LATEX ALLERGY & DERMATITIS: PREVENTION AND MANAGEMENT IN HEALTH CARE WORKERS
Version / 3Name of responsible (ratifying) committee / Health and Safety Committee
Date ratified / 02 November 2016
Document Manager (job title) / Consultant Occupational Health Physician
Date issued / 05 December 2016
Review date / 30 November 2018
Electronic location / Health and safety policies.
Related Procedural Documents / -
Key Words (to aid with searching) / Latex allergy; irritant dermatitis; allergic contact dermatitis.
Version Tracking
Version / Date Ratified / Brief Summary of Changes / Author3 / 02.11.16 / No changes / -
2 / 05.11.14. / Clarification dermatitis health surveillance arrangements.
Removal of dermatitis handcare leaflet to OH web site only. / Dr S. Harvey
CONTENTS
QUICK REFERENCE GUIDE 3
1. INTRODUCTION 4
2. PURPOSE 4
3. SCOPE 4
4. DEFINITIONS 4
5. DUTIES AND RESPONSIBILITIES 5
6. PROCESS 5
7. TRAINING REQUIREMENTS 6
8. REFERENCES AND ASSOCIATED DOCUMENTATION 6
9. EQUALITY IMPACT STATEMENT 6
10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS 7
QUICK REFERENCE GUIDE
This policy must be followed in full when developing or reviewing and amending Trust procedural documents.
For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.
- Latex is recognised as a ‘sensitiser’ and a substance ‘hazardous to health’ as defined by the Control of Substances Hazardous to Health 2002 (COSHH) Regulations. Associated health problems include Immediate Type 1 Latex Allergy and allergic contact dermatitis.
- The Health and Safety Executive (HSE) consider that work related dermatitis is a significant cause of work related ill health in the NHS. It can be related to the use of latex gloves (contact dermatitis) or to irritant substances in the workplace. Irritant dermatitis is associated with frequent hand washing and frequent use of soaps, gels and other irritants.
- A HSE report following a Portsmouth Hospitals NHS Trust inspection in 2008 stated that there are very few clinical areas where continued use of latex is justified. Therefore the glove of first choice in the Trust should be non-latex. In circumstances where there is a clinical requirement to use latex gloves, this must be justified with a risk assessment.
4. Latex use and dermatitis risk from other substances, including regular use of any gloves and frequent hand washing with soaps and gels, must be assessed as part of regular COSHH and general risk assessments and appropriate health surveillance undertaken where indicated.
5. Dermatitis Health Surveillance is required on an annual basis for all healthcare workers who regularly wear gloves of any kind and use soaps and hand gels. The Health and Safety Advisor will liaise with senior managers in clinical areas to organize distribution of dermatitis questionnaires to be completed by employees. These will be followed up and managed in OH where indicated.
6. Any employee with suspected latex allergy or contact/ irritant dermatitis should inform their manager and the Occupational Health Department for further advice on management.
1. INTRODUCTION
Latex allergy came to prominence in the United Kingdom in the 1980s and has become a significant issue both for Health Care Workers (HCW) and patients. Natural Rubber Latex is the sap of the tree Hevea Braziliensis. Latex products are widespread within the medical and social environments. The increase in sensitivity to latex is thought to be due to the widespread adoption of infection control procedures (including glove use) to prevent infection with blood borne viruses, as well as to changes in the production and manufacturing processes to allow for increased demand.
Latex is recognised as a ‘sensitiser’ and a substance ‘hazardous to health’ as defined by the Control of Substances Hazardous to Health 2002 (COSHH) Regulations. Associated health problems include Immediate Type 1 Latex Allergy and allergic contact dermatitis (see section 4 for definitions).
The Health and Safety Executive (HSE) consider that work related dermatitis is a significant cause of work related ill health, particularly in the NHS. An independent survey, conducted by HSE suggested that up to 100,000 nurses (19%) consider themselves to have work-related skin damage. This can include dermatitis due to known sensitisers such as latex, as well as irritant dermatitis which can be caused by frequent hand washing and frequent contact with soaps and other irritants.
