In push for safer gloves, we have a long way to go’
Latex allergy risk persists, advocates say
When Lise Borel, DMD, developed symptoms of a severe latex allergy in 1994, she was barely aware of the risks associated with the gloves and powder. Today, thanks in part to her advocacy efforts through the organization, ELASTIC of Torrington, CT, latex allergy is widely recognized as a major occupational health hazard for health care workers.
On Jan. 31, Borel quietly shut down ELASTIC due to personal reasons. As she transitions to a life of more private advocacy, she reflects on an environment that includes better glove choices and safer workplaces — yet one with significant hazards that remain. While many hospitals have switched to low-protein, powder-free or synthetic gloves, many health care workers remain at risk of latex allergy across the country, says Borel.
"There are pockets of awareness and islands of latex-safe facilities," she says. Efforts need to continue to make hospitals latex-safe for both staff and patients. "I know the people I’ve worked with closely over the years are not going to stop [their efforts]," she says. "I’m not stopping either. I’m just going to do it from a different perspective and at my own speed."
The American Nurses Association (ANA) in Washington, DC, and other specialty nursing associations continue to lobby federal and state agencies and legislatures to promote latex safety, while they encourage voluntary action by hospitals. "We have a long way to go," says Susan Wilburn, RN, MPH, ANA senior specialist for occupational safety and health. "I think that we have been stalled in progress. People think they have done what they need to do.
"I go into health care facilities, and I’ll see a box of synthetic gloves, a box of powder-free gloves, and a box of powdered gloves on a shelf side by side. If you have any powdered gloves in a facility you have circulating [aerosolized particles] of latex allergens."
In interviews with Hospital Employee Health, advocates for safer glove use gave this assessment of the efforts to promote latex safety:
• Litigation. At one time, plaintiffs’ lawyers anticipated that latex gloves would generate thousands perhaps hundreds of thousands of cases from injured of cases from injured workers. Instead, there have been just a couple thousand cases related to latex allergy among health care workers, says David Shrager, the national lead counsel for the plaintiffs in the federal, multidistrict litigation and an attorney with Shrager, Spivey & Sachs in Philadelphia.
In fact, the litigation seems to have spurred improvements in the products, says Shrager, who is the former president of the Association of Trial Lawyers of America. "Very quickly after latex allergy was identified as a problem with powdered gloves, we saw a change in manufacturing technology, which lowered the incidence of protein and powder," he says. "I think industry probably reacted very quickly when they saw the development in the early ’90s of this problem."
Only about 10 cases have reached trial in various states, and those verdicts were mixed, says Shrager. In some cases in which the manufacturer prevailed, juries have concluded that an allergy was "nobody’s fault," he says. Recently, about 700 federal latex-allergy cases that had been consolidated for pretrial discovery were sent back to their origin courts. Most of those are likely to result in a settlement before they reach trial, Shrager says.
• Regulation. In 1998, the Food and Drug Administration (FDA) proposed a rule that would require labeling of protein and powder content in medical gloves. It would also reclassify latex gloves as Class 2, which involves greater regulatory attention.
Gloves already undergo FDA testing, but any "up-classing" of a device invites scrutiny, says John Farnham, consumer safety officer in FDA’s Center for Devices and Radiological Health. The FDA also conducted extensive economic analysis of the rule and sifted through numerous comments. Despite the long time frame, the FDA is still actively pursuing the rule, he says. "We’ve had some meetings to try to move the process along," he says.
Meanwhile, several states (Arizona, Rhode Island, Oregon, and New Jersey) have prohibited the use of latex gloves by food handlers. "That protects those food service workers from allergy to latex. It makes food safe for latex-sensitive people to eat," says Wilburn. "It does nothing to stop the new incidence of latex allergy in health care facilities."
Ironically, she notes that the Centers for Disease Control and Prevention (CDC) issued a warning in the wake of the anthrax incidents that postal workers should use nonlatex gloves when handling mail. The agency has never issued such a warning for health care workers, she notes. "You would think the CDC, having made progress on this one issue for a particular work area, would revise their other statements. But it hasn’t happened."
The Occupational Safety and Health Administration is expected to release an updated technical assistance bulletin on latex later this year. But further regulation seems unlikely on a federal level due to heavy industry opposition, Wilburn says.
She notes that one-quarter of nurses cited latex allergy as one of their top health and safety concerns in a recent ANA survey. "If you’ve got a population of workers that, according to [the National Institute for Occupational Safety and Health], is 8% to 12% sensitive, what is your threshold for saying this is a product that is too dangerous to use? Isn’t 10% a significant minority of workers?"
• Voluntary action. No data are available on how many hospitals nationwide have created a latex-safe environment, with synthetic gloves and/or low-protein and powder-free gloves. But surveys show a mixed response.
In the ANA survey, 60% of nurses said their facilities continue to use powdered latex gloves. A 2001 survey of hospitals in Washington state found that about one-third of hospitals had adopted latex-free gloves or were phasing out latex. About 15% of hospitals still used some powdered latex gloves.1
"There are many institutions that have made some changes and think they’ve taken care of the problem when they haven’t," says Wilburn.
Even changing glove type may not be enough to protect sensitized workers. When hospitals switch from powdered to powder-free or synthetic gloves, they should clear their HVAC filters to remove latex powders, she notes. The aerosolized latex proteins are a significant cause of work-related asthma and can trigger reactions in latex-allergic staff and patients, she says.
Other organizations echo that concern. The Emergency Nurses Association in Des Plaines, IL, calls for latex-safe emergency settings and "the removal or abatement of latex contamination from the pre-hospital environment and the entire hospital setting, including contamination through ventilation systems."
Greater precautions might have allowed Borel to continue working and to face fewer health consequences from her latex allergy. "I was diagnosed in ’94 and tried to practice [dentistry]," she recalls. "I switched to nonlatex gloves, but everyone else was still using powder. I ended up in the ICU. I was so sick, I lost my practice."
Borel notes that today, many latex-allergic health care workers are able to continue their careers by working in latex-safe hospital environments. If she been in such an environment, "my life would have turned out completely differently," she says.
Reference
1. Marino C, Cohen M. Prevention of hand dermatitis in the health care setting. Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington Department of Labor and Industries, July 2001; Technical Report Number 66-6-2001 (www.lni.wa.gov/sharp/derm/prevent_hcw.pdf).
When Lise Borel, DMD, developed symptoms of a severe latex allergy in 1994, she was barely aware of the risks associated with the gloves and powder. Today, thanks in part to her advocacy efforts through the organization, ELASTIC of Torrington, CT, latex allergy is widely recognized as a major occupational health hazard for health care workers.
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