Latex Allergy Karen Haskill-Kibler, RN, MSN September 2008

Latex Allergy Self Learning Packet After successful completion of this course, you will be able to… n Discuss how healthcare professionals can reduce their risk of latex sensitivity in themselves and their patients. n Discuss management strategies to address latex sensitivity and the need for latex products in healthcare settings. n Define an appropriate course of action for a person newly diagnosed with a latex allergy. n Identify the characteristics of people most at risk for latex allergy. n Summarize the steps required to safely care for patients who are allergic to latex. NOTE: Please use the blue buttons to advance to the next slide or return to the previous slide Objectives

Purpose n The purpose of the Latex Allergy presentation is to introduce and provide information about latex allergies to healthcare providers. The information may help either the healthcare provider with a latex sensitivity or the healthcare provider caring for the latex sensitive patient.

What is Latex? n Latex is a type of rubber. It is made from tree sap and chemicals. n Latex is used in medical equipment such as gloves, stethoscopes, dressings, bandages and in tubes used to put fluids into the body. It is a very tough rubber, even when it is stretched thinly.

What products contain natural rubber latex? n Disposable gloves n Airway & IV tubing n Syringes n Stethoscopes n Catheters n Dressings & bandages n 40,000 consumer products (i.e. condoms, athletic shoe soles, rubber toys, nipples and pacifiers, etc.)

Products containing Latex at Kaleida Health n Products containing latex are labeled by the manufacturer on the outside wrapper n More and more products are being made out of silicone or other non-rubber materials n Rubber products are being identified and are being replaced (when available) with non- latex products n WCHOB is a latex free facility

What is Latex Allergy? n An allergic, or immediate hypersensitivity reaction Occurs when the body’s immune system is sensitized to a foreign protein

Who is at risk? n There are varying factors that make individuals susceptible to latex allergy. n The type and severity of a reaction depends on: –The site(s) of exposure –The individuals’ level of sensitivity –The amount of allergen to which they are exposed

People at risk n Healthcare workers n Persons requiring frequent bladder catheterization n Neural tube defects (spina bifida, myelomeningocele) n Multiple surgeries Multiple allergies (especially to balloons, or other latex products)

People at risk…cont.. n History of anaphylactic reactions during surgery

People at risk…cont.. n Occupational exposure (frequent use of latex gloves) n Prior allergic reactions to latex are most at risk for anaphylactic reaction.

Latex Gloves n Most common cause of latex allergy n Airborne latex proteins (located in the powder or corn starch inside the gloves) are absorbed when the powder used to lubricate latex gloves come in contact to the skin. n When gloves are snapped on and off, proteins become airborne and risk to some people with latex hypersensitivity increases.

Allergic Reactions n Three types of reactions can occur in people exposed to products containing latex. These are: –Irritant contact dermatitis –Allergic contact dermatitis –Latex Allergy –Anaphylactic Shock

Allergic Reactions –Type 1 n Irritant Contact Dermatitis –people allergic to the chemicals used when medical equipment is made out of latex may get a red scaly rash several hours after they come into contact with latex. Doctors call this contact dermatitis. The skin may just be a bit itchy or feel very sore and leathery.

Allergic Reactions –Type 2 n Allergic Contact Dermatitis –If you are allergic to latex itself, symptoms can start very quickly (within 30 minutes) and can be serious. The skin may get raised, blotchy red patches. This is called hives.

Allergic Reactions –Type 2 n Signs & Symptoms –Symptoms are similar to individuals who are allergic to bee venom or cat dander. –Symptoms may include nasal congestion, hives or difficulty breathing. –Symptoms may mimic hay fever or asthma

Allergic Reactions –Type 3 Anaphylactic Reaction –You may also get asthma, a runny nose and sore eyes. In rare cases, people have difficulty breathing and their blood pressure drops. This is called anaphylaxis and can be life-threatening.

How is a suspected latex allergy confirmed? n Allergy skin test performed under close supervision.

Why are latex allergies a concern? n Health care workers are at risk of latex allergies –Workers are exposed to latex products daily (gloves, stethoscopes, inserting foley catheters, band-aids) n Allergic reactions or symptoms should lead healthcare workers to look at their potential to develop a latex allergy

People at Risk –Food Allergies Allergy to foods such as banana, avocado, chestnut, kiwi, potato, tomato

Persons at High, Moderate and Low Risk HighModerateLow or Undetermined bananasapplepearmango avocadocelerypeachrye chestnutpapayaplumwheat kiwicherrygrasses carrotsstrawberryragweed potatofigmugwort tomatograpehazelnut melonsapricotwalnut passion fruitsoybean nectarinespeanut

How can healthcare workers protect themselves? n Limit your exposure to latex products or stop wearing latex gloves -especially if you have a history of allergic reaction. n Limit their exposure to latex products. n Become a Latex free facility (WCHOB is a Latex free facility) WCHOB is continually substituting latex products for alternate products containing silicone, plastics, or other alternatives.

Protect patients from unnecessary exposure to latex While wearing latex gloves, touch patients ONLY when absolutely necessary. n Never inflate gloves and use them as toys for pediatric patients. n If balloons are still permitted, work with your manager to achieve a facility-wide “no rubber balloon” policy in which only balloons made of Mylar are permitted n WCHOB has become a latex free facility allowing only Mylar balloons for their patients.

