Health care worker disability due to latex allergy and asthma: a cost analysis

Considering the switch to a latex-free glove policy to safeguard staff and patients

While it is difficult to imagine that before the late 1800s, surgeons in the theatre environment operated on patients without gloves, gloves are now a clinical necessity. Their use has risen exponentially over the last 30 years, along with concerns over staff and patient allergy and sensitivity to the natural rubber latex proteins used in their manufacture. Having used latex gloves for the better part of 35 years, the author recently evaluated a latex-free alternative. In this article, which presents a rationale for the introduction of a latex-free glove policy across NHS departments and trusts, particularly in theatre settings, the author presents his experience, together with cases from four other surgeons, as well as evidence from the literature regarding potential clinical outcomes, quality of life and cost-effectiveness associated with latex-free gloves.

The benefits of latex-free gloves in the operating room environment

Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.

Management of latex hypersensitivity in the perioperative setting

Despite the introduction and use of latex-free gloves, natural rubber latex hypersensitivity is still an issue in hospital medicine both for patients and healthcare professionals. Clear understanding of the groups at risk as well as perioperative assessment and management is key to reducing complications and improving safety. In this literature review, we cover the perioperative management of patients with latex hypersensitivity, as well as the implications for healthcare professionals. We also review the cost analyses of latex hypersensitivity in the healthcare system and the evidence available.

Conversion to Low-Protein, Powder-Free Surgical Gloves: Is it Worth the Cost?

This study was conducted to determine changes in overall costs associated with conversion to powder-free gloves including cost of workers' compensation cases for natural rubber latex (NRL)-related symptoms and health care workers' glove satisfaction. The study, a 2–year, longitudinal design with retrospective and prospective aspects, was developed to determine health care worker use of powder-free, low-protein NRL gloves, sensitization, cost, and glove satisfaction. Informed consent was obtained from 103 health care workers. Prior to glove conversion, nearly one-half (44%, 36 of 82) of the operating room staff reported symptoms related to NRL exposure. At the end of the 14–month data collection period, only 27% (22 of 82, McNemar test = .007) reported symptoms related to NRL exposure. Additionally, a cost savings of $10,000 per year for gloves was evident with reports of increased user satisfaction. This study demonstrated that conversion to the use of powder-free, low-protein NRL gloves not only reduces health care worker NRL symptoms, but also positively affects the costs of glove purchases and workers' compensation.

Identification of phenolic dermal sensitizers in a wound closure tape

A latex-allergic patient presented with a severe local reaction to a non-latex wound closure bandage following surgery. Extracts of the bandage were analyzed by gas chromatograph-electron impact-mass spectrometry (GC EI-MS) in the total ion monitoring mode. Components were identified by their ion mass fingerprint and elution time as a corresponding standard from the GC column. The chemicals identified were 4,4'-thiobis-(6-tert-butyl-m-cresol) (TBBC), 6-tert-Butyl-m-cresol (BC), 2,4-di-tert-butylphenol (BP) and erucamide (EA). Sensitization potential of these chemicals was evaluated using two quantitative structure-activity relationship (QSAR) programs. The phenol 2,6-di-tert-butyl-4-(hydroxymethyl)phenol (BHP) was also included in the test series. It was initially thought to be present in the bandage but detectable levels could not be confirmed. The potential for TBBC to induce a sensitization response was predicted by both Derek for Windows and TOPKAT 6.2. The potential for BC and BP to induce a sensitization response was predicted by Derek for Windows, but not TOPKAT. BHP and EA were not predicted to be sensitizers by either QSAR program. Local lymph node assay (LLNA) analysis of the chemicals identified TBBC, BP, and BC as potential sensitizers with EC3 values between 0.2 and 4.5%. None of the animals exhibited body weight loss or skin irritation at the concentrations tested. In agreement with the toxicological modeling, BHP did not induce a sensitization response in the LLNA. Following a positive LLNA response, TBBC, BP, and BC were further characterized by phenotypic analysis of the draining lymph nodes. A positive LLNA result coupled with a lack of increase in B220(+)IgE(+) cell and serum IgE characterize these chemicals as Type IV sensitizers. These studies used a multidisciplinary approach combining clinical observation, GC-EI-MS for chemical identification, QSAR modeling of chemicals prior to animal testing, and the LLNA for determination of the sensitization potential of chemicals in a manufactured product.

Latex-free gloves: safer for whom?

