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

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.

The prevalence of latex sensitisation and allergy and associated risk factors among healthcare workers using hypoallergenic latex gloves at King Edward VIII Hospital, KwaZulu-Natal South Africa: a cross-sectional study

OBJECTIVES

The present study describes latex sensitisation and allergy prevalence and associated factors among healthcare workers using hypoallergenic latex gloves at King Edward VIII Hospital in KwaZulu-Natal, South Africa.

DESIGN

Cross-sectional study.

SETTING

A tertiary hospital in eThekwini municipality, KwaZulu-Natal, South Africa.

PARTICIPANTS

600 healthcare workers were randomly selected and 501 (337 exposed and 164 unexposed) participated. Participants who were pregnant, with less than 1 year of work as a healthcare worker and a history of anaphylactic reaction were excluded from the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Latex sensitisation and latex allergy were the outcome of interest and they were successfully measured.

RESULTS

The prevalence of latex sensitisation and allergy was observed among exposed workers (7.1% and 5.9%) and unexposed workers (3.1% and 1.8%). Work-related allergy symptoms were significantly higher in exposed workers (40.9%, p<0.05). Duration of employment was inversely associated with latex allergy (OR 0.9; 95% CI 0.8 to 0.9). The risk of latex sensitisation (OR 4.2; 95% CI 1.2 to 14.1) and allergy (OR 5.1; 95% CI 1.2 to 21.2) increased with the exclusive use of powder-free latex gloves. A dose-response relationship was observed for powdered latex gloves (OR 1.1; 95% CI 1.0 to 1.2). Atopy (OR 1.5; 95% CI 0.7 to 3.3 and OR 1.4; 95% CI 0.6 to 3.2) and fruit allergy (OR 2.3; 95% CI 0.8 to 6.7 and OR 3.1; 95% CI 1.1 to 9.2) also increased the risk of latex sensitisation and allergy.

CONCLUSIONS

This study adds to previous findings that healthcare workers exposed to hypoallergenic latex gloves are at risk for developing latex sensitisation highlighting its importance as an occupational hazard in healthcare. More research is needed to identify the most cost effective way of implementing a latex-free environment in resource-limited countries, such as South Africa. In addition more cohort analysis is required to better understand the chronicity of illness and disability associated with latex allergy.

Latex allergy in the prehospital setting

INTRODUCTION

Latex allergy first was recognized early in the 20th Century, but was not a matter of concern until the last decade of that Century. The reported incidence of latex allergy in different occupations varies considerably. It has been documented in dental workers, operating theater staff, anesthetists, and laboratory technicians. However, little data specifically related to those involved in patient care in the emergency prehospital setting are available.

METHODS

A questionnaire was distributed to a sample of both volunteer and salaried first responders from St. John Ambulance Australia in South Australia and Western Australia, and the South Australian Ambulance Service. The first responders were surveyed to: (1) determine the incidence of latex allergy; (2) consider possible factors associated with its development; (3) compare characteristics of the surveyed groups; and (4) reinforce the development of an educational program. The study tool had predetermined statistical qualities. Data were collated and processed using standard statistical procedures. Surveys were collected anonymously.

RESULTS

Of the 2,716 forms distributed, 1,099 were returned, resulting in an overall response rate of 40.5%. Atopy was identified in 14.9% of participants, hand dermatitis in 9.4%, and latex allergy in 6.4%. In the group of full-time ambulance officers, there was a significantly higher incidence of hand dermatitis and latex allergy. There also was a significant relationship between latex allergies and both dermatitis and glove usage (as measured by frequency and duration).

CONCLUSION

In a group of first responders assessed by an anonymous, voluntary questionnaire, the subset of full-time, salaried ambulance officers was identified as having a higher incidence of hand dermatitis and latex allergy than their volunteer co-workers. These results require further assessment to substantiate the frequency of latex allergy and determine the predisposing factors. All personnel must learn about hand care. Non-powdered, natural rubber latex gloves should be supported for general use in this setting.

