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Policy No.: 2003
Effective Date: 05/15/01
Revised Date: 12/03/12
Reviewed Date: 12/03/12

Prevention and Management of Latex Sensitivity Policy

Basis for Policy

The University of Nebraska Board of Regents Policy 6.3.5 requires that the University of Nebraska Medical Center (UNMC) develop and implement an effective written Injury and Illness Prevention Program (IIPP) which promotes occupational safety and health practices and strives to reduce work-related accidents and injuries on campus. The IIPP is required to comply with Nebraska law and the Nebraska Department of Labor Workplace Safety Consultation Program Rules and Regulations, Neb. Rev. Stat. Secs. 48-443 to 48-446 and 230 NAC 6, respectively.

Policy

Human health hazards to latex sensitive individuals from latex exposure are recognized. Therefore, UNMC shall implement appropriate measures to minimize latex exposure among staff, students, patients and visitors.

Patient Care

• All Patient Care areas shall:

• Institute a screening process to identify patients who are latex sensitive. The screening process includes the use of the Latex Sensitivity Screening Questionnaire for Patients.
• Implement procedures to minimize risk to latex sensitive patients.
• Develop a method to alert staff, on an ongoing basis, regarding patients with latex sensitivity/allergy or those identified as being in a high risk group for latex allergy.
• Assess the environment to identify products and equipment containing latex and identify alternative products and equipment.

• Patients with a known allergic response to latex exposure or identified as being in a high risk group for latex allergy shall be placed on "Latex Precautions."
• Signs about latex sensitivity shall be posted in waiting areas of ambulatory care and diagnostic care areas. These signs shall be designed to alert patients and their family members to notify staff if they are latex sensitive.

Employee Education/Awareness

• Policies and procedures regarding the prevention and management of latex sensitivity shall be covered during new employee safety orientation.
• The use of powdered latex gloves is prohibited. Employees shall use powder-free non-latex gloves whenever possible. Powder-free non-latex gloves shall be provided to all employees who are sensitized/allergic to latex.
• Employees shall maintain prudent hand care including the following:

• Wash hands after removing gloves.
• Dry hands to prevent irritation by residual soap.
• Avoid the use of hand lotions or lubricants that contain mineral oil, petroleum salves and other hydrocarbon-based gels or lotions.

• Unless essential, latex that may contain powder or come in contact with skin should not be used.
• Latex balloons are not to be used on campus as they are coated with powder which will be released into the air when the balloon is handled, manipulated or popped.

Employee Screening for Latex Sensitivity

Employee Health shall assess all job applicants/prospective employees for latex sensitivity during the post-offer medical evaluation. Applicants with known sensitivity/allergy to latex will be asked to provide documentation from their private physician along with recommendations for duty restrictions and will be evaluated by Employee Health. This information will be used by Human Resources and the hiring department manager to determine whether the individual can perform the essential functions of the position with or without reasonable accommodations.

The department manager will refer employees who exhibit signs and symptoms of latex allergy (e.g., itching, rash or wheezing after wearing latex gloves) to Employee Health with an incident report for a medical evaluation. An assessment of the employees’ fitness for duty will be made and the department manager and employee provided a written medical opinion regarding fitness for duty and, where applicable, restrictions using the Employee Health Work Status Report.

Background Information

The first documented case of latex-induced anaphylaxis was reported in 1979. Today latex sensitivity has become a major concern in the medical community as health care workers are confronted with a dramatically increased incidence of reactions to latex exposure not only among their patients, but also among themselves.

Workers who wear latex gloves on a regular basis are at risk due to their continued exposure to latex by virtue of their jobs and work environment. The increased use of latex devices in health care and research, especially glove use since the introduction of standard blood and body fluid precautions, may have contributed to the increase in allergic reactions.

Latex proteins can bind to glove powder and become airborne. Latex glove powder carries the latex protein into the air when gloves are donned or removed, exposing the respiratory system and increasing the potential for sensitization.

Risk Groups

• People with the following disorders are high risk groups for latex allergy:

• Myelodysplasia (e.g. spina bifida, myelomeningocele).
• Congenital genitourinary anomalies requiring frequent surgeries or catheterization.

• The following groups are at risk for latex allergy and should be screened carefully and monitored for signs/symptoms of latex allergies:

• History of multiple procedures.
• Frequent instrumentation or catheterization of the genitourinary tract.
• History of occupational contact with latex products, such as workers in the rubber and health care industries. (Environmental Service workers, lab personnel, and other ancillary service workers fall into this category).
• Atopic patients (asthma, rhinitis, eczema).
• Allergies to bananas, kiwi, avocados, water chestnuts, tropical fruits.

Epidemiological Factors

• Hypersensitive or allergic reactions to latex may occur immediately or some time after exposure producing local or systemic symptoms of varying severity.
• Repeated exposure, usually extending over several years, is necessary before an individual’s immune system becomes sensitive. In other words, the more the body comes in contact with latex, the greater the opportunity for the body to recognize and react to it.
• Once an individual has become latex sensitive, further (secondary) exposure may provoke a reaction, the severity of which depends on the body’s type of immunological response.
• Reactions to natural rubber latex (NRL) gloves can result from either irritation or allergy. There are three possible reactions to NRL gloves. They are:

• Mechanical or Irritant Contact Dermatitis – this is an irritation, not a true allergy. This is the most common reaction to NRL gloves. Because of the intense focus on latex allergy today, many individuals who experience irritant contact dermatitis assume they are experiencing a latex allergy. It is very important to assess reactions carefully to determine their cause so that the right treatment can be implemented.
• Allergic Contact Dermatitis (Delayed, or Type IV Hypersensitivity)- a true allergic response, symptoms are localized to area of contact with allergen.
• Systemic Allergic Response (Immediate or Type I Hypersensitivity) - the most severe allergic response, an intense allergic reaction which may cause anaphylaxis and death.

• The table below describes each type of reaction:

Mechanical/Irritant Contact Dermatitis	Type IV (Delayed) Hypersensitivity (Allergic Contact Dermatitis)	Type I (Immediate) Hypersensitivity (Systemic Allergic Response)
Not an allergic reaction Symptoms do not extend past area of glove contact Symptoms occur rapidly after wearing gloves – usually minutes to few hours after gloves removed acute- red, scalded appearance, swelling, itching chronic - dry, thickened skin; crusting, papules, peeling	T-Cell mediated response Symptoms may extend past glove border Symptoms occur much later than with mechanical/ irritant contact dermatitis, usually 6-72 hours after gloves removed acute - red appearance, itching, swelling, small blisters chronic - dry, thickened skin; crusting; scabbing sores; papules, peeling, vesicles	IgE mediated Symptoms are generalized and may affect any part of the body Symptoms occur immediately (within minutes up to one hour from time of exposure) Hives, itching, runny nose, wheezing, difficulty breathing; facial swelling; nausea, abdominal cramping, rapid heart rate, laryngeal edema, bronchospasms, low blood pressure, anaphylactic shock

Additional Information

• Contact the Safety Operations Department
• Latex Sensitivity Screening Questionnaire for Patients
• Neb. Rev. Stat. Secs. 48-443 to 48-446 (use scroll button to move between statute sections) and 230 NAC 6

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