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 non-latex products when appropriate.
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.
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.
Blood pressure cuffs, stethoscopes, disposable gloves, oral and nasal airways, endotracheal tubes, tourniquets, intravenous tubing, syringes, electrode pads
Gloves, surgical masks, goggles, respirators, rubber aprons
Rubber bands, rubber erasers
Anesthesia masks, catheters, wound drains, injection ports, tops of multi-dose vials, dental dams
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
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.
Three types of reactions can occur in persons using latex products:
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.
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 (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.
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.
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.
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.
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.
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:
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:
Instructors, staff and students should take the following steps to protect themselves from latex exposure and allergy at the College:
Individuals exposed to latex gloves and other products containing natural rubber latex may develop allergic reactions such as skin rashes; hives; nasal, eye, or sinus symptoms; asthma; and (rarely) shock.
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