Latex Product Safety Policy 

PURPOSE

The purpose of this written policy is the prevention of allergic reactions to natural rubber latex in the Community College of Rhode Island. Latex allergy can result in potentially serious health problems for workers and students who are often unaware of the risk of latex exposure. Such health problems can be minimized or prevented by following the recommendations in this Policy.

The following recommendations for preventing latex allergy in the workplace are based on current knowledge and a common-sense approach to minimizing latex-related health problems. Evolving manufacturing technology and improvements in measurement methods may lead to changes in these recommendations in the future. For now, adoption of the recommendations wherever feasible will contribute to the reduction of exposure and risk for the development of latex allergy. In this document, the term "latex" refers to natural rubber latex and includes products made from dry natural rubber. Natural rubber latex is the product manufactured from a milky fluid derived mainly from the rubber tree, Hevea brasiliensis.

The National Institute for Occupational Safety and Health (NIOSH) is striving to prevent allergic reactions to natural rubber latex among workers who use gloves and other products containing latex. Latex gloves have proved effective in preventing transmission of many infectious diseases to health care workers. But for some, exposures to latex may result in skin rashes, hives, flushing, itching, nasal, eye, or sinus symptoms, asthma and (rarely) shock. Reports of such allergic reactions to latex have increased in recent years, especially among health care workers. At present, scientific data are incomplete regarding the natural history of latex allergy. Also, improvements are needed in methods used to measure proteins causing latex allergy. This Policy presents NIOSH recommendations for minimizing latex-related health problems in workers and students while also minimizing their exposure to infectious materials. (Note that no glove materials provide absolute protection from all etiological agents; they only reduce exposure risk.) These recommendations include reducing exposures, using appropriate work practices, training and education, monitoring symptoms, and substituting nonlatex products when appropriate.

BACKGROUND

Composition of Latex
Latex products are manufactured from a milky fluid derived from the rubber tree, Hevea brasiliensis. Some proteins in latex can cause a range of mild to severe allergic reactions. Currently available measurement methods do not provide easy or consistent identification of allergy-causing proteins (antigens) and their concentrations. Until well-accepted standardized tests are available, total protein serves as a useful indicator of the exposure of concern. Chemicals added during processing may also cause skin rashes. Several types of synthetic rubber are also referred to as "latex," but these do not release the proteins that cause allergic reactions.

Products Containing Latex
A wide variety of products contain latex: medical supplies, personal protective equipment, and numerous household objects. Most persons who encounter latex products only through their general use in society have no health problems from the use of these products. Individuals who already have latex allergy should be aware of latex-containing products that may trigger an allergic reaction. Some of the products listed below are available in latex-free forms.

Emergency Equipment
Blood pressure cuffs, stethoscopes, disposable gloves, oral and nasal airways, endotracheal tubes, tourniquets, intravenous tubing, syringes, electrode pads

Personal Protective Equipment
Gloves, surgical masks, goggles, respirators, rubber aprons

Office Supplies
Rubber bands, rubber erasers

Hospital Supplies
Anesthesia masks, catheters, wound drains, injection ports, tops of multidose vials, dental dams

Household Objects
Automobile tires, motorcycle and bicycle handgrips, carpeting, swimming goggles, racquet handles, shoe soles, expandable fabric (waistbands), dishwashing gloves, hot water bottles, condoms, diaphragms, balloons, pacifiers, baby bottle nipples

Latex in the Workplace
Workers and students in allied health care programs and the health care industry (physicians, nurses, dentists, dental technicians, dental assistants, dental hygienists, medical laboratory technicians, Respiratory Therapy technicians, laboratory students, clinical students, laboratory paraprofessionals, phlebotomists, etc.) are at risk for developing latex allergy because they use latex gloves and other latex articles frequently. Other laboratory workers at risk because they use latex gloves and other products are staff and students in chemistry, biology, art and photography courses. Maintenance, janitorial and dining service personnel and campus police officers use latex gloves and are also at risk. Those who repeatedly use latex products at the Community College of Rhode Island are the focus of this Policy.

