Clinical. Natural Rubber Latex (NRL) Policy Section A- Patient Care. Last Updated March 2017

Transcription

1 Clinical Natural Rubber Latex (NRL) Policy Section A- Policy Manager Dr Sharizan Abdul Ghaffar Consultant Dermatologist Policy Group NHS Tayside Latex Advisory Group Policy Established December 2011 Last Updated March 2017 Policy Review Period/Expiry March 2018 This policy does / does not apply to Medical/Dental Staff (delete as appropriate) UNCONTROLLED WHEN PRINTED

2 Natural Rubber Latex (NRL) Policy Section A Version Control Version Number Purpose/Change Author Date 1.0 Policy established Dr Ross Hearn Policy Review Dr Sharizan Abdul Ghaffar 3.0 Policy Review Dr Sharizan Abdul Ghaffar 4.0 Policy Review Dr Sharizan Abdul Ghaffar 4.1 Policy Review Dr Sharizan Abdul Ghaffar March 2013 March 2014 January 2015 March 2017 Policy Manager: Dr Sharizan Abdul Ghaffar Page 2 of 3 0 Review Date: March 2018

3 Contents Page number 1. Purpose and Scope 4 2. Statement of Policy Responsibilities and Organisational Arrangements Key Contacts 7 5. Further Information 7 6. Sources of Information 8 Appendix 1 Clinical Presentation of Latex Allergy 9-10 Appendix 2 Treatment of Anaphylaxis 11 Appendix 3 In-patient Care of Patients with Latex Allergy Appendix 4 Latex Allergy Screening Questionnaire 14 Appendix 5 Care of Latex Allergy in the Peri-Operative Environment Appendix 6 Management of Latex Allergy within the Dental Setting 18 Appendix 7 NHS Tayside Policy/Strategy Approval Checklist 19 Appendix 8 Equality and Diversity Rapid Impact Assessment Policy Manager: Dr Sharizan Abdul Ghaffar Page 3 of 3 0 Review Date: March 2018

4 1. PURPOSE SCOPE AND DEFINITIONS In accordance with the Control of Substances Hazardous to Health (COSHH) Regulations 2002 as amended, NHS Tayside will endeavour to ensure that the health and safety of employees and patients is not put at risk as a result of contact with Natural Rubber Latex (NRL) products. Aims This Policy has been developed to ensure that all NHS Tayside staff are aware of, and know how to deal with, allergy to natural rubber latex The Policy compliments NHS Tayside Control of Employees Exposure to Latex Policy (pending), which gives guidance to staff on appropriate glove selection Raise awareness of health care workers to latex allergy, its implications and its management Encourage the development of an environment that minimises the risk of patients and healthcare staff acquiring latex sensitivity or allergy Encourage the development of an environment that will provide latex-safe care for sensitised and allergic patients, and that will enable if possible for continuing employment of sensitised and allergic staff Definitions Latex refers to natural rubber latex (NRL) obtained from the rubber tree Hevea braziliensis Latex-allergic an individual who exhibits clinical symptoms on exposure to NRL-containing products and who (usually also) has a positive latex-specific IgE antibody blood test or skin prick test to latex Latex-sensitised an individual who has a positive latex-specific IgE antibody blood test or skin prick test to latex, but with no history of clinical symptoms on exposure to latex-containing products these individuals are, however, at risk of developing clinical allergic reactions on subsequent exposure to NRL Latex-safe environment an area in which identified principal sources of NRL allergen have been removed, any remaining latex being unlikely to elicit symptoms in latex-sensitive or allergic individuals Latex-free product a product that has no NRL allergen present Latex-aware an individual or institution that is informed about latex allergy along with its implications and management Policy Manager: Dr Sharizan Abdul Ghaffar Page 4 of 3 0 Review Date: March 2018

