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Management Of Latex And Latex Allergy

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					             Management of Latex and Latex Allergy Policy

Document Information (does not change)

Board         Document         Document          Original Document Author           Assured By          Review
Library       Type             Subject                                                                  Cycle
Reference
HS_IGCS_19    Policy           Health & Safety   Head of Health & Safety            Quality and         3 years
                                                                                    Healthcare
                                                                                    Governance
                                                                                    Committee




Version Tracking (updated for all subsequent versions)

 Version     Date         Revision Description                             Editor     Ratification Status
 2.00        2005-04-25   Approved by Board                                PAD        Ratified by Board
 2.01        2009-05-14   Draft version                                    PAD        Draft
 2.02        2009-05-18   Amended and approved by the Health, Safety,      PAD        Draft
                          Security and Fire Group and the Safety Forum
 2.1         2009-05-27   Amended and approved by the Quality &            PAD        Ratified Policy
                          Healthcare Governance Committee
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Table of Contents




1. Introduction ....................................................................................................................... 3
2. Purpose ............................................................................................................................ 3
3. Scope ............................................................................................................................... 3
4. Definitions ......................................................................................................................... 3
5. Policy ................................................................................................................................ 4
6. Arrangements for Implementing this Policy ...................................................................... 4
7. Responsibilities................................................................................................................. 6
8. Training............................................................................................................................. 9
9. Monitoring or Audit ........................................................................................................... 9
10. Review ............................................................................................................................ 10
11. References ..................................................................................................................... 10
Appendix 1: Risk Assessment – Glove Usage ....................................................................... 11
Appendix 2: Risk Assessment – Glove Selection ................................................................... 12
Appendix 3: Generic Risk Assessment .................................................................................. 13
Appendix 4: Common Items Containing Latex ....................................................................... 15
Appendix 5: Identification and Assessment of Latex Risks .................................................... 16
Appendix 6: Management of Staff With Latex Allergy ............................................................ 19
Appendix 7: Management of Patients With Latex Allergy ...................................................... 20
Appendix 8: Natural Rubber Latex Allergy Screening Questionnaire .................................... 23




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Introduction

Latex Allergy is a condition that has been recognised for many years. However, there has been a rise in
the incidence of Latex Allergy due to increased exposure to natural rubber latex in the form of medical
and non-medical products, especially latex gloves used by healthcare workers.

Universal precautions against blood borne viruses have resulted in a greater use of hand protection.
Latex is the single most used material for gloves and it is this combination that is believed to have
caused the increase in latex allergy


Purpose

This policy aims to remove the unnecessary usage of latex gloves within the Trusts activities by
prohibiting the use of latex gloves within the Trust.

This Policy has been produced in order to give guidance for staff on a proactive approach to Latex
Allergy. This is to prevent, or reduce the risk of, allergy occurring and is to be followed at all times.


Scope

This Policy applies to all clinical areas and extends to all staff on Trust business in a hospital setting,
third party premises or within a patient’s home.


Definitions
Natural rubber latex (NRL) is a natural substance produced by the Hevea brasiliensis (rubber) tree. It is
used in thousands of household, industrial and medical products. NRL is composed of many different
types of natural proteins. A number of chemicals (accelerators) are added during production, most of
which are removed in the washing processes during the latter stages of manufacture.

4.1     What Is Latex Allergy?
Latex Allergy is an immune system response to one or more of the components of natural rubber latex
products. The immune system develops antibodies during a sensitisation period, which may last just a
few weeks to years. Once the body learns to recognise the foreign substance or allergen, exposure will
always cause a response by the immune system and the symptoms of allergy. Reactions are divided
into two categories:

           Reaction is usually immediate, that is within 2-3 minutes after exposure.
 Type 1    Symptoms include localised weal and flare reaction, asthma, rhinitis,
           conjunctivitis and anaphylaxis

           Delayed reaction occurring up to 48 hours after exposure and causes localised
 Type 4
           reddening of skin and itching




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Staff with Type 1 and Type 4 reactions need to be seen by the Occupational Health Physician. Once an
allergy develops to latex it is a serious and irreversible condition, posing a threat to health and work for
patients and staff.

Not all skin reactions are allergies. A large number of skin reactions among staff are irritant responses
due to localised damage to the skin from physical or chemical agents. These are confined to the area of
contact (glove). Advice needs to be sought from Occupational Health Department on diagnosis and
treatment.