A Health and Safety Executive (HSE) report following a Portsmouth Hospitals NHS Trust inspection in 2008 stated that there are very few clinical areas where continued use of latex is justified. Therefore the glove of first choice in the Trust should be non-latex. In circumstances where there is a clinical requirement to use latex gloves, this must be justified with a risk assessment. Latex use and dermatitis risk must both be assessed as part of regular COSHH and risk assessments. Appropriate health surveillance is required. Any latex gloves used must be low protein and unpowdered.
2. PURPOSE
Provide guidance on issues relating to the use of latex and the problems of dermatitis of the hands in health care workers (HCW); encourage adoption of a proactive approach to prevent and minimise latex allergy and dermatitis in HCW; reduce the risk of HCW developing latex allergy and dermatitis and ensuring safe employment of those who become affected.
3. SCOPE
This policy applies to all employees within the Trust and in all areas within the Trust where regular hand-washing and glove wearing takes place.
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’
4. DEFINITIONS
Immediate Type 1 Latex Allergy: allergy to the latex protein which occurs quickly after exposure, usually within 15 minutes. Symptoms include: itchy skin with urticarial rash (‘hives’); lip and tongue swelling; shortness of breath or wheeze. Anaphylactic reactions are rare. Allergy may also occur with other latex containing products e.g. balloons and condoms and reactions can occur to other substances with cross-reacting antigens, e.g. avocados, kiwi fruits and bananas. Powdered gloves are particularly problematic as the powder is coated with latex and on removal of gloves forms a cloud of latex particles, which can be inhaled. However, powdered latex gloves have not been used in the National Health Service for several years now. Blood (RAST) testing for latex specific IgE may assist in confirming the diagnosis of latex allergy, but is not always positive.
Allergic Contact Dermatitis: an allergic reaction (Type IV, Delayed) to chemical additives used in the latex manufacturing process (e.g. thiurams and dithiocarbamates) rather than to the latex protein itself, although this does occur in rare cases. Presentation is with an eczema-like rash (dry, itchy, cracked skin) on the back of the hand and wrist where gloves may be tightest. The reaction occurs 4-6 hours after wearing latex gloves. There is no urticaria, lip swelling or breathing difficulties. Skin patch- testing will aid diagnosis.
Irritant dermatitis:
This is a common problem affecting the skin of the hands in Health Care Workers (HCW). It is caused by frequent hand washing, incomplete hand drying and frequent contact with soaps and other irritant substances. It presents as dry, itchy, cracked skin between the fingers, which spreads to involve the rest of the hand. Treatment is by avoidance of irritants on the hands, careful hand drying and the use of emollients.
Health Care Worker: Includes all staff working in hospitals and General Practice who have direct patient contact, e.g. cleaners on wards, some catering staff, ambulance staff, some reception and clerical staff, as well as medical and nursing staff.
5. DUTIES AND RESPONSIBILITIES
Managers: ensure that risks associated with latex allergy and dermatitis are managed in accordance with this policy; provide information and training about latex allergy and dermatitis to new and existing employees; perform appropriate risk assessments and COSHH assessments; identify and implement actions or controls; ensure employees undergo appropriate health surveillance; refer suspected cases of latex allergy and dermatitis to Occupational Health.
Occupational Health: Work Health Assessment process and provision of relevant information on latex allergy and dermatitis to new employees; investigation of suspected cases with referral to dermatology via GP where indicated; organisation of health surveillance programmes.
Health & Safety: advice and assist in performance of relevant risk and COSHH assessments; report confirmed cases of latex allergy and work related dermatitis to HSE under RIDDOR to allow national monitoring of the problem among HCW.
Employees: comply with information provided about latex allergy and dermatitis and with relevant PHT policies; report symptoms suggestive of latex allergy or dermatitis to managers and Occupational Health; comply with health surveillance procedures
6. PROCESS
Following the recommendations of an HSE inspection of Portsmouth Hospitals NHS Trust in 2008, the glove of first choice in the Trust should be non-latex. In circumstances where there is a clinical requirement to use latex gloves, this must be justified with a risk assessment. Any latex gloves used must be low protein and unpowdered.
