis, chestnuts, tomato, Celery, melon,

13 Manifestations of Latex Allergy
Delayed hypersensitivity Contact pruritus, erythema, uriticaria, eczema Immediate hypersensitivity Rhinorrhea, conjuctival pruritis & edema, wheezing, bronchospasm, angina, tachycardia & progressively severe hypotension

14 Onset & Symptoms Type I: Immediate Hypersensitivity
Progresses in minutes Resolves spontaneously over 1-2 hours Immediate, local and generalized uriticaria, feeling faint, feeling of impending doom, angioedema, nausea, vomiting, abdominal cramps, bronchospasm, anaphylaxis

15 Onset & Symptoms Type I: Immediate Hypersensitivity
Anaphylaxis: Typically within 30 minutes after exposure Cutaneous, GI, CV, Respiratory Laryngeal edema and CV collapse most common cause of death Immunoglobulin & mediated systemic reaction to the latex proteins that if untreated lead to fatality

16 Onset & Symptoms Type IV: Delayed Hypersensitivity
Contact Dermatitis Appears in hours Resolves in hours Redness & inflammation over exposed sites Blister formation Allergic Dermatitis T-cell mediated delayed localized reaction to chemicals used in manufacture of gloves

17 More prolonged the latent period between antigen exposure and the onset of symptoms, the more benign the reaction

18 Equipment Issues act as a vector for patient sensitization
GLOVES act as a vector for patient sensitization Workers are at risk as a population from multiple exposures 5-6 million workers wear gloves regularly 117 million pairs of latex gloves were supplied to NHS in 1992 NHS – National Health Services


20 Equipment Issues itching, hives, vesicles, erythema, and eczema
Latex gloves can cause contact allergic reactions itching, hives, vesicles, erythema, and eczema Usually a delayed hypersensitivity reaction Workers may have concurrent chemical sensitivities to additives in latex

21 Equipment Issues 40,000 consumer products that contain latex in their composition. Makes it difficult to completely delete latex

22 Environmental Issues Latex particles are suspended in indoor air in health care settings Powder in gloves is the vehicle for latex particle aerosolization Aeroallergens are higher in areas where workers frequently apply and discard gloves When latex particles are inhaled, workers become sensitized

23 Sources of Latex - Hospital
Gloves - sterile and exam Catheters IV injection ports Medication vials with needle access Ventilator, anesthesia, and respiratory therapy equipment Latex tipped enemas, endoscopy parts Mattresses on stretchers Stethoscopes & blood pressure cuff tubing

24 Source of Latex - Home Environment
Household gloves Diapers, bottle nipples, pacifiers Household insulation material, carpet backing Newsprint, coupons, and magazines dusted with latex coating Feminine sanitary pads, adult diapers, condoms, diaphragms Clothing including elastic on underwear

25 Methods of Exposure Cutaneous & Mucosa Inhalants IV & Parenteral
Gloves, dental equipment, surgical procedures, food prepared by people wearing latex gloves, toys, clothing, sports equip. Inhalants Anesthesia machines, powder from latex gloves, balloons, car tires IV & Parenteral IV ports, tubing, burettes, bottles and syringes

26 Clinical Management of systemic reactions
Antihistamines - oral, IM, IV Chlorphenamine Diphenhydramine Steroids - inhaled, oral, IV Bronchodilators - inhaled, oral, IV Epinephrine - SQ & IV

27 Clinical Management Latex-safe preoperative and patient rooms
Latex-safe OR, PACU and anesthesia equipment Latex-safe neonatal resuscitation equipment Drugs must not be administered through latex ports, nor dwell in syringes with latex plungers

28 Clinical Management Operating Room
Schedule latex - safe cases first of the day to allow settling of latex dust overnight Latex-safe anesthesia equipment Latex-safe respiratory equipment Latex-safe IV delivery systems Recognition of inadvertent latex exposure

29 Clinical Management Emergency Department
Latex-safe intubation & ventilation equipment Latex-safe IV equipment Latex-safe gloves and monitoring equipment Laminar air flow available for the “exquisitely” sensitized