Policy

Avon and Wiltshire Mental Health Partnership NHS Trust recognises its duty under the Health and
Safety at Work Act, (1974), the Control of Substances Hazardous to Health Regulations (2002), and the
Management of Health and Safety at work Regulations, (1999), to provide a safe environment for both
its employees and patients and to protect them from hazards, which may arise in the course of health
care activities.

The Trust recognises that Natural Rubber Latex (NRL) is a hazard to both health care workers and
patients in hospital environments, and that it is a potent sensitiser, which may give rise to serious
allergic reactions and imposes on the Trust the obligation to minimise exposures as far as is reasonably
practicable.

This policy document sets out the steps, which are to be taken to protect both patients and employees
from the risks of NRL allergy arising from health care activities.

It is the aim of this policy: -

     To improve awareness and prevention of latex allergy.
     To provide guidelines for all Trust employees on minimising and managing latex allergy problems
      in addition to hand care protocol.
     To provide guidelines for the safe management of patients throughout the trust.
     To provide information and advice to Healthcare workers with latex allergies.


Arrangements for Implementing this Policy

6.1      Glove Usage

         Gloves should only be worn where infection control and safety concerns dictate. See the
         guidance chart in Appendix 1 for information


6.2      Glove Selection

         Gloves should be selected on the basis of end usage and appropriate protection. See the
         guidance chart in appendix 2 for more information.




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6.3    Avoidance Strategy

       The Trust operates a latex avoidance policy with regard to gloves.

       Routinely there is no reason to use latex gloves within the Trusts normal activities. Alternative
       materials will be made available for procedures where gloves are required.

       Latex gloves will not be available through supplies routinely. Usage for latex gloves will be
       also monitored.

       •       Only wear gloves when necessary following a risk assessment approach
       •       Do not use powdered or non-powdered latex gloves at all
       •       Reporting of any problems to Occupational Health quickly

6.4    Identification of Patients with Latex Allergy

       Patients who are considered high-risk, suspect or symptomatic can be identified through the use
       of the admissions history screening or asked directly about allergy to rubber. Groups known to
       be at risk include:

           Healthcare workers
           Workers in the rubber industry
           Patients who have had multiple surgical operations
           Patients with meningomyelocoele or urogenital abnormalities
           Patients allergic to certain fruits: banana, melon, avocado, chestnut, orange and kiwi due to
            cross reactivity with similar proteins contained in them

       Where latex allergy is indicated, a risk assessment of all medical equipment should be
       undertaken to identify other sources of latex; i.e. tubing, mattress covers, syringe seals etc.
       Further information is given in Appendix 8 on health questionnaires and in Appendix 7 on
       management action required when latex allergy is indicated

6.5    Generic Risk Assessment

       Latex and latex allergy are covered by the Control of Substances Hazardous to Health
       Regulations 2002 (as amended) (also known as the COSHH Regulations). Whilst these
       regulations impose a duty to assess the risk within the workplace, the Trust has taken a general
       view of the risks and implements the avoidance strategy (in 6.3 above) as the appropriate control
       measure for latex gloves (see Appendix 3). Gloves are not the only source of latex within the
       workplace and COSHH risk assessments should be undertaken to identify other sources of latex.
       A list of common items likely to contain latex can be found in Appendix 4.




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6.6    Incident Reporting

All untoward incidents involving staff latex allergy must be investigated and reported to the Risk
Management Department on an Incident Report Form as per the Adverse Incident Policy

All incidents involving patient latex allergy must be investigated and reported to the Risk Management
Department on an Incident Report Form as per the Adverse Incident Policy


7.     Responsibilities


       7.1      Executive Management

       The Board has overall responsibility for the health, safety and welfare of all staff, service users,
       visitors and others within AWP. The Chief Executive is responsible for monitoring and
       reviewing health and safety in the Trust. The Board will be informed of health and safety
       matters on a regular basis and ensure adequate resources are made available to provide and
       maintain the necessary standards of health and safety in the Trust.
       Members of the Executive Management Team have full responsibility for the health, safety and
       welfare of all staff, visitors and others within the wards, offices etc under their specific
       management.

       The Nursing, Compliance, Assurance and Standards Director has responsibility for the co-
       ordination of health and safety policies, activities and governance within the Trust.

       The Medical Director has responsibility for the co-ordination of health and safety policies
       applying to Medical Staff working in the Trust.

