Transcript LATEX ALLERGY (Lois Schick)

Lois Schick MN, MBA, RN, CPAN, CAPA
Review the development diagnosis and
current treatment of latex allergies
 Describe each of the 3 types of human
reactions to natural rubber/latex
containing products
 Identify currently available diagnostic
tests and medical treatment options
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National Institute for Occupational
Safety and Health
 Established under the 1970
Occupational Safety and Health Act
 A division of the Centers fro Disease
Control and Prevention (CDC)
 Not OSHA
 In Ireland and Great Britain it is the NHS
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June 1997 released-prevention
oriented
 Use the appropriate glove for the
task at hand
 Summarizes employer and worker
info
 Targeted towards hospitals, day
care facilities, food service industry,
environmental services
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Cheryl was a 41 year old RN in Oregon
Worked 3-11 Shift
Cheri never came home from work one night
Her Story:
◦ Visiting father in hospital and she develops a
severe allergic reaction which required 3 days on a
ventilator
◦ Carpets were being cleaned at hospital and her
reaction was attributed to a reaction to the cleaning
chemicals
◦ Had a second bout again when carpets were being
cleaned at a hospital where she was employed
Cheri realized she was only having
reactions when wearing Latex gloves
 In 1994, Cheri was tested for and
diagnosed with a latex allergy.
 She switched to hypoallergenic gloves
which are meant for those who suffer from
dermatitis.
 Some hypoallergenic gloves have been
found to have 3000 times the latex protein
as regular latex gloves making them more
dangerous to latex sensitive nurses
 Eventually she got latex-free gloves.
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June 10, 1996 Cheri had a severe attack while
at work.
She was rushed to the ED and told the staff
there that she was latex sensitive.
At one point Cheri grabbed one nurse by the
arm so hard that she left bruises and her last
words to this nurse were:
“You’re just going to let me die. I’m not
going to make it this time.”
Cheri was right – she did die in the ED that
night.
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Milky fluid derived from the rubber tree
(Hevea Brasiliensis)
Two methods of treatment prior to use
◦ Coagulate to solidify
 Dry natural rubber i.e. tires, shoe soles
◦ Ammonionate to prevent coagulation
 Gloves, condoms
◦ Proteins can cause range of
allergic reactions
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Latex allergy affects 18 million Americans
Increasing rates of sensitization
◦ 18-73% sensitization rate in children
with Spina Bifida
◦ 33% sensitization rate in those having 3
or more surgeries
◦ 15% sensitization rate in RN’s
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17% sensitization rate in ALL health care
workers (2% have occupational asthma)
Increased sensitivity in operating room
personnel from 2.95% to 15% in less than 10
years
Increased rates in dental personnel from
13.7% to 38% in 4 years
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Congenital neural tube
disorders
Urologic disorders
requiring
catheterizations
3 or more surgeries
History of systemic
reactions to balloons,
latex gloves, condoms,
cosmetics, rocket
handlers, Poinsettas
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History of allergy to fruits with cross reactive
proteins
◦ Hay fever, asthma, contact dermatitis
◦ Food allergies to:
 bananas, avocados, passion fruit,
kiwis, chestnuts, tomato, Celery,
melon,
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Delayed hypersensitivity
◦ Contact pruritus, erythema,
uriticaria, eczema
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Immediate hypersensitivity
◦ Rhinorrhea, conjuctival pruritis &
edema, wheezing, bronchospasm,
angina, tachycardia & progressively
severe hypotension
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Progresses in 15-20 minutes
Resolves spontaneously over 1-2 hours
Immediate, local and generalized uriticaria,
feeling faint, feeling of impending doom,
angioedema, nausea, vomiting, abdominal
cramps, bronchospasm, anaphylaxis
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Anaphylaxis:
Typically within 30 minutes after exposure
Cutaneous, GI, CV, Respiratory
Laryngeal edema and CV collapse most
common cause of death
Immunoglobulin & mediated systemic
reaction to the latex proteins that if untreated
lead to fatality
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Contact Dermatitis
◦ Appears in 18-24 hours
◦ Resolves in 72-96 hours
◦ Redness & inflammation over exposed
sites
◦ Blister formation
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Allergic Dermatitis
◦ T-cell mediated delayed localized reaction to chemicals
used in manufacture of gloves
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GLOVES
◦ act as a vector for patient
sensitization
◦ Workers are at risk as a population
from multiple exposures
◦ 5-6 million workers wear gloves
regularly
◦ 117 million pairs of latex gloves
were supplied to NHS in 1992
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Latex gloves can cause contact allergic
reactions
◦ itching, hives, vesicles, erythema,
and eczema
◦ Usually a delayed hypersensitivity
reaction
◦ Workers may have concurrent
chemical sensitivities to additives in
latex
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40,000 consumer products that contain latex
in their composition.
Makes it difficult to completely delete latex
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Latex particles are suspended in indoor air
in health care settings
Powder in gloves is the vehicle for latex
particle aerosolization
Aeroallergens are higher in areas where
workers frequently apply and discard
gloves
When latex particles are inhaled, workers
become sensitized
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Gloves - sterile and exam
Catheters
IV injection ports
Medication vials with needle access
Ventilator, anesthesia, and respiratory therapy
equipment
Latex tipped enemas, endoscopy parts
Mattresses on stretchers
Stethoscopes & blood pressure cuff tubing
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Household gloves
Diapers, bottle nipples, pacifiers
Household insulation material, carpet backing
Newsprint, coupons, and magazines dusted with
latex coating
Feminine sanitary pads, adult diapers, condoms,
diaphragms
Clothing including elastic on underwear
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Cutaneous & Mucosa
◦ Gloves, dental equipment, surgical procedures,
food prepared by people wearing latex gloves, toys,
clothing, sports equip.