5 2. STATEMENT OF POLICY ALL latex-sensitive and allergic individuals must receive latex-safe care within healthcare establishments It is not possible at present to predict which individuals might progress from sensitisation to clinical reaction, and previously mild reactions can be followed by more severe reactions on next exposure. For this reason, the greatest potential danger to a sensitised or allergic individual comes from mucosal contact with NRL (eg during an operation or internal examination) or from inhalation of NRL proteins (carried in the air by powder from glove or balloon). NO Latex products are safe for a latex-allergic individual Latex is contained within many products inclusive of items used within healthcare. It is therefore important that all drugs and equipment used in emergency trolleys should be latex free Synthetic glove alternatives are readily available for use by or for use on latex allergic and sensitised individuals Advances in technology are producing improved synthetic gloves as a viable alternative to latex for many clinical tasks. Where there is no clear need for latex to be used, items of medical equipment are gradually being replaced by synthetic substitutes, although lack of European legislation for labelling of medical equipment can make latex content difficult to ascertain. Patients and staff with suspected latex allergy must be referred to trained practitioners for investigation and management. Diagnosis of latex allergy is not always straightforward and it is important that within NHS Tayside, this is to the Dermatology Department Contact Dermatitis Investigation Unit. Staff are to be referred to OHSAS in the first instance. All clinical staff are aware of and are complying with Appendix 3 In patient care of patients with latex allergy. All patients will be asked on admission/at preadmission if they think they might be allergic to Latex or any other forms of rubber. If the patient says they do have an allergy, the questionnaire in appendix 4 must be completed All staff working in the peri-operative environment must be aware of, and understand their responsibilities in relation to appendix 5, Care of Latex Allergy in the Peri-operative Environment All staff working within dentistry must be aware of, and understand their responsibilities in relation to appendix 6 Management of Latex Allergy with the Dental Setting 3. ROLES AND RESPONSIBILITIES 3.1 Organisational Responsibilities The principles of COSHH assessment of risk need to be applied to NRL and healthcare organisations are expected to have in place robust policies to minimise the development of latex allergy in the workforce and provide a latex-safe environment for allergic patients and staff. Policy Manager: Dr Sharizan Abdul Ghaffar Page 5 of 3 0 Review Date: March 2018

6 3.2 Clinical and departmental responsibilities Managers are ultimately accountable to the Chief Executive of NHS Tayside for the implementation of these guidelines within their sphere of responsibility. Line Managers must ensure that: staff within their area of responsibility are made aware of this Policy All clinical staff are aware of and understand Appendix 1 Clinical Presentation of Latex Allergy and are aware of their respective roles in identifying, reporting /treating anaphylaxis ( appendix 2) suitable and sufficient assessment of risks to health of staff and patients is carried out in relation to products containing NRL used in their area of responsibility (COSHH Regulations 2002) a skin health management process is in place for staff who wear latex gloves any adverse reaction in staff that is thought to be due to contact with latex within the working environment is immediately referred to the Occupational Health Department advice received from OHSAS regarding glove selection / use and skin health is implemented any adverse incident related to NRL exposure is reported via the NHS Tayside Incident Reporting System 3.3 OHSAS responsibilities Responsibilities of OHSAS are to: undertake pre-employment screening for identification of staff who will be working in clinical areas who may have pre-existing allergies or skin problems to allow appropriate advice to be given to management receive referrals from managers or from staff who have concerns about latex allergy, and refer for dermatology assessment where allergy is suspected or where advice is required record information relating to diagnosed latex allergies in individual staff clinical Occupational Health records, and advise managers accordingly monitor areas of high incidence of skin problems suspected as being due to latex exposure or other latex allergy reactions and make recommendations to the appropriate manager on remedial action advise the Occupational Health & Safety Forum and Risk Management Board on incidences and trends assist in risk assessment when required 3.4 Employees responsibilities It is the responsibility of employees to: safeguard their own health, colleagues health and the health of patients by following the advice set out in this Policy be aware of the infection control policy particularly when glove use is required pay attention to their own hand skin care to protect against damage refer themselves to the Occupational Health Department with any skin condition that results in broken skin including eczema and dermatitis, especially if it is thought to be work-related implement advice received from the Occupational Health Department regarding glove use and skin health Policy Manager: Dr Sharizan Abdul Ghaffar Page 6 of 3 0 Review Date: March 2018

7 4. KEY CONTACTS OHSAS Dermatology Reception Ext Procurement/Customer Services Ext FURTHER INFORMATION Background Information Allergy to natural rubber latex (NRL) was first described in 1979, and the past 30 years has seen its recognition as a health issue of increasing importance. Latex allergy is thought to affect less than 1% of the general population, although is more common in certain groups who are regularly exposed to NRL, including healthcare workers from widespread use of medical gloves. A diagnosis of latex allergy may have profound consequences for the patient from worry about the ubiquitous nature of NRL in the environment together with its potentially serious impact. Visits to healthcare can produce particular anxiety because of widespread use of NRL in this setting coupled with frequently reported lack of awareness amongst staff. Latex allergy is strictly speaking an allergic reaction to the constituent proteins of NRL, and is an immediate Type I IgE-associated reaction in which clinical symptoms appear within minutes of exposure. This is quite different from Rubber chemical allergy, a delayed Type IV reaction to chemicals used in the manufacture of rubber products where clinical symptoms take several hours or even days to appear following exposure. The clinical effects of Type I latex allergy are similar to those from allergy to eg peanuts or kiwi fruit in that most people have relatively mild local reactions, some have more troublesome local and respiratory problems and a few will be at risk of serious reactions including anaphylaxis. NRL has many positive attributes. Comfort, strength, biological protection and low cost have traditionally made latex the glove of choice for use within healthcare. Recognition of the problem with latex allergy has led manufacturers to reduce protein content and remove powder, and latex gloves currently used in healthcare are thought to be very unlikely to cause individuals to become allergic to NRL. Policy Manager: Dr Sharizan Abdul Ghaffar Page 7 of 3 0 Review Date: March 2018

