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Perioperative Care of Patients with Latex Allergy
JULY 2000, VOL 72, NO 1 Davis
Perioperative Care of Patients%th Latex Allergy
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The allergic response. Latex contains hundreds of proteins, natural rubber products, and enzymes that are involved in the biosynthesis of rubber molecules. Protein fractions in latex are responsible for anaphylaxis, a reaction that can lead to death. Allergic reactions involve the immune system. During an allergic reaction, an antigen interacts with antibodies and produces a massive release of histamine at a local or whole body level." In latex reactions, the latex protein is the antigen. Types of reactions. Types of reactions to latex products includes dermatitis, contact dermatitis, and immediate hypersensitivity resulting in anaphylaxis. Dermatitis is a chemical imtation, however, and is not a true allergic response. For most affected people, the skin is irritated, dry, and crusty, and symptoms IATMAUERGY The proteins present in natural rubber latex prod- resolve when the contact with latex stops. Contact dermatitis, or delayed hypersensitivity, ucts are thought to be the cause of latex sensitivity and allergic reactions. Immediate hypersensitivity occurs between six and 48 hours after contact with an was first reported in 1979, with only sporadic cases allergen. The affected area becomes dry, crusty, and until 1990. In the late 1980s, there were 450 incidents leathery, with eruptions of sores and blisters. of anaphylactic reactions from the latex cuff used on Repeated latex exposure causes the dermatitis to barium enema catheters that resulted in 15 deaths. extend beyond areas of latex contact. Many people These reactions caused the US Food and Drug with delayed hypersensitivity have a history of atopy. Administration (FDA) to issue an Emergency Alert in This is an inherited tendency toward certain allergies, 1990, which led to a recall of latex-containing barium characterized by symptoms such as hay fever, hives, enema catheters that year? or asthma, which are produced on exposure to an exciting antigen. The most severe allergic response is immediate hypersensiA B S T R A C T Initially identified in the pediatric population, latex allergy and tivity and anaphylactic reaction. sensitivity now are seen at increasingly higher rates in all age groups, This is an allergic response mediand are especially prevalent in health care workers. Knowledge about ated by immunoglobulin E (IgE) the sources of latex in the environment, the signs and symptoms for latex antibodies found in the seen in latex sensitivity and allergic reaction, risk factors for sensitiv- circulation. On the skin, this can ity, and how to assess patients and those working in the health care present as hives that migrate profession for possible latex sensitivity is important for perioperative beyond the point of contact with latex. Systemic allergic symptoms nurses. AORN J 72 (July 2000) 47-54. atex is a natural elastic product from the milky sap of the rubber tree Hevea brusiliensis. The tree is native to South America but is widely cultivated throughout the tropics. It produces a milky juice, which is the major source of commercial rubber.' The trees are tapped for latex by cutting spiral grooves in the bark and inserting a spout with a cup for collection of the latex. Ammonia is added to promote liquefaction and prevent spoilage. By placing the latex into a centrifuge, a concentrated product is obtained. Latex is made heat stable and elastic by vulcanization (ie, heating in the presence of sulfur). Other chemicals (eg, accelerators, antioxidants) are added for strength, stretch, and durability.*
BLANCA ROSA DAVIS, RN
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include itching, watery eyes, swelling of the lips or glove powder and can become aerosolized and airtongue, shortness of breath, wheezing, dizziness, borne. Additionally, latex proteins may be liberated abdominal pain, nausea, tachycardia, hypotension, from the latex by body sweat and then absorbed through the skin.'' shock, and, potentially, death.' Patients become sensitized to latex in various Latex rubber has been found to contain more than 240 different polypeptides. Nearly 60 of these ways. Patients increase their risk of latex sensitivity show reactivity specific with latex IgE. These with repeated exposure to latex products (eg, through polypeptides also can be found in various plants and multiple hospital admissions, surgeries, procedures). fruits, which is thought to be why latex allergic indi- Patients with neural tube defects (eg, spina bifida), viduals have cross-sensitivity to some foods. The patients who have experienced spinal cord injury, most common and prevalent of these cross-reactions patients with urogenital malformations or others who are to bananas, avocados, kiwis, and chestnuts.' require repeated catheterizations, and patients with Papaya, mango, melon, potato, tomato, carrot, and multiple allergies are at increased risk for latex allercelery also are documented as having the potential to gy." Patients with spina bifida are especially at risk cause moderate reactions, and passionfruit, apricot, because they typically require surgery within their fig, peach, pear, cherry, pineapple, and hazelnut are first days of life. In addition, they often undergo freresponsible for low intensity reactions in latex-sensi- quent orthopedic, urologic, and neurologic procetive individuals.' dures, as well as daily contact with latex products to During a latex-associated anaphylaxis study con- maintain bladder and bowel continence." People with ducted from October 1988 through September 1992 occupational exposure to latex include medical profor the FDA, researchers explored the prevalence of fessionals, housekeepers, tire manufacturers, and reactions, number of injuries, and deaths that occurred. latex industry workers. Latex sensitivity currently affects 5% to 10% of During this period more than I , 100 cases of latex anaphylaxis were voluntarily reported. The most frequent- health care workers in the United States. This number ly reported reactions were due to the use of latex exam- increased between 1987 and 1992, probably as a ination gloves and barium enema catheters.X result of the appearance of HIV and the resulting uniNatural rubber is derived from latex and should versal precautions mandated by the Centers for be distinguished from synthetic rubber, which is Disease Control and Prevention (CDC)." In the derived from petrochemicals. Synthetic rubber does United States, glove use increased between 1988 and not contain allergy-inciting plant proteins, but it is 1992. A 1997 Health Care Hazardous Material virtually identical to natural rubber and its physical Management Report describes examination glove use properties.' When managing latex-allergic patients, rising to 11.8 billion pairs per year and surgical glove nonlatex gloves, made of synthetic rubber, must be use rising to 1.8 billion pairs per year with the advent substituted for latex-containing gloves. There are sev- of universal precautions. Some health care workers eral gloves available that, according to the manufac- wear as many as 40 to 50 pairs of gloves per day.'' turers, do not contain latex. Some of the materials The CDC-mandated universal precautions also used include neoprene, styrene butadiene, and resulted in new manufacturers entering the glove polyvinylchloride. The FDA imposes the same qual- market to meet the increased need for gloves, which ity control standards on all gloves, regardless of man- in turn caused a sudden influx of poorly made, substandard latex gloves. These contributed significantly ufacturing material.'" Latex routes of exposure. Latex protein sensi- to the latex sensitivity and allergy issue. tivity is increasing not only among certain high-risk groups, but also within the general population. People MULTlDlSClWNARYTEAIIIMTORK Latex sensitivity is increasing not only among especially at risk for developing latex allergy are patients with repeated medical exposure and those certain high-risk groups, but also within the general population. Ideally, all patients should be assessed for who are occupationally exposed. Common pathways of exposure to latex proteins a history of latex allergy, regardless of the care that is include cutaneous (skin), mucosal (ingestion or con- planned. Doctor's Community Hospital (DCH) is a tact), parenteral (intravascular), and airborne (inhala- 250-bed hospital in Washington, DC, that has 14 surtion) routes. Reactions may vary depending on the gical suites. A multidisciplinary team developed the route. Latex proteins have been found to bind to current latex policy, which states that the hospital will 48 AORN JOURNAL
