This code gives guidance on:

• Examples of use of latex within the County Council.
• The purchase of gloves appropriate to the task.
• Safe working procedures for the use of latex gloves.
• Action to take if you believe you may be affected by latex.

Latex is a natural rubber which is a durable, flexible material which gives a high degree of protection from many micro-organisms.  Latex is often used in the manufacture of protective gloves.  It currently provides the best protection against infection and gives the sensitivity and control needed for many uses within the Council.

Protective gloves are manufactured from a variety of synthetic materials e.g. vinyl, polythene, nitrile etc.   However, natural rubber latex (NRL) remains the material of choice for user protection.  However, whilst offering the user protection the risks relating to the wearing of gloves have become apparent.  Sensitivity can range from anaphylaxis (see Section 3.0) to chapped itching hands.  The major risks relate to the proteins found in NRL, accelerators added during the manufacturing process and the use of cornstarch powder.

There has been a steady increase in the number of reported cases of asthma and skin complaints attributed to latex during the 1990s.  There are a number of possible reasons for this including:

• increased awareness of the problem
• increased use of latex gloves, following the introduction of universal precautions
• increased use of other equipment containing latex, for example:
• catheters
• barium enema tips
• rubber bungs on medication vials.

Latex exposure can lead to a number of health problems including:

• Irritation – symptoms include: redness, soreness, dryness or cracking of the skin

in areas exposed to latex. This type of reaction is not an allergic reaction. Once the irritant agent, e.g. latex, has been identified and contact with it ceases, the symptoms will disappear and not recur.

• Type I allergic reaction – symptoms include: localised or generalised rash (urticaria or hives), inflammation of the mucous membranes in the nose (rhinitis), red and swollen eyes with discharge (conjunctivitis). asthma-like symptoms.

This is an allergic response to the extractable latex proteins and occurs almost immediately on contact.  In rare cases it may result in an extreme reaction known as anaphylactic shock, this may be life threatening but can be treated with medication.

• Type IV allergic reactions – symptoms include: dermatitis, and itching

with oozing red blisters, which are usually localised to the hands and arms.  These occur between 10-24 hours after exposure and can get worse over the next 72 hours.  This is an allergic response to the chemical additives, known as accelerators, used in the manufacturing process.

The amount of latex exposure needed to produce sensitisation is unknown.  A substance which causes sensitisation is one which is capable of causing an allergic reaction in certain people.  Once sensitisation has taken place, further exposure to the substance, even to the tiniest trace, will cause the symptoms to recur.  Increasing the exposure to latex proteins increases the risk of developing allergic symptoms.

Several types of synthetic rubber are incorrectly referred to as ‘latex’.  Equipment (e.g. gloves), which is manufactured from these synthetic rubbers may also cause an allergic response in someone sensitised to the chemicals used in the manufacturing process.

There are a number of different types of latex glove available.  Due to prolonged and close contact, all latex gloves present a particular risk of skin sensitisation, but the risk is reduced in gloves with lower levels of latex protein and process chemicals.  Powdered gloves pose an additional risk, not only to the user but also to sensitised people in the area.  The proteins in the latex glove leach into the powder, which becomes airborne when the gloves are removed.  Inhaling the powder may lead to respiratory sensitisation.

examples:

• Personal Care – to provide protection from body fluids, broken skin.
• For use when shaving, washing, showering and bathing clients.
• Medication – when applying prescribed creams, gels and lotions.
• Emptying catheter bags or commodes.
• Handling biological specimens.
• Handling material in unhygienic areas e.g. where there is evidence of human or animal faeces.
• Use by First Aiders.

In addition to this it is also found in a variety of products and medical devices including:

• airways
• intravenous tubing
• stethoscopes
• catheters
• dressings and bandages.

Persons responsible for purchasing protective gloves or any other equipment which may contain latex should:

• Ensure appropriate synthetic gloves, e.g. vinyl or nitrile, are also available for use by staff and with clients who are known to be sensitised to latex.
• Implement a purchasing policy which specifies gloves which are both powder free and have the lowest possible levels of extractable proteins (<50 ug/g) and accelerators (BSI, 1994). The glove suppliers should provide such information.

Products are available to purchase from the County Supplies and Contract Services Catalogue 2001/02, page 293.

Managers Will:

Include in their risk assessments consideration of the most appropriate glove choice for the specific task/procedure to be undertaken.  The following factors should be considered when undertaking a risk assessment of individual procedures:

• the nature of the task
• the risk of contamination
• barrier efficacy of gloves
• sterile or non-sterile gloves required
• patient/user sensitisation.

In addition the following general principles should be adopted:-

• Limit exposure by, for example, having a policy of not wearing gloves when there is no risk of infection, such as when making beds.
• Ensure that staff follow good hygiene practices, such as washing hands after removing gloves.
• Ensure that barrier creams are not used in conjunction with latex gloves as they may increase the penetration of the allergens.
• Provide regular reminders to staff about the risks posed by latex and encourage staff to report any skin problems or other symptoms of latex allergy to you as soon as they arise.
• Refer staff with non-intact skin on hands and forearms due to dermatitis, eczema, psoriasis etc. or latex allergy symptoms to Occupational Health via the relevant HR Manager.
• Consider latex allergy during the assessment of clients.

The Occupational Health Provider has been supplied with a current list of jobs which may involve the wearing of latex gloves. Managers should notify them of any job changes or new jobs which may also involve latex exposure so that this can be taken into account during pre employment health screening.

Employees Should:

As any glove cannot guarantee complete safety, the following precautions should be taken:

• Minimise the wearing of latex gloves as far as possible, taking into consideration your activities.
• Cover unhealed cuts and abrasions etc. with waterproof plasters before putting on your gloves.
• Change your gloves if there is evidence of perforation or other damage.
• Wash your hands after removing gloves.
• Report any skin problems however minor e.g. non-intact skin on hands and forearms due to dermatitis, eczema, psoriasis etc. to your manager.
• Report any latex allergy symptoms to your line manager immediately. You may be referred to the Council’s Occupational Health provider. Typical symptoms  include:
• skin rash
• hives
• itching
• nasal, eye or sinus problems

Remember, helping with early symptoms may prevent more serious effects.

 

Latex sensitisation is a reportable disease under Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) and must be reported on Form F2508A (contact your Health and Safety Adviser for further information).