Latex Policy For Patients
Prevention and management of latex allergy in patients

EQUALITY IMPACT

The Trust strives to ensure equality of opportunity for all both as a major employer and as a provider of health care. This policy has therefore been equality impact assessed by the Risk Management Committee to ensure fairness and consistency for all those covered by it regardless of their individual differences, and the results are shown in Appendix 3. Version: Authorised by: Date authorised: Next review date: Document author: 2.0 Risk Management Committee Feb 09 Feb 11 Clinical Risk Officer
TAMESIDE HOSPITAL NHS FOUNDATION TRUST
latex policy for patients

VERSION CONTROL SCHEDULE

latex policy for patients Version : 2.0 Version Number 0.1 (draft) 1.0 1.1 (draft) 2.0 final Issue Date Oct 06 Dec 06 Jan 09 Feb 09 Revisions from previous issue Initial draft Final ratification following comments Reformatted and updated circulated for comments Ratified by RM Committee
VERSION 2.0 Feb 09 Check the Intranet for the latest version

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EQUALITY IMPACT.... 1 1.0 INTRODUCTION... 4 2.0 PURPOSE... 4 3.0 SCOPE..... 4 4.0 DEFINITIONS... 4 5.0 DUTIES.... 5 Trust Board / Chief Executive... 5 Directorate Management Teams.... 5 Line Managers (Including Consultants).. 5 Responsibilities of all Staff... 6 Responsibilities of the Supplies Department... 6 Responsibility of the Risk Management Department... 6 6.0 POLICY STATEMENT... 6 7.0 THE POLICY.... 6 7.1 Routes of Exposure to Latex.... 6 7.2 Identifying Patients at Risk on admission\pre-operative assessment. 7 7.3 Documentation of Allergy.... 7 7.4 The Patient Environment... 8 7.5 Theatre Procedure.... 8 7.6 Preparing the Theatre Environment... 8 7.7 Once the Case has been Completed...10 7.8 Maternity and Delivery Suite...100 8.0 POLICY DEVELOPMENT & CONSULTATION..111 9.0 IMPLEMENTATION...111 10.0 MONITORING....111 11.0 REVIEW....111 12.0 REFERENCES & BIBLIOGRAPHY...111 Appendix 1 Equipment Selection...122 Appendix 2 Screening Checklist for Patients..133 Appendix 3 EQUALITY IMPACT ASSESSMENT TOOL..144

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1.0 INTRODUCTION
Natural rubber latex (NRL) is found in the healthcare setting in disposable gloves, medical devices and equipment, and in many household or clothing items such as elasticated cuffs. Allergy associated with latex can result from contact with the residue of chemicals used in the manufacture of latex products and presents as a red scaly rash (allergic contact dermatitis). Contact with natural rubber latex itself can cause a more immediate reaction with symptoms such as local or generalised urticaria ('hives'), swelling, rhinitis, conjunctivitis or asthma. In rare cases it can lead to life threatening respiratory difficulties and anaphylactic shock. Contact with latex may be direct e.g. skin contact or indirect e.g. exposure to airborne particles. Some tropical fruits are also known to cause a pre-disposing sensitivity such as banana or kiwi fruit. The National Patient Safety Agency (NPSA) and the Health and Safety Executive (HSE) require Trusts to protect the health of their staff and patients with respect to exposure to natural rubber latex. The Trust has a separate policy for staff, Latex Sensitivity Policy for Staff and advice for latex sensitive staff can be sought from the Occupational Health department.

2.0 PURPOSE

This purpose of this policy is to provide guidance on the avoidance and management of latex sensitivity in patients and the protection of the health of patients who are known to have a pre-existing allergy to latex.

3.0 SCOPE

This policy relates to the expected practices of all levels of employees, bank staff locums and voluntary staff involved in the planning, admission, care and discharge of patients at Tameside Hospital NHS Foundation Trust.

