Decline of occupational allergies to natural rubber latex in the German health care system
H. Allmers*1, J. Schmengler2, S.M. John1, C. Skudlik1
1University of Osnabrueck, Osnabrueck, Germany
2Praeventionsdienst der Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, Delmenhorst, Germany
Introduction
Recent investigations have shown that up to 17 % of healthcare workers (HCWs) are sensitised to natural rubber latex (NRL) allergens. The proteins present in gloves and other products made of NRL and the inhalation and skin contact with this material are responsible for sensitisation. Even though there have been recommendations to use powder-free and low-allergen gloves as preventive measures there are few investigations that have studied the effects of interventions involving decreases in NRL protein over time. Turjanmaa et al. in Finland reported cessation or declines in sensitisation following changes in powder and/or allergen levels in gloves in hospitals. In a cross-sectional study Levy et al. found that no cases of sensitisation occurred among dental students using powder-free gloves while 5- 15% of those using powdered gloves were sensitised. In a previous study we were able to show that by switching to powder-free NRL gloves detectable NRL aeroallergens were completely removed in a healthcare facility. Sensitised healthcare workers were able to remain at work by supplying them with NRL free gloves, thus showing that these simple and practical measures led to a successful secondary prevention of NRL allergy in HCWs.
We describe the impact of switching from powdered to powder-free NRL gloves in Germany to educate personnel and policy makers about the dangers of the continued usage of powdered NRL gloves and how these efforts have changed the glove purchasing policies in acute care hospitals and the incidence reported suspected cases of NRL allergies among HCWs in Germany.
Materials and methods
In the regulatory field a new version of the compulsory technical regulations for dangerous substances (TRGS 540) was published in December 1997. This explicitly stated that only low allergen powder-free NRL gloves should be used and that the use of powdered NRL gloves was not permissible in the workplace.
Glove usage data
The glove data were provided by the Gesellschaft für Pharma-Informationssysteme mbH for the period from 1986 until 2002. The numbers represent the purchases of all acute care hospitals by projecting the sample of 280 hospitals. Data for the former East Germany have been incorporated since 1991. Separate numbers for powder-free NRL gloves became available in 1992.
Epidemiological data regarding cases of suspected NRL allergies
Every physician and dentist is required by law to report a suspected occupational disease to the appropriate statutory accident insurance company. The number of reported cases of suspected NRL allergies (both skin and respiratory) became available from 1996 until 2002 for all HCWs insured by the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), the statutory accident insurance company for healthcare that is responsible for accident insurance, worker’s compensation and preventive measures. A detailed analysis of the insurance data made it possible to determine the number of insured personnel and the number of suspected cases in all BGW insured acute care hospitals.
Results
The number of purchased non-sterile examination NRL gloves increased by 1,287 percent between 1986 and 2002 reaching almost 1 billion per annum. In contrast the number of surgical NRL-gloves only rose by 40 percent in the same period (Figure 1). The greatest increase in the use of powdered NRL gloves was registered in
Figure 1: Purchase of surgical and examination NRL-gloves in all German acute care hospitals from 1986 until 2002.
1990 when the purchase of non-sterile examination gloves more than doubled from 166 million in 1989 to 364 million pieces. In 1992 only 1 percent of the purchased NRL-gloves were powder-free, but by 1998 sales of powder-free non-sterile NRL examination gloves had surpassed the purchase of powdered NRL examination gloves, and by 2002 their market share had reached 88 percent of all non-sterile examination gloves bought by acute care hospitals. The number of sterile surgical gloves increased between 1990 and 1992, mainly because of the addition of data from former East Germany. A decline in the usage of powdered gloves started in 1997 and by 2000 the sale of powder-free sterile surgical NRL gloves had overtaken that of powdered gloves for the first time. In 2002 the market share for powder free sterile surgical NRL gloves had risen to 89.4 percent.
The incidence of suspected occupational allergy cases caused by NRL rose until 1997 (OA) and 1998 (skin allergies). By 2002 there was a 83.6 % decrease of new skin allergy cases and a 87.8 % reduction of reported new cases of OA (Figure 2). There was a positive linear correlation between the declining purchase of powdered-NRL examination gloves and the reduction in new suspected occupational allergy cases.
Content last modified: 22 May 2005