       All Directors have a corporate responsibility to promote a responsible approach in health and
       safety in the Trust


       7.2      Responsibilities Of The Chief Executive

       While ultimate responsibility is vested in the Trust Board, executive responsibility is delegated
       to the Chief Executive for managing health and safety, including compliance with relevant
       legislation and Trust policies.


       7.3      Responsibilities of the Director Of People

       The Director of People, as Director responsible for training takes responsibility for ensuring that
       the Learning & Development Department provides adequate training to ensure this policy is
       implemented and that the content of the training is regularly reviewed to ensure it continues to
       provide the necessary skills and knowledge to ensure staff are able to discharge their legal duties
       and duty of care in accordance with current standards and best practice




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       7.4        Responsibilities of the Director Of Nursing, Compliance, Assurance and
                  Standards

       The Nursing, Compliance, Assurance and Standards Director has responsibility for the co-
       ordination of Infection Control and health and safety policies, activities and governance within
       the Trust.

       7.5        Responsibilities of the Operations Director

       The Operations Director takes responsibility for ensuring that this policy is implemented within
       teams. The Operations Director will ensure that SBU’s follow the policy and that all levels of
       management fulfil their responsibilities as described within this policy.


       7.6        Responsibilities Of SBU Directors

       SBU Directors will bring this policy to the attention of all their staff, including new and
       temporary staff, and management team and ensure that it is observed at all times. SBU
       Directors will also require each team to:


            Ensure risk assessments are undertaken which identify the risks of latex allergy and the
             adequacy of the systems that manage these risks.

            Risk assessment findings must be recorded and should be entered on the SBU service
             specific risk register. Action should be taken to rectify any risks in line with good risk
             management process.

            Ensure control measures and safe systems of work as necessary are developed and
             implemented in accordance with this policy

            Ensure that the process is monitored and adequate support is provided for line managers to
             ensure that their responsibilities are met.

            Ensure arrangements which implement this policy are devised and reviewed.

       Play a key leadership role in developing and sustaining a pro active culture, personal and
       professional responsibility for health and safety issues and work as they relate to latex allergy.


       7.7        Responsibilities Of Line/Ward Managers & Team Leaders

       All managers and lead clinicians must ensure that:

            This policy is brought to the attention of all staff;




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            All Latex gloves are removed from stock and non latex gloves are provided (see appendices
             1 & 2 for selection of appropriate gloves)

            Other products containing latex are identified, listed and when possible warning labels
             affixed to them;

            Risk assessments are carried out, and where possible, measures put in place to prevent
             exposure to latex, e.g. by replacing products containing latex with non-latex alternatives
             (See Appendix 4);

            Where the above is not possible safe systems of work are developed to minimise exposure.

            Where a manager purchases latex gloves independently, and without the knowledge of the
             procurement manager, the manager will carry the responsibility for the associated risks. This
             will be dealt with under the Trust’s disciplinary policy.

            Clinical procedures are developed to ensure that patients that may be prone to latex allergy
             are identified and those who develop or have an existing latex allergy can be managed
             within the Trust safely; (see Appendices 6 & 7)

            There are sufficient staff trained to implement these procedures and they are followed;

            All 'new' (new to Trust) staff are given Occupational Health screening as per Recruitment
             and Selection Policy.

            Staff with symptoms suggestive of latex allergy is referred to Occupational Health and an
             Incident Report Form completed in accordance with Incident Reporting Policy.

            Any action that may be necessary as a result of the above investigation is taken and
             documented, with a report sent to the appropriate SBU Director with a copy to Risk
             Management and Health and Safety;

            Affected staff are given support and are informed of any action taken;

            Staff are given adequate information, instruction, training and supervision in the health risks
             involved with working with latex, how to recognise symptoms and how to care for a patient
             when a problem arises;

            Risk assessments, safe systems of work and written protocols are evaluated and reviewed at
             least annually, or when circumstances dictate, e.g. when there is a change in working
             practices, equipment, adverse incidents, etc.



       7.8        Responsibilities Of Individual Employees

       It is the responsibility of all Trust employees to co-operate with Managers to assist in the
       compliance of this Policy and for reporting all incidents connected with Latex Allergy.




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       Staff should familiarise themselves with the guidelines on when and what type of gloves should
       be worn (see Appendices 1 & 2) and to obtain prompt help from Occupational Health should
       problems arise.