8 6. SOURCES OF INFORMATION British Association of Dermatology in-depth information resource US National Library of Medicine and National Institutes of Health interactive tutorial on latex allergy National Patient Safety Association Patient Safety Information Notice Health and Safety Executive latex allergy web-site Royal College of Physicians and NHS Plus. Occupational aspects of latex allergy Cullinan P, Brown R, Field A et al. Latex allergy. A position paper of the British Society of Allergy and Clinical Immunology. Clin Exp Allergy 2003; 33: Medical Devices Agency. Latex sensitisation in the health care setting (use of latex gloves). MDA DB 9601 April 1996 Medical Devices Agency. Powdered latex medical gloves (surgeons and examination). MDA SN 9825 June Policy Manager: Dr Sharizan Abdul Ghaffar Page 8 of 3 0 Review Date: March 2018

9 APPENDIX 1 CLINICAL PRESENTATION OF LATEX ALLERGY For the majority of individuals, an allergic reaction to latex causes only mild symptoms For a very small number of people, exposure to latex may result in anaphylactic shock This is why latex allergy always has to be taken seriously The type of reaction experienced and its severity will depend on: Individual sensitivity Route of exposure The type and amount of allergen contacted MOST REACTIONS OCCUR WITHIN MINUTES OF EXPOSURE TO LATEX Contact with latex may present in different ways: Itching or swelling caused by direct contact with latex Breathing or nasal / eye problems caused by airborne allergens in powder Anaphylaxis caused by latex in direct contact with mucous membranes Itching or swelling caused by direct contact with latex The most common way people get a reaction is when a latex-containing product comes into contact with the body directly. This might come from: wearing latex gloves which can trigger a reaction on the hands using latex condoms which can cause a reaction on the genitals blowing up balloons which can lead to a reaction around the lips or in the mouth In these situations, individuals are likely to get stinging or burning of the skin, or an itchy, red, swollen rash known as urticaria (also called nettle rash, hives or wheals). Urticaria affecting the skin is not a serious condition, although it may spread with repeated exposure to other areas and become quite uncomfortable. Angioedema is similar to urticaria except that the swelling is deeper in the skin or mucous membrane (mucous membranes are soft, moist areas, such as the inside of the mouth or vagina). Angioedema is potentially serious if it causes the tongue or larynx to swell up, because this can make it difficult to breathe. Breathing or nasal / eye problems caused by airborne allergens in powder Sometimes, the latex allergens become airborne, having been carried there (aerosolized) by the powder that is present in gloves or balloons Contact with these airborne allergens by breathing them in may cause: a runny nose (rhinitis) watery itchy eyes (conjunctivitis) wheezing (bronchospasm) Policy Manager: Dr Sharizan Abdul Ghaffar Page 9 of 3 0 Review Date: March 2018

10 Rhinitis and conjunctivitis are not serious, but bronchospasm can be, particularly in people with poorlycontrolled asthma Anaphylaxis In a very small number of people, a severe and potentially life-threatening reaction may occur if they are very sensitive to latex this is anaphylaxis. Allergic individuals are more at risk of developing anaphylaxis when latex is in direct contact with mucous membranes, or with internal surfaces during a procedure or operation. Mucous membranes are soft, moist areas, such as the inside of the mouth, vagina or rectum. In these situations, the latex allergens are absorbed into the body more easily, so have a much greater clinical effect. Symptoms of anaphylaxis may include: flushing and urticaria (nettle rash / hives) anywhere on the body - due to leaky, dilated blood vessels difficulty in swallowing or speaking - due to swelling at back of throat difficulty in breathing - due to narrowing of airways abdominal pain, nausea and vomiting - due to swelling of the gut wall sudden feeling of weakness, with possible collapse and unconsciousness - due to drop in blood pressure Anaphylaxis is very rare, but as there is no way of predicting in advance who this might happen to, or when it might happen, it is very important that all people with latex allergy should be aware of this possibility, and in particular: avoid latex coming into contact with mucous membranes wherever possible alert all healthcare professionals to their allergy so that all medical and dental procedures / operations are conducted in a latex-safe environment Policy Manager: Dr Sharizan Abdul Ghaffar Page 10 of 3 0 Review Date: March 2018

