1. Restricting Latex Glove Use in Food Service Establishments in Oregon: A Public Health Response Michael A. Heumann, MPH MA Oregon Department of Human Services Environmental and Occupational Epidemiology 800 NE Oregon St., # 827 Portland, OR 97232-2162

2. Outline of testimony What did we do? How did Oregon become aware if the problem? Why did we act? The role of our partners in developing a response

3. What did we do? Oregon Administrative Rules OAR 333-150-0000 1999 FDA Food Code Section 3-304.15 Glove, Use Limitation. (E) Effective March 1, 2003, the use of latex gloves in food service establishments is prohibited.

4. How did Oregon become aware of the problem? Tracking occupational illness & injury in Oregon since 1992 Workers compensation claims Occupational skin conditions Latex allergy in health care industry

5. Responding to Latex Allergy in Health Care Research the science around latex allergy Education about hazards & alternatives Encourage latex-safe environments Partners hospitals & other employers employees workers compensation insurers NIOSH

6. Latex glove use in the food service industry 1998 first case reports identified latex glove dermatitis among food workers in W.C. data Text of accident description: Allergic reaction to wearing latex gloves Received severe rash on both hands due to latex gloves Text of injury description: Respiratory disorders lungs Dermatitis on hands

7. Latex glove use in the food service industry

8. 12 cases among workers in 1 st two years Reports of allergic reactions among restaurant customers with prior history of latex sensitivity Range of symptoms Anaphylaxis throat tightness difficulty breathing

9. Latex glove use in the food service industry -- DHS response Confirm cases with WC Insurer Confirm use of latex gloves in restaurants Confirm cases among customers Identify partners with clear self interest Oregon Restaurant Association (ORA) United Food & Commercial Workers Union (UFCW) Local Health Departments Liberty Northwest Insurance

10. Latex glove use in the food service industry -- DHS response Liberty Northwest & ORA Meeting & agreement to collaborate Immediate changes among large restaurants and corporate chains Articles in ORA newsletter Goal of voluntary change (similar to health care industry) UFCW Meeting & agreement to collaborate Article in union newsletter

11. Latex glove use in the food service industry -- DHS response Local Health Departments Training about hazards and alternatives Developed Latex Alert for restaurants 5 Counties collaborated in a pilot intervention gather information provide education distribute Latex Alert in English & Spanish

12. Why did we act? Positive response among restaurants and suppliers contacted Potential liability from customer incidents was the greatest motivator to change Contact from attorneys looking for cases

13. Why did we act? Latex allergy cases continued to be reported Sought a way to address latex glove use in food services statewide Simply way to prevent cases Protect customers, employees, employers & suppliers

14. Why did we act? DHS planned to adopt 1999 FDA Food Code Opportunity to act Oregon rules require hand washing, not glove use Rhode Island & Arizona had latex glove bans Complex language Proposed simple language The use of latex gloves in food service establishments is prohibited. Implementation date negotiated with ORA

15. Why did we act? Food Code rule adopted in August 2002 Major media coverage to announce the ban Advised restaurants & suppliers of change Letters Articles Local Health Dept. inspectors provided advice Encouraged to adopt prior to implementation date Many questions, general support

16. The role of our partners in developing a response Important to cultivate wide support among affected parties Identify who has a stake & what is their interest Provide appropriate education about the issue Involve them in the decision-making process as much as possible

17. Conclusions Oregons actions Based on tracking to identify patterns and problems Understand the science underlying the issue Apply science to policy in collaboration with key stakeholders First attempted voluntary change Adopted formal rule change only when needed

18. Conclusions Natural rubber latex has an important place Protection against exposure to blood borne pathogens –> in health care Low protein/powder free gloves safest option for people who are not already latex sensitive Many alternative glove materials exist Glove selection should be specific to use

19. Conclusions Powdered natural rubber latex gloves are being promoted in many other settings Child care, janitorial, house keeping, agriculture, food processing & nutritional supplements industries Latex allergies are real and preventable