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“provide a latex-safe environment to latex sensitive patients through the development of policies and procedures which reduce the amount of latex in the environment” throughout the patient’s hospitalization.’0 The multidisciplinary team policy addresses the following issues: identifying patients and caregivers at risk for latex sensitivity, creating treatment protocols for patients with latex sensitivity, identifying the latex content of products currently used in patient care, identifying acceptable alternatives to known latexcontaining products, education of hospital and medical staff members regarding latex sensitivity, and creating a mechanism to identify the latex content of new products. Additionally the latex committee recommended the elimination of nonsterile powdered gloves throughout the hospital. The value analysis team (VAT) reviews all new products purchased by DCH. This team consists of managers from the materials management, patient registration, respiratory therapy, laboratory, emergency services, pharmacy, education, clinical and support services, infection control, surgical services, radiology, and critical care departments. This group examines all new products suggested for purchase for their appropriateness, clinical need, and cost-effectiveness. Among criteria considered during product evaluation is latex content. Safe alternatives are provided where indicated. For example, sterile nonpowdered surgeon’s gloves, sterile nonlatex surgeon’s gloves, and nonsterile nonlatex gloves are all available from the hospital storeroom on request. PAllENT CARE
All patients who are treated at DCH are assessed for latex sensitivity, regardless of which point the patient enters the health care system (eg, outpatient, emergency care). Care may be provided by personnel in many departments, but because of the efforts of the multidisciplinary team, the patient’s care is consistent throughout his or her stay. On admission, the admission clerk requests that each patient complete a latex allergy screening tool (Table I), and the information is placed in the patient’s medical chart. The tool includes an assessment of the patient’s food allergies. All patients are contacted and assessed before
care is provided. This assessment is completed via the telephone at least 24 hours before admission or surgery, if possible, and is completed at the time of admission for patients requiring emergency treatment or surgery. If indicated, implementation of latex allergy precautions begins when patients are admitted to the hospital. Patients are not assigned a room or transferred to a designated receiving area until latex allergy has been determined. If a patient answers yes to the first three questions, review by an RN is required. He or she will determine whether a latex-reduced environment is indicated. If a risk for latex sensitivity or allergy is determined, the nurse documents a “risk for latex allergy response” in the patient’s medical chart.” The admitting RN initiates providing a latex-safe environment for the patient by communicating with the appropriate department directors or charge nurses. Documentation includes a note indicating latex sensitivity or allergy on the physician’s order sheet.’*The nurse places an orange-striped wrist band on the patient that identifies latex allergy. The nurse also documents the allergy on the front and spine of the patient’s medical chart. On the unit, nursing personnel post signage that indicates the need for latex allergy precautions and a latex-safe environment on the door of the patient’s room and above the patient’s bed. Latex allergy precautions for surgical outpatients follow the same latex protocol as those for admitted patients. Patients are interviewed and prepped in a latex-safe environment and transferred directly to the OR suite. In patient care areas, the following measures are used to reduce latex exposure. Gauze or cotton webbing is wrapped around the patient’s arm before application of a blood pressure cuff containing latex. Sheets or blankets are used to prevent the patient from contacting possible latex rubber in mattresses, gurneys, or chairs. Stopcocks are used on IV tubing rather than latex ports. Glass syringes, or plastic disposable syringes marked “latex free” are used. All medications are removed directly from vials after the rubber stoppers are removed Flat sheets, rather than fitted sheets, which may contain latex, are used to cover the mattress. A latex-safe cart and a high efficiency particulate air (HEPA) filter are brought to the patient’s room. These items remain with the patient throughout
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SAMPLE LATEX ALLERGY SCREENING TOOL
This screening tool is intended to assist in identifying patients with a latex sensitivity. It is not intended to be oll-inclusive, and individuals who are uncertain whether they are sensitive to natural rubber latex should consult their physician. 1. Have you ever had a reaction to or been told by a physicion that you have an allergy to any latex or natural rubber product? Yes No 2. Have you ever had itching, swelling, hives, or trouble breathing when you use any of the following items?
Balloons Rubber gloves Hot water bottles Rubber bands, balls Foam pillows Baby bottle nipples Pacifiers, teething rings Belts, bras, suspenders Other
Yes
No
-
-
-
-
-
-
-
Yes Condoms or birth control devices Dental dams Erasers Face masks Elastic bandages Cuffs, elastic waistbands Ostomy bags Urinary catheters Rubber grips
-
-
No -
-
3. Have you ever had itching, swelling, hives, or trouble breathing offer eating any of the following? Bananas Avocados Kiwi Chestnuts
Yes Yes Yes Yes -
No -
No No No -
4. If you hove checked yes to any of the above questions, you will be evaluated by a nur.5.e. If the nurse believes you may be latex sensitive, your physician will be contacted for furlher orders.
Patient‘s signature
Date
If any questions were answered “yes,“ the patient was evaluated by: ,
Registered Nurse
are kept at each nursing station, including the control desk in the OR. One of the manuals also is attached to each latex-safe cart.”’ The quick reference guide can be helpful to nurses working on call during evenings, weekends, or holidays who must admit a patient with this allergy. It addresses key steps in the patient’s admission process.2’ When anticipating the arrival of a latex-sensitive patient, the nurse removes all latex-containing products from the assigned room. This includes all items normally stocked in the room, all latex examination and sterile gloves, and any other equipment not necessary for direct patient care. Only nonlatex gloves are used. The housekeeping staff members terminally clean the OR after the last surgical procedure performed in the room (ie, the day before the scheduled procedure or before the patient’s arrival). Traffic flow is restricted to essential personnel. Signs alert
his or her entire hospitalization. PERlOPERATlVE CARE
Personnel in patient registration notify personnel in surgical services 24 hours in advance, or as soon as possible in emergency situations, when a patient is identified as being at risk for latex sensitivity. Doctor’s Community Hospital follows the guideline that surgery for latex sensitive patients must be scheduled as the first procedure of the day, if possible.I9 Scheduling these patients as first procedures and preparing the OR according to the latex protocol helps reduce latex in the environment. At DCH, OR staff members can review a quick reference (a brief review of policy and procedure) for admission policies necessary for latex allergic patients and for implementation guidelines. This quick reference guide and the latex reference manual 50
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nonessential staff members to not enter the room and that a latex-safe environment is required. Staff members prepare the room to accommodate both the surgical procedure and recovery of the patient. The perioperative nurse contacts the pharmacy to ensure that necessary medications are available in vials or ampules that do not contain latex. The OR managers ensure that the perioperative and postanesthesia care unit (PACU) nurses assigned to the procedure have all been notified of the latex precautions. Instrument processing and sterilization (IPS) department personnel are notified the day before surgery, so articles containing latex (eg, Penrose drains, rubber catheters, scissors-protecting tips) are not placed in sterile trays during preparation. Exposure to powdered latex gloves is one of the most common routes of latex sensitization; therefore, powdered latex gloves are not used in the latex-safe room. Nursing staff members clean all horizontal hard surfaces in the OR early in the morning or immediately before the procedure. Anesthesia personnel also must be aware of latex-containing products. Nothing may be injected or withdrawn through the latex port of any medication bottle or IV tubing. Nonlatex tourniquets, a nonlatex examination glove, or polyvinyl chloride tubing (eg, IV tubing) must be used as tourniquets. The anesthesia care provider must use a latex-free breathing circuit with plastic mask and bag, and the ventilator bellows must be nonlatex. All monitoring devices (eg, cords, tubes, pulse oximetry, blood pressure cuff, electrocardiogram wires) are wrapped in stockinette or cotton webbing and secured with tape if no latexfree products are available. A disposable nonlatex heating blanket also must be used. These efforts may seem excessive; however, avoiding exposure to the latex antigen is the only method demonstrated to prevent latex-induced anaphylaxis. The PACU staff members should be notified 15 minutes before the procedure will end, to allow them time to prepare. A second call requesting their arrival as soon as possible allows for a smooth patient recovery from anesthesia. All the measures that have been followed in the OR should continue during the postoperative course. At DCH, we recover latex-sensitive/allergic patients in the OR in which the procedure has taken place because we believe it is the safest place to recover the patient and to continue the perioperative latex-safe plan of The PACU nursing staff members arrive in appropriate attire to recover the patient in the OR.
