Implementation recommendations for making health care facilities latex safe

Making Glove Decision Less of a White Knuckling Experience: A Systematic Review and Inventory of Glove Accelerator Contents

Background

Accelerators in medical gloves are a common cause of allergic contact dermatitis among healthcare workers.

Objective

A systematic review of medical and nursing literature, patch testing reports, and chemical analyses of gloves was conducted to assess accelerator contents reported in the literature and to identify accelerator-free gloves.

Methods

A systematic literature search was performed in OVID Medline and OVID EMBASE. Hand-searching of reference lists of articles in the field and author input generated the remainder of articles assessed.

Results

We present an inventory of accelerator contents of gloves and accelerator-free glove options as reported in the literature as a clinical reference tool to assist allergen-free glove selection for individuals suffering from allergic contact dermatitis due to rubber accelerators.

Limitations

Pertinent limitations of our review include lack of predefined study exclusion criteria and screening of the studies identified in the search by 1 review author only.

Conclusion

The glove inventory we provide summarizes the available literature regarding medical and surgical glove accelerator content, describing gloves both by brand and manufacturer as well as by accelerators.

The Synergy Model and the Role of Clinical Nurse Specialists in a Multihospital System

The role of clinical nurse specialists was formalized in the 1950s; the goal was to prepare inpatient, bedside nurses who would serve acutely ill patients via consultation and direct care. Clinical nurse specialists were to be expert clinicians, consultants, educators, and researchers. In the early stages of practice development, the focus was the specific needs of the assigned unit or floor. Organizational restructuring led to the elimination of many positions for clinical nurse specialists, with a shift of some of the nurses’ responsibilities to others (ie, managers) or the abandonment of some of the traditional roles. Recently, a reversal occurred in this trend, evidenced by a steady growth in the demand for these advanced practice nurses by organizations seeking to improve patients’ outcomes while remaining fiscally responsible. This demand led to changes in role expectations and expanded the responsibilities of clinical nurse specialists to a system-wide or organization-wide level. Contemporary practice of clinical nurse specialists is not well reflected in traditional role definitions or commonly accepted practice models. The Synergy Model, developed by the AACN Certification Corporation, was introduced as a way of linking certified practice to patients’ outcomes. The model describes 8 nurse characteristics and 3 spheres of influence. This article describes how a group of clinical nurse specialists applied the model to successfully change from a unit-based to a multisystem practice.

The changing face of hand protection

Perioperative nurses are empowered to act as patient advocates. As such, it is their responsibility to critically evaluate all products used in the surgical environment, including gloves. A basic understanding of the history of surgical gloves, health issues associated with their use, glove materials, and the essential properties of hand scrubs can help perioperative nurses choose appropriate products. This article explores these issues so that nurses and other health care workers can develop a framework for making informed decisions based on clinical reasoning.

Reducing the hazards of exposure to cornstarch glove powder

Latex allergy has received considerable attention during the past decade. The occurrence of latex allergy in health care workers is higher than in the general population. Latex gloves are the most frequent form of exposure that health care workers have to natural rubber latex; therefore, the relationship between gloves and latex allergies, has been well studied. Scientific evidence supports the link between glove powder and the occurrence of latex allergies, as well as the development of postoperative complications in surgical patients. This article describes how a multihospital system, which is the seventh largest not-for-profit health care corporation in the nation and includes 35 ORs, successfully eliminated powdered gloves from the environment.

Dental management of children with latex allergy

This paper reviews the aetiology, epidemiology and dental management of children with latex allergy. The issue of latex allergy has serious consequences for the dental management of children with one or more of the following risk factors: spina bifida, atopy, first surgery before one year of age, history of multiple surgical procedures, congenital urologic abnormalities, gastrointestinal malformations, hydrocephalus internus, ventriculo-peritoneal shunts, spinal cord injuries, and family history of atopy. Management of latex allergy is based upon the diligent avoidance of latex exposure. Universal use of powder-free low-allergen latex gloves is recommended.

Relation of latex-specific IgE titer and symptoms in patients allergic to latex

BACKGROUND

The relation between latex-specific IgE titer and the type or total number of latex-induced symptoms has not been previously investigated.

OBJECTIVE

We sought to determine the association of latex-IgE in vitro assay results with the type, number, or severity of symptoms in patients allergic to latex.

METHODS

Ninety-one patients with positive histories and positive skin test responses were identified as having type I allergy. Data was collected for reported symptoms after latex exposure. Symptom severity was quantitated by 2 scores: (1) the total number of symptoms to latex exposure and (2) a symptom severity score (3 = anaphylaxis, 2 = asthma, and 1 = rhinoconjunctivitis, urticaria, or both). All subjects underwent AlaSTAT and CAP tests.

RESULTS

AlaSTAT class was associated with total number of symptoms (r = 0.32, P <.001) and severity score (r = 0.33, P <.002). Similarly, CAP class was associated with both number of symptoms (r = 0.32, P <. 0001) and severity score (r = 0.31, P <.001). Among the symptoms reported, asthma had the strongest association with a positive in vitro IgE assay (odds ratio = 6.7 [95% confidence interval = 1.9, 25. 6]), followed by urticaria (odds ratio = 1.9 [95% confidence interval = 0.8, 4.6]). Contact dermatitis had no statistical association with in vitro assays in this study. AlaSTAT and CAP class correlated together significantly (r = 0.58, P <.001).

CONCLUSION

Patients allergic to latex with higher AlaSTAT or CAP class were more symptomatic. Increasing class or titer also predicted more severe symptoms. Higher class of either the AlaSTAT or CAP assay to latex was strongly associated with latex-related asthma and urticaria and marginally associated with latex-related rhinoconjunctivitis.