Dr Anne Raynal Senior Medical Inspector HSE March 2007 Regulatory Issues in Managing Natural Rubber Latex Exposures in Healthcare Dr Anne Raynal Senior Medical Inspector HSE March 2007

Purpose of this talk Clarify: What does HSE require for legal compliance with regard to NRL use in health care? Risk assessment for NRL exposure Health surveillance, what form should it take?

Legal Requirements Health & Safety at Work Act 1974 – duty to keep employees and others safe at work Control of Substances Hazardous to Health Regs. 2002 – Risk Assessment for hazardous substances

Risk Assessment for NRL Identify the hazard Who may harmed and how Evaluate risks and decide on precautions Record findings and implement them Regularly review and update risk assessment

Precautions:=Control Measures Eliminate the risk – gloves should only be worn where there is a risk of infection Substitute with other suitable materials Limit exposure – only use where risk assessment has shown is necessary. If used must be low-protein and powder-free Health Surveillance for those still exposed Instruct, inform and educate staff on risks and control measures

Legal Duty to Provide Health Surveillance Management of Health and Safety at Work Regulations, Regulation 6, 1999 Control of Substances Hazardous to Health Regulations, Regulation 11, 2002 HSE Guidance Series HSG61, Health Surveillance at work

What is health surveillance? Regular and appropriate procedures to detect early signs of work-related ill health Acting on the results Select from a range of specific techniques

When is Health Surveillance Appropriate? It is part of the overall management of health risks Where the risk cannot be reduced or controlled to a level that it will not be harmful to health (a residual risk remains)

When is Health Surveillance Appropriate? The work is known to damage health in some way Damage to health under particular work conditions Valid methods exist to detect the disease early The technique is safe, practical and acceptable Finding disease early will benefit the employee

Valid Techniques Precise enough to detect something wrong Safe and practicable in the workplace setting

Validity of Screening Tests Sensitivity - the proportion of all diseased patients for whom there is a positive test, determined as the number of true positives divided by the sum of true positives + false negatives Specificity - the proportion of non-diseased patients for whom there is a correctly negative test, expressed as the number of true negatives divided by the sum of true negatives + false positives

Range of specific techniques Checks by a responsible person Inspection or symptom questioning by a qualified person Clinical examination by a doctor (medical surveillance) Biological or biological effect monitoring Keeping individual health records Self-checks by employees Baseline health assessment for a new job Giving information and referring employees to an OH professional where extra checks are needed

Self-checks by employees Not sufficient on their own Employees must be trained about the symptoms and signs to report to a responsible person or occupational health professional Also subject to periodic checks by a responsible person

What is a sensitive test in this context? Taking a history of reacting to latex gloves and improving when away 1.Itching/irritation of eyes, nose or chest, cough or wheeze 2. Redness, itching, scaling or vesicles on exposed skin

What is a Specific test in this context? IgE to latex Skin prick test Visual inspection of skin on its own – Is neither sensitive or specific as most redness/itching is due to drying out of skin from frequent washing

A non-confidential paper or computer based record Health Surveillance always requires keeping of individual Health Records A historical record of jobs involving exposures to substances or processes requiring health surveillance A record of outcome of health surveillance in terms of fitness to work/restrictions etc A non-confidential paper or computer based record

Acting on the results Prevent further harm to that individual Prevent further harm to others still exposed by re-examining the risk-assessment and decide what action to take to reduce exposure Reduce exposure by improving control measures Regularly review how health surveillance programme is working