       Staff must not use latex gloves.

       Staff should advise their manager if any procedure gives cause for concern when using latex
       free alternative gloves


       7.9       Learning & Development Department

       The Learning & Development Department will provide an adequate training resource to ensure
       that the Trust can comply with its policy. It will liaise with operational management to ensure
       that training needs are monitored and that provision reacts accordingly.


 8.    Training

       The Trust's overarching policy for training is the Learning and Development Policy and this
       should be read in conjunction with this policy. Attached as appendices to that policy are the
       Trust's learning and development matrices. These matrices describe the minimum statutory,
       mandatory and required training for all staff groups in respect of health and safety.

       The Learning and Development Policy also describes the Trust's arrangements for training, in
       particular how there are processes in place to ensure staff receive the training they require and
       how non-attendance is followed up. These arrangements are further supported by management
       supervision and appraisal processes.

       The Trust lead for health and safety has agreed the training standard with the Learning and
       Development Team and training standards have been informed by statutory requirements,
       professional standards and national best practice.

       The Trust lead for health and safety participates in a programme of continuous professional
       development to ensure they remain up to date and keep abreast of developments in this field.

       Latex allergy and glove use is covered as part of Infection Control Training and COSHH
       awareness training.


 9.    Monitoring or Audit


       The Trust will establish key performance indicators for health and safety and closely monitor
       performance through the use of the balanced scorecard. The corporate balanced scorecard will
       be reported to the Board on a quarterly basis and directorate balanced scorecards will be
       considered on a quarterly basis as part of performance review meetings.

       Implementation of this policy will follow a number of lines, and include:
       -     Monitoring of training uptake and any gaps


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       -    Action plans to address any gaps in performance
       -    Audit and review of risk assessments
       -    Undertaking and reviewing the results of the Annual Health and Safety Self
            Assessment process
       -    Monitoring of adverse incidents.
       -    Inspection of workplaces for evidence of use of latex gloves
       -    Auditing of purchasing records to determine if latex gloves have been ordered.

       An annual assurance report on health and safety will be provided to the Safety Management
       Group.


 10.   Review


This policy will be reviewed every three years.



 11.   References

HSE (1974), The Health and Safety at Work etc. Act 1974
HSE (1999), The Management of Health and Safety at Work Regulations 1999
HSE (2002), The Control of Substances Hazardous to Health Regulations 2002

HS_IGCS_01           Health and Safety Policy
HS_IGCS_28           Risk Assessment (Non-Clinical Risks) Policy
HS_IGCS_31           Policy on the Control of Substances Hazardous to Health
HR_GOV_35            Recruitment and Selection Policy
GOV_IGCS_06          Medical Equipment Policy
CLI_IGCS_01          Standard (Universal) Infection Control Precautions
CLI_IGCS_05          Safe Handling and Disposal of Sharps
CLI_IGCS_06          Prevention of Exposure to blood-borne viruses
CLI_IGCS_09          Disinfection (Decontamination)
CLI_IGCS_20          A-Z of Communicable Diseases and Disease Specific Precautions
CLI_IGCS_21          Hand Hygiene
CLI_IGCE_01          Policy for the Monitoring of Physical Health Checks

HSC 1999/186 - "Latex Medical Gloves and Powdered Latex Medical Gloves" – (Health Service
Circular).

"Latex Sensitisation in the Health Care Setting (Use of Latex Gloves)" - (Medical Devices Agency).

IND320 - "Latex and you" - (Health and Safety Executive).




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Appendix 1: Risk Assessment – Glove Usage

  Are Gloves Really
  Necessary?
                                                              Gloves ARE required for procedures where
                                                              there is a risk of cross infection between
      Gloves are NOT required for procedures where
                                                              patients and staff and further risk assessment
      there is minimal risk of cross infection between
                                                                           IS THERE
                                                              should be carried out A HIGH RISK OF
      patients and staff,, e.g.
                                                                           EXPOSURE TO BLOOD OR
        Basic care procedure without contact with                         BODY FLUIDS ?
            blood or body fluids
        Transferring food from food trolleys to                           N                  Y
            patient bedside                                                O                  E
        Making uncontaminated beds/changing or                     NON                  IS A S
                        DON’T WEAR                                  STERILE              STERILE
            removing patients’ uncontaminated clothing
                        GLOVES                                      VINYL                FIELD
        Taking recording (BP,Temp, Pulse)
                                                                                          Y
                                                                                         REQUIREDN ?
                                                                                          E
                                                                                                   O
                  NON THEATRE                      THEATRE                                S
                                                                                            NON STERILE
                  ENVIRONMENT:                     ENVIRONMENT:
                                                                                            NITRILE OR
                                                                                            SYNTHETIC
                     STERILE NITRILE                   Not applicable to AWP
                                                                                            GLOVE WITH
                                                                                            EQUIVALENT
                                                                                            BARRIER
                                                                                            PROPERTIES
Management Of Latex And Latex Allergy            Version Error! Unknown document property name.2.1


