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NIOSH Respiratory Diseases Research Program

Evidence Package for the National Academies' Review 2006-2007

NIOSH Programs > Respiratory Diseases > Evidence Package > 4. Airways Diseases > 4.1 Work-Related Asthma

4.1a) Prevent and Reduce Latex-Induced Asthma

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Issue

There are approximately seven million healthcare workers in the U.S., six percent of the workforce. Between 1987 and 1996, the use of natural rubber latex gloves increased by over 1000 percent among these workers after CDC recommended glove use as part of universal precautions for the prevention of transmission of bloodborne pathogens such as hepatitis and HIV.101 In studies conducted from the late 1980s to the late 1990s, sensitization to latex was identified in 2.9 percent to 22 percent of healthcare workers.102,103,104 Based on RDRP-funded surveillance conducted during 1993-1997, healthcare workers accounted for 16 percent of all WRA cases but only eight percent of the employed population, and natural rubber latex was the second most common exposure for WRA cases in this workforce.105

In the mid-1990s, there was a need for recommendations to guide healthcare workers and others in the use of natural rubber latex products. There was also a need for a validated method to identify latex allergy.

Approach

RDRP developed recommendations for controlling latex sensitization among healthcare workers, in collaboration with personnel from the CDC National Center for Infectious Diseases (NCID), the Food and Drug Administration (FDA), the Health Industries Manufacturers Association, OSHA, the American Hospital Association, the American Nursing Association, and the American College of Allergy, Asthma, and Immunology. The recommendations included avoiding use of latex gloves entirely, if possible, and the use of non-powdered latex gloves when it was medically necessary to use latex gloves. Subsequently, RDRP staff prepared a NIOSH Alert on the subject that was released in 1997. It included a summary of relevant literature, recommendations, information on how to recognize symptoms of latex allergy, and what to do if one developed latex allergy.

RDRP scientists conducted research on the effects of the NIOSH Alert on hospitals. Surveys were conducted of directors of infection control or directors of nursing at 323 randomly selected hospitals. The research showed that hospitals that received the NIOSH Alert were more likely to have progressed from a position of “inaction” to “advocacy” on the issue of latex and latex use. Directors who had seen the NIOSH Alert were more likely to report that they intended to have a relevant employee health education program, replace powdered latex gloves, and restrict latex glove use, compared to directors that had not seen it (references in “Outputs and Transfer” below).

Between 1996 and 2003, RDRP staff worked with FDA to validate methods for the identification of latex allergy. In addition, RDRP also provided support to three Veterans’ Administration (VA) hospitals to investigate levels of staff sensitization to latex before and after switching from powdered to non-powdered latex gloves. The percentage of healthcare workers sensitized declined from as high as 15 percent to 0.6 percent (n = 1959 subjects) after the change (A4-3).

Outputs and Transfer

The primary output from this research was the publication, “NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Workplace” (A4-4). Between 1997 and 2006, more than 360,000 copies of the NIOSH Alert were disseminated. Probably as many as 250,000106 of those copies were requested via telephone by interested individuals and organizations such as nursing directors, medical schools, infection control centers, fire departments, dentist’s offices, veterinarians, nursing and convalescent homes, training programs, community health centers, public health departments, and rural health departments.

A second NIOSH numbered document was published in 1998 called “Latex Allergy: A Prevention Guide” (A4-5). This document contained RDRP recommendations for prevention of latex allergy, and was similarly widely disseminated (more than 370,000 copies with more than 150,000 in the first year).

Two articles on the study of the effectiveness of the Alert were published in peer-reviewed journals (1, 2, A4-6, A4-7), as was the validation of the method for identifying latex allergy (3, A4-8). RDRP’s collaborative work with the VA also resulted in a peer-reviewed publication (4, A4-3).

Intermediate Outcomes

A search of journals published between 1997 and 1999 indicated that several healthcare professional organizations highlighted the Alert’s recommendations in their publications. The publications included both national journals (e.g. American Family Physician, Journal of Emergency Nursing, Occupational Health and Safety, and OR Manager) and state-based journals (e.g. Oregon Nurse and the New York State Dental Journal). References for 10 of the articles are presented in the Appendix (A4-9).

Progress Towards End Outcomes

Although the Alert made NIOSH one of the first organizations to recommend avoiding powdered latex gloves, many other organizations called for this change in the healthcare industry. By 1998, there was a shift away from powdered to non-powdered latex gloves and to other non-natural rubber gloves. This was documented in healthcare trade journals. An article in the October 1998 edition of Health Industry Today noted sales of exam gloves that year were characterized by a “strong boost in the powder-free latex segment.”107

RDRP research with the VA on sensitization levels before and after glove change showed that three healthcare facilities experienced a decrease in the percentage of healthcare workers sensitized. A similar finding was reported among the three million workers in the German national healthcare service in 2002.108

What’s Ahead

RDRP will monitor the frequency of latex asthma among healthcare workers to ensure this problem remains under control. Surveillance for WRA will occur in California, Massachusetts, Michigan, and New Jersey as part of the SENSOR program. We will use SENSOR data to identify annual trends until 2010.

101. Kellet PB [1997]. Latex allergy: A review. J Emerg Nurs 23:27-36.

102. Turjanmaa K [1987]. Incidence of immediate allergy to latex gloves in hospital personnel. Contact Dermatitis 17:270-275.

103. Liss GM, Sussman GL, Deal K, et al [1997]. Latex allergy: epidemiological study of 1351 hospital workers. Occup Environ Med 54:335-342.

104. Kelly KJ. Walsh-Kelly CM [1998]. Latex allergy: a patient and health care system emergency. Annals of Emergency Medicine 32:723-9.

105. Pechter E, Davis LK, Tumpowsky C, Flattery J, Harrison R, Reinisch F, Reilly MJ, Rosenman KD, Schill DP, Valiante D, Filios M [2005]. WRA among health care workers: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993-1997. Am Journal Ind Med 47:265-275.

106. The estimate of 250,000 requests was made from consultation with NIOSH staff who handled the requests between 1997 and 2002, during those years NIOSH kept no formal records of these requests. Note that there appear to have been 10 print runs for the Alert with dissemination of almost 140 thousand copies in the first two years.

108. Allmers H, Schmengler J, Skudlik C [2002]. Primary prevention of natural rubber latex allergy in the German health care system through education and intervention. J Allergy Clin Immunol 110:318-323.