Latex allergy among staff poses major headache for hospitals
By Meredith Goad
Marie King, a registered nurse, pulled on latex gloves dozens of times a day while treating patients at the Portland nursing home where she worked.
Now, the gloves that were supposed to protect her from infectious diseases could kill her, if she’s not careful.
King is one of a growing number of health-care workers across the country who have developed allergies to latex, the natural rubber that is so ubiquitous it’s found in 40,000 products, from underwear and condoms to Kooshballs.
King’s problem started in nursing school, when her face would turn red and swell after she wore latex gloves. Then red welts appeared on her hands. Eventually, every time that King got near latex, she worried that she’d go into anaphylactic shock.
“Within half an hour of going to work, I had trouble breathing,” King recalled.
Ultimately, she had to quit her job.
Researchers studying the problem say that as many as 10 to 20 percent of medical workers may now be sensitive to latex. And although latex allergies once were considered rare in the general population, recent studies have shown that more than 6 percent of Americans have anti-latex antibodies in their blood, and are at risk of developing symptoms.
As more health-care workers lose their careers, and the number of deaths from latex allergies increases, hospitals are struggling to find ways to control the problem. Locally, both Portland hospitals have developed new policies for dealing with latex-allergic patients and employees.
On Monday, Maine Medical Center began its first hospitalwide trial of a non-latex glove, a major step for doctors and nurses who have become used to the feel, stretch and strength of latex.
“One of the nurses who worked in this hospital can no longer work (because of latex allergies), and that is so frightening for health-care people,” said Jan Stilke, nurse coordinator at Maine Medical Center’s Spina Bifida Clinic. “Most of us really love what we do, and to think about never being able to work again is a very frightening thing.”
AIDS starts problem
Latex, a milky white sap tapped from the rubber trees of Africa and South Asia, is especially common in medical settings. It’s in tourniquets, catheters, IV tubing, ace wraps, Band-Aids, syringes and many other products.
“Nurses are getting (reactions) around their necks from the stethoscopes because the stethoscope is pure rubber, and they break out around their neck and don’t know why,” said Karen Thurlow, a nurse educator at Northern Diagnostic Laboratories whose 6-year-old son is allergic to latex.
The allergy often starts simply, with red, itchy skin and watery eyes. But with more exposure to latex, it can develop into something more deadly: anaphylactic shock.
Once sensitized to latex, an allergic person has to be careful about coming into contact with any of the thousands of everyday objects that contain the material. Latex is in the buttons on phones, remote controls and calculators. It’s in pacifiers, basketballs, bath mats, computer mouse pads and even on lottery tickets.
The cornstarch powder in latex gloves is especially troublesome. Latex proteins can coat those powdery grains, then the proteins get into the air where they can be breathed and trigger an allergic reaction.
It’s widely believed that the increase in sensitization to latex began with the dramatic increase in the use of latex gloves beginning in 1987. That was the year the federal Centers for Disease Control and Prevention mandated universal precautions to slow the spread of HIV and other infectious diseases. The use of latex gloves shot from 12 billion to more than 200 billion pairs per year.
To meet demand, manufacturers made changes in the production process that increased the amount of latex proteins in the gloves. Suddenly, there were more health-care workers using more latex gloves than ever before, and they were being exposed to more latex allergens in those gloves.
Food handlers use latex gloves to hold, serve and slice food.
But Dr. B. Lauren Charous of the Milwaukee Medical Clinic doesn’t believe that universal precautions alone are to blame. Charous, chair of the Latex Hypersensitivity Committee of the American College of Allergy, Asthma and Immunology, says he thinks there’s something wrong with the product.
“Latex had been used in the medical field for a whole century and we never saw anything like this, so something’s funny,” he said. “There is no other product that has had the wide use that latex has had that suddenly turned into a potent sensitizer.”
Charous, who has been sounding the alarm to health-care groups, says the FDA is not moving quickly enough to protect workers or their patients, more of whom are becoming sensitized every day.
There is an FDA proposal in the works to require that medical devices with latex be labeled, but it is moving slowly, Charous said. Charous also would like to see the agency regulate allergen content of gloves.
Without those kinds of guidelines, he said, hospitals aren’t sure how to handle the situation, and workers developing symptoms are afraid to come forward for fear of losing their jobs.
“The next group that I want to talk to are the workmen’s compensation insurers, because if anybody’s going to change things, it’s going to be them,” Charous said. “They’re going to say, ‘We won’t insure you unless you use this kind of glove.’ And that will get the attention of everybody.”
Some hospitals, including the famous Mayo Clinic, have switched to non-latex or low-protein-latex gloves, and have made other changes to try to deal with the problem. Local hospitals also are coming up with solutions.