Appendix 2: Risk Assessment – Glove Selection

   GLOVE SELECTION -
                                                  Type of Activity
   GUIDANCE


    Cleani          Food                   Tasks where there      Procedures involving    Procedures which
      ng          Handling,                is a low risk of       high risk of exposure   require a sterile field
                 Preparation,              contamination,         to BBV’s and where      and high barrier
                   Serving                 non-invasive           high barrier            protection, for
                                           clinical care, or      protection is needed.   example:
                   Polythe                 environmental          E.g.                         Clinical care to
                     ne                    cleaning. Eg.               Potential               surgical
                                                 Emptying              exposure to             wounds/drain
                                                  urinals,              blood/body              sites
                                                  bedpans and           fluids, e.g.           Insertion of
                                                  suction               blood spillage,         urinary
                                                  bottles               faecal                  catheters
   Blood                                         Clinical              incontenance,
    borne      General          Isolatio          cleaning              blood glucose
     virus     Cleanin          n Room           Dressing              monitoring,
   exposu         g                               wounds                administering
      re/                                         where                 suppositories             Sterile
     Non-
   spillag      Colour           Vinyl            contact with
                                                    Non-                and rectal or
                                                                           Non-                   Nitrile
    sterile     coded                             blood/body
                                                   sterile              vaginal
                                                                          sterile                 examin
       e
    nitrile    marigold                           fluids is
                                                    vinyl               examination
                                                                          nitrile                  ation
                  s                               unlikely             Handling                   gloves
                                                 Applying              disinfectants
                                                  creams               Basic care and
                                                 Touching              specimen
                                                  patients skin         collection
                                                  with                  procedures on
                                                  unknown               patients known
                                                  skin rash/            or suspected of
                                                  scabies               being high risk
                                                 Making                of BBV
                                                  beds/changin          Venopuncture
                                                  g of patients        Handling
                                                  clothing in           used/dirty
                                                  isolation             instuments



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Appendix 3: Generic Risk Assessment


Hazard               Risk                             Persons at Risk            Controls

COSHH –                 Irritant response: usually   Healthcare workers         Advice:
Latex products           reversible i.e. skin         especially nurses/         AWP has a latex free
with starch powder       irritation, dry and itchy,   physicians;                glove policy.
or potential             resolves once contact         Staff/ patients who      Restrict supply of latex
allergens,               with irritant discontinued       have acquired          products and ensure:
                        Delayed hypersensitivity         sensitivity to latex    Managers checking
                         (Type IV) also known as          proteins especially       and acting on skin
                         Allergic Contact                 patients with Spina       complaints for
                         Dermatitis. Reaction             Bifida or urological      individuals
                         delayed, occurs several          malformations;          Staff awareness;
                         hours after contact          At risk:                    Guidance available;
                         reaching a maximum 24-        Staff/ patients with      Occ. Health
                         48 hours and then                a background of           facilities and advice
                         subsides.                        atopic eczema,          Appropriate Health
                         Repeated exposure may            asthma, and hay           Surveillance
                         cause spread beyond              fever                     measures;
                         immediate area of             Individuals with          Patients referred to
                         contact.                         certain food              Dermatologist
                         Individual may become            allergies e.g.          Staff referred to
                         sensitised to other latex        avocado, chestnut,        Occ. Health
                         products.                        banana;                 Monitor and audit
                        Immediate                     Partners of                 incidences of Latex
                         hypersensitivity (Type 1)        Healthcare Workers        sensitivity.


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                   or Immunoglobulin E (Ig     from powder
                   E)                          brought home on
                   Response usually within     clothing.
                   30 minutes of
                   exposure – diminishes
                   once contact ceases.
                   Symptoms:
                  Local or generalised
                   urticaria/ oedema;
                  Mucous membranes if
                   affected – rhinitis,
                   conjunctivitis or asthma;
                  Respiratory difficulties,
                   anaphylaxis in extreme
                   cases, fatalities.