Latex is recognised as a ‘sensitiser’ and a substance ‘hazardous to health’ as defined by the Control of Substances Hazardous to Health 2002 (COSHH) Regulations. Latex use and dermatitis risks must both be assessed as part of regular COSHH and risk assessments. Regular health surveillance must be undertaken.
Dermatitis Health Surveillance is required on an annual basis for all HCW who regularly wear gloves and use soaps and hand gels. This will be arranged by the Health and Safety Advisor, who will liaise with senior managers in clinical areas to organize distribution of dermatitis questionnaires to be completed by employees. These will be followed up and managed in OH as necessary.
7. TRAINING REQUIREMENTS
Information contained within this policy will be made available to new employees at pre-placement health assessments (where these are indicated through the Work Health Assessment process); general staff inductions; junior doctor induction. Information leaflets are available through OH.
For existing staff, information and training will be available through health promotion activities such as annual dermatitis screening programmes, Health and Safety updates and in the OH department.
8. REFERENCES AND ASSOCIATED DOCUMENTATION
Latex Allergy. Occupational aspects of management. A national guideline. Royal College of Physicians.2008.
Dermatitis. Occupational aspects of management. A national guideline. Royal College of Physicians. 2009.
HSE website on latex allergy at www.hse.gov.uk/skin/employ/latex
9. EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds.
This policy has been assessed accordingly
Our valuesare the core of what Portsmouth Hospitals NHS Trust is and what we cherish. They are beliefs that manifest in the behaviours our employees display in the workplace.
Our Values were developed after listening to our staff. They bring the Trust closer to its vision to be the best hospital, providing the best care by the best people and ensure that our patients are at the centre of all we do.
We are committed to promoting a culture founded on these values which form the ‘heart’ of our Trust:
Respect and dignity
Quality of care
Working together
Efficiency
This policy should be read and implemented with the Trust Values in mind at all times.
Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers
Version: 3
Issue Date: 05 December 2016
Review Date: 30 November 2018 (unless requirements change) Page 2 of 9
10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
Minimum requirement to be monitored / Lead / Tool / Frequency of Report of Compliance / Reporting arrangements / Lead(s) for acting on RecommendationsDermatitis health Surveillance / Health and Safety Advisor / audit / annual / Policy audit report to:
Health and Safety Committee / tbc
This document will be monitored to ensure it is effective and to assurance compliance.
Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers
Version: 3
Issue Date: 05 December 2016
Review Date: 30 November 2018 (unless requirements change) Page 2 of 9
Equality Impact Screening Tool
To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval for service and policy changes/amendments.
Stage 1 - ScreeningTitle of Procedural Document: Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers
Date of Assessment
/ 02.11.16 / Responsible Department / Health, Safety WellbeingName of person completing assessment / Jenny Cattle / Job Title / Health & Safety Advisor
Does the policy/function affect one group less or more favourably than another on the basis of :
Yes/No / Comments
· Age / N
· Disability
Learning disability; physical disability; sensory impairment and/or mental health problems e.g. dementia / N
· Ethnic Origin (including gypsies and travellers) / N
· Gender reassignment / N
· Pregnancy or Maternity / N
· Race / N
· Sex / N
· Religion and Belief / N
· Sexual Orientation / N
If the answer to all of the above questions is NO, the EIA is complete. If YES, a full impact assessment is required: go on to stage 2, page 2
More Information can be found be following the link below
www.legislation.gov.uk/ukpga/2010/15/contents
Stage 2 – Full Impact Assessment
What is the impact / Level of Impact / Mitigating Actions
(what needs to be done to minimise / remove the impact) / Responsible Officer
Monitoring of Actions
The monitoring of actions to mitigate any impact will be undertaken at the appropriate level
Specialty Procedural Document: Specialty Governance Committee
Clinical Service Centre Procedural Document: Clinical Service Centre Governance Committee
Corporate Procedural Document: Relevant Corporate Committee
All actions will be further monitored as part of reporting schedule to the Equality and Diversity Committee
Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers
Version: 3
Issue Date: 05 December 2016
Review Date: 30 November 2018 (unless requirements change) Page 2 of 9