Exposure to powdered latex gloves is one of the most common routes of latex sensitization.
The surgical team members transfer the patient from the OR bed to a covered stretcher, and the PACU nurses recover the patient in the OR. The PACU nurses must observe the patient closely for the signs and symptoms of a delayed latex reaction, which may include skin reactions (dermatitis), respiratory problems, asthma attack, or anaphylactic shock. When the patient is ready, he or she is discharged home or to a latex-safe room on the nursing unit. If the patient is scheduled to go home, he or she is discharged in a wheelchair through the closest exit out of the building, thus minimizing the exposure to the hospital environment. If the patient is returned to a nursing unit, personnel there follow the same protocols as outpatient surgery, preoperative nursing unit, and OR personnel. The latex-safe equipment, cart, and the HEPA air filter remain with the patient throughout the institution until discharge. I A T M SUBsmVcES
To avoid exposure to the latex antigen, it is important to be aware of items that can be substituted for common latex products in the OR. We have developed guidelines at DCH for replacing commonly used items when caring for latex-sensitive individuals. Some examples are as follows. Silicone or nonlatex Foley catheters can be used in place of urinary catheters that commonly are made of latex. Rubber bands, often used to secure C-arm drapes during draping, can be replaced with self-adhesive wound approximating strips to secure the drape. The foam stick pad used in needle counting pads should be removed, leaving only the magnetic pad. Rolled stockinette should be placed around the patient’s extremity before applying an elastic bandage.
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All latex items (eg, bulb syringes, suction tubing, elastic wrap) should be removed from custom packs or specialty packs as soon as the pack is opened. Surgeons’ paper tie caps should be used rather than caps with elastic. Patients should not be given paper shoe covers, as they contain latex in the elastic. After discarding sterile latex items, the scrub person also should discard his or her gloves and reglove.
accompanies them to their assigned room. The cart is returned to IPS for complete cleaning and restocking after the patient is discharged. EDUCATION
Education is the key to the recognition, management, and prevention of an adverse reaction and must be viewed as a partnership between the health care facility and the community. Hospital employees. At DCH, everyone in the institution participates in an educational program on the subject of latex allergy. The aim is to educate the staff members about the care of latex-allergic patients and high-risk patients, change inappropriate behavior, and do this with motivation and creativity. Our hospital has developed a latex allergy precautions reference manual that contains the protocol for admission and treatment of patients with latex allergy, supportive and therapeutic care procedures, and protocols for employees with latex sensitivity. In general, all employees should know and be aware of their institution’s latex allergy prevention protocols. The employer should provide workers with education programs and training materials about latex allergy. This information should be included in orientation and continuing education sessions. In addition, all departments involved in the care of a latex-sensitive patient must have specific orientation and plans. It is important to educate nursing staff members about the potential severity of latex allergy to reduce incidence of reactions, and professional networking is helpful in understanding the problem and finding solutions to it.” Surgical team members. Educating the surgical team members about the risks of using latex gloves and other supplies that contain latex is of prime importance. The use of powdered latex gloves has been so universal that it may be difficult for some people to accept that “if you have to use latex gloves, make it a low-protein, powder-free glove. Aerosolized latex is a cardinal sin.”25Communication with and education of all members of the health care team will reduce latex risks for everyone. Patients and family members. Patient education reduces risk. Latex proteins can be life threatening, and the patient and his or her family members need to be aware of the causes of the sensitivity or allergy. At DCH, the patient registration clerk gives all patients who are identified as having latex allergy a booklet titled About Latex Allergies.” Patient education is part of the patient care plan and
ACCESS TO SUPPLIES AND MUIPMENT
Identifying all the products that either contain latex or are packaged with latex-containing material is the greatest task for implementing a latex-safe environment. Hospital personnel should contact product manufacturers for written documentation that a product is latex-free. This can be complicated. Manufacturers may be reluctant to document that the product is latex-free because portions of the manufacturing process often are subcontracted out to other companies, and the latex content is uncertain or unknown. Other manufacturers may not know if their packaging materials contain latex. Latex-free products ultimately are identified through review of the literature and efforts to contact the primary medical and health care product companies. Latex-safe case cart. As so many items in the OR contain latex, a special latex-safe cart is helpful for use in procedures on latex-allergic patients. At DCH, an OR case cart for latex-allergic patients is ready at all times. It is easily identified and is kept in the main hallway of the OR. On the cart, staff members can find a ready-to-use basic pack, latex-free items, and signs for the doors. There also is a quick reference sheet, admission procedure, and a list of patient care items. A list of latex versus nonlatex items is available to help expedite safe preparation of the OR. The latex-safe cart also contains the basic essentials for patient care during the surgical procedure. There are latex-free kits for starting IV lines, bladder catheterization, blood drawing, and other procedures. This can increase waste and expense if personnel open a kit only for selected items.’’ Although there are customized latex-free packs available, they are expensive, and we have chosen not to use them. A personal latex-safe cart also is assigned to the patient on admission and is brought into the OR with the patient. For patients requiring a hospital stay, the cart 52
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is documented in the multidisciplinary education record. People who are confirmed to be latex allergic are encouraged to wear a Medic-Alert bracelet at all times. People who have experienced serious adverse reactions to latex must eliminate all exposure to latex. The role of family members is very important. When someone is diagnosed with a latex allergy, many aspects of his or her life change. Latex is everywhere (eg, more than 40,000 items in commercial and medical use). The patient and his or her family members need to consider the many items that they have and use in their home environment and replace those items that contain latex. It is a challenge to live with this type of change, which can alter life style, career, and sometimes a person’s independence. Latex allergy, like any other illness, can result in symptoms of loss, grief, depression, and lifestyle adjustments for both the individual and his or her family members?’