TYPES OF REACTIONS TO LATEX

Three types of reactions can occur in persons using latex products:

• Irritant contact dermatitis
• Allergic contact dermatitis (delayed hypersensitivity)
• Latex allergy

Irritant Contact Dermatitis
The most common reaction to latex products is irritant contact dermatitis, the development of dry, itchy, irritated areas on the skin, usually the hands. This reaction is caused by irritation from using gloves and possibly by exposure to other workplace products and chemicals. The reaction can also result from repeated hand washing and drying, incomplete hand drying, use of cleaners and sanitizers and exposure to powders added to gloves. Irritant contact dermatitis is not a true allergy. However, the signs of irritant contact dermatitis and chemical sensitivity are similar and may be difficult to differentiate.

Chemical Sensitivity Dermatitis
Allergic contact dermatitis (delayed hypersensitivity, also sometimes called chemical sensitivity dermatitis) results from exposure to chemicals added to latex during harvesting, processing, or manufacturing. These chemicals can cause skin reactions similar to those caused by poison ivy. As with poison ivy, the rash usually begins 24 to 48 hours after contact and may progress to oozing skin blisters and may spread away from the area of skin touched by the latex.

Latex Allergy
Latex allergy (immediate hypersensitivity) is a more serious reaction to latex than irritant contact dermatitis or allergic contact dermatitis. Certain proteins in latex may cause sensitization (positive blood or skin test, with or without symptoms). Although the amount of exposure needed to cause sensitization or symptoms is not known, exposures at very low levels can trigger allergic reactions in some sensitized individuals. Reactions usually begin within minutes of exposure to latex, but they can occur hours later and can produce various symptoms. Mild reactions to latex involve skin redness, hives, or itching. More severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat, and asthma (difficult breathing, coughing spells, and wheezing). Rarely, shock may occur; but a life-threatening reaction is seldom the first sign of latex allergy. Such reactions are similar to those seen in some allergic persons after a bee sting.

LEVELS AND ROUTES OF EXPOSURE

Studies of other allergy-causing substances provide evidence that the higher the overall exposure in a population, the greater the likelihood that more individuals will become sensitized. The amount of latex exposure needed to produce sensitization or an allergic reaction is unknown; however, reductions in exposure to latex proteins have been reported to be associated with decreased sensitization and symptoms.

Note: The proteins responsible for latex allergies fasten to powder that is used on some latex gloves. When powdered gloves are worn, more latex protein reaches the skin. Also, when gloves are changed, latex protein/powder particles get into the air and can be distributed by a building's ventilation system. They can be inhaled and contact body membranes of persons far removed from the site of latex use. In contrast, work areas where only powder-free gloves are used show low levels or undetectable amounts of the allergy-causing proteins. Wearing latex gloves during episodes of hand dermatitis may increase skin exposure and the risk of developing latex allergy. The risk of progression from skin rash to more serious reactions is unknown. However, a skin rash may be the first sign that someone has become allergic to latex and that more serious reactions could occur with continuing exposure.

WHO IS AT RISK?

Persons with ongoing latex exposure are at risk for developing latex allergy. They include health care workers and students (physicians, nurses, nurse's aides, dentists, dental assistants, dental hygienists, operating room employees, laboratory technicians, phlebotomists and hospital housekeeping personnel) who frequently use latex gloves and other latex-containing medical supplies. Workers who use latex gloves and other products less frequently (law enforcement personnel, ambulance attendants, funeral-home workers, fire fighters, painters, gardeners, and food service workers) may also develop latex allergy. Workers in factories where latex products are manufactured can also be affected. Atopic individuals (persons with a tendency to multiple allergic conditions) are at increased risk for developing latex allergy. Latex allergy is also associated with allergies to certain foods especially avocado, potato, banana, tomato, chestnuts, kiwi fruit, and papaya. People with spina bifida are also at increased risk for latex allergy.

DIAGNOSING LATEX ALLERGY

Latex allergy should be suspected in anyone who develops certain symptoms after latex exposure, including nasal, eye, or sinus irritation; hives; shortness of breath; coughing; wheezing; or unexplained shock. A physician should evaluate any exposed person who experiences these symptoms, since further exposure could result in a serious allergic reaction. A diagnosis is made by using the results of a medical history, physical examination, and tests.