4.0 DEFINITIONS

Natural rubber latex (NRL) Natural rubber latex (NRL) is a milky fluid obtained from the Hevea brasiliensis tree, which is widely grown in South East Asia, and other countries. NRL is an integral part of thousands of everyday consumer and healthcare items. As with many other natural products, natural rubber latex contains proteins to which some individuals may develop an allergy. (HSE website definition 2009) http://www.hse.gov.uk/latex/about.htm
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Latex-free is the term used to describe products that are not manufactured from natural rubber latex (NRL). Latex-safe is the term used to describe an environment that minimises the risk of a reaction occurring in sensitised or allergic individuals. This is achieved by removing the NRL products that are most likely to cause a reaction. Type I latex allergy is an immediate hypersensitivity reaction characterized by urticaria, conjunctivitis, rhinitis and occasionally life threatening anaphylaxis. Type IV latex allergy is characterized by an eczematous rash often developing hours after exposure; it may be due to latex proteins or chemical residues used in latex processing. This reaction predisposes individuals to developing Type I allergy.

5.0 DUTIES

Trust Board / Chief Executive The Board vests in the Chief Executive responsibility for ensuring the Trust meets it statutory and non statutory obligations in respect of the risks associated with reactions to latex in patients. The delegated authority for coordinating and monitoring implementation of this policy and the associated protocols/procedures lies with the Director of Nursing. Directorate Management Teams The Directorate Management Teams have responsibility for ensuring that risks associated with NRL allergy to patients are managed in accordance with this policy and the associated protocols/procedures. Line Managers (Including Consultants) Line managers are responsible for Ensuring that general NRL risk assessment is undertaken with regard to work and clinical activities within their areas of responsibility. Specific individual risk assessment will be required where patients are at risk of allergy to NRL Identifying and implementing any action/control required following the NRL risk assessment, using the NRL NRL allergic reactions suffered by patients via the Trusts incident reporting mechanism. Ensuring that the allergy is added as an alert on Medway and in the designated alert section of the case notes.
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All Staff Staff will comply with this policy and follow the associated protocols/procedures/safe systems of work for their area(s) of work and responsibility. Supplies Department To liaise with clinical staff where products have latex content and advise on the availability of alternative products. Risk Management Department The Risk Management Team will record patient incidents arising from reaction to latex on the Trusts database and provide anonymous summaries of all patient related NRL allergy incidents on request. Any incidents arising due to a patients reaction to latex will be investigated according to the Trusts incident reporting and investigation policy.

6.0 POLICY STATEMENT

The aim of this policy is to ensure the safe treatment for patients by reducing the risk of exposure to sensitized patients to NRL. A safe environment for patients will be undertaken by:identification and protection of sensitised patients; substitution, control or elimination of latex where appropriate and possible; ensuring staff are aware of, and have access to, safe and effective latex-free alternatives; limit the use of latex to its most valuable uses;
7.0 THE POLICY 7.1 Routes of Exposure to Latex
The potential routes of exposure to latex allergens are: 1. Cutaneous - via gloves, tapes, masks, urine drainage bags; 2. Mucous membranes - via products used in dentistry, anaesthesia and rectal examinations, including eye and ear droppers; 3. Intra-uterine devices 4. Inhalation - via aerosolisation of glove powder; 5. Internal tissue - via latex products used in surgery; Intravascular - via latex products used in intravascular devices (e.g., IV cannulae) or devices used to deliver IV fluids and injectables (syringes and IV administration sets). This should be divided into appropriate sections to guide the reader through all the issues the policy is designed to address.

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7.2 Identifying Patients at Risk on admission\pre-operative assessment
Careful history taking from patients and\or carers on admission should identify the high risk patient. These include: known patients with latex allergy atopics patients with spina bifida, health care workers patients with a history of multiple surgery when young. The nursing \midwifery admission procedure routinely asks about known allergies. At pre-operative assessment, the patient will be specifically questioned about allergy to latex or to any specific foods. Patients will be questioned regarding a history of immediate reaction to skin-rubber contact such as following dental surgery, blowing up rubber balloons wearing of rubber gloves any history of immediate allergic reaction to fruit, especially banana and kiwi fruit The risk of adverse reaction during clinical examinations including dental, endoscopic and manual pelvic examinations must be brought to the attention of all appropriate staff by recording the allergy in the case notes and on Medway.
When a patient gives a history of atopy and of adverse reaction to fruit, or giving a history of immediate adverse reaction to rubber contact, they should have their surgery deferred if possible to enable appropriate investigation and diagnosis. An IgE RAST test to latex protein should be considered and a referral to the dermatology department for further diagnosis and investigation. Wherever a patient requires surgery or a clinical procedure, every effort must be made to avoid the use of equipment and devices containing latex. The Theatre department should be alerted by the admitting team prior to the patients admission to allow a specific care plan to be completed for the individual patient.