NOTES 1. National Institute for Occupational Safety and Health, NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Work Place (Cincinnati: US Department of Health and Human Services, 1997) 1; Healthcare Hazardous Materials Management, “Latex sensitivity: Current issues,” Healthcare Hazardous Materials Management: The Newsletter of the Centerfor Healthcare Environmental Management 10 (June 1997) 1. 2. M Bemstein, “An overview of latex allergy and its implications for emergency nurses,” Journal of Emergency Room Nursing 22 (February 1996) 29-36; Cleveland Clinic Foundation, “what is latex?” Available from http://gasnet.med. yale.edu/gta/latex/html. Accessed 26 November 1997. 3. M P Truscott, “Reactions of natural rubber latex,” First Hand 1 (Winter 1994) 1; A J Weido, T Sim, “The burgeoning problem of latex sensitivity: Surgical gloves are only the beginning,” Postgraduate Medicine 98 (September 1995) 173179.
CONCLUSION
Caring for or working with latex-sensitive individuals requires knowledge and team work to provide a latex-safe environment. It is important that nurses familiarize themselves with latex allergy and ways to counteract it in the hospital environment. A
Blanca Rosa Davis, RN, MS, is a perioperative staff nurse, a laser safety oficer, and a basic life support instructor in the OR at DoctorS Community Hospital, Lanham, Md. The author would like to thank Marilyn Glaser,RN, M S , director, department of education and Debra Koi-ding, RN, BS, surgical services educator at Doctor’s Community Hospital, Lanham, Md, for their assistance in the preparation of this article.
4. S L Halpem, “Latex sensitivity,’’ seminar presented at King of Prussia, Pa, 9 June 1998. 5. National Institute for Occupational Safety and Health, NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Work Place, 1,2; Medical Educational Services, Stop Latex Allergy: How to Make your Medical Facility Latex Safe, Part I (Knoxville, Tenn: Medical Educational Services, 1996)Videotape. 6. Medical Educational Services, Stop Latex Allergy: How to Make your Medical Facility Latex Safe, Part I. 7. Latex Allergy Information Service, “Managing latex in the hospital environment,” BrieJings on Hospital Safety suppl (January 1998) 7; S McGann et al, “Latex allergy alert,” The Nursing Spectrum 8 (Feb 23, 1998) 16-19. 8. J Slater, “Latex allergy,” Journal of Allergy and Clinical Immunology (September 1994) 2. 9. Cleveland Clinic Foundation, “What is latex?” 10. Cleveland Clinic Foundation “All about gloves: Latex and nonlatex.” Available from http://www. 53 AORN JOURNAL
anesth.com/lair/latex/gloves.html. Accessed 2 July 1998. 11. Healthcare Hazardous Materials Management, “Latex sensitivity: Current issues,” 1-4; Halpem, “Latex sensitivity,”1-4. 12. Cleveland Clinic Foundation, “Population at risk for development of latex allergy.” Available from http://gasnet.med.yale.edu/gta/latex/ risk.html. Accessed 26 November 1997. 13. “AORN latex guidelines,”in Standards,Recommended Practices, and Guidelines (Denver: AORN, Inc, 2000) 107-121;T Goodman, Rational Approach to Latex Allergy, second ed (Arlington,Tex: Johnson & Johnson Medical, 1998) 28 14. National Institute for Occupational Safety and Health, NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Work Place, 1. 15. Healthcare Hazardous Materials Management,“Latex sensitivity: Current issues,” 1-4 16. Multidisciplinary Committee, Doctor’s Community Hospital, Mission (February 1998). 17. “AORN latex guidelines,” 107-121.
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18. Doctor’s Community Hospital, “Protocol for admission and treatment of latex allergic patient,” Policy and Procedure, Doctor’s Community Hospital (Lanhm Md: Doctor’s Community Hospital, July 1998) 1. 19. “AORN latex guidelines,” 107-121. 20. D Kording, “Quick reference,” OR education seminar presented at Doctor’s Community Hospital, Lanhm, Md, October 1997. 21. Doctor’s Community Hospital,
”Latex allergy precautions,” Reference Manual, Doctor’s Community Hospital (Lanham,Md: Doctor’s Community Hospital, October 1997) 3. 22. “AORN latex guidelines,” 107-121. 23. D Bailey et al, ‘‘Implementing a system for care of patients with latex allergy,” Infection Control and Sterilization Technology 4 (April 1998) 5. 24. M Evangelisto, “Making the choice: Can you go latex free?”
Today’sSurgical Nurse 20 (January/February 1998) 42. 25. D Adkins, “Briefings on hospital safety,” The Newsletter for Hospital Safety Committees 4 (May 1991) 3. 26. About Latex AElergies (South Deerfield, Mass: Channing L. Bete CO, 1997) 1-16. 27. S Ball, M Charous, J Gotlieb, “Surviving with latex allergy: How to cope with change in lifestyle, career and independence,” Latex Allergy News 5 (July 1998) 8.
Tofu Connected to Impaired Mental Function in Later Life The more tofu men and women eat, the more likely they are to show signs of impaired mental function later in life, according to an April 4,2000, American College of Nutrition news release. Consuming tofu two or more times per week was determined to be detrimental to brain function. Men who ate the most tofu during their mid 40s to mid 60s showed the most signs of mental deterioration during their mid 70s to early 90s. They had more brain atrophy and performed poorer on cognitive tests, which measured attention, concentration, memory, judgment, and other brain functions. This analysis was part of the Honolulu Heart Program, which began tracking the health of 8,000 men of
Japanese-American heritage in 1965. Researchers administered cognitive function tests to 3,734 men, obtained brain images from 574 men, and evaluated brain atrophy in 290 male autopsy results. Test scores of SO2 wives of participants also were analyzed. The proposed link between consuming tofu and decreased brain function is isoflavones, which affect the tyrosine kinase enzyme that blocks changes in the brain related to learning.
Tofu and Brain Aging (press release, New York:American College of Nufition, April 4, 2000) 1. Available from hftp:// w.newswise.co~articI&2000/4/TOFU.NUT.html. Accessed 13 April 2000.