Glove selection as personal protective equipment and occupational dermatitis among Japanese midwives

This study was conducted to 1) evaluate the personal selection and use of protective gloves against bloodborne pathogens and management of glove selection in the workplace, 2) survey the experience with occupational dermatitis and other allergic symptoms, 3) explore the relationships between occupational dermatitis experience and glove use, and 4) determine the impact of glove selection upon occupational dermatitis among midwives. Subjects were 1,150 midwives working in Japan. Participants were selected from the members of Japanese Nursing Association and 835 responded to the survey. More than 30% of respondents wore gloves only when clients had an infectious disease, 41% reported experience of occupational dermatitis, 26% associated the dermatitis with medical glove use, and 2% had a diagnosis of latex allergy. Demographic variables that were significantly associated with occupational dermatitis included history of allergic symptoms other than due to occupational exposure, age, tenure and type of working institution. Using latex gloves during administering enema, shaving, changing pads, washing perineum, receiving newborns, suctioning, and handling waste significantly increased the risk of occupational dermatitis experience compared to not using gloves. Logistic regression analysis with backward stepwise elimination revealed glove selection management, such as availability of alternative glove types, using latex gloves for washing perineum, and using latex gloves for handling waste were significant predictors of occupational dermatitis. Occupational dermatitis is a significant issue and glove use as personal protective equipment is not standardized. Some occupational dermatitis may be preventable by managing appropriate glove selection.

Latex allergy: a follow up study of 1040 healthcare workers

BACKGROUND

Natural rubber latex allergy can cause skin and respiratory symptoms The aim of this study was to evaluate the prevalence and incidence of latex related symptoms and sensitisation among a large group of healthcare workers in Trieste hospitals, followed for three years before and after the introduction of powder-free gloves with low latex release.

METHODS

In the years 1997-99 the authors evaluated 1040 healthcare workers exposed to latex allergen for latex related symptoms and sensitisation by means of a questionnaire, a medical examination, skin prick tests, and IgE specific antibody assay. The second evaluation was carried out in the years 2000-02, subsequent to the changeover to a powder-free environment.

RESULTS

Glove related symptoms were seen in 21.8% of the nurses (227), mostly consisting of mild dermatitis: 38 (3.6%) complaining of contact urticaria and 24 (2.3%) of asthma and/or rhinitis. These symptoms were significantly related to skin prick tests positive to latex (OR = 9.70; 95% CI 5.5 to 17) and to personal atopy (OR = 2.29; 95% CI 1.6 to 3.2). Follow up was completed in 960 subjects (92.3%): 19 new subjects (2.4%) complained of itching erythema when using gloves, but none was prick positive to latex. Symptoms significantly improved and in most cases disappeared (p<0.0001).

CONCLUSIONS

Simple measures such as the avoidance of unnecessary glove use, the use of non-powdered latex gloves by all workers, and use of non-latex gloves by sensitised subjects can stop the progression of latex symptoms and can avoid new cases of sensitisation.

Self-reported allergy to latex gloves among health care workers in Jordan

The objective of this study is to determine the prevalence of natural rubber latex allergy and its associated factors among health care workers in Jordan based on a self-administered questionnaire. In this cross-sectional study, the data were obtained through a self-reported hand-delivered questionnaire that was distributed to 500 health care workers who use natural rubber latex gloves. A total of 420 (84%) health care workers responded by filling the questionnaire. Of the total number of 420 health care workers who filled the questionnaire, 57 (13.6%) reported allergy to latex gloves. The prevalence of allergy to latex gloves was significantly higher for those who had allergy to some foodstuffs (especially avocado, kiwifruits and chestnuts) or with history of eczema and hay fever. However, allergy to latex gloves was independent of gender, age, job, family history, type of gloves, hours of use/day and number of years of use. It is concluded that a high rate of allergy to latex gloves was reported among health care workers in Jordan.

A Review of Latex Sensitivity Related to the Use of Latex Gloves in Hospitals

Beginning in the 1980s, use of latex gloves to protect health care workers against exposure to blood and body fluids increased. Since then, the number of reported cases of latex sensitivity also has increased. Reactions to latex range from contact dermatitis to anaphylactic shock. Low-powder, powder-free, and non-latex gloves provide alternatives to protect health care workers from occupational latex exposure.

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.

Self-reported skin and respiratory symptoms related to latex exposure among 5,087 hospital employees in Norway

BACKGROUND

Latex allergy has become prevalent among health care workers.

OBJECTIVES

To determine the prevalence of self-reported symptoms related to latex exposure among hospital personnel.

METHODS

Questionnaires addressing symptoms and risk factors for latex allergy were distributed to all employees (n = 5,087) at Haukeland University Hospital.