Taking a complete medical history is the first step in diagnosing latex allergy. In addition, blood tests approved by the Food and Drug Administration (FDA) are available to detect latex antibodies. However, no FDA-approved materials are yet available to use in skin testing for latex allergy. Skin testing and glove-use tests should be performed only at medical centers with staff who are experienced and equipped to handle severe reactions. Testing is also available to diagnose allergic contact dermatitis. Occasionally, tests may fail to confirm a worker who has a true allergy to latex, or tests may suggest latex allergy in a worker with no clinical symptoms. Therefore, test results must be evaluated by a knowledgeable physician.

TREATING LATEX ALLERGY

Once a person becomes allergic to latex, special precautions are needed to prevent exposures during work as well as during medical or dental care. Certain medications may reduce the allergy symptoms, but complete latex avoidance (though quite difficult) is the most effective approach. Many facilities maintain latex-safe or latex-free areas for affected patients and workers.

HOW COMMON IS LATEX ALLERGY?

The prevalence of latex allergy has been studied by several methods: Questionnaires to assess reactions to latex gloves; Medical histories of reactions to latex-containing products; Skin tests; Tests for latex antibodies in a worker's blood.

Reports about the prevalence of latex allergy vary greatly. This variation is probably due to different levels of exposure and methods for estimating latex sensitization or allergy. Recent reports in the scientific literature indicate that about 1% to 6% of the general population and about 8% to 12% of regularly exposed health care workers are sensitized to latex. Among sensitized workers, a variable proportion have symptoms or signs of latex allergy. Several reasons may exist for the large numbers of latex allergies recently reported in workers and students:

1. Workers rely increasingly on latex gloves to prevent the transmission of human immunodeficiency virus (HIV), hepatitis B virus, and other infectious agents as outlined in Recommendations for Prevention of HIV Transmission in Health-Care Settings [CDC 1987] and in Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public-Safety Workers and students [CDC 1989]. A new and important concern is exposure to Hepatitis C.

2. Since 1992, the Occupational Safety and Health Administration (OSHA) has required employers to provide gloves and other protective measures for their employees [29 CFR 1910.1030, Bloodborne pathogens].

3. Some manufacturers may have produced more allergenic gloves because of changes in raw materials, processing, or manufacturing procedures to meet the increased demand for latex gloves. These production changes may account partly for the varied concentrations of extractable latex proteins reported for latex gloves. Variations also exist between lots produced by the same manufacturer. Research indicates that gloves manufactured in the United States are superior to those manufactured abroad with respect to maintenance of integrity.

4. Physicians are more familiar with latex allergy and have improved methods for diagnosing it.

PRECAUTIONS AGAINST LATEX ALLERGY AT CCRI

Latex allergy can be prevented or minimized only if employers adopt policies to protect workers from undue latex exposures. NIOSH recommends that employers take steps to protect workers from latex exposure and allergy in the workplace: While the Community College of Rhode Island cannot guarantee a latex-free environment, the College will:

1. Encourage its departments to work toward a latex-safe environment.
2. Encourage its departments to change over to nonlatex products whenever possible.
3. Require all departments to provide a selection of nonlatex gloves and other products made of nitrile, neoprene, vinyl or other material to faculty and staff who request them when they can be used without compromising patient care. Departments that provide latex gloves to their students must also provide gloves made from alternate materials to students that request them. Departments whose students are required to purchase their own gloves must inform students of alternate choices available for sale in the College bookstores.
4. Will continue to require appropriate barrier protection as necessary when handling infectious materials [CDC 1987].
5. Will provide non-latex gloves to workers allergic to latex.
6. Ensure that workers use good housekeeping practices to remove latex-containing dust from the workplace by frequent wet sponging or disinfecting of areas such as laboratory bench tops.
7. Provide workers and students with education programs and training materials, including signs and copies of this policy, about latex allergy.
8. Evaluate current prevention strategies whenever someone is diagnosed with latex allergy.