Surgical Reatments for Osteoarthritis Announced Osteoarthritis, the most common form of arthritis or joint inflammation, affects as many as 36 million people in the United States. According to a March 15,2000, news release from the American Academy of Orthopaedic Surgeons, many new surgical treatments are available to relieve the pain caused by osteoarthritis. As the population ages, osteoarthritis, which occurs in weight-bearing joints of the knee, hip, and spine, has become a significant health problem that may affect everyday activities such as walking or standing. Nutritional supplements, braces, exercise, medication, and heel wedges are some of the new treatments available, according to the release. Another new treatment designed to specifically treat knee osteoarthritis is a procedure in which a lubricating
substance is injected directly into the knee joint. This procedure is performed during a one-week period and consists of three to five injections. Typically, relief can last up to six months. According to the release, researchers also noted, that supplements may aid in pain relief of osteoarthritis but warned that patients should consult their physicians before self-medicating. Many supplements, both prescription and over-the-counter, can provide cartilage nutrition, which in turn can reduce inflammation and increase mobility. Nonoperative Treatments for Knee Osteoarthritis (news release, Orlando, Fla: American Academy of Orlhopaedic Surgeons, March 15, 2000) 1-2.Available from htlp://hulw.newswse.com/ai7iclees/2000/3/3/KNEEARTH.OSR .html. Accessed 16 March 2000. 54
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The allergic response. Latex contains hundreds of proteins, natural rubber products, and enzymes that are involved in the biosynthesis of rubber molecules. Protein fractions in latex are responsible for anaphylaxis, a reaction that can lead to death. Allergic reactions involve the immune system. During an allergic reaction, an antigen interacts with antibodies and produces a massive release of histamine at a local or whole body level." In latex reactions, the latex protein is the antigen. Types of reactions. Types of reactions to latex products includes dermatitis, contact dermatitis, and immediate hypersensitivity resulting in anaphylaxis. Dermatitis is a chemical imtation, however, and is not a true allergic response. For most affected people, the skin is irritated, dry, and crusty, and symptoms IATMAUERGY The proteins present in natural rubber latex prod- resolve when the contact with latex stops. Contact dermatitis, or delayed hypersensitivity, ucts are thought to be the cause of latex sensitivity and allergic reactions. Immediate hypersensitivity occurs between six and 48 hours after contact with an was first reported in 1979, with only sporadic cases allergen. The affected area becomes dry, crusty, and until 1990. In the late 1980s, there were 450 incidents leathery, with eruptions of sores and blisters. of anaphylactic reactions from the latex cuff used on Repeated latex exposure causes the dermatitis to barium enema catheters that resulted in 15 deaths. extend beyond areas of latex contact. Many people These reactions caused the US Food and Drug with delayed hypersensitivity have a history of atopy. Administration (FDA) to issue an Emergency Alert in This is an inherited tendency toward certain allergies, 1990, which led to a recall of latex-containing barium characterized by symptoms such as hay fever, hives, enema catheters that year? or asthma, which are produced on exposure to an exciting antigen. The most severe allergic response is immediate hypersensiA B S T R A C T Initially identified in the pediatric population, latex allergy and tivity and anaphylactic reaction. sensitivity now are seen at increasingly higher rates in all age groups, This is an allergic response mediand are especially prevalent in health care workers. Knowledge about ated by immunoglobulin E (IgE) the sources of latex in the environment, the signs and symptoms for latex antibodies found in the seen in latex sensitivity and allergic reaction, risk factors for sensitiv- circulation. On the skin, this can ity, and how to assess patients and those working in the health care present as hives that migrate profession for possible latex sensitivity is important for perioperative beyond the point of contact with latex. Systemic allergic symptoms nurses. AORN J 72 (July 2000) 47-54. atex is a natural elastic product from the milky sap of the rubber tree Hevea brusiliensis. The tree is native to South America but is widely cultivated throughout the tropics. It produces a milky juice, which is the major source of commercial rubber.' The trees are tapped for latex by cutting spiral grooves in the bark and inserting a spout with a cup for collection of the latex. Ammonia is added to promote liquefaction and prevent spoilage. By placing the latex into a centrifuge, a concentrated product is obtained. Latex is made heat stable and elastic by vulcanization (ie, heating in the presence of sulfur). Other chemicals (eg, accelerators, antioxidants) are added for strength, stretch, and durability.*
BLANCA ROSA DAVIS, RN
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include itching, watery eyes, swelling of the lips or glove powder and can become aerosolized and airtongue, shortness of breath, wheezing, dizziness, borne. Additionally, latex proteins may be liberated abdominal pain, nausea, tachycardia, hypotension, from the latex by body sweat and then absorbed through the skin.'' shock, and, potentially, death.' Patients become sensitized to latex in various Latex rubber has been found to contain more than 240 different polypeptides. Nearly 60 of these ways. Patients increase their risk of latex sensitivity show reactivity specific with latex IgE. These with repeated exposure to latex products (eg, through polypeptides also can be found in various plants and multiple hospital admissions, surgeries, procedures). fruits, which is thought to be why latex allergic indi- Patients with neural tube defects (eg, spina bifida), viduals have cross-sensitivity to some foods. The patients who have experienced spinal cord injury, most common and prevalent of these cross-reactions patients with urogenital malformations or others who are to bananas, avocados, kiwis, and chestnuts.' require repeated catheterizations, and patients with Papaya, mango, melon, potato, tomato, carrot, and multiple allergies are at increased risk for latex allercelery also are documented as having the potential to gy." Patients with spina bifida are especially at risk cause moderate reactions, and passionfruit, apricot, because they typically require surgery within their fig, peach, pear, cherry, pineapple, and hazelnut are first days of life. In addition, they often undergo freresponsible for low intensity reactions in latex-sensi- quent orthopedic, urologic, and neurologic procetive individuals.' dures, as well as daily contact with latex products to During a latex-associated anaphylaxis study con- maintain bladder and bowel continence." People with ducted from October 1988 through September 1992 occupational exposure to latex include medical profor the FDA, researchers explored the prevalence of fessionals, housekeepers, tire manufacturers, and reactions, number of injuries, and deaths that occurred. latex industry workers. Latex sensitivity currently affects 5% to 10% of During this period more than I , 100 cases of latex anaphylaxis were voluntarily reported. The most frequent- health care workers in the United States. This number ly reported reactions were due to the use of latex exam- increased between 1987 and 1992, probably as a ination gloves and barium enema catheters.X result of the appearance of HIV and the resulting uniNatural rubber is derived from latex and should versal precautions mandated by the Centers for be distinguished from synthetic rubber, which is Disease Control and Prevention (CDC)." In the derived from petrochemicals. Synthetic rubber does United States, glove use increased between 1988 and not contain allergy-inciting plant proteins, but it is 1992. A 1997 Health Care Hazardous Material virtually identical to natural rubber and its physical Management Report describes examination glove use properties.' When managing latex-allergic patients, rising to 11.8 billion pairs per year and surgical glove nonlatex gloves, made of synthetic rubber, must be use rising to 1.8 billion pairs per year with the advent substituted for latex-containing gloves. There are sev- of universal precautions. Some health care workers eral gloves available that, according to the manufac- wear as many as 40 to 50 pairs of gloves per day.'' turers, do not contain latex. Some of the materials The CDC-mandated universal precautions also used include neoprene, styrene butadiene, and resulted in new manufacturers entering the glove polyvinylchloride. The FDA imposes the same qual- market to meet the increased need for gloves, which ity control standards on all gloves, regardless of man- in turn caused a sudden influx of poorly made, substandard latex gloves. These contributed significantly ufacturing material.'" Latex routes of exposure. Latex protein sensi- to the latex sensitivity and allergy issue. tivity is increasing not only among certain high-risk groups, but also within the general population. People MULTlDlSClWNARYTEAIIIMTORK Latex sensitivity is increasing not only among especially at risk for developing latex allergy are patients with repeated medical exposure and those certain high-risk groups, but also within the general population. Ideally, all patients should be assessed for who are occupationally exposed. Common pathways of exposure to latex proteins a history of latex allergy, regardless of the care that is include cutaneous (skin), mucosal (ingestion or con- planned. Doctor's Community Hospital (DCH) is a tact), parenteral (intravascular), and airborne (inhala- 250-bed hospital in Washington, DC, that has 14 surtion) routes. Reactions may vary depending on the gical suites. A multidisciplinary team developed the route. Latex proteins have been found to bind to current latex policy, which states that the hospital will 48 AORN JOURNAL
