Getting rid of latex in hospitals not an easy task
The gloves are off in the war on latex.
Amid mounting concern about allergic reactions, many hospitals are trying to virtually eliminate the rubber-based material, which has long been used to make surgical gloves, catheters and thousands of other medical products.
But getting rid of latex is proving difficult for hospitals, and patients need to remain vigilant. Many hospitals have stopped using the main culprit in allergic reactions -- heavily powdered gloves that release a latex protein into the air when removed. But latex is found in so many products, including adhesive tapes, wheelchair tires, syringes and rubber vial stoppers, that it's easy to miss items that contain trace amounts. And some of the substitutes drive up costs or are less effective, posing new risks for patients, hospitals say.
The push to cut out latex has accelerated in the past year. The U.S. military is calling for latex-free products in a number of new contracts for its medical facilities, and Premier Inc., a large hospital purchasing cooperative, is issuing the group-purchasing industry's most comprehensive latex-free catalog, featuring 16,675 items, ranging from urinary-tract catheters to blood-pressure cuffs, suction devices and syringes. "Hospitals need to know the content of the products they use so they can make sure patients and staff are safe," says Gina Pugliese, a nurse who is vice president of Premier's Safety Institute.
Johns Hopkins Hospital last month announced plans to end the use of all latex gloves and almost all latex medical products. For surgery, it has switched to sterile neoprene and polyisoprene gloves, which cost 30 percent to 50 percent more, but which surgeons have found to have the same sensitivity and fit as latex.
"There have been questions about whether the increased cost is worth the benefit," says Robert Hamilton, a professor of medicine and pathology. "But we are erring on the side of conservatism, and the answer we've come to is yes."
Though latex has been around for more than a century, its use exploded in the 1980s with the AIDS epidemic, when billions of surgical and exam gloves were produced to protect health-care workers. Strong enough to hold up after hours of surgery, latex offered the best protection against blood-borne diseases such as AIDS.
But as the gloves' use rose, so did the rate of allergic reactions, as some people who came into prolonged or repeated contact with latex became sensitized to it. A protein in the tropical rubber trees used to make latex has also been shown to trigger allergic reactions in as many as one in 10 people. By some estimates, 15 percent of medical workers are allergic to latex.
Patients, too, are affected, especially those who have been exposed through multiple surgeries. Children and infants can develop a latex allergy at a hospital and then face a lifetime of avoiding the material. Allergic reactions can be mild, such as a skin rash or irritation, but can also include respiratory distress and the severe reaction known as anaphylactic shock, which can lead to a life-threatening drop in blood pressure and death.
Like some other allergens, such as peanuts, latex can spark a reaction even in tiny amounts. Severely allergic people can react, for instance, to blowing up a latex balloon, having a latex dental dam put on for a root canal, or getting injected with a syringe that has punctured a latex port on a medication vial.
Some hospitals, like Vanderbilt University Medical Center, which says it's about 90 percent "latex-safe," have long had a policy of using latex-free supplies when possible. But eliminating latex completely is a complicated task. The Food and Drug Administration now requires all products containing latex to be labeled, but hospital administrators say labeling practices are all over the map. For example, a label identifying tape that contains latex may be included on a bulk supply box but not on individual rolls of tape, so a nurse might not see it.
"Latex is in so many products used in hospitals, it's unbelievable," says Claire Rupert, division director of value analyses at Norton Healthcare, the largest hospital and health-care system in Louisville, Ky., and a Premier member that helped develop the latex-free catalog.
Latex also is used in office supplies, she notes, and items that hospitals have little control over, such as balloons delivered to patient rooms. One of the thorniest problems: finding a substitute for the tape used to secure breathing and feeding tubes on premature infants that doesn't damage their delicate skin when removed. While there are latex-free alternatives, she says, they are more likely to fall off and pull a tube out of an infant's body.
Sue Lockwood, a former surgical technician from Slinger, Wis., says that more than a decade ago, she noticed her eyes swelling up and her hands itching when she donned medical gloves.
A group she co-founded, the American Latex Allergy Association (latexallergyresources.org), provides resources to consumers, including information on the many latex-free consumer products now available, which range from crayons and children's toys to cosmetics and condoms. She advises anyone concerned about a latex allergy to see a doctor and be tested.