AORN latex guideline

AORN Journal, March, 2004

I. OVERVIEW

A. INTRODUCTION

PREAMBLE. Natural rubber latex allergy is a significant medical concern because it affects health care workers, as well as the general population. It crosses racial and ethnic boundaries, and it can affect males or females anytime during their lives.

There is no cure at this time, only prevention. Three types of reactions are associated with latex products. In order of frequency of occurrence they are an irritant reaction, a delayed hypersensitivity reaction (ie, type IV), and an immediate hypersensitivity reaction (ie, type I) (Table 1). Any individual who experiences any type of latex-associated reaction should be evaluated by a qualified health care practitioner.

ASSUMPTIONS. Natural rubber latex allergy can be a serious and potentially life-threatening condition. Health care workers and others who experience repeated exposure to latex allergens can develop a latex sensitivity or allergy. Several hundred cases of severe allergic reactions and anaphylaxis and 17 deaths have been reported to the US Food and Drug Administration (FDA). (1,2)

Sensitivity can be described as development of an immunologic memory to the specific latex proteins; however, the affected individual may be asymptomatic. Allergy is the demonstrated outward expression of the sensitivity (eg, hives, rhinitis, conjunctivitis, anaphylaxis). Sensitivity to natural rubber latex is more common than the actual allergy; however, any individual sensitized to natural rubber latex is at risk of a life-threatening reaction and should be treated in the same way as an allergic individual.

Powdered latex gloves are the most common item contributing to the latex load in health care facilities. Recent estimates have shown a 20-fold increase in medical glove use (in billions of pairs) since the introduction of universal precautions in 1987. (3) During the manufacturing process, powder usually is applied to the glove as cornstarch slurry when the glove still is on the mold or former. When the powder slurry is applied to the glove, the extractable, water-soluble proteins leach from the surface of the glove onto the cornstarch particle. When dry, the glove powder then acts as a vector that carries latex proteins from the glove into the environment.

Health care facilities and providers have an ethical responsibility to prevent latex sensitization in patients and employees by creating an environment in which it is safe to be treated and to work. Many facilities in the United States consciously have moved toward a latex-safe environment by switching from powdered latex gloves (eg, examination, surgical) and other latex products to powder-free products with reduced latex protein content. High-protein, powdered, latex gloves and other products that create aerosolization can contaminate a facility's environment with latex allergens.

In 1998, Sussman et al reported a 1% annual incidence of sensitization among powdered latex-glove users, whereas users of powder-free, low-protein, latex gloves reported a 0% sensitization rate. (4) In 1999, Levy et al studied a group of dental students in both France and England, reporting that students who wore protein-rich (ie, high protein), powdered latex gloves had a 15% and a 5% sensitization rate, respectively, while students who wore powder-free, protein-poor (ie, low protein) gloves had a 0% sensitization rate. (5)

It is unsafe to treat latex-allergic individuals in an environment laden with latex allergens. Individuals who have been clinically diagnosed as either sensitive or allergic to natural rubber latex should be treated or work in an environment that is latex-safe, with additional measures taken for the immediate vicinity (ie, room) in which the individual receives or provides care. If the entire care facility is maintained as a latex-safe environment, few additional precautions will be needed for latex-allergic individuals. If the facility is not maintained as latex safe, comprehensive latex precautions will be required each time a latex-allergic individual presents for care or services.

This revised "AORN latex guideline" is based on research and expert opinion available at the time of its revision. Ongoing and future research likely will enhance and expand current knowledge about this topic.

Review of this document has been solicited from content experts at the American Association of Nurse Anesthetists (AANA), the American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), the American Academy of Allergy, Asthma, and Immunology (AAAAI), The American College of Allergy, Asthma, and Immunology (ACAAI), the American Nurses Association (ANA), the Association of Practitioners of Infection Control, Inc (APIC), the Spina Bifida Association, and the National Institute of Occupational Safety and Health (NIOSH) division of the Centers for Disease Control and Prevention, as well as the AORN Board of Directors and other recognized experts. This guideline may not apply to every individual and may require modification based on specific needs of a given patient, health care provider, or situation.