30 Latex Allergy Identification
Screening criteria and diagnosis of latex allergy Methods of allergy testing RAST – RIA (invitro test IgE) with variable sensitivity AlaSTAT – ELISA testing ( IgE testing) Skin Prick - Most sensitive but carries risk of anaphylaxis

31 Management of the Latex sensitive individual
Non latex gloves for the employee Non latex for co-workers (Preferred) or powder free Medications ( epi-pen, antihistamines, inhalers, steroids) Education of co-workers Complete removal of latex sources from work place

32 Environmental Preparation
Remove latex sources from room Dust and vacuum with HEPA filters Mop all surfaces Label room with a “Latex Allergy”Sign Obtain non-latex medical equipment (Cart) Reverse laminar air flow room if possible

33 Equipment Concerns Non-latex exam and sterile gloves. NO Exceptions !
neolon, nitrile, & butadene-styrene Latex-Free respiratory support equipment Non-latex ambu bag, ETT, cannulas, & masks readily available Non latex anesthesia machine components (Ohmeda, North American Draeger & Anesthesia Associates retrofits

34 Latex-Free IV Equipment
Clave ( ICU Medical), Interlink ( Baxter), IVAC & Braun needleless IV tubings Protective Plus (Johnson & Johnson) Insyte (Critikon), Abbocath, Clear-cath Central lines-check with Arrow & Bard Heparin Locks - B. Braun and Abbot

35 Medications & Specialty Procedures
Use needleless systems with latex free syringes or prefills Abboject for most emergency drugs Approved Wyeth-Ayerst blunt tip or tubex drugs only Latex-free syringes - Terumo, Norm-ject ( Air-tite) & Becton Dickinson DeRoyal Procedure Packs

36 Personnel Specifics Nursing, Laboratory, Pharmacy, Housekeeping & Food Service staff don fresh gowns when entering a latex-allergic person’s room to prevent latex glove residue on clothing from being introduced. All personnel wear non-latex gloves Food prep done with non-latex gloves

37 Items that have caused Anaphylaxis and Fatalities
Latex gloves Meds injected through latex topped vials into latex IV ports Latex tipped enema catheters, urinary catheters Respiratory and resuscitation equipment

38 Nursing Research Sample of 79 Type I allergic response to latex
49% RNs Qualitative - Fears, Lifestyle changes, Job and family impact Findings in a nutshell Almost all respondents fear needing EMS and Medical care Denial of symptoms often results in worsening

39 10 Latex Precaution Interventions
1. Identify those at risk as well as those who have had reactions. 2. Communicate information about the patient to all departments who have contact with the patient. Latex Precaution checklist 3. Admit patient to environment that reduces exposure to latex

40 10 Latex Precaution Interventions
4. Call for Latex Precautions cart. 5. Use Latex-free gloves for any patient contact. Sterile & nonsterile. 6. Schedule surgeries/procedures as first case of the day. 7. Protect patient from direct contact. 8. Follow physicians orders for pre and/or post anaphylaxis medications. BE Prepared!

41 10 Latex Precaution Interventions
9. If appropriate, maintain a unit specific Latex Free “Tool Box”. 10. Educate the patient and the family-Refer cases to appropriate medical care, contact latex information networks. LISTEN TO THE PATIENT!!!

42 Summary Obtain latex free equipment before it is needed
Suspect every patient and any employee with symptoms Resources: Elastic - Latex Cart Products List - Journal of Emergency Nursing 1998; 24L58-61

43 Foot to the Pedal

44 Resources: Elastic -
Latex Cart Products List - Journal of Emergency Nursing 1998; 24:58-61 AANA: American college of Allergy Asthma immunology:

45 See YOU in Seattle, WA. USA
April 3-7, 2011

46 Thank YOU Lois Schick MN, MBA, RN, CPAN, CAPA 12823 W. 3rd Place
Lakewood, CO USA E- Mail: Home: Cell:

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