INSTRUCTORS, STAFF AND STUDENTS

Instructors, staff and students should take the following steps to protect themselves from latex exposure and allergy at the College:

1. Use nonlatex gloves whenever possible. Gloves made from nitrile or neoprene may also be suitable for patient care. Loose fitting polypropylene gloves may be suitable for nonpatient care activities such as chemistry experiments, food preparation, routine housekeeping, maintenance, etc.

2. Appropriate barrier protection is necessary when handling infectious materials [CDC 1987]. If you choose latex gloves, use only powder-free gloves: 

• Such gloves reduce exposures to latex protein and thus reduce the risk of latex allergy (though symptoms may still occur in some persons).
• So-called hypoallergenic latex gloves do not reduce the risk of latex allergy. However, they may reduce reactions to chemical additives in the latex (allergic contact dermatitis).
• The College does not supply gloves to its staff, instructors and students through Central Stores. Rather, they are purchased by the individual departments or by the students themselves, according to department needs and policies. Departments and students may only purchase non-powdered gloves. The College no longer permits the purchase of powdered gloves for use on its premises.

3. Use appropriate work practices to reduce the chance of reactions to latex:

• When wearing latex gloves, do not use oil-based hand creams or lotions (which can cause glove deterioration) unless they have been shown to reduce latex-related problems and maintain glove barrier protection.
• When wearing latex gloves, wear washable cotton gloves (if department policy permits) under the latex gloves to reduce contact between your skin and the latex. Wash the cotton gloves after each wearing.
• After removing latex gloves, wash hands with a mild soap and dry thoroughly.
• Use good housekeeping practices to remove latex-containing dust from the workplace by damp sponging or disinfecting of surfaces:
• Frequently clean areas such as laboratory bench tops that may be contaminated with latex dust.

4. Take advantage of all latex allergy education and training provided by the College:

• Become familiar with procedures for preventing latex allergy.
• Learn to recognize the symptoms of latex allergy: skin rashes; hives; flushing; itching; nasal, eye, or sinus symptoms; asthma; and shock.

5. If you develop symptoms of latex allergy, avoid direct contact with all latex-containing products until you see a physician experienced in treating latex allergy. If you or anyone else develops severe symptoms of latex allergy on College premises, immediately call the Department of Security and Safety and Campus Police for assistance. Security can be reached by dialing 333-7035 at the Flanagan Campus, 825-2109 at the Knight Campus, 455-6050 at the Liston Campus and 851-1620 at the Newport Campus.

6. If you have latex allergy, consult your physician and other health care providers (dentist, nurses, etc.) and take the following precautions:

• Tell your supervisor, department chair and laboratory instructors that you have latex allergy.
• Avoid contact with latex gloves and other latex-containing products.
• Avoid areas where you might inhale the powder from latex gloves worn by others.
• Ask your physician about wearing a medical alert bracelet or medical alert necklace.

7. Carefully follow your physician's instructions for dealing with allergic reactions to latex.

For additional information about latex allergy:

• Click here for the Rhode Island Department of Health rules and regulations pertaining to the use of latex gloves in Health Care Facilities and other agencies.

• The RIDOH also has a latex safety WebPage at http://www.health.ri.gov/topics/latex.php. 

•  Call 1-800-35-NIOSH (1-800-356-4674); or visit the NIOSH Home Page on the World Wide Web at http://www.cdc.gov/niosh/homepage.html  

• Job accommodation ideas for persons allergic to latex can be found at      http://www.jan.wvu.edu/media/LATEX.html

• Click on the following links for NIOSH articles on latex allergy in the workplace: 

http://www.cdc.gov/niosh/topics/latex/

http://www.cdc.gov/niosh/98-113pd.html

http://www.cdc.gov/niosh/latexfs.html

• Visit the home page of the American Academy of Allergy, Asthma and Immunology at http://www.aaaai.org/.  

• Access the Latex Allergy Information Service (LAIS) at http://www.familyvillage.wisc.edu/lib_latx.htm or at 176 Roosevelt Avenue, Torrington, CT 06796, tel. (860) 482-6869.

• The American Latex Allergy Association has information on latex-free consumer products at http://www.latexallergyresources.org/Pressroom/pressRelease.cfm?PressID=14 

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