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Allergy HAZARD Growing number of health care workers developing dangerous reactions to latex By Liz Kowalczyk Doctors at South Shore Hospital in Weymouth weren’t sure what was wrong when Barbara Bezanson started wheezing on the operating table. But before long, they knew it was something serious. As soon as she arrived in the recovery room, her blood pressure plummeted. She was no longer just wheezing, but gasping for air. Bezanson, 48, of Weymouth, was going into shock. Her doctors put her on a respirator and desperately tried to figure out what was wrong. They checked for internal bleeding. Negative. They searched for a drug allergy. Nothing. Then Bezanson’s husband mentioned that latex gloves made her hands itch. The catheter doctors had inserted into her wound was made of the same material. She was having a severe reaction to latex. She didn’t know it until the anesthesia wore off, but Bezanson had become one of the growing number of health care workers with serious and sometimes life-threatening allergies to latex. The natural rubber is not only found in surgical gloves, but in hundreds of household products and medical supplies. Many Massachusetts hospitals have started buying non-latex alternatives and set up “latex-free” or “latex-safe” operating rooms. “It’s been a bit of an epidemic, really,” said Dr. Aidan Long of Hingham, an allergist at New England Medical Center in Boston, where studies have shown that 10 percent of operating room staff test positive for the allergy. “It’s frightening,” said Dr. Donald Accetta, president of the Massachusetts chapter of the American College of Asthma, Allergy and Immunology. “A lot of health care workers know they’re having a problem wearing latex gloves but they say, ‘It’s just part of my job, so I’ll do it.’” At Boston’s Brigham and Women’s Hospital, about 15 nurses who became so allergic that they can’t work are suing glove manufacturer Baxter Inc., and the contractors who were working on the hospital’s ventilation system. “Sometimes I start to cry when people talk to me about it,” said one of the nurses, Joyce Mutrie, 52, of Scituate. “Nursing was part of my identity. One day I went to work, I had a terrible reaction. And the next day I could never go back again.” Risk increases with exposure No one knows how many people are allergic to latex, which is the milky sap from the rubber tree Hevea brasiliensis. The U.S. Food and Drug Administration estimates that 1 percent of the population has latex “sensitivity,” meaning they test positive for the allergy but have no symptoms yet. Estimates for health care workers and others who are regularly exposed to latex are much higher, from 15 to 50 percent, depending on the study. People with spina bifida, who were continually exposed to latex tips on enema bottles as children, are at highest risk. From 34 to 100 percent of people with this birth defect are latex sensitive, the FDA estimates. And at least 16 spina bifida patients nationwide have died from exposure to latex since 1988. The tendency to develop allergies is inherited. But as with all allergies, people with the tendency must be repeatedly exposed to latex before they develop a sensitivity to it. “Since the 1980’s, health care workers have been exposed to more and more latex,” Long said. “They’re using gloves a lot more often because of universal precautions against AIDS. And they’re changing their gloves a lot more often.” Every time nurses or doctors change their latex gloves, they send the cornstarch that coats the gloves wafting into the air. Protein molecules from the latex bind to the cornstarch molecules, and everyone nearby breathes them in. So, Long said, health care workers don’t need to touch latex to react to it. Thomas Lynch, a Quincy lawyer who represents Mutrie, argues that there’s another reason for the surge in latex-allergic people. He said that glove manufacturers were struggling to meet the growing demand for gloves after AIDS came on the scene and were not properly removing extra protein molecules. “They were not washing the gloves as thoroughly as they were before,” said Lynch, who lives in Hingham. “This is probably going to be the next type of major medical liability tort.” The nurses at Brigham and Women’s are also suing the contractors who worked on the hospital’s heating, ventilation and air-conditioning systems, charging that poor air quality contributed to the nurses’ latex allergies and other health problems. About 80 of the roughly 1,800 nurses at the hospital said they were disabled by various environmental hazards between 1992 and 1995. Most health care workers who are sensitive to latex have no symptoms or a mild form of the allergy, which causes red, itchy hands, hives and wheezing. But many of the doctors, nurses, dentists and lab technicians who have developed severe latex allergies say their