7.3 Documentation of Allergy
The allergy section in the healthcare record will be noted and the Medway medical alerts section will completed.
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Any sensitivity will also be recorded at the front of the nursing\ midwifery kardex. See Appendix 1 for a list of products known to contain latex. If a latex-free device is required, please phone the Supplies Department for advice. See Appendix 2 for Screening Checklist for Patients
7.4 The Patient Environment
Whenever a patient with a known latex sensitivity is admitted, a patient risk assessment should be completed. This should take into account the patients environment and actions to minimise patient contact with NRL products. The Ward Manager\ Patients Nurse must ensure latex free equipment is available to meet the needs of the patient. Theatres or other departments that the patient may access during their hospital stay should be alerted to the patients allergy in advance to allow appropriate precautions to be taken by that department. Good housekeeping practices should be followed to remove latex-containing dust from the patients immediate environment. Areas potentially contaminated with powder from latex devices should be identified for frequent cleaning. Ventilation filters and vacuum bags should be changed frequently in these identified areas.

7.5 Theatre Procedure

The person taking charge of the operating theatre session is responsible for the care the patient receives. Should there be any doubt over the integrity of latex free environment, the operation should be postponed and rescheduled and a full explanation given to the patient. The patient must be the first patient on the operating list ideally the morning list. Where this is not achievable a risk assessment must be undertaken to ensure that the area has had sufficient time to remove latex particles from the air. Theatres will maintain within easy reach a box containing a stock of latex free alternative products. All personnel that will be in contact with the patient must use only latex free gloves. No product containing latex must touch the patient.
7.6 Preparing the Theatre Environment
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All staff, including the recovery room, must be notified by the operating team that there is a latex sensitive patient. This must be done the day before surgery or as soon as the patient is admitted. All staff that will be in contact with the patient must wear tie caps rather than caps with elastic or latex free theatre caps. The latex free box must be available. The operating theatre must be prepared by staff using latex free gloves. All latex products must be removed from the operating theatre, lay up room and anaesthetic room. A latex allergy sign must be posted on all doors entering the operating theatre. Traffic through the operating theatre must be reduced with the minimum amount of staff to stay within the operating theatre during the case. Any latex products that cannot be removed must be covered to ensure that the patient does not come into direct contact with the product, eg; operating table mattress. To control the environment the patient must be anaesthetised in the operating theatre. The anaesthetic staff must ensure that latex free equipment is used which will include the following items: Breathing Circuits Breathing bags; Intravenous equipment; Blood Pressure monitoring equipment; Other monitoring equipment Pressure monitoring lines all monitoring cables; Electrical cables gloves must be changed if electrical equipment is moved Tourniquets; Medications that are dispensed from vials that have rubber stoppers must be removed from the vial for preparation of the medicine. The rubber stopper must not be injected to withdraw the medication, eg; Vecuronium. Staff must remain vigilant to ensure that no latex products are made available during the surgery. Recovery of the patient must be carried out in an isolated area within the recovery room. This area must be pre-prepared to remove any latex products prior to the patients arrival. The recovery nurse must recover the patient on a one-to-one basis and have no contact with other patients.

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7.7 Once the Case has been Completed
Any items used from the latex free box must be replaced. Any shortages must be notified to the designated person in charge. Any new products that may contain latex must be included in the list of equipment that may contain latex in the latex free box. The latex free box once re-stocked must be returned to the storeroom.
7.8 Maternity and Delivery Suite
A patients full medical history will be taken at ante-natal booking clinic when specific patients at risk will be identified. See section 5 of this policy. All staff, including the delivery suite must be notified there is a latex sensitive patient and of the patients expected date of delivery. All personnel that will be in contact with the patient must use only latex free gloves. No product containing latex must touch the patient. All staff that will be in contact with the patient must wear tie caps rather than caps with elastic or latex free theatre caps. At delivery a latex free box must be available. The delivery suite must be prepared by staff using latex free gloves. All latex products must be removed from the delivery suite and preparation rooms. A latex allergy sign must be posted on all doors entering the delivery suite and traffic through CDS (Central Delivery Suite) must be reduced with the minimum amount of staff to stay within the CDS during the delivery. Any latex products that cannot be removed must be covered to ensure that the patient does not come into direct contact with the product, eg; delivery table. If the patient requires a caesarian section, then theatre need to be informed and procedures as in section 7.5 to 7.8 of this policy must be followed.