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Appendix 4: Common Items Containing Latex

  The list below provides guidance on products commonly used in healthcare. The list is not exclusive or exhaustive. Further advice on the extent of
  risk should be sought from the NHS supplies, Occupational Health, Pharmacy or directly from the Customer Service Department at the product
  manufacturers.
        Sterile and non-sterile disposable gloves
        Adhesive plaster e.g. Elastoplast
        Electrode pads – the glue may contain latex
        Tourniquets
        Oxygen and facemasks - the elastic tape contains latex.
        Sphygmomanometer cuffs – protect the arm with a light cotton bandage before the cuff is applied.
        Stethoscope tubing and ear pieces
        Airways
        Endotracheal tubes
        Some local anaesthetic cartridges contain latex.
        Multidose injection vials have a latex rubber port.
        Intravenous giving sets - many have latex at the injection port.
        Syringes – the ‘plunger’ may be made from latex
        Goggles
        Urinary catheters - the sample port contains latex.
        Enema catheters.
        Wound drains
        Wheelchairs - Components of wheelchairs and tyres contain rubber latex
        Reflex hammer
        Suction tubing
        Latex mattresses and pillows
        Elastic


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                                        AVON & WILTSHIRE MENTAL HEALTH PARTNERSHIP NHS TRUST
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DATE: 9 AUGUST 2005                                                                                                          DOCUMENT NO. H&S 0019
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Appendix 5: Identification and Assessment of Latex Risks

1.1 Health Risks
   Latex allergy may vary from slight skin reaction to severe anaphylactic reactions. The minor reactions can progress rapidly to the more severe variety.
   There appears to be no clear way of predicting at the moment when the reactions will become severe. It is therefore important that conditions are
   created within the working environment to minimise the chances of inducing allergy in health care workers. These conditions should also allow the
   safe treatment of patients who have already become sensitised to latex.


  There are three main types of reaction to latex:


  Irritation - a non-allergic condition consisting of a dry and itchy rash, which may occur on the back of the hand when latex gloves are used - usually
  reversible once contact with latex ceases. This can predispose an individual to progress to allergic problems.
  (NB: a wide range of substances can cause skin irritations - so it is important to seek advice from Occupational Health.)


  Delayed Hypersensitivity (Type IV) - also known as allergic contact dermatitis and is predominately a response to the chemical additives known as
  accelerators used in the manufacturing process. It consists of a red rash on the back of the hands and between the fingers; the skin may become
  leathery and express papules or blisters. The reaction can be delayed for several hours to days after contact and then subside. It can progress to a skin
  condition extending beyond the area of contact. It can predispose the affected individual to a Type I allergic reaction.


  Immediate Hypersensitivity (Type I) - is predominately a response to the natural protein residue found in natural rubber latex. Symptoms include
  local or generalized urticaria and oedema, if mucous membranes are affected, rhinitis, conjunctivitis or asthma may result. Respiratory difficulties
  and anaphylaxis (see below) may occur in extreme cases. Symptoms are usually produced within 5 - 30 minutes of exposure but delayed reactions
  have been noted.
  Anaphylactic shock is characterised by a generalised rash, respiratory distress and low blood pressure usually occurring within minutes of exposure. It
  is most likely to occur when the skin barrier is broken or rubber latex device comes into contact with mucous membranes. Repetitive contact with any



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  rubber latex product containing high protein residues may cause sensitisation and once this has occurred future allergic reactions may be caused by
  contact with rubber latex products containing lower antigen levels.


  NB: The amount of latex exposure needed to produce sensitisation is unknown. A substance, which causes sensitisation, is one that is capable of
  causing an allergic reaction in certain people. Once sensitisation has occurred, further exposure to even the smallest amount of substance can cause
  the symptoms to recur. Increasing the exposure to latex proteins increases the risk of developing allergic symptoms.


1.2   Identification of those Who May be at Risk

      Staff should undergo a pre-employment health assessment to identify those that might be at increased risk of latex allergy.

      Routine patient admission already involves information gathering about a patient's known allergies and should be extended to include specific
      questions which may detect known or possible occurrence of latex allergy (see Appendix 8).