At Mercy Hospital, latex allergies first popped up in the maternity ward. Nurses and dental hygienists who came there to have their babies started showing up with sensitivities to latex and needed special care.
By June 1996, the hospital had developed a formal policy for dealing with patients and workers who are latex allergic.
Now carts filled with latex-free products are placed outside the door of every latex-allergic patient, says Pat Rybak, the registered nurse in charge of the program. Every new employee at Mercy is verbally screened for latex allergies. The hospital also has surveyed employees to find those who have a constant problem with contact dermatitis — the redness, itching and swelling that is among the first signs of a latex allergy.
“They are provided the latex-free gloves, and we have little stethoscope coats so they don’t put the stethoscopes on their skin that are made out of latex,” Ryback said. “And we have some educational information for them as well, in terms of what they can and can’t use. We have one person here who can’t even sit in rubber chairs.”
The hardest task Ryback has faced in making the hospital “latex safe” has been replacing medical supplies with latex-free products. Without mandatory labeling, Ryback has to spend a lot of time on the phone trying to verify with a manufacturer that a product does not contain latex.
“When we have the option, we choose the latex-free products,” Ryback said. “As much of our IV tubing as possible is latex-free, and I’m trying to look at latex-free gloves.”
Supply may pose problem
Medical workers love latex gloves because they fit so well and stay strong while maintaining the tactile sensitivity needed for delicate procedures. At Maine Medical Center, workers from doctors and nurses to housekeepers and phlebotomists go through 90,000 pairs of latex gloves per year.
Now they are trying to kick the habit.
In addition to adopting safeguards for patients similar to those instituted by Mercy, Maine Med has decided to switch all of its nonsterile gloves to latex-free brands. Nonsterile gloves are what the hospital uses most, for the widest variety of purposes, from phlebotomy to pathology.
Sterile gloves — those used in the operating room, to change dressings, and for medical procedures such as cardiac catheterizations — will remain latex, for now.
A committee appointed to examine latex alternatives considered six to eight new brands of gloves, ranging in price from $3.50 to $43.85 per box of 100.
It will test two brands in May and June. The gloves have been checked for strength in the hospital’s clinical engineering department. Now, they’ll face the most rigorous critics: doctors and nurses who will decide if they’re an acceptable substitute for latex.
While cost typically has been a big concern for many hospitals trying to switch from latex, Ryback and others say price really isn’t much of a problem.
Some hospitals even save money when they switch products. The Mayo Clinic, for example, claims to have saved more than $200,000 when it switched to non-powdered, low-protein latex gloves.
The biggest problem may be availability.
“We’ve been working on this for a year, and the problem we’ve had is that we haven’t been able to get a supply (of nonlatex gloves) from the vendors,” said Kim Thomstad, the nurse administrator in charge of the project. “Nobody could guarantee us that if we started, they could supply us. It’s happening all over the country, so there’s more demand for nonlatex products.”
Because of the shortage of nonlatex products, Charous generally advises clinics, hospitals and medical offices to switch to non-powdered, low-allergen latex gloves, which are manufactured with less of the latex protein.
“Everybody can move to low-allergen, and that should be done immediately,” he said. “Nonlatex gloves should be used if you don’t need latex.”
Manufacturers of nonlatex gloves are cranking out new products as fast as they can.
Don Groce of Best Manufacturing in Menlo, Ga., said his company will double production of its synthetic glove, made of the polymer Nitrile, by June. This glove costs twice as much as a typical latex glove, but the company still has sold more than a billion of them so far.
“We’ve been in a back-order situation ever since we came out with the glove,” Groce said.
Affects whole life
Marie King, the registered nurse who quit her nursing-home job, now works as a home-care nurse one or two days a week. Instead of latex, she uses Nitrile gloves.
Although she’s able to do some nursing, King says she knows her career will never be the same. Neither will the rest of her life.
She constantly has to be careful of what she touches, and she can’t go into places like toy stores or shoe stores anymore because the latex in toys and the soles of shoes can trigger a reaction.
“I had to sell my new car because that wonderful ‘new car’ smell is rubber, and it was making me ill,” she said.
King now spends some of her time giving seminars on latex allergies, urging others to heed the warning signs.
“I hear some people say, ‘Oh, I’m allergic to latex, but I just have those red rashes on my hands.’ she said. “Yes, that’s step one. Get out. Pay attention. You have to change.”
[photo caption: Karen Thurlow, a nurse educator whose son is allergic to latex, assembled this collection of items ranging from lottery tickets to telephones — all contain latex.]
[photo caption: Karen Thurlow of South Portland poses with her “no latex” sweatshirt. She is starting a state task force to educate hospitals about the dangers of latex.]
Staff photos by David A. Rodgers
Press Herald Online Portland, Maine
Reproduced here with permission.