lives and careers have been devastated. Lynch said an anesthesiologist at Brigham and Women’s, who had been making $250,000 a year, is now so allergic she can’t leave her house. But many doctors, he believes, keep their condition secret because, unlike nurses, they are not hospital employees and don’t qualify for worker’s compensation benefits. Mutrie, who worked at Brigham and Women’s and at Boston City Hospital during a 22-year nursing career, said her allergist warned her that she can never work in a hospital again. Her reactions to latex were minor until one morning in November 1993, when she was taking a patient’s vital signs in the Women’s Health Services Department. Mutrie felt her throat tighten. She walked to her locker to get a lozenge and suddenly couldn’t breathe. The hospital’s emergency room doctors gave her a shot of epinephrine, which stops severe allergic reactions. Mutrie hasn’t worked since. She had stripped her house of latex products, pulling up the wall-to-wall carpeting and throwing away everything from a favorite easy chair to shower-curtain liners. There are times, however, when she just can’t avoid latex. She’s had several asthma attacks in the underwear department at the former Jordan Marsh store in the South Shore Plaza in Braintree. The elastic in bras and underpants is made with latex. Bezanson feels fortunate that she’s been able to keep her job in central processing at South Shore Hospital, where she stocks operating-room carts and sterilizes equipment. “After my surgery, I really couldn’t believe what happened,” she said. “I was never allergic to anything. It was shocking.” She can’t eat rice packaged in plastic, or bananas, kiwi fruit or water chestnuts, which for some reason cause reactions in many people with latex allergies. She wears non-latex gloves and masks on the job, takes an allergy pill every morning and always carries a portable supply of epinephrine in her purse. Low-latex zones South Shore Hospital has also developed a plan for coping with latex-allergic patients. At a moment’s notice, staff can convert any operating room and recovery room into a “latex-safe” area by wisking out latex tubing and equipment and wheeling in carts stocked with latex-free gloves, masks and catheters. If doctors and nurses know a latex-allergic patient is on the way, they don’t wear latex gloves that day. “We try to make it as safe as we can, but it’s impossible to make everything latex-free,” said Linda Coulombe, nurse manager of central processing. “Latex is in so many items. Being latex-free would mean we couldn’t let people wearing pantyhose into the hospital or serve kiwi fruit in the cafeteria.” Brigham and Women’s Hospital has a “low-latex” environment, said Jack McCarthy, director of the department of environmental affairs. The hospital has switched to non-powdered gloves, and air-quality tests show no detectable levels of latex in the air, he said. Hospital officials believe the ventilation system was adequate, but acknowledge that a number of nurses developed latex allergies. Brigham and Women’s and the Massachusetts Nurses Association reached an agreement that allows nurses to retire who are unable to work because of latex allergies, and they will receive worker’s compensation benefits. Brigham and Women’s agreed to help pay to retrain the nurses so they can work in non-hospital jobs. Quincy Hospital uses latex-safe carts and is gradually switching the entire hospital over to non-latex gloves. Jordan Hospital’s strategy “is to eliminate all latex products from the hospital,” said spokeswoman Janice Kinder at the Plymouth hospital. But as in many hospitals, surgeons are the last to switch to vinyl and other non-latex gloves, which they complain are looser-fitting, thicker, and less comfortable than latex. And Accetta said very few doctors have eliminated latex in their private offices. Sharon Snider of the FDA said the agency is trying to work with latex manufacturers to reduce protein levels in their products. “We’ve done a lot of public education on this, and the industry has made a lot of changes,” she said.
SOME FACTS AND FIGURES
Who’s at risk Less than 1 percent of the general public is at risk of an allergic reaction to latex. But because constant exposure to latex increases the chances of a life-threatening reaction, several groups are at higher risk.
Warning signs Reactions to latex range from minor rashes to life-threatening shock in which the blood pressure plummets, the throat swells and the lungs constrict. Usually latex-sensitive or allergic people have warning signs.
Where latex is found More than 40,000 everyday products contain latex. So do hundreds of medical products. These products can pose a danger to people with latex allergies.
Liz Kowalczyk The Patriot Ledger Quincy, MA Phone 617-786-7000 Reproduced here with permission. |
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