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“provide a latex-safe environment to latex sensitive patients through the development of policies and procedures which reduce the amount of latex in the environment” throughout the patient’s hospitalization.’0 The multidisciplinary team policy addresses the following issues: identifying patients and caregivers at risk for latex sensitivity, creating treatment protocols for patients with latex sensitivity, identifying the latex content of products currently used in patient care, identifying acceptable alternatives to known latexcontaining products, education of hospital and medical staff members regarding latex sensitivity, and creating a mechanism to identify the latex content of new products. Additionally the latex committee recommended the elimination of nonsterile powdered gloves throughout the hospital. The value analysis team (VAT) reviews all new products purchased by DCH. This team consists of managers from the materials management, patient registration, respiratory therapy, laboratory, emergency services, pharmacy, education, clinical and support services, infection control, surgical services, radiology, and critical care departments. This group examines all new products suggested for purchase for their appropriateness, clinical need, and cost-effectiveness. Among criteria considered during product evaluation is latex content. Safe alternatives are provided where indicated. For example, sterile nonpowdered surgeon’s gloves, sterile nonlatex surgeon’s gloves, and nonsterile nonlatex gloves are all available from the hospital storeroom on request. PAllENT CARE
All patients who are treated at DCH are assessed for latex sensitivity, regardless of which point the patient enters the health care system (eg, outpatient, emergency care). Care may be provided by personnel in many departments, but because of the efforts of the multidisciplinary team, the patient’s care is consistent throughout his or her stay. On admission, the admission clerk requests that each patient complete a latex allergy screening tool (Table I), and the information is placed in the patient’s medical chart. The tool includes an assessment of the patient’s food allergies. All patients are contacted and assessed before
care is provided. This assessment is completed via the telephone at least 24 hours before admission or surgery, if possible, and is completed at the time of admission for patients requiring emergency treatment or surgery. If indicated, implementation of latex allergy precautions begins when patients are admitted to the hospital. Patients are not assigned a room or transferred to a designated receiving area until latex allergy has been determined. If a patient answers yes to the first three questions, review by an RN is required. He or she will determine whether a latex-reduced environment is indicated. If a risk for latex sensitivity or allergy is determined, the nurse documents a “risk for latex allergy response” in the patient’s medical chart.” The admitting RN initiates providing a latex-safe environment for the patient by communicating with the appropriate department directors or charge nurses. Documentation includes a note indicating latex sensitivity or allergy on the physician’s order sheet.’*The nurse places an orange-striped wrist band on the patient that identifies latex allergy. The nurse also documents the allergy on the front and spine of the patient’s medical chart. On the unit, nursing personnel post signage that indicates the need for latex allergy precautions and a latex-safe environment on the door of the patient’s room and above the patient’s bed. Latex allergy precautions for surgical outpatients follow the same latex protocol as those for admitted patients. Patients are interviewed and prepped in a latex-safe environment and transferred directly to the OR suite. In patient care areas, the following measures are used to reduce latex exposure. Gauze or cotton webbing is wrapped around the patient’s arm before application of a blood pressure cuff containing latex. Sheets or blankets are used to prevent the patient from contacting possible latex rubber in mattresses, gurneys, or chairs. Stopcocks are used on IV tubing rather than latex ports. Glass syringes, or plastic disposable syringes marked “latex free” are used. All medications are removed directly from vials after the rubber stoppers are removed Flat sheets, rather than fitted sheets, which may contain latex, are used to cover the mattress. A latex-safe cart and a high efficiency particulate air (HEPA) filter are brought to the patient’s room. These items remain with the patient throughout
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SAMPLE LATEX ALLERGY SCREENING TOOL
This screening tool is intended to assist in identifying patients with a latex sensitivity. It is not intended to be oll-inclusive, and individuals who are uncertain whether they are sensitive to natural rubber latex should consult their physician. 1. Have you ever had a reaction to or been told by a physicion that you have an allergy to any latex or natural rubber product? Yes No 2. Have you ever had itching, swelling, hives, or trouble breathing when you use any of the following items?
Balloons Rubber gloves Hot water bottles Rubber bands, balls Foam pillows Baby bottle nipples Pacifiers, teething rings Belts, bras, suspenders Other
Yes
No
-
-
-
-
-
-
-
Yes Condoms or birth control devices Dental dams Erasers Face masks Elastic bandages Cuffs, elastic waistbands Ostomy bags Urinary catheters Rubber grips
-
-
No -
-
3. Have you ever had itching, swelling, hives, or trouble breathing offer eating any of the following? Bananas Avocados Kiwi Chestnuts
Yes Yes Yes Yes -
No -
No No No -
4. If you hove checked yes to any of the above questions, you will be evaluated by a nur.5.e. If the nurse believes you may be latex sensitive, your physician will be contacted for furlher orders.
Patient‘s signature
Date
If any questions were answered “yes,“ the patient was evaluated by: ,
Registered Nurse
are kept at each nursing station, including the control desk in the OR. One of the manuals also is attached to each latex-safe cart.”’ The quick reference guide can be helpful to nurses working on call during evenings, weekends, or holidays who must admit a patient with this allergy. It addresses key steps in the patient’s admission process.2’ When anticipating the arrival of a latex-sensitive patient, the nurse removes all latex-containing products from the assigned room. This includes all items normally stocked in the room, all latex examination and sterile gloves, and any other equipment not necessary for direct patient care. Only nonlatex gloves are used. The housekeeping staff members terminally clean the OR after the last surgical procedure performed in the room (ie, the day before the scheduled procedure or before the patient’s arrival). Traffic flow is restricted to essential personnel. Signs alert
his or her entire hospitalization. PERlOPERATlVE CARE
Personnel in patient registration notify personnel in surgical services 24 hours in advance, or as soon as possible in emergency situations, when a patient is identified as being at risk for latex sensitivity. Doctor’s Community Hospital follows the guideline that surgery for latex sensitive patients must be scheduled as the first procedure of the day, if possible.I9 Scheduling these patients as first procedures and preparing the OR according to the latex protocol helps reduce latex in the environment. At DCH, OR staff members can review a quick reference (a brief review of policy and procedure) for admission policies necessary for latex allergic patients and for implementation guidelines. This quick reference guide and the latex reference manual 50
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nonessential staff members to not enter the room and that a latex-safe environment is required. Staff members prepare the room to accommodate both the surgical procedure and recovery of the patient. The perioperative nurse contacts the pharmacy to ensure that necessary medications are available in vials or ampules that do not contain latex. The OR managers ensure that the perioperative and postanesthesia care unit (PACU) nurses assigned to the procedure have all been notified of the latex precautions. Instrument processing and sterilization (IPS) department personnel are notified the day before surgery, so articles containing latex (eg, Penrose drains, rubber catheters, scissors-protecting tips) are not placed in sterile trays during preparation. Exposure to powdered latex gloves is one of the most common routes of latex sensitization; therefore, powdered latex gloves are not used in the latex-safe room. Nursing staff members clean all horizontal hard surfaces in the OR early in the morning or immediately before the procedure. Anesthesia personnel also must be aware of latex-containing products. Nothing may be injected or withdrawn through the latex port of any medication bottle or IV tubing. Nonlatex tourniquets, a nonlatex examination glove, or polyvinyl chloride tubing (eg, IV tubing) must be used as tourniquets. The anesthesia care provider must use a latex-free breathing circuit with plastic mask and bag, and the ventilator bellows must be nonlatex. All monitoring devices (eg, cords, tubes, pulse oximetry, blood pressure cuff, electrocardiogram wires) are wrapped in stockinette or cotton webbing and secured with tape if no latexfree products are available. A disposable nonlatex heating blanket also must be used. These efforts may seem excessive; however, avoiding exposure to the latex antigen is the only method demonstrated to prevent latex-induced anaphylaxis. The PACU staff members should be notified 15 minutes before the procedure will end, to allow them time to prepare. A second call requesting their arrival as soon as possible allows for a smooth patient recovery from anesthesia. All the measures that have been followed in the OR should continue during the postoperative course. At DCH, we recover latex-sensitive/allergic patients in the OR in which the procedure has taken place because we believe it is the safest place to recover the patient and to continue the perioperative latex-safe plan of The PACU nursing staff members arrive in appropriate attire to recover the patient in the OR.