Increasing latex hypersensitivity among patients and health care workers has prompted the development of latex-free surgical gloves. Latex-free gloves must perform equally as the existing latex standard. We analyzed perforation rates in a clinical trial comparing latex and a latex-free alternative during primary hip and knee arthroplasty. The overall latex glove perforation rate was 8.4% compared with 21.6% for the latex-free alternative (chi(2) P < .001). The operation perforation rate for latex gloves was 34.4% compared with 80% for latex-free gloves (chi(2) P < .001). We suggest that the latex-free glove tested cannot provide a reliable barrier between the surgeon and the patient. As such, we question the safety of these gloves and the standards sets by the regulators.

Latex allergy in children: modalities and prevention

Allergic or immediate hypersensitivity reactions to latex have been reported in children with increasing frequency in the past. The reported prevalence varies greatly depending upon the population studied and the methods used to detect sensitization. Children's subpopulations at particular risk include: atopics, individuals with spina bifida, children undergoing surgical procedure during the neonatal period and individuals who required frequent surgical instrumentations. Latex allergy is also an important medical issue, particularly for healthcare personnel. Sensitization mainly occurs by wound or mucosal contact with latex devices during surgery or by inhalation of airborne allergens released from powdered latex gloves. Regarding diagnosis, the medical history, skin prick test and search for specific serum IgE are crucial but cost effective. The development of a guide listing latex-containing drugs is essential for the primary prevention of allergic reactions. Immunotherapy or specific premedication seems not effective in preventing the risk of anaphylaxis during the perioperative course. The most effective strategy to decrease the incidence of latex sensitization is complete avoidance. This strategy is efficient in patients and also in health care workers and has been applied since 2002 in our pediatric surgical hospital. One of major problem with the latex-free gloves was that surgeons find them considerably more difficult to work with. But today, manufacturers made considerable effort and free-latex gloves with an equal tactile sensation than the latex-gloves are now available. The extra cost of free latex gloves is well counterbalanced as allergen test, long stay hospital for allergic reaction, and worker's compensation are no longer needed. Since the introduction of this program in our institution, no allergic reaction to latex has been reported in 25000 anesthetized children or with the health care workers.

Latex-induced occupational asthma: time trend in incidence and relationship with hospital glove policies

BACKGROUND

Natural rubber latex (NRL) has become as a major cause of occupational asthma (OA) in workers using NRL gloves. Few population-based studies have assessed the impact of changes in the patterns of glove usage on the incidence of NRL-induced OA.

OBJECTIVE

To characterize the time trends in incident cases of NRL-induced OA in Belgium and examine whether incidence rates were related to the types of gloves used in hospitals.

METHODS

Incident cases of NRL-induced OA were identified through a retrospective review of all claims submitted to the Workers' Compensation Board up to December 2004. Based on the results of diagnostic procedures, the diagnosis of NRL-induced OA was categorized as definite, probable, unlikely, or indeterminate. The patterns of glove usage were characterized through a questionnaire survey of Belgian hospitals.

RESULTS

A total of 298 claims for NRL-induced OA were identified, including 127 subjects with definite OA and 68 with probable OA. Categorized by the year of asthma onset, the incident cases of definite and probable NRL-induced OA markedly decreased from 1999 onwards. The use of powdered NRL gloves fell from 80.9% in 1989 to 17.9% in 2004. Powdered NRL gloves were predominantly substituted with NRL-free gloves, especially in the case of non-sterile procedures.

CONCLUSION

These national compensation-based data confirm that a persistent decline in the incidence of NRL-induced OA has occurred since late 1990s. This downward trend has temporally been associated with a decreasing usage of powdered NRL, further supporting a beneficial role of changes in glove policies.

Patient Safety: Latex Allergy

Reactions to latex rubber products are a growing problem. The danger of latex allergy has been noted for many years, but it has gained significantly more attention since the institution of so-called"universal precautions" following the identification of AIDS and other transmitted viral diseases. Recognition of the various latex reactions ranging from contact dermatitis to true latex allergy is required to prevent unnecessary morbidity and mortality among health-care workers and patients. Several approaches to the problem of latex allergy are reviewed and guidelines for minimizing exposure are recommended.

Grand rounds: latex-induced occupational asthma in a surgical pathologist

CONTEXT

Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice.

CASE PRESENTATION

A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time.

DISCUSSION

The patient's presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work.

RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE

The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.

Preventing and managing catheter-associated urinary tract infections

Since the Foley catheter was introduced in the 1930s it has become one of the primary sources of hospital acquired infections and long term urinary catheters used in community based patients account for some 4% of community nurses' time. This burden is likely to increase given the projected rise in life expectancy and size of the ageing population. This article considers the current literature around indwelling urinary catheterization and its management with a focus on long term catheterization in the community. The authors discuss contemporary strategies to manage or prevent CAUTI that are based on best practice guidelines. However, it is clear from the dearth of empirical evidence that there is an urgent need to establish well constructed research studies to investigate the prevalence of long term urinary catheterization in the community and the prevention and management of CAUTI.

