1. 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

2. 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?

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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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