Exposure to powdered latex gloves is one of the most common routes of latex sensitization.
The surgical team members transfer the patient from the OR bed to a covered stretcher, and the PACU nurses recover the patient in the OR. The PACU nurses must observe the patient closely for the signs and symptoms of a delayed latex reaction, which may include skin reactions (dermatitis), respiratory problems, asthma attack, or anaphylactic shock. When the patient is ready, he or she is discharged home or to a latex-safe room on the nursing unit. If the patient is scheduled to go home, he or she is discharged in a wheelchair through the closest exit out of the building, thus minimizing the exposure to the hospital environment. If the patient is returned to a nursing unit, personnel there follow the same protocols as outpatient surgery, preoperative nursing unit, and OR personnel. The latex-safe equipment, cart, and the HEPA air filter remain with the patient throughout the institution until discharge. I A T M SUBsmVcES
To avoid exposure to the latex antigen, it is important to be aware of items that can be substituted for common latex products in the OR. We have developed guidelines at DCH for replacing commonly used items when caring for latex-sensitive individuals. Some examples are as follows. Silicone or nonlatex Foley catheters can be used in place of urinary catheters that commonly are made of latex. Rubber bands, often used to secure C-arm drapes during draping, can be replaced with self-adhesive wound approximating strips to secure the drape. The foam stick pad used in needle counting pads should be removed, leaving only the magnetic pad. Rolled stockinette should be placed around the patient’s extremity before applying an elastic bandage.
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All latex items (eg, bulb syringes, suction tubing, elastic wrap) should be removed from custom packs or specialty packs as soon as the pack is opened. Surgeons’ paper tie caps should be used rather than caps with elastic. Patients should not be given paper shoe covers, as they contain latex in the elastic. After discarding sterile latex items, the scrub person also should discard his or her gloves and reglove.
accompanies them to their assigned room. The cart is returned to IPS for complete cleaning and restocking after the patient is discharged. EDUCATION
Education is the key to the recognition, management, and prevention of an adverse reaction and must be viewed as a partnership between the health care facility and the community. Hospital employees. At DCH, everyone in the institution participates in an educational program on the subject of latex allergy. The aim is to educate the staff members about the care of latex-allergic patients and high-risk patients, change inappropriate behavior, and do this with motivation and creativity. Our hospital has developed a latex allergy precautions reference manual that contains the protocol for admission and treatment of patients with latex allergy, supportive and therapeutic care procedures, and protocols for employees with latex sensitivity. In general, all employees should know and be aware of their institution’s latex allergy prevention protocols. The employer should provide workers with education programs and training materials about latex allergy. This information should be included in orientation and continuing education sessions. In addition, all departments involved in the care of a latex-sensitive patient must have specific orientation and plans. It is important to educate nursing staff members about the potential severity of latex allergy to reduce incidence of reactions, and professional networking is helpful in understanding the problem and finding solutions to it.” Surgical team members. Educating the surgical team members about the risks of using latex gloves and other supplies that contain latex is of prime importance. The use of powdered latex gloves has been so universal that it may be difficult for some people to accept that “if you have to use latex gloves, make it a low-protein, powder-free glove. Aerosolized latex is a cardinal sin.”25Communication with and education of all members of the health care team will reduce latex risks for everyone. Patients and family members. Patient education reduces risk. Latex proteins can be life threatening, and the patient and his or her family members need to be aware of the causes of the sensitivity or allergy. At DCH, the patient registration clerk gives all patients who are identified as having latex allergy a booklet titled About Latex Allergies.” Patient education is part of the patient care plan and
ACCESS TO SUPPLIES AND MUIPMENT
Identifying all the products that either contain latex or are packaged with latex-containing material is the greatest task for implementing a latex-safe environment. Hospital personnel should contact product manufacturers for written documentation that a product is latex-free. This can be complicated. Manufacturers may be reluctant to document that the product is latex-free because portions of the manufacturing process often are subcontracted out to other companies, and the latex content is uncertain or unknown. Other manufacturers may not know if their packaging materials contain latex. Latex-free products ultimately are identified through review of the literature and efforts to contact the primary medical and health care product companies. Latex-safe case cart. As so many items in the OR contain latex, a special latex-safe cart is helpful for use in procedures on latex-allergic patients. At DCH, an OR case cart for latex-allergic patients is ready at all times. It is easily identified and is kept in the main hallway of the OR. On the cart, staff members can find a ready-to-use basic pack, latex-free items, and signs for the doors. There also is a quick reference sheet, admission procedure, and a list of patient care items. A list of latex versus nonlatex items is available to help expedite safe preparation of the OR. The latex-safe cart also contains the basic essentials for patient care during the surgical procedure. There are latex-free kits for starting IV lines, bladder catheterization, blood drawing, and other procedures. This can increase waste and expense if personnel open a kit only for selected items.’’ Although there are customized latex-free packs available, they are expensive, and we have chosen not to use them. A personal latex-safe cart also is assigned to the patient on admission and is brought into the OR with the patient. For patients requiring a hospital stay, the cart 52
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is documented in the multidisciplinary education record. People who are confirmed to be latex allergic are encouraged to wear a Medic-Alert bracelet at all times. People who have experienced serious adverse reactions to latex must eliminate all exposure to latex. The role of family members is very important. When someone is diagnosed with a latex allergy, many aspects of his or her life change. Latex is everywhere (eg, more than 40,000 items in commercial and medical use). The patient and his or her family members need to consider the many items that they have and use in their home environment and replace those items that contain latex. It is a challenge to live with this type of change, which can alter life style, career, and sometimes a person’s independence. Latex allergy, like any other illness, can result in symptoms of loss, grief, depression, and lifestyle adjustments for both the individual and his or her family members?’