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8.0 POLICY DEVELOPMENT & CONSULTATION
The original version of this policy was developed by the Quality and Risk Manager in conjunction with specialist advice from Theatres and Maternity. The policy was circulated at Risk Management Committee, ratified following comments and uploaded to the Trust intranet. An all acute users e-mail sent advising staff as to the new guidance document. Revision and reformatting of this document was undertaken by the Clinical Risk Officer with consultation with the Theatre Manager and Matron of Womens Services the revised document was circulated for comments to Risk Management Committee. Comments were incorporated before final ratification by Risk Management Committee. The final policy was circulated for dissemination through Risk Management Committee and uploaded to the Trust intranet.

9.0 IMPLEMENTATION

The final policy was circulated for dissemination by Committee members to their areas via Risk Management Committee and the revised version uploaded to the Trust intranet.

10.0 MONITORING

Compliance to policy will be monitored at a local level by ward/department managers. Incidents arising out of a NRL allergy will be investigated and where appropriate lessons to be learned will be discussed at Risk Management Committee. The Risk Management Committee reports to the Clinical Governance Committee which is a sub committee of the Trust Board.

11.0 REVIEW

This policy will be formally reviewed in Jan 2011, or earlier depending on the results of monitoring.
12.0 REFERENCES & BIBLIOGRAPHY
National Patient Safety Agency (2005) Patient safety information 08, Protecting people with allergy associated with latex. Brigden, R 1998. Operating Department Practice. Edinburgh: Churchill Livingstone. Medical Devices Agency. Latex sensitisation in the Health Care Setting (Use of Latex Gloves) Device Bulletin, May 1996. H.S.E advisory site http://www.hse.gov.uk/latex/policy.htm

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Appendix 1 Equipment Selection
The following devices potentially contain latex. The list should not be considered as exhaustive. Adhesive Tape Adhesive plasters Airways Blood pressure cuffs Bile bags Chest drainage units Colostomy Pouches Condom/sheath urinary collection devices Dental cofferdams Elastic Bandages Enema tubing kits Epidural catheter injection adaptors Eye shields ET tubes Fluid warming blankets Gloves Haemodialysis equipment Head straps Infant feeding bottles Infant pacifiers IV set injection ports Laparoscopy insufflation hoses Latex cuffs on plastic tracheal tubes Mattresses on stretchers Naso-pharyngeal airways Neonatal incubator Oral-pharyngeal airways PCA syringes Penrose tubing Protective Sheets Rectal catheters Rubber suction catheters Rubber breathing circuits Rubber masks Rubber tourniquets Stethoscope Tubing Stomach and GI Tubes Syringes \ vial stoppers Teeth protectors and bite blocks Tourniquets Urinary Catheters Wound drainS

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Appendix 2 Screening Checklist for Patients
The prompts used by admitting nurses\midwives will include the following questions: 1. Do you have a history of atopic asthma and/or eczema. 2. Have you ever experienced itching or swelling following the wearing of household gloves ? 3. Have you ever experienced itching or swelling after eating tropical fruits such as kiwi or bananas ? 4. Are you allergic to latex ? 5. Do you have any food allergies ?

If the patient answers yes to any of the above, the admitting nurse\midwife will refer the patient to the patients Consultant and\or the Anaesthetist who will assess each individual case. A referral to the dermatologist for further investigation should be made as appropriate.

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Appendix 3 EQUALITY IMPACT ASSESSMENT TOOL
Yes/No 1. Does the policy/guidance affect one group less or more favourably than another on the basis of:
Race Ethnic origins (including gypsies and

Comments

No No No No No No No No No

travellers)

Nationality Gender Culture Religion or belief Sexual orientation including lesbian,

gay and bisexual people

Age Disability - learning disabilities, physical
disability, sensory impairment mental health problems
Is there any evidence that some groups are affected differently? If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? Is the impact of the policy/guidance likely to be negative? If so can the impact be avoided? What alternatives are there to achieving the policy/guidance without the impact? Can we reduce the impact by taking different action?

No N/A

4. 5. 6.

No N/A N/A

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