Health and Safety
Executive / Commission
Latex Allergies
Reactions to Natural Rubber Latex (NRL) affect all staff working in the perioperative environment because:
Ensure that you have and are familiar with:
In best practice, the ward will receive notification in advance that a patient due for admission is sensitised to NRL Warning notice for entrances. Consultant secretaries should indicate this to ward staff if they have themselves received the information. Admissions may have the opportunity to "flag" the information on the patient IT records and documents that are received on wards in advance of elective admissions.
All staff (including domestics and transient staff) need to be made aware when a patient with NRL allergy is admitted. All wards should keep a list of items in their area that contain natural rubber latex. Every ward should hold a stock of the following NRL-free items: -
The patient should be nursed in a cubicle from which all items containing natural rubber latex have been removed. An NRL-free bed and mattress should be used. A clear notice should be on the door Warning notice for entrances. Aprons and NRL-free gloves should be by the door. If the patient has to be nursed in an open ward, precautions should be taken to ensure that there are no NRL items near their bed-space.
| Action | Purpose |
|---|---|
| Before to admission, ward cubicle/bed space should be cleaned by staff wearing NRL-free gloves | To remove NRL proteins. |
| All items containing NRL should be removed or, if not possible, covered with stockinette and secured with NRL free tape. | To prevent NRL from coming into contact with the patient. |
| An NRL -free mattress and bed should be used | As above |
| Use NRL-free blood pressure cuffs and oximeter probes or cover with stockinette and NRL free tape | As above |
| Aprons and NRL free gloves should be by the door or bed | As above |
| Warning signs should be placed on doors, medical notes, prescription charts, observation charts | To alert staff and visitors |
| Use red bracelet patient ID | To identify patient as allergic |
| Ensure there are no elastic bands around the notes | To prevent contamination of patient area |
| Only NRL-free anti-embolism stockings should be used | To prevent exposure to NRL |
| When preparing IV medication, use ampoules wherever possible, otherwise remove bung before drawing up. Liaise with pharmacists for alternative medication/presentation | To avoid contamination of the medication with NRL proteins from the bung |
| Cover NRL IV ports in giving sets (latex-free are available) | Use three way taps in preference to ports if unsure whether the giving set contains NRL. |
| If patient needs further investigations e.g.X-ray, scan, ensure that department staff areinformed of NRL status of patient | To ensure that risks are minimised in other departments |
| If patient is to have surgery, ensure theatre staff prepare are informed of the patient’s allergy | To enable theatre staff to plan patient safety |
| Give patient information about Latex Allergy Support Group | To reduce the patients fears and feeling of isolation |
Best practice would suggest that patient assessment is undertaken in the Outpatient or pre-assessment unit prior to all elective surgery using a Patient screening tool to identify at risk individuals. Ideally, the General practice will have informed the surgeon of the patient's sensitisation in the initial referral letter.
If pre-screening suggests that the patient may have an NRL sensitivity, diagnostic confirmation should be sought Diagnosis.
All forward planning and documentation should inform future carers of the patient's sensitisation by effective recording in notes, on operating lists and the use of Labels for Patient notes. Patient confidentiality must be taken into account.Usually undertaken by both anaesthetist and medical staff it is vital to the safe planning of perioperative care that an effective assessment of the allergic potential of each patient is undertaken. Allergy to related rubber products may give rise to deepening of questions but an allergy to cross-reactive allergens (in the main foodstuffs) may lead to a more informed decision about the patient's allergic status.
All new staff must be assessed using a pre-employment screening tool by the Occupational Health Department
If staff are identified as sensitised to NRL, Occupational Health must work with the person responsible for health and safety/latex in the ward or department to undertake a risk-assessment to ensure that the working environment is safe for the employment of the prospective member of staff or continuing employment of staff. In many clinical areas, staff with Type I NRL allergies are successfully working using synthetic gloves for their personal practice with colleagues using low protein powder-free gloves. This is where a risk-assessment has determined that the level of sensitivity makes it safe to do so. However, if the risk-assessment determined that the Type 1 allergy was particularly severe, then other arrangements would have to be made as appropriate eg the area would be made latex free.
Risk minimisation and education of colleagues is the vital element to working in clinical areas.
If you or your patient are not NRL-sensitive and you choose to wear NRL gloves to protect yourself from blood-borne pathogens choose Powder-Free and Low Protein (<50ug/g) gloves only.
If the diagnosis or a high-risk assessment has been made whilst in hospital, the primary care team should be informed when the patient is discharged to ensure that risk-management of the patient is continued or for the General Practitioner to make an appropriate referral for diagnosis to take place. This should be done when any communication is made with the primary care nursing team and/or in the GP discharge letter.
Association for Perioperative Practice (AfPP) "Understanding Latex Allergy
in the Perioperative Setting" 2000
ISBN 0 9537287 2 2
Infection Control Nurses Association "A Comprehensive Glove Choice" ISBN - 0 9541962 048