What do we do as a health care provider with a latex allergy patient?

Nursing Guidelines n Upon Admission: Ask patients if they have sensitivity or allergy to latex n Initiate the “Latex Sensitivity Protocol Questionnaire” n Patients who admit to having a sensitivity or allergy – the Latex Allergy Screening Tool must be initiated and completed by the nurse

How do I obtain the form? n The form can be obtained by: –Log onto “Kaleidascope” –Click on “Documents” –Click on the “Patient/Clinical” area –Click on the “Clinical Forms (Forms Central) icon –Click on the “Latex Allergy Screening Tool” (KH01186) Form

What does the form look like? If any question in Section 1 is answered “YES,” the patient should be considered latex allergic. A green latex allergy sticker is applied to the patient ID wrist band and the patient is treated with latex precautions.

What questions are on the form? If any question in Section 2 is answered “YES,” the patient should be considered high risk for latex allergy. A Green latex precaution sticker is applied on the patient ID wrist band and the patient is treated with latex precautions.

What questions are on the form? Latex Allergy Screening Tool (KH01186) Section 3 of the Latex Allergy Screening Tool includes the screening criteria for environmental and food allergies.

What questions are on the form? Latex Allergy Screening Tool (KH01186) The final portion of the form is a summary of findings, physician notification, and a check list of necessary actions taken. A physician will review the form after completion to determine the allergy risk for the patient. The form lists the precautions/indications needed to be followed..

Nursing Guidelines Obtaining a Latex Safe Patient Care Kit The Latex Allergy Kits, in orange containers, will be provided to each site. Several will be housed in high risk areas (ED, OB, etc.), but the majority will be housed in Central Distribution. Each kit has disposable latex-free equipment that should be used for latex precautions. Once the patient is discharged, the orange container is to be returned to Central Distribution If patient is to be transferred to another floor/unit -have the patient’s room cleared of all latex materials -have the patient’s room cleaned (latex particles may be present on furniture, floors) -Cleaning the room will help -Notify the receiving floor Place “No Latex” signs on the patient’s door, and above the bed Place “No Latex” sticker on outside of patient chart or bedside chart

Nursing Guidelines Flag the patient’s chart Place a latex allergy alert sticker on the patient’s ID band, noting allergy or sensitivity Latex Allergy

Notify key departments of special needs I.e.: Dietary, Pharmacy. Distribution, Environ. Svcs., & Lab KEYPOINT: Dietary- Order latex free diet Pharmacy is notified –drug vials/containers are latex free When preparing medications from vials, remove the rubber stopper so you do not core it when drawing up the medication. Use only latex-free syringe plungers. Based on patient need notify: OR, Xray, PT, OT, Respiratory, etc. Operating room patients with latex allergies are scheduled as first case of the day. The OR rooms are terminally cleaned at the end of the day so there are less latex particles present in the OR. Nursing Guidelines

Be sensitive to “hidden” latex, such as latex in the balloons of most pulmonary artery catheters Document the latex allergy in: powerchart, on nursing assessment forms, and patient care documents/records Nursing Guidelines

If an allergic reaction should occur a STARS Report is to be initiated Nursing Guidelines

Kaleida Health Policy Care of Patients with Latex Sensitivity or Allergy CL45 To obtain the policy: Log onto the Kaleidascope website Click on the purple “Documents” icon Type in “latex” The policy “Care of Patients with Latex Sensitivity or Allergy” will appear. Click on the policy for viewing. How to Obtain the Latex Policy

Precautionary Steps If, because of other allergies or intensive exposure, you believe that you are at high risk to develop latex sensitivity, you may want to take the following precautionary actions: Create a latex-reduced home environment for yourself. Minimize your risk for cross-reactivity from foods.

“I’M ALLERGIC” Persons with newly diagnosed latex sensitivities need to be aggressive in self-care measures: 1. Obtain and carry quick-acting oral antihistamines (liquid or rapidly dissolving) and auto-injectable epinephrine at all times. 2. Wear a “latex allergy” medical-alert bracelet. 3. Carry a wallet card informing emergency care workers of the latex allergy. 4. Ensure that your regular physician (if an allergist or dermatologist makes the diagnosis) is informed of the allergy. 5. Inform employer of the allergy and ask for any necessary accommodations to work safely.

“I THINK I’M BECOMING ALLERGIC TO LATEX” Warning Signs of Developing Sensitivity n Do you develop symptoms at work – skin rash, runny nose, burning or watery eyes, or trouble breathing – which clear up when you get home and never develop on your day off? n Have you ever experienced swelling, itching, hives, shortness of breath, or coughing after blowing up balloons or using condoms or a diaphragm? n Have you ever had a respiratory reaction from an unknown cause after having a vaginal, rectal, or dental exam with symptoms resolving shortly after the end of the visit?

“Is This the End of My Career?” n If you have, or develop, a latex allergy, the bad news and the good news is that you are one of a growing number of healthcare workers with this sensitivity. n Given the shortage of tenured, qualified nurses, most employers are developing strategies to deal with latex exposure in order to retain their latex-sensitive employees.

Latex Allergy Summary n Remember –Limit the use of latex gloves –Complete the latex screening tool upon admission of a patient. –Limit exposure of your self and your family members to latex proteins.