Risky business: pre-powdered gloves or powder-free gloves in the operating suite?

Two of the emerging issues for the health-care sector in the 1990s are occupational health and safety, and iatrogenic issues. Both of these issues are implicated in the use of pre-powdered latex gloves. Hospital health-care workers are exposed to latex in many ways: gloves, intravenous sets, ventilator circuits, dental products, resuscitation equipment, anaesthetic equipment. Post-operative complications, delayed wound healing, scar formation, and the potential for misdiagnosis, in the presence of starch powder, have been well documented in the literature with the need for through glove rinsing prior to surgery. Another route for glove powder to enter wounds is through a barrier breach. For an institution to ensure it provides the most durable and effective barrier for healthcare worker protection and patient safety, knowledge is needed regarding the various factors which lead to glove barrier failure. The primary aim of the study was to evaluate the in-use durability of the surgical gloves in current use against powder-free gloves. Descriptive statistics were used to analyse the data, in addition a cost analysis was calculated. The results of this study demonstrated clinically important differences between existing glove products in terms of barrier quality.

Alison Bell Memorial Award. Latex sensitivity and allergy: fact and fiction

Health care workers (HCW) have a higher incidence of latex sensitivity than car maintenance workers! The wearing of latex gloves over several years increases the risk of developing latex allergy! All glove related skin reactions are due to latex! People with spina bifida have a high incidence of latex sensitivity! There is a relationship between allergies to natural latex rubber and avocados, chestnuts and bananas! We should all stop using latex products! Powdered gloves are as safe as unpowdered ones, as long as they are rinsed well!

Rationalizing the purchase and use of gloves in health care

The last two decades have seen a substantial increase in the use of protective gloves in healthcare establishments. This is attributed to the widespread publicity regarding the risks of transmission of human immunodeficiency virus and hepatitis B and C from blood and body fluid contact. Further, directives from official agencies stressing the need to protect staff from blood-borne viruses in the workplace led to the introduction of a variety of disposable gloves, each claiming total or adequate protective ability. The resulting sensitization to latex in some users has caused concern. This article reports on the process used within one NHS trust to explore glove use and determine the level of latex sensitization among staff. The audit identified an irrational approach to glove purchasing as well as inappropriate use of different types of gloves. The audit was followed by a trial aimed at rationalizing both the purchase and use of gloves.

The implications of latex allergy in healthcare settings

Latex allergy is on the increase. This paper focuses on how sensitization can occur and the use of latex gloves. Implications for the healthcare setting are addressed and recommendations made focusing on glove usage.

Dental surgeons with natural rubber latex allergy: a report of 20 cases

Latex allergy is becoming a major occupational health issue and dental surgeons are at risk from becoming sensitized to natural rubber latex. A study was conducted to investigate risk factors and glove-related symptoms reported by dentists with natural rubber latex allergy. Twenty dentists, who had undergone serological or dermatological testing for a Type I allergy to latex, were identified from a questionnaire survey. Risk factors investigated were: gender, years in clinical practice, exposure to latex gloves, atopic history and food allergy. The majority of dentists (75%) gave an atopic history. Glove-related adverse reactions ranged from cutaneous to systemic manifestations. All twenty dentists reported itching of the hands in response to latex gloves. One respondent was unable to continue in dental practice because of her glove-related allergies; nineteen dentists were able to continue by using synthetic, non-latex gloves.

The dental team and latex hypersensitivity. ADA Council on Scientific Affairs

BACKGROUND

In the late 1980s, there were notable increases in reports of allergic reactions to natural rubber latex, or NRL, particularly in association with barium enema procedures and medical procedures performed on children with spina bifida. These reports also raised awareness of the growing concern about NRL allergy in both patients and health care workers.

DESCRIPTION OF THE DISORDER

This report by the American Dental Association Council on Scientific Affairs summarizes the signs and symptoms of NRL protein allergy, allergic contact dermatitis and irritant dermatitis; offers information on means to diagnose these conditions definitively; and suggests means of reducing occupational exposure to the causative allergens and irritants in the dental office.

CLINICAL IMPLICATIONS

Reducing health care workers' occupational exposure may assist in minimizing adverse reactions associated with frequent wearing of gloves. The Council on Scientific Affairs will address issues relating to latex hypersensitivity among patients in a future report.

Latex allergy in an orthognathic patient and implications for clinical management

A 19-year-old girl with mild asthma had had 16 months of orthodontic treatment as part of the joint orthodontic/orthognathic approach to her 9.5 mm overjet. At the time of banding her second molars she developed latex protein allergy as a reaction to the operator's non-sterile powdered latex gloves. She also gave a history of allergy to other substances as well as of eczema. The patient was confirmed as allergic to latex protein by radioallergosorbent test (RAST) for IgE, requiring precautions be taken during further orthodontic procedures as well as during the subsequent orthognathic surgery for the underlying Class II skeletal pattern.

A review of current literature on epidemiology of immediate glove irritation and latex allergy

Natural rubber latex (NRL) allergy has attained world-wide importance with the diagnosis of glove hypersensitivity, contact urticaria, rhinitis, conjunctivitis, asthma and anaphylaxis. In the present report, the latest literature of the epidemiology of NRL allergy is reviewed, an account on the incidence of NRL allergy (19 new cases of contact urticaria/100,000 workers per year) among health care workers is given and the prevention of NRL allergy is discussed. Among health care workers, NRL allergy has gained prominence particularly with the spread of AIDS and an increase in the use of rubber gloves for barrier protection. For screening NRL allergy, a simple and quick test based on a self-administered questionnaire has been presented, but it needs further evaluation before routine use can commence. Further analytic studies will show if the use of low allergen gloves reduces the incidence of NRL allergy.

