Chris,
Sorry to disagree in part "there is a need to treat NRL gloves differently" especially in the NHS, if only because the HSE are telling us to and threatening enforcement action!
Secondly, yes, this has come about because of the universal barrier scenario but we are now living with it and because of infection control issues the situation is worsening, we now have over twenty individuals with a type one allergy working in this Trust who are potentially at risk of anaphylactic reaction and I would imagine thjis would be repeated across the Country.
Increased use and increased incidence of skin problems combined with the use of alcohol gels is in my view increasing the incidence of HCW's with latex allergy problems or problems with other proteins in the gloves, good point for a research question I think!
regards
David
David R Maslen-Jones RGN BA SCPHN(OH) MIOSH
Nurse Consultant, Occupational Health
Plymouth Hospitals NHS Trust
Kingstor House
Derriford
Plymouth
PL6 8DH
Tel: 01752 437234 int:37234
[log in to unmask]
-----Original Message-----
From: Chris Packham [mailto:[log in to unmask]]
Sent: 11 October 2005 18:26
To: [log in to unmask]
Subject: Re: Latex in the NHS
Glenn
There is absolutely no reason to treat natural rubber latex as any more
hazardous than any other glove material. This is one area where there is a
great deal of misinformation. We were using natural rubber latex gloves for
many years with no "latex allergy" problem.The problem arrived with the
universal barrier precaution approach and the switch (mainly for cost
reasons) to powdered (and usually high free protein) single use gloves.
In Germany they banned the use of powdered natural rubber latex gloves but
stayed with natural rubber latex. I have a paper from one of the German
experts showing just how the incidence of latex allergy has virtually
disappeared, despite the retention of natural rubber latex. In the words of
Dr. Henning Allmers, "latex allergy is history". His studies have also shown
that latex allergic health care workers can work alongside others who use
natural rubber latex gloves (unpowdered, of course) without a problem. I
also have a case of a latex sensitive person who was able to continue to
wear natural rubber latex gloves simply by wearing a silk under-glove.
(Obviously, as a general practice, if anyone is already latex sensitive,
then it would be a wise precaution to avoid direct contact with this
substance.)
The alternatives, e.g. nitrile, are more expensive. Why should the NHS
increase its expenditure on gloves merely to deal with a problem that isn't
really there? Could not this money be more usefully used treating patients?
Incidentally, the HSE statement that natural rubber latex is a hazardous
substance needs to be treated with caution. It does not distinguish between
the natural product as it comes from the tree and the substance when
incorporated into a product, such as a glove. In fact, if you consult COSHH,
even water is a hazardous substance requiring a risk assessment.
COSHH includes the following definition of a substance hazardous to health:
=====
“(e) which, not being a substance falling within sub-paragraphs (a) to (d)
because of its chemical or toxcological properties and the way in which it
is used or is present at the workplace creates a risk to health;”
=====
Consideration of the implications of this statement suggest that in order to
establish whether a substance is hazardous to health we must first identify
how it is used or is present in the workplace. Only then can we decide
whether it represents a risk to health and whether we therefore need to
consider the substance as hazardous to health. In other words, everything is
potentially a hazardous substance unless proven otherwise. Actually, water
is probably a much more common cause of contact dermatitis than latex ever
was. In Germany, if exposure to water/wet work is prolonged (and many health
care workers would fall into this category) then it officially becomes a
hazardous substance and special precautions have to be taken (Technische
Regel fur Gefahrstoffe TRGS531). Are you risk assessing exposure to water?
If anyone wants to know more about the German experience please let me know
off the forum and I will e-mail them the paper by Dr. Allmers.
Regards
Chris
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