Take this short quiz to see if you're doing all you can to protect your patients and staff from an increasingly common threat.

After pulling off your surgical gloves you notice that your hands are a little red and slightly itchy. No big deal, right? That's exactly what my nurse friend believed before she almost died because of a latex allergic reaction gone horribly wrong. Constant exposure had worn away her immunity until a dentist's latex glove landed her in the ER. Then a latex IV port sent her into anaphylactic shock. She recovered, but couldn't return to work or a normal life. With that very real example in mind, let's see how much you know about the dangers of latex allergies — dangers that too many of us still ignore.

Protecting your own
Latex surgical and exam gloves are often linked to irritant contact dermatitis and Type IV delayed hypersensitivity. These reactions are often relatively minor: reddening of the eyes, runny nose and skin itching and redness.

Irritant contact dermatitis is not an allergic reaction, but the dry and cracked skin it causes jeopardizes the body's natural layer of protection, potentially exposing healthcare workers to higher levels of latex proteins and increasing their risk of additional and perhaps more serious reactions.1

Delayed hypersensitivity typically surfaces 48 to 96 hours after exposure. Healthcare workers often overlook the true cause of their latex-induced reactions because symptoms can appear days after exposure and resemble those of pollen or pet allergies, poison ivy or skin redness noticed after wearing gloves to clean around the house.

While awareness of latex allergies is increasing in the healthcare industry, the problem is more widespread than many realize. A 2000 study reports that about 5% to 15% of healthcare workers have latex allergies,2 although current general consensus places that rate as high as 17%. Clearly, it's important to screen new hires for latex sensitivity. I recommend using radioallergosorbent (RAST) tests, which rely on blood analysis to identify allergens to which a person is susceptible.

Remember that latex allergy is a cumulative condition: The more you're exposed to latex, the higher your risk for developing an allergy to it. There is no cure, so the best way to avoid developing an allergy is to prevent exposure in the first place.3 Sounds simple enough, but some healthcare workers push back against transitioning away from latex products, arguing that the potential for developing an allergy, and the seriousness of potential symptoms, don't merit replacing the supplies they use.

So before introducing latex-free gloves in the OR, you may have to first dispel the common myth that the gloves don't feel or endure as well as their latex cousins. A study appearing in the April 2003 AORN Journal might help your cause. Researchers examined the barrier protection of 4,006 surgical gloves (962 latex, 2,046 neoprene, 500 nitrile and 498 isoprene) under stressed and unstressed conditions.4 They discovered that the durability and barrier protection of nitrile and neoprene surgical gloves were comparable to latex gloves in a simulated surgical stress protocol. I've concluded through my own use and observations that newer options in latex-free gloves are more comfortable, resilient and form-fitting than those of previous generations.

But don't take my word for it. The American Society for Testing and Materials tests gloves for performance indicators such as sterility, freedom from holes, physical dimensions, tensile strength, ultimate elongation and stress at elongation. Glove manufacturers are required to disclose the ASTM scores of their products. Ask for the data when shopping for non-latex options and compare it to the latex gloves you're currently using. Ultimately, however, switching to non-latex gloves in your procedure rooms will demand an extensive trial to see which brands your staff and surgeons prefer in actual practice.

Protecting patients
Type I allergic reactions occur immediately upon contact. They are local or systematic reactions resulting in shortness of breath or swelling of the airway that can rapidly progress to life-threatening conditions.1

These reactions are frightening, especially when they involve patients under general anesthesia. I was involved in caring for a patient who developed a Type I reaction during surgery. The incident took place several years ago, before the dangers of latex allergies were fully realized. As the patient's blood pressure dropped, throat swelled and breathing became labored, the surgical team struggled to identify the cause. Eventually, the anesthesia provider asked if the patient was allergic to latex. We didn't know. A pre-op screening didn't take place and there was no mention of a latex allergy in the patient's chart.

Not waiting to find out, the surgical team immediately replaced the latex airway tube with a disposable silicon model and stepped away from the patient to exchange their surgical gloves for non-latex brands. After removing the airway and all latex material from the surgical site (and several touch-and-go minutes), the patient's vitals returned to normal and the surgery resumed.

It was a scary and dramatic time, and it could all have been avoided. Learn from our experience. Screen all patients for latex sensitivity during pre-op phone calls. Asking patients if they have a latex allergy is an obvious, but inadequate, precaution because most individuals don't know if they're at risk around latex products. Dig deeper. Ask patients if they've seen red splotches on their hands after wearing dish gloves. See if they've noticed skin reddening or experienced breathing difficulties after visiting the dentist. Inquire about patients' food allergies; adverse reactions to bananas, kiwis and chestnuts, for example, might be associated with latex allergies.5 Many pre-op interviewers don't think to ask if patients experience a sore mouth after blowing up a birthday balloon, even though those latex party favors can serve as great indicators of potential problems in the OR.

Place "Latex Sensitive" stickers on the outside of charts of at-risk cases and hang small signs from IV poles above sensitive patients or from OR doors when operating on an allergic individual. These simple alerts tell perioperative staff to keep latex products away from those patients and clinical areas.

Transforming your facility into a latex-free environment is unrealistic because natural rubber latex exists in seemingly innocuous products (pantyhose, for example). Instead, focus on making clinical areas latex-safe, meaning every reasonable effort has been made to remove high-allergen and airborne latex sources from coming into direct contact with affected individuals.3

Become a latex-safe facility by replacing direct patient care items such as EKG pads, blood pressure cuffs, catheters, surgical tape and adhesive bandages with latex-free alternatives. Ask your anesthesia providers to do the same with IV injection ports, airway tubes, stethoscopes, Ambu bags and oxygen facemasks. During the transition, store latex-free supplies in a designated cart that's easily accessible during surgery performed on high-risk patients.

A passionate plea
Take the time to educate your staff about the dangers of latex allergies. Use the example of my friend to emphasize that even the slightest reaction can lead to major problems. Ask your surgical team to notify clinical managers if they experience minor itching, soreness or notice redness on their hands. Screen patients for latex allergies and follow through on preventative measures. Dedicate yourself to making your facility latex-safe before an allergic event that you never thought could happen on your watch actually does.

Answers to the Latex Allergy Quiz: 1. d, 2. a, 3. b, 4. b, 5. e, 6. a, 7. b