Latex glove hypersensitivity and irritation: a literature review

Latex hypersensitivity is an emerging health problem that is reaching epidemic proportions. Since the introduction of universal precautions, latex glove manufacture and use has risen dramatically. With more and more individuals exposed to latex, the incidence of acquired latex sensitivity is increasing, especially in the health care professions. Latex is a natural product and is processed in a manner that retains protein allergens and leaves residual chemicals on the latex gloves. The reactions to these allergens and irritants are varied and can be classified as allergic or non-allergic. Dental health care professionals are among the populations at risk for developing these problems, the most dangerous of which is an immediate allergy to latex proteins. To increase awareness of this important issue, several studies have been completed with results showing an average prevalence of about ten percent in selected populations of dental professionals.

Latex-allergic patients: operating room considerations

With the potential for intraoperative reactions, it's imperative that operating room nurse managers are informed and prepared to handle latex-allergic patients.

Medical gloves and glove materials

Latex gloves are widely used in health care, but latex allergy is increasingly becoming a problem. Nurses should be aware of the alternatives to latex gloves and when these can be used. Nurses should know their organisation's policy on glove use and latex allergy.

Influence of absorbable dusting powders on wound infection

Surgical glove dusting powders are commonly used as mold-release agents and to facilitate donning. Cornstarch and CaCO3 are commonly used absorbable dusting powders. This experimental study demonstrates that these absorbable dusting powders significantly potentiate bacterial growth and enhance a wound's inflammatory response. The infection-potentiating effects of CaCO3 are significantly greater than those of cornstarch.

Latex allergy and gloving standards

In response to universal precautions, latex gloves are used more frequently in health care settings, and more health care workers are reporting latex sensitivity or allergic reactions to natural rubber latex (NRL). As a result, there continues to be controversy about what gloves should be used in clinical practice and what are the appropriate clinical recommendations about gloving practices. This article reviews the current issues about gloving practices, addresses national standards related to gloving, and makes recommendations about future gloving practices.

An evaluation of the prevalence of latex sensitivity among atopic and non-atopic intensive care workers

BACKGROUND

Exposure to latex is known to cause an array of symptoms, including pruritus, dermatitis, erythema, and urticaria. Workers at elevated risk for latex exposure include health care personnel whose repeated patient contact or surgical work require extensive use of latex gloves. This study evaluated the prevalence of latex allergies in atopic and non-atopic intensive care workers and sought to determine the impact of risk factors such as frequency of glove use and hand washing on latex sensitization.

METHODS

We evaluated the prevalence of latex sensitivity in 122 intensive care unit (ICU) workers using a questionnaire and skin prick test. Atopy and latex sensitivity were determined by skin prick test using a battery of common inhalant allergens and an extract prepared from the gloves used in the ICU. Frequency of glove use and hand washing were determined by questionnaire.

RESULTS AND CONCLUSIONS

Forty ICU workers (32.8%) were considered atopic by having at least one positive response to the inhalant allergens. Atopic ICU workers were more likely to have positive latex skin test than non-atopic ICU workers (atopic vs. non-atopic workers: p < 0.001, odds ratio = 14.2). Frequency of current glove use or hand washing frequency were not significant predictors of a positive response to latex; however, a positive history of atopic eczema and family history of allergies, as determined by questionnaire were significant predictors of a positive response to latex antigens.

Are latex gloves a contributing cause of percutaneous injury in dentists?

Fifty dentists were examined to determine if (and how) latex gloves contributed to percutaneous injury, the leading cause of occupational AIDS/HIV transmission in health care workers. Latex glove wear is closely associated with a 16-fold increase in percutaneous injury with endodontic file manipulation than when subjects were tested barehanded. Dynamometer tests showed a 36 percent decrease in light-touch proprioception in subjects when they were gloved as compared to scores when they were tested barehanded. A 28 percent glove-related dermatitis rate among test subjects is also reported.

Prevalence of latex allergy among anesthesiologists: identification of sensitized but asymptomatic individuals

BACKGROUND

Occupational exposure to natural rubber latex has led to sensitization of health-care workers. However, the prevalence of latex allergy among occupationally exposed workers in American hospitals has not been reproducibly determined. The objectives of the current study were to determine the prevalence of and risk factors for latex sensitization among a cohort of highly exposed health-care workers.

METHODS

Participants were 168 of 171 eligible anesthesiologists and nurse anesthetists working in the Department of Anesthesiology and Critical Care Medicine. A clinical questionnaire was administered, and testing was performed using a characterized nonammoniated latex reagent for puncture skin testing, a Food and Drug Administration-approved assay to quantify latex-specific immunoglobulin E antibody in serum, and, when required for clarification, a validated two-stage (contact-inhalation) latex glove provocation procedure.

RESULTS

The prevalence of latex allergy with clinical symptoms and latex sensitization without clinical symptoms was 2.4% and 10.1%, respectively. The prevalence of irritant or contact dermatitis was 24%. The risk factors identified for latex sensitization were atopy (odds ratio, 14.1; 95% CI, 1.8-112.1; P = 0.012); history of allergy to selected fruits, such as bananas, avocados, or kiwis (odds ratio, 9.8; 95% CI, 1.6-61.9; P = 0.015); and history of skin symptoms with latex glove use (odds ratio, 4.6; 95% CI, 1.6-13.4; P = 0.006).

CONCLUSIONS

The prevalence of latex sensitization among anesthesiologists is high (12.5%). Of these, 10.1% had occult (asymptomatic) latex allergy. Hospital employees may be sensitized to latex even in the absence of perceived latex allergy symptoms. These data support the need to transform the health-care environment into a latex-safe one that minimizes latex exposure to patients and hospital staff.