Latex allergy and otorhinolaryngological surgery

Latex allergy in the otorhinolaryngology patient requires forward planning and coordination of management plans between the surgical, nursing and anaesthetic departments in order to ensure a safe outcome.

A Review of Natural‐Rubber Latex Allergy in Health Care Workers

This brief review of natural-rubber latex (NRL) allergy in health care workers (HCWs) includes the definition of NRL allergy and data on its epidemiology, pathogenesis, diagnostic algorithm, management, long-term outcomes, economic impact, cost-effectiveness of changing facilities to a latex-free environment, and prevention. The data presented suggest that an individual with type I or type IV hypersensitivity to NRL should be able to continue to work in the workplace with careful evaluation and reasonable accommodations. Reducing exposure to latex is a safe and more economical alternative to complete removal of the individual from the place of employment. The use of low-allergen, nonpowdered NRL gloves substantially reduces airborne exposure to latex in most health care settings.

Update on latex allergy among health care personnel

Occupational exposure to natural rubber latex has sensitized 10% to 17% of health care personnel in Europe and the United States. The increased incidence of latex allergy is believed to be a direct result of the implementation of standard precautions. The purpose of this literature review is to examine latex allergy studies and discuss the emerging problem of latex allergy in health care personnel. Latex composition, prevalence, clinical manifestations, and populations at risk also are discussed.

Occupational allergies caused by latex

Allergy to natural rubber latex is an important cause of occupational allergy in healthcare workers. Disposable medical gloves are the major reservoir of latex allergens, particularly powdered gloves, in healthcare delivery settings. Diagnosis of latex allergy requires a history of exacerbation of cutaneous, respiratory, ocular, or systemic signs and symptoms after exposure to natural rubber latex products; and evidence of sensitization by patch testing, skin testing, measurement of latex-specific IgE antibodies, or challenge testing. Optimal management of latex allergy involves education concerning cross-reacting allergens, reduction of cutaneous or mucosal contact with dipped rubber products, and minimization of exposure to latex aeroallergens in work environments.

Costs of occupational asthma and of occupational chronic obstructive pulmonary disease

PURPOSE OF REVIEW

The purpose of this review is to summarize the most recent findings on the costs of occupational asthma and chronic obstructive pulmonary disease, illustrating the different approaches for estimates, the results and the social and financial implications.

RECENT FINDINGS

Many published data in the literature show that occupational asthma and chronic obstructive pulmonary disease represent a relevant proportion of the total prevalence of these diseases. Previous findings demonstrated that occupational asthma has adverse economic and employment consequences for the worker, and a significant cost related to the claims. Recent studies using a standard method have specifically estimated the cost of the proportion of cases of asthma and chronic obstructive pulmonary disease attributable to occupational exposure out of the total costs of these diseases, and demonstrated that it is significant. Some recent data indicate a beneficial outcome of occupational asthma and a reduction in the number of the claims from primary and secondary preventive intervention at the workplace.

SUMMARY

In conclusion, occupational asthma and chronic obstructive pulmonary disease are likely to pay a substantial contribution to the total costs of the two disorders. These costs are expected to rise with the increasing prevalence of the diseases. Intervention strategies for effective control and prevention at the workplace should lessen the burden of long-term illness and impact on public health costs.

Cataract surgery for natural rubber latex allergic patients

The prevalence of reactions against natural rubber latex (NRL) is thought to be increasing in both the general public and healthcare workers. These can vary from mild benign skin reactions to bronchospasm, anaphylactic shock, and death. Difficulties exist for ophthalmic departments wishing to establish protocols in providing 'latex-free environments' for patients undergoing cataract surgery. Currently no legislation exists regarding the labelling of NRL-containing products in the United Kingdom with information on a product's NRL content provided by the manufacturer on a voluntary basis only. It is hoped this review article will act as a basic guide in the management of NRL-sensitive patients undergoing cataract surgery in the United Kingdom.

Clinical and occupational outcomes in health care workers with natural rubber latex allergy

BACKGROUND

There is limited information pertaining to clinical outcomes and economic consequences of natural rubber latex (NRL) allergy in health care workers (HCWs).

OBJECTIVE

To evaluate retrospectively health and economic outcomes in HCWs identified with NRL allergy and percutaneous reactivity to NRL.