1.3   Risk Factors

      The following factors are likely indicators of increased risk of latex allergy although it is possible that all staff and patients could potentially be at
      risk

              People with a history of anaphylaxis due to latex.

              People who have undergone multiple operations and instrumentation due to conditions like myelodysplasia; spina bifida, urethral dilatation,
               etc. are at an increased risk due to the repeated mucosal exposure to latex devices.

              Individuals who are atopic (i.e. those with a history of allergic reactions, e.g. hay fever, asthma) or who have had dermatitis, have an increased
               likelihood of developing Type I allergy.

              Cross-reactions with certain foods, e.g. bananas and avocados due to a shared antigenic similarity between the fruits and the latex.


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              Occupational groups who in the course of their work are likely to be exposed to frequent and large doses of the antigen, e.g. healthcare
               workers, dentists and dental hygienists.

              The more equipment used containing latex the greater the exposure and risk.

              Invasive procedures, when mucous membranes are exposed or when intravenous therapy is to be used. (NB: Latex molecules introduced direct
               into the circulation via giving set port syringe diaphragms or drugs stored under latex pharmaceutical enclosures cause anaphylactic reactions
               that are more difficult to reverse).

              Gloves made from latex are likely to be the main cause of sensitisation in healthcare workers as well as the main cause of reactions in those
               who are already allergic. The use of powdered gloves increases exposure to latex allergens to the user and the people in the near vicinity. These
               are not acceptable for any use in the Trust.

              All latex gloves present a risk of sensitisation but the risk is reduced in gloves with lower levels of latex proteins and process chemicals.

1.4   Controls to Reduce Risk of Allergic Reaction


              Reduce the exposure to latex by gradual replacement of latex products with non-latex alternatives and adopting purchasing policies that reflect
               this. It is at present, however, very difficult to identity all products that contain latex and it is not always possible to find suitable substitutes.

              Latex free (synthetic gloves) should be used as standard (see appendices 1 & 2). Care should be taken to ensure the appropriate glove is
               chosen for the risk activity (for example exposure to blood and body fluids that may contain harmful pathogens).

              Adopt a high standard of hygiene and skin maintenance - wash hands after removing gloves and do not wear barrier creams with latex as they
               may facilitate penetration of allergens. However, frequent use of moisturising creams in clinical areas where there is frequent hand washing is
               good practice.




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Appendix 6: Management of Staff With Latex Allergy

1.   The pre-employment health assessment should identify new staff who have, or who are at high risk of latex allergy. The occupational health
     department will discuss this in detail with the individual concerned and advise on appropriate control measures.

2.   Staff should report any symptoms that may be the result of latex allergy to their managers who will then complete an Incident Report Form.
     Managers should then refer them to Occupational Health who will:

             Assess the situation & take appropriate action
             Refer onto specialist if symptoms suggest latex allergy

3.   Staff with symptoms of latex allergy should be thoroughly investigated by an allergist or expert dermatologist and the diagnosis must be confirmed
     so that correct measures can be taken at work. Some workers may in fact just be allergic to cornstarch and not latex and the difference is
     important. Confirmation of the allergy and interpretation of the results are important. These may include, glove wear, skin prick tests and RAST
     tests for latex specific IgE.
4.   Once the diagnosis has been made, it is important that the manager reviews the whole working environment to make sure it is safe for the worker.
5.   Vinyl or nitrile gloves are standard alternatives to Latex gloves . If sterile gloves are needed, then latex free gloves must always be allocated.
6.   The healthcare worker should have a med alert bracelet if indicated and their fellow workers should be made aware of their allergy in case they
     develop symptoms if latex is unwittingly introduced into the workplace. If they have shown any signs other than local skin reactions then they
     should be given an Epipen and colleagues should be instructed in its use.
7.   Staff should be encouraged to keep close contact with the Occupational Health Service and discuss any problems that they might have. They
     should be made aware of the effects of latex allergy and its problems on life in general. This is particularly relevant if they have to go into hospital
     for any treatment, particularly surgical treatment.
8.   They should be made aware of the cross sensitivity that often results between latex and certain fruits.




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Appendix 7: Management of Patients With Latex Allergy

1. Each Clinical Team Leader/ Manager should have:

        Clear, written procedures specific to their area on how to assess (see Appendix 8) patients for their allergic status;

        Clear, written procedures specific to their area on how to manage patients who develop or have a known latex allergy; and

        Suitably trained staff to implement develop and monitor these procedures.