RESULTS

Symptoms associated with latex exposure were reported by 23.8% of the participants. Skin symptoms were most frequently reported - flushing/itching/hives: 21.0%, hand eczema: 11.8% - while systemic and respiratory symptoms were reported by 1.4 and 1.2%, respectively. Approximately twice as many women than men reported symptoms (odds ratio 2.55, confidence interval 2.04-3.18). Symptoms were reported by 33.7% of those with atopy and by 20.0% of those without. The occurrence of symptoms increased significantly with the frequency of use of latex gloves but was unrelated to age, years of exposure or number of surgical procedures.

CONCLUSIONS

The occurrence of self-reported symptoms was associated with the frequent use of latex gloves, atopy and female gender.

Epidemiology of latex sensitization and allergies in health care workers

Although it is often claimed that health care workers are at increased risk of latex sensitization and type I allergies, there has been no systematic analysis of the epidemiologic studies that are relevant to this conclusion. A systematic analysis of the epidemiologic literature found that, in the past 14 years, there have been 48 epidemiologic studies of type I latex allergy among health care workers. Of these, 2 cohort studies estimated the incidence of latex sensitization by skin prick testing at between 1% and 2.5% per year. Neither compared the risk to that in the general population. The prevalence of sensitization in health care workers varied between 0% and 30%, yet this large variation was unexplained. Increased risk of sensitization was not clearly associated with the duration of work in health care, the time spent wearing latex gloves, the frequency of exposure, the specific job categories, the use of powdered versus nonpowdered latex gloves, the use of latex versus nonlatex gloves, or any measurements of ambient exposure to latex proteins. The epidemiologic studies do not support a conclusion that health care workers are at clearly increased risk of latex sensitization or type I allergies compared to other occupations in the United States. The role of latex gloves in causing latex sensitization and type I allergic symptoms remains poorly defined because of the inconsistent results across studies. Future epidemiologic studies are needed that include measured exposures to latex antigens, that compare health care workers to appropriate referent groups, and that address confounding by atopy, age, sex, and race.

Natural rubber latex: glove use, sensitization, and airborne and latent dust concentrations at a Denver hospital

Exposure to natural rubber latex may cause immediate hypersensitivity reactions. Published latex sensitization prevalence rates range from 2.9% to 22% among health care workers, and from 0.12% to about 20% of occupationally unexposed populations. In this study, self-administered questionnaires addressed job and personal characteristics, glove use, and symptoms in two groups of hospital workers: those who regularly used latex gloves and those who did not. Serum was tested for latex-specific immunoglobulin E. Air, surface, and air-filter dust samples for natural rubber latex were collected. The prevalence of latex sensitization was 6.3% in the non-users and 6.1% in the latex glove users (P = 0.9); 81.3% of sensitized workers were atopic compared with 59.5% of non-sensitized workers (P < 0.05). Reporting of work-related hand dermatitis was more common in the latex glove users (23.4%) than in the non-users (4.9%), as were rhino-conjunctivitis (16.3% and 7.9%, respectively, [P < 0.01]), and hand urticaria (9.9% and 2.1%, respectively, [P < 0.01]). There was no significant difference in work-related symptoms between the sensitized and non-sensitized workers. Environmental concentrations of latex were higher in the work areas of the non-sensitized workers, but higher in the clinical than in the non-clinical areas. Occupational latex glove use was not a risk factor for sensitization.

The occupational hazards of emergency physicians

Emergency physicians are exposed to a variety of occupational hazards. Among these are infectious diseases, such the human immunodeficiency virus, hepatitis B and C viruses, and tuberculosis. Hepatitis G virus is transmissible but may not be a cause of illness. The likelihood of being exposed to these agents appears to be higher in the ED than other medical settings but estimates of the prevalence of these diseases in the ED vary, depending on the patient population served. Estimates of risk for contracting these infections are reviewed. Measures to prevent these exposures can reduce risk, but compliance is low, particularly for those involving changes in the behavior of emergency physicians (such as not recapping needles). Latex allergy is a hazard of health care workers. Its prevalence is reported to be quite high, but these findings are difficult to interpret in the absence of a universally accepted definition of the condition. Its prevalence in emergency physicians is not known. Other noninfectious hazards include workplace violence and exposure to nitrous oxide. The health effects of rotating shift work may put emergency physicians at increased risk of coronary artery disease and impaired reproductive health. Emotional stress is another hazard of emergency physicians, and may lead to burnout.