METHODS

Sixty-seven HCWs with NRL allergy, confirmed by percutaneous reactivity to non-ammoniated latex (NAL) extract, were administered a detailed questionnaire to evaluate clinical and economic outcomes of active work and environmental interventions subsequent to recognition of work-related symptoms associated with NRL gloves.

RESULTS

Diagnoses based on predetermined case definitions associated with direct or indirect exposure to NRL gloves included contact urticaria in 67 (100%); work-related rhinitis in 23; work-related asthma symptoms in 25; and work-related anaphylaxis in 4 workers. Work related symptoms reportedly resolved in 44 of 49 (90%) of NAL skin test-positive workers who had reported skin, respiratory, and/or systematic symptoms and remained in their current work area and who switched to non-NRL gloves. Four of 24 (17%) workers with work-related asthma symptoms were compelled to change employment to NRL-safe workplaces, resulting in a mean 24% reduction in annual income.

CONCLUSIONS

Clinical outcomes in this group of HCWs with NRL allergy were favorable after institution of interventions but incurred deleterious consequences in a minority of workers.

Prevalencia de sensibilización al látex en personal sanitario

BACKGROUND AND OBJECTIVE

Latex exposure at work has been related to sensitization in health care workers. The aim of the present study was to determine the prevalence of this sensitization in health care workers and its risk factors.

PATIENTS AND METHOD

The occupation, prevalence of latex-related symptoms and sensitization was determined in a sample of health care workers by questionnaire and skin testing.

RESULTS

461 subjects were studied during a year. 30.2% of them reported dermatitis symptoms, 23.2% rhinitis, 12.6% urticaria-like rashes, and 5.6% reported asthmatic symptoms. 17.6% of workers reported symptoms when using latex gloves and 5% after the contact or ingestion of tropical fruits. Sensitization to latex was indentified in 12 workers (2.6%, CI95% 1.2-4.0). Dermatitis, urticaria-like rashes, rhinitis and asthmatic symptoms upon exposure to latex products and/or tropical fruits were all significantly more prevalent in sensitized subjects. In the logistic regression analysis, dermatitis, urticaria-like rashes, and asthmatic symptoms after the ingestion of tropical fruits were related to latex sensitization.

CONCLUSIONS

The prevalence of sensitization to latex in health workers is nearly 3% and it must be suspected in subjects reporting symptoms when using latex gloves or after the ingestion of tropical fruits.

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.

Management of occupational allergy to natural rubber latex in a medical center: the importance of quantitative latex allergen measurement and objective follow-up

When our employees began coming to the Occupational Health Service, Dermatology, and Allergy Clinics with symptoms of allergy to rubber gloves 12 years ago, the Mayo Clinic initiated 3 responses. (1) The Allergic Disease Research Laboratory adapted well-established technology to measure both the IgE antibody specific to natural rubber allergens, and by use of this IgE antibody, the allergens in rubber products and in the air of the workplace. (2) The Division of Allergic Diseases and Internal Medicine reviewed the prevalence and severity of the problem. (3) The Clinical Practice Committee appointed a multidisciplinary task force to implement measures to reduce exposure. The 3 sections of this article describe the Mayo Clinic's experience of successful control of this occupational health problem. Use of only gloves with low or undetectable allergen content greatly reduced the concentration of allergen in the work site, reduced the number of new cases of occupational allergy to rubber, and allowed individuals with latex allergy to work at their usual jobs.

Latex allergy: the perspective from the surgical suite

Latex allergy in the perioperative setting presents unique challenges to the health care system. Specific needs of the latex-sensitive patient are paramount, but consideration must also include the impact on health care workers vis-a-vis latex sensitization, environmental allergen control, and barrier protection against blood-borne pathogens. It has been well documented that the greatest source of latex aeroallergen in the surgical setting is latex gloves (both sterile and nonsterile). Levels of latex aeroallergen correlate strongly with use of high-allergen and powdered gloves, total number of gloves used, and the hours of activity in a given environment. A significant reduction in aeroallergen (>10-fold) can be achieved by switching to low-allergen gloves. Ready availability of and encouragement to use nonlatex alternatives when appropriate can further reduce exposure to latex allergens. Since 1998, the Food and Drug Administration has required all medical devices (or their packaging) that contain natural rubber latex to be so labeled. In addition, industry has responded with a host of latex-free products for use in patient care. This has helped eliminate a great deal of confusion about which products are safe for use with latex-sensitive individuals. However, despite significant efforts to educate the public and the health care industry regarding latex allergies, considerable misinformation persists. Provision of a completely latex-free environment in most surgical suites may be unrealistic, but every effort should be made to minimize the unnecessary exposure of patients and health care workers to latex allergens in this high-risk arena.

