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Latex allergies are an increasing source of concern for healthcare providers and healthcare institutions. Latex or natural rubber consists of a family of products produced from the sap of the Hevea braziliensis tree. Latex is widely used in the home and hospital; there are more than 40,000 consumer products (e.g., balloons, rubber bands) and 20,000 medical products (e.g., latex gloves, bottle stoppers). With the introduction of universal (now standard) precautions designed to reduce healthcare worker's exposure to blood or contaminated fluids, reactions to latex have become more prominent. The spectrum of reactions to latex includes the following. First, contact dermatitis which is a nonallergic cutaneous reaction caused by chemical damage to the skin. Second, a type IV immune or cell-mediated reaction to latex. These reactions occur 12 to 96 hours after exposure. Finally, a type I or IgE-mediated reaction to latex. These reactions typically occur 1 to 30 minutes after exposure and may include dermal, respiratory, and cardiac symptoms. This type of reaction may be life-threatening. Persons with type I reactions may be unable to continue to work in a health related field.
In order to minimize latex allergies in patients UNC Hospitals has undertaken the following activities: education of the staff regarding the importance of identifying patients with latex allergies, routine screening of all patients for latex allergies using a "screening" questionnaire, and provision of a latex free environment for patients with medically important latex allergies. In order to minimize latex allergies in employees UNC Hospitals has undertaken the following activities: reduction of latex exposure by minimizing the use of powdered latex gloves (powdered gloves generate airborne latex particles), purchasing low protein latex gloves, elimination of unneeded use of latex gloves by providing workers with non-latex products (e.g., vinyl gloves), "screening" of new employees to identify persons with latex allergies and providing such persons with alternative products and counseling, and development of a standard management protocol.
PertussisAn article in the November issue of the journal Infection Control and Hospital Epidemiology (1998;19:861-864) discusses protocols for the management of patients and employees exposed to pertussis. Haiduven and colleagues share standardized forms developed for their institution including: a pertussis work-up checklist for post-exposure follow-up, guidelines for patient pertussis exposures (treatment regimens), a memorandum to be sent to involved departments about possible pertussis exposure; employee health service (EHS) management of employee pertussis exposure (ER or EHS treatment protocols), post-pertussis exposure employee guidelines (whether receiving prophylaxis or not receiving prophylaxis). The authors recommend following the CDC guidelines plus the additional measures of allowing exposed asymptomatic employees to work while wearing a mask with children <4 years of age until 5 days of antibiotic prophylaxis are completed or wearing a mask for the entire potential contagious period if prophylaxis is refused. An accompanying editorial by Weber and Rutala discusses the importance of pertussis today. Studies in adults are suggesting pertussis infection is common in both immunized and unimmunized persons and that lifelong immunity does not exist. These authors review the rising rates of reported pertussis cases, the epidemiology of pertussis in the community, the multiple outbreaks in healthcare facilities, the problems with implementing control policies and recent advances in diagnostic tests and vaccines. Together these articles should prove useful in development of facility protocols and in the education of healthcare workers regarding the detection and management of patients with pertussis.
REGULATORY/LEGISLATIVEIn the last Congressional session, Public law 105-277 was passed which included recommendations from the Senate Appropriations Committee overseeing OSHA for more stringent reporting of occupational needlestick injuries. While the Senate Appropriations Committee has urged OSHA to require that all injuries from potentially contaminated needles and other sharps be recorded on the OSHA 200 log, this is only a recommendation from Congress. No changes to the Final Rule of Bloodborne Pathogen Standard has been made.
QUESTION OF THE MONTHQ: I have heard that hand lotions and hand soaps may be incompatible. What factors should I consider in choosing these products?
A: Hand lotions are often recommended to minimize drying which may result from frequent handwashing. Outbreaks of bacterial infection have been caused by contaminated hand lotions. OSHA has expressed concerns about the potential for oil-based lotion formulations (petroleum) to weaken latex gloves and cause increased permeability. Additionally, lotions with anionic moisturizing agents may interfere with the residual antibacterial activity of some antiseptics such as CHG. Thus, the interaction between lotions and antimicrobial activity as well as the effect of lotions on the permeability of gloves must be considered at the time of product selection. The hand product manufacturer should supply compatibility information or at a minimum specify whether a lotion formulation is anionic.
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control in Long-Term Care Facilities will be held March 22-23, 1999 in Chapel Hill at the Sheraton Hotel.
"Infection Control Part I: Clinical Surveillance of Nosocomial Infections" will be held May 3-7, 1999 at the Holiday Inn in Chapel Hill
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Report of the Month is also available on the home page of the Statewide Program for Infection Control and Epidemiology at http://www.unc.edu/depts/spice/
The Statewide Program for Infection Control and Epidemiology (SPICE) is funded by the General Assembly of North Carolina to serve the State. SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Copyright 1998 North Carolina Statewide Program for Infection Control and Epidemiology