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Inhalants
◦ Anesthesia machines, powder from latex gloves,
balloons, car tires
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IV & Parenteral
◦ IV ports, tubing, burettes, bottles and syringes
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Antihistamines - oral, IM, IV
◦ Chlorphenamine
◦ Diphenhydramine
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Steroids - inhaled, oral, IV
Bronchodilators - inhaled, oral, IV
Epinephrine - SQ & IV
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Latex-safe preoperative and patient rooms
Latex-safe OR, PACU and anesthesia
equipment
Latex-safe neonatal resuscitation equipment
Drugs must not be administered through
latex ports, nor dwell in syringes with latex
plungers
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Schedule latex - safe cases first of the day to
allow settling of latex dust overnight
Latex-safe anesthesia equipment
Latex-safe respiratory equipment
Latex-safe IV delivery systems
Recognition of inadvertent latex exposure
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Latex-safe intubation & ventilation
equipment
Latex-safe IV equipment
Latex-safe gloves and monitoring equipment
Laminar air flow available for the “exquisitely”
sensitized
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Screening criteria and diagnosis of latex
allergy
Methods of allergy testing
◦ RAST – RIA (invitro test IgE) with variable sensitivity
◦ AlaSTAT – ELISA testing ( IgE testing)
◦ Skin Prick - Most sensitive but carries risk of
anaphylaxis
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Non latex gloves for the employee
Non latex for co-workers (Preferred) or
powder free
Medications ( epi-pen, antihistamines,
inhalers, steroids)
Education of co-workers
Complete removal of latex sources from work
place
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Remove latex sources from room
Dust and vacuum with HEPA filters
Mop all surfaces
Label room with a “Latex Allergy”Sign
Obtain non-latex medical equipment (Cart)
Reverse laminar air flow room if possible
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Non-latex exam and sterile gloves. NO
Exceptions !
◦ neolon, nitrile, & butadene-styrene
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Latex-Free respiratory support equipment
◦ Non-latex ambu bag, ETT, cannulas, & masks
readily available
◦ Non latex anesthesia machine components
(Ohmeda, North American Draeger & Anesthesia
Associates retrofits
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Clave ( ICU Medical), Interlink
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Baxter), IVAC & Braun needleless IV tubings
Protective Plus (Johnson & Johnson) Insyte
(Critikon), Abbocath, Clear-cath
Central lines-check with Arrow & Bard
Heparin Locks - B. Braun and Abbot
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Use needleless systems with latex free
syringes or prefills
◦ Abboject for most emergency drugs
◦ Approved Wyeth-Ayerst blunt tip or tubex drugs
only
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Latex-free syringes - Terumo, Norm-ject (
Air-tite) & Becton Dickinson
DeRoyal Procedure Packs
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Nursing, Laboratory, Pharmacy,
Housekeeping & Food Service staff don fresh
gowns when entering a latex-allergic
person’s room to prevent latex glove residue
on clothing from being introduced. All
personnel wear non-latex gloves
Food prep done with non-latex gloves
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Latex gloves
Meds injected through latex topped vials into
latex IV ports
Latex tipped enema catheters, urinary
catheters
Respiratory and resuscitation equipment
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Sample of 79 Type I allergic response to latex
◦ 49% RNs
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Qualitative - Fears, Lifestyle changes, Job and
family impact
Findings in a nutshell
◦ Almost all respondents fear needing EMS and
Medical care
◦ Denial of symptoms often results in worsening
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1. Identify those at risk as well as those who
have had reactions.
2. Communicate information about the
patient to all departments who have contact
with the patient. Latex Precaution checklist
3. Admit patient to environment that reduces
exposure to latex
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4. Call for Latex Precautions cart.
5. Use Latex-free gloves for any patient
contact. Sterile & nonsterile.
6. Schedule surgeries/procedures as first
case of the day.
7. Protect patient from direct contact.
8. Follow physicians orders for pre and/or
post anaphylaxis medications. BE Prepared!
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9. If appropriate, maintain a unit specific
Latex Free “Tool Box”.
10. Educate the patient and the family-Refer
cases to appropriate medical care, contact
latex information networks.
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LISTEN TO THE PATIENT!!!
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Obtain latex free equipment before it is
needed
Suspect every patient and any employee with
symptoms
Resources:
◦ Elastic - www.latexallergyhelp.com
◦ Latex Cart Products List - Journal of Emergency
Nursing 1998; 24L58-61
◦ Elastic - www.latexallergyhelp.com
◦ Latex Cart Products List - Journal of
Emergency Nursing 1998; 24:58-61
◦ http://www.cdc.gov/niosh/latexalt.html
◦ AANA: http://www.aana.com
◦ http://www.immune.com/allergy
◦ American college of Allergy Asthma
immunology: http:// www.acaai.org
 See
YOU
in Seattle,
WA. USA
 April 3-7,
2011
Lois Schick MN, MBA,
RN, CPAN, CAPA
 12823 W. 3rd Place
 Lakewood, CO USA
80228
 E- Mail:
[email protected]
 Home:303-989-2281
 Cell: 303-475-9854
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