Hospital's latex-free program fits like a glove - What Works

Healthcare Purchasing News, Sept, 2002 by Karin Lillis

Judy Holbein and the staff at Ohio State University Medical Center saw firsthand the complications latex allergies caused hospital employees.

"We even had one person who went into anaphylaxis. She knew she had a latex allergy, but she didn't want to admit it," says Holbein, a nurse by profession who also serves as purchasing manager for the five-hospital, 850-bed system based in Columbus, OH. "That was one of the things that brought us right up to snuff. We knew we had to do something."

As part of a program aimed at taking proactive measures to protect staff and patients, a team of practitioners from the medical, center gathered reams of data about latex allergies and its associated risks. Risk management staff also figured the cost of converting to a latex-free, powder-free system would be far less than potential workers' compensation claims associated with latex allergy-related complications.

Through the housewide latex-and powder-free program implemented five years ago, Ohio State University Medical Center converted to the Sensicare line of exam gloves, manufactured by Waltham, MA-based Maxxim Medical.

Those criteria included the following:

* Availability. Would the glove manufacturer be able to guarantee that the gloves the hospital ordered would be available? How would the manufacturer handle special or emergency orders? If there was a problem with the quality of a shipment, how fast and how easily would the manufacturer send replacement products?

* Viral penetration. "How did the glove hold up under a viral penetration test?" Holbein asks. "This is a really critical factor to consider. Our staff frequently asked whether the nonlatex gloves could protect them as well as rubber ones."

* Color, texture and finish. "When you're looking at gloves, you have to look at things like the color, texture and finish," Holbein explains. "For example, is the glove too slick? When you slide your gloved hands under a patient to move the person, do the gloves stay on your hands when you pull them back out, or are the gloves under the patient? And how do the gloves handle under heavy-duty use, like in the emergency room?"

* Length. Once on the caregiver's hand, does the glove extend at least one inch beyond the wrist?

* Primary material. What is the primary material the glove is made from? Are there chemicals or accelerators in it that could cause allergies?

* Pinhole levels. In quality studies done by an independent laboratory, what's the acceptable level related to pinholes in gloves?

* Elongation criteria. How "stretchy" is the glove?

The hospital ultimately selected three kinds of exam gloves, and Holbein developed a chart (reproduced on page 22) to help staff know which ones to wear.

"You have to consider the level of activity, the length of exposure and the amount of chemical exposure," she says. For instance, Holbein explains, dietary staff might wear gloves designed for lighter use, while all caregivers in areas where chemotherapy is done wear nitrile gloves. The hospital also selected a nitrile utility glove for its housekeeping staff. She estimates about 35 percent of exam gloves hospital staff wears are nitrile. The remaining 65 percent of gloves used are polymers, she says.

"We have all of the staff in nitrile gloves areas like the emergency department, the laboratories where they wear gloves for several hours at a time, and any unit that has chemotherapy. It's more convenient to do it that way, rather than having two glove boxes on the wall [and requiring staff to choose]," Holbein says.

"There are a couple of areas you don't want to forget about in your hospital--housekeeping and dietary staff," she adds. "Suppose you have a latex-sensitive patient, and someone from housekeeping, wearing rubber gloves, comes in to clean the room. The housekeeper wipes down the bed, the bathroom, etc. with hot soapy water. You've just smeared latex all over the entire room. You typically have someone who is used to having hand irritation from cleaning all the time. They typically don't have the understanding of latex allergies that professional staff does."

"Look at the gloves worn by your dietary department, too. Employees in ours used to wear cheap latex gloves they got from the food vendor," Holbein says.

Staff education is critical

"There was no increase in cost to switch to nonlatex exam gloves, but it was a huge increase in staff education and confidence in the product," Holbein says. "You must do the staff education. You need to take anxiety and turn it toward a positive attitude. Help them understand that it's for their benefit. It will keep them healthier. People tend to think that we buy something new because it was cheaper. We didn't do that."

After an information blitz that included in-services, meetings and a variety of brochures and other handouts, hospital staff gained confidence in the new program.

"Initially, we had bulletins coming out from the infection control department reassuring staff that they weren't going to get diseases because they weren't wearing a latex glove," Holbein says. "Staff didn't like the feel or the fit--nonlatex gloves don't have the stretchiness that latex has. We provided boxes of gloves to see what would fit. We also tried to get a few leaders in the in-house nursing community to help staff realize that the gloves are for their own protection.