NOTES 1. National Institute for Occupational Safety and Health, NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Work Place (Cincinnati: US Department of Health and Human Services, 1997) 1; Healthcare Hazardous Materials Management, “Latex sensitivity: Current issues,” Healthcare Hazardous Materials Management: The Newsletter of the Centerfor Healthcare Environmental Management 10 (June 1997) 1. 2. M Bemstein, “An overview of latex allergy and its implications for emergency nurses,” Journal of Emergency Room Nursing 22 (February 1996) 29-36; Cleveland Clinic Foundation, “what is latex?” Available from http://gasnet.med. yale.edu/gta/latex/html. Accessed 26 November 1997. 3. M P Truscott, “Reactions of natural rubber latex,” First Hand 1 (Winter 1994) 1; A J Weido, T Sim, “The burgeoning problem of latex sensitivity: Surgical gloves are only the beginning,” Postgraduate Medicine 98 (September 1995) 173179.
CONCLUSION
Caring for or working with latex-sensitive individuals requires knowledge and team work to provide a latex-safe environment. It is important that nurses familiarize themselves with latex allergy and ways to counteract it in the hospital environment. A
Blanca Rosa Davis, RN, MS, is a perioperative staff nurse, a laser safety oficer, and a basic life support instructor in the OR at DoctorS Community Hospital, Lanham, Md. The author would like to thank Marilyn Glaser,RN, M S , director, department of education and Debra Koi-ding, RN, BS, surgical services educator at Doctor’s Community Hospital, Lanham, Md, for their assistance in the preparation of this article.
4. S L Halpem, “Latex sensitivity,’’ seminar presented at King of Prussia, Pa, 9 June 1998. 5. National Institute for Occupational Safety and Health, NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Work Place, 1,2; Medical Educational Services, Stop Latex Allergy: How to Make your Medical Facility Latex Safe, Part I (Knoxville, Tenn: Medical Educational Services, 1996)Videotape. 6. Medical Educational Services, Stop Latex Allergy: How to Make your Medical Facility Latex Safe, Part I. 7. Latex Allergy Information Service, “Managing latex in the hospital environment,” BrieJings on Hospital Safety suppl (January 1998) 7; S McGann et al, “Latex allergy alert,” The Nursing Spectrum 8 (Feb 23, 1998) 16-19. 8. J Slater, “Latex allergy,” Journal of Allergy and Clinical Immunology (September 1994) 2. 9. Cleveland Clinic Foundation, “What is latex?” 10. Cleveland Clinic Foundation “All about gloves: Latex and nonlatex.” Available from http://www. 53 AORN JOURNAL
anesth.com/lair/latex/gloves.html. Accessed 2 July 1998. 11. Healthcare Hazardous Materials Management, “Latex sensitivity: Current issues,” 1-4; Halpem, “Latex sensitivity,”1-4. 12. Cleveland Clinic Foundation, “Population at risk for development of latex allergy.” Available from http://gasnet.med.yale.edu/gta/latex/ risk.html. Accessed 26 November 1997. 13. “AORN latex guidelines,”in Standards,Recommended Practices, and Guidelines (Denver: AORN, Inc, 2000) 107-121;T Goodman, Rational Approach to Latex Allergy, second ed (Arlington,Tex: Johnson & Johnson Medical, 1998) 28 14. National Institute for Occupational Safety and Health, NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Work Place, 1. 15. Healthcare Hazardous Materials Management,“Latex sensitivity: Current issues,” 1-4 16. Multidisciplinary Committee, Doctor’s Community Hospital, Mission (February 1998). 17. “AORN latex guidelines,” 107-121.
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18. Doctor’s Community Hospital, “Protocol for admission and treatment of latex allergic patient,” Policy and Procedure, Doctor’s Community Hospital (Lanhm Md: Doctor’s Community Hospital, July 1998) 1. 19. “AORN latex guidelines,” 107-121. 20. D Kording, “Quick reference,” OR education seminar presented at Doctor’s Community Hospital, Lanhm, Md, October 1997. 21. Doctor’s Community Hospital,
”Latex allergy precautions,” Reference Manual, Doctor’s Community Hospital (Lanham,Md: Doctor’s Community Hospital, October 1997) 3. 22. “AORN latex guidelines,” 107-121. 23. D Bailey et al, ‘‘Implementing a system for care of patients with latex allergy,” Infection Control and Sterilization Technology 4 (April 1998) 5. 24. M Evangelisto, “Making the choice: Can you go latex free?”
Today’sSurgical Nurse 20 (January/February 1998) 42. 25. D Adkins, “Briefings on hospital safety,” The Newsletter for Hospital Safety Committees 4 (May 1991) 3. 26. About Latex AElergies (South Deerfield, Mass: Channing L. Bete CO, 1997) 1-16. 27. S Ball, M Charous, J Gotlieb, “Surviving with latex allergy: How to cope with change in lifestyle, career and independence,” Latex Allergy News 5 (July 1998) 8.
Tofu Connected to Impaired Mental Function in Later Life The more tofu men and women eat, the more likely they are to show signs of impaired mental function later in life, according to an April 4,2000, American College of Nutrition news release. Consuming tofu two or more times per week was determined to be detrimental to brain function. Men who ate the most tofu during their mid 40s to mid 60s showed the most signs of mental deterioration during their mid 70s to early 90s. They had more brain atrophy and performed poorer on cognitive tests, which measured attention, concentration, memory, judgment, and other brain functions. This analysis was part of the Honolulu Heart Program, which began tracking the health of 8,000 men of
Japanese-American heritage in 1965. Researchers administered cognitive function tests to 3,734 men, obtained brain images from 574 men, and evaluated brain atrophy in 290 male autopsy results. Test scores of SO2 wives of participants also were analyzed. The proposed link between consuming tofu and decreased brain function is isoflavones, which affect the tyrosine kinase enzyme that blocks changes in the brain related to learning.
Tofu and Brain Aging (press release, New York:American College of Nufition, April 4, 2000) 1. Available from hftp:// w.newswise.co~articI&2000/4/TOFU.NUT.html. Accessed 13 April 2000.
Surgical Reatments for Osteoarthritis Announced Osteoarthritis, the most common form of arthritis or joint inflammation, affects as many as 36 million people in the United States. According to a March 15,2000, news release from the American Academy of Orthopaedic Surgeons, many new surgical treatments are available to relieve the pain caused by osteoarthritis. As the population ages, osteoarthritis, which occurs in weight-bearing joints of the knee, hip, and spine, has become a significant health problem that may affect everyday activities such as walking or standing. Nutritional supplements, braces, exercise, medication, and heel wedges are some of the new treatments available, according to the release. Another new treatment designed to specifically treat knee osteoarthritis is a procedure in which a lubricating
substance is injected directly into the knee joint. This procedure is performed during a one-week period and consists of three to five injections. Typically, relief can last up to six months. According to the release, researchers also noted, that supplements may aid in pain relief of osteoarthritis but warned that patients should consult their physicians before self-medicating. Many supplements, both prescription and over-the-counter, can provide cartilage nutrition, which in turn can reduce inflammation and increase mobility. Nonoperative Treatments for Knee Osteoarthritis (news release, Orlando, Fla: American Academy of Orlhopaedic Surgeons, March 15, 2000) 1-2.Available from htlp://hulw.newswse.com/ai7iclees/2000/3/3/KNEEARTH.OSR .html. Accessed 16 March 2000. 54
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