Outcomes of a natural rubber latex control program in an Ontario teaching hospital

BACKGROUND

Allergy to natural rubber latex (NRL) has been frequently reported in health care workers. However, there is little published evidence of the outcome of hospital intervention programs to reduce exposure and detect cases of sensitization early.

OBJECTIVE

This study assesses the effects of intervention to reduce NRL allergy in an Ontario teaching hospital with approximately 8000 employees.

METHODS

A retrospective review assessed annual numbers of employees visiting the occupational health clinic, allergy clinic, or both for manifestations of NRL allergy compared with the timing of introduction of intervention strategies, such as worker education, voluntary medical surveillance, and hospital conversion to low-protein, powder-free NRL gloves.

RESULTS

The number of workers identified with NRL allergy rose annually, from 1 in 1988 to 6 in 1993. When worker education and voluntary medical surveillance were introduced in 1994, a further 25 workers were identified. Nonsterile gloves were changed to low-protein, powder-free NRL gloves in 1995: Diagnoses fell to 8 workers that year, and 2 of the 3 nurses who had been off work because of asthma-anaphylaxis were able to return to work with personal avoidance of NRL products. With a change to lower protein, powder-free NRL sterile gloves in 1997, allergy diagnoses fell to 3, and only 1 new case was identified subsequently up to May 1999. No increased glove costs were incurred as a result of consolidated glove purchases.

CONCLUSIONS

This program to reduce NRL allergy in employees was effectively achieved without additional glove costs while reducing expenses from time off work and workers' compensation claims.

Biogel Skinsense N: surgical glove management for latex allergies

Healthcare staff with a high occupational exposure to latex gloves, such as those who work in the operating theatre, have a higher than average incidence of latex allergies. Certain patient groups are also known to be considered "high risk" for latex allergies. When wearing gloves, staff allergic to latex and those working with patients allergic to latex must wear latex-free gloves to protect themselves and their patients. Of all the different types of gloves available--examination, medical or diagnostic--surgical gloves have to meet the highest standards, offering both protection and comfort. However, latex-free surgical gloves have previously lacked some of the "comfort" qualities of natural latex. This article describes appropriate glove management for latex allergies and looks at the new generation of latex-free surgical gloves.

Natural rubber latex allergy and asthma

Allergic responses to natural rubber latex (NRL) continue to be reported. In adults, the major exposure is in the occupational setting, especially in relation to NRL glove use by health care workers. Issues addressed over the past year include improving diagnostic methods for NRL allergy and characterization of NRL allergens relevant to various exposure groups and evaluating strategies for prevention and early detection of NRL allergy. Assessment of in vitro tests show good intertest correlation but lower sensitivity compared with skin test responses. NRL allergens have been further characterized as reported in the past year. Development of recombinant Hev b 3, a major NRL allergen relevant to children with spina bifida, enhances the likelihood for improved diagnostic reagents. Preliminary reports of primary preventive strategies suggest that avoidance of high-protein, powdered gloves in health care facilities can be cost-effective and is associated with a decline in sensitized workers.

The latex and food allergy connection

Natural rubber latex is used in the manufacture of many products in the United States. As natural rubber latex allergy becomes of increasing concern, dietitians need to have an understanding of this allergy and how it relates to workplace safety, employee health, and patient feeding and counseling. Natural rubber latex contains more than 35 proteins that may be related to Type I, Ig-E-mediated allergy in numerous segments of the population, including health care workers and patients. Many foods, especially chestnut, banana, and avocado, have the potential to cross-react with natural rubber latex. Chitinase enzymes, related to plant defense, are believed to be involved in this cross-reaction. A strong connection between food allergy and natural rubber latex allergy is recognized and described in this review.

Workers' compensation claims from latex glove use: a longitudinal analysis of Minnesota data from 1988 to 1997

Allergic reaction experienced by health care workers from latex glove use has increasingly become the focus of researchers evaluating occupational sources of injury in health care settings. Many studies have attempted to estimate the prevalence of latex sensitization among health care workers by using various methods, but the findings have been inconsistent and do not predict reactivity. This study used workers' compensation data from Minnesota from 1988 to 1997 to assess allergic reactivity rates, injury severity, and costs associated with latex allergic reactions. The average reactivity rate was 7.1 claims per 100,000 health care workers, and total cost associated with the claims averaged $0.295 per health care employee. Using empirical cost data from another study, it was found that it is not cost-beneficial for health care institutions to globally adopt latex glove-free policies solely on the basis of workers' compensation costs.