        The introduction of measures to protect staff from latex allergy will produce a safer environment for patients.

2. Management of Local Procedures

   Trained, nominated staff in each area must ensure that when a patient develops or has a known latex allergy that:


        Local procedures are implemented and adequate supervision provided where necessary;

        A latex free environment is prepared;

        All the necessary equipment required for that patient is prepared (each area should have latex free kits readily available);

        All relevant staff have been informed of the patient's latex allergy;




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         Any emergency equipment that may be necessary is readily available and latex free.

         Patients should wear a Medic-alert badge or alternative and also their medical records must be clearly marked.

         Patients that develop a latex allergy whilst in hospital must be given information and counselled regarding their condition and they should be
          reminded to inform doctors, dentists, and health professionals of this allergy prior to treatment.

3. Latex Free Environment

         As far as possible a latex free environment must be provided for patients with latex allergy to carry out any treatment or procedures necessary,
          e.g. side room.

      Latex gloves must not be worn.

      All areas set up and the patient's bed must be clearly labelled "Latex Free".

4. Equipment

   All departments must have latex free kits.

   All the necessary latex free equipment likely to be needed in the particular situation, such as gloves, blood pressure machines, giving sets,
    medication, masks, incubation apparatus and any other equipment should be obtained.




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         For example: equipment such as sphygmomanometers can be covered with plastic so no rubber is exposed; giving sets without latex ports
         should be used or the ports be removed and replaced by stop cocks; syringes should not have latex diaphragms. Two component syringes
         (Becton Dickenson), mini-jet syringes and Epipens are all latex free; the anaesthetic machine should have been vetted and be latex free.


   Intravenous solutions or drugs that have been stored under latex free enclosures should be identified and used exclusively for these patients.

   Non- latex gloves should be used.




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Appendix 8: Natural Rubber Latex Allergy Screening Questionnaire

When patients are first being assessed, whether on initial admission, in outpatients or prior to any intervention in clinical settings, it is important that
their allergic status is determined as far as is possible. This assessment tool should aid the process.


1.     Risk Groups

     G1.        History of anaphylaxis to natural rubber latex or positive skin prick test to latex (Type I)
     G2.        History of allergy/sensitivity to natural rubber latex (Type I)
                a)    Itching, swelling or redness after contact with rubber products
                b)    Swelling of tongue or lips after dental examinations or blowing balloons
     G3.        Group at risk but without history of natural rubber latex sensitivity
                a)    Repeated catheterisation e.g. Spina bifida, urogenital abnormalities
                b)    Atopic nature/multiple allergies especially specific fruits e.g. bananas, avocado, and kiwi.
     G4.        Type IV chemical sensitivity

2.     Initial Assessment

                a.    Ask the patient if they have had anaphylaxis to natural rubber latex or a positive skin prick test to latex. If patient states yes – TREAT
                      AS G1.
                b.    Ask the patient if they have an allergy to any medicines, foods or other items.
                c.    If the patient states that they have no allergies, there is NO IDENTIFIED RISK.
                d.    If the patient states they are allergic to any of the following they are AT RISK, ask the patient if they suffer with: breathlessness, skin
                      redness, chapping or cracking of hands, swelling of lips or tongue, runny nose, congestion, hives, itching.




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  List 1 – Latex products                             List 2 – Specific Fruits


  Balloons, contraceptives, rubber gloves           Apples, avocados, bananas, celery, cherries,
                                                    chestnuts, figs, grapes, kiwi, latex, mangoes,
  Hot water bottles, erasers, pillows,
                                                    melons, passion fruit, peaches, pears, pistachios,
  Rubber bands/balls, elastic dressing,             potatoes, ragweed, strawberries, tomatoes.
  Elastic bandages, elastic waistbands,
  Dental blocks.


           If following exposure to products in list 1, the patient suffers with the above symptoms. TREAT AS G2

           If following exposure to products in list 2, the patient suffers with the above symptoms. TREAT AS G3

           If the patient has the following conditions, without history of NRl sensitivity: Contact Dermatitis, Spina Bifida, Eczema, Multiple
            genitourinary surgery, Asthma, Auto Immune disease (e.g. Lupus), Hay Fever. TREAT AS G3

Management of Groups 1&2:                 Total NRL Free Environment Essential


Management of Groups 3&4:                 Use NRL-Free Gloves and Maintain A High Degree of Suspicion




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