11 APPENDIX 2 TREATMENT OF ANAPHYLAXIS This is the Resuscitation Council (UK) March 2008 Anaphylaxis algorithm. Some areas, particularly in the community setting, may not have access to all medications in the algorithm, and staff should use what is available to them. Full details of the management of anaphylactic reactions can be found at Policy Manager: Dr Sharizan Abdul Ghaffar Page 11 of 3 0 Review Date: March 2018

12 IN-PATIENT CARE OF PATIENTS WITH LATEX ALLERGY APPENDIX 3 Action to be followed when caring for a patient with known or suspected latex allergy ACTION RATIONALE All records, requests for investigation or treatment, theatre lists, drug charts and diet requests are clearly marked LATEX ALLERGY The patient wears a red identification band at all times Good communication is paramount for the safe care of patients with latex allergy within healthcare environments Red identification bands are NHS Tayside policy for any allergy All items used in the patient s care are latexfree Gloves are synthetic nitrile for contact with blood or body fluids, vinyl for low biohazard risk Check medical equipmenteg catheters, wound drains, stoma appliances, BP cuffs, syringes, injection ports on IV tubing, elastic bandages, adhesive tapes, airways Check drugs for injection, eg bungs in vials, plungers in pre-loaded syringes Prepare items in advance of patient s admission All admission, emergency and theatre areas must have a latex-free box of key equipment ready for use All resuscitation equipment must be latexfree There is NO safe level of natural rubber latex (NRL) exposure for allergic patients Follow NHS Tayside glove guidance advice on risk assessment for glove wear Labelling is improving, although not always easy to identify NRL-free items - supplies department can assist through Policy database Parenteral introduction of NRL is potentially serious. The ward pharmacist can assist with this. Should ideally check prior to admission Ready to deliver latex-safe care In an emergency, time is of the essence Patients requiring resuscitation may be having an anaphylactic reaction to latex Nurse patient in a side-room if possible with door labelled Speak to Charge Nurse before entering and remove all latex gloves and equipment from immediate area If NRL-containing items of medical equipment are not present in the immediate patient area, they are less likely to be inadvertently used Policy Manager: Dr Sharizan Abdul Ghaffar Page 12 of 3 0 Review Date: March 2018

13 A special clean beforehand is no longer required Because gloves are no longer powdered ACTION RATIONALE Wash hands before contact with patient to remove traces of latex protein acquired from gloves worn for care of other patients NRL residue from previous glove use may be sufficient to trigger an allergic reaction Before transferring a latex-allergic patient to another department, ward, hospital or discharging to the community, inform the person taking over responsibility for care and record this in medical / nursing record Help the next providers of care to prepare a latex-safe environment for the patient Accurate records are normal good practice Give other staff who may have contact with the patient, eg porters, domestic staff, phlebotomists or ambulance staff sufficient information to protect the patient To avoid inadvertent exposure to NRLcontaining medical equipment / gloves Do not under any circumstances allow latex balloons into the patient s environment Many latex-allergic patients are also allergic to fruits, eg banana, kiwi, avocado, melon, tomato. Do not provide foods or fruit drinks without checking for a history of food allergy. Involve dietician if necessary These are a major risk due to the presence of powder which allows airborne NRL transfer 40% of latex-allergic individuals are also allergic to fruits as they share similar plant-derived proteins On admitting the patient to a ward or a hospital department ensure that he / she is aware of the precautions being taken, the reason for them and what steps they should take to minimise the risk of accidental latex exposure Effective communication with patients about rationale for care plans enhances safe care Patients should not be afraid to remind staff of their allergy if they feel this is necessary Policy Manager: Dr Sharizan Abdul Ghaffar Page 13 of 3 0 Review Date: March 2018

14 APPENDIX 4 SCREENING QUESTIONNAIRE TO BE USED IF PATIENT ANSWERS YES OR MAYBE TO Do you think you might be allergic to latex or any form of rubber? Have you had any of these symptoms developing within a few minutes of contact with latex or rubber products such as balloons, gloves or condoms? Circle Y or N Itchy red skin rash or swelling like hives Itchy red eyes Sneezing, runny or blocked nose Wheezing, chest tightness, or difficulty breathing Have you ever experienced an allergic reaction or adverse event during a surgical procedure which your surgeon or anaesthetist could not explain? Have you ever had any itching, swelling, rash, vomiting or difficulty breathing after dental, rectal or pelvic examinations? Y Y Y N N N Do you have spina bifida or did you undergo frequent surgery or invasive medical procedures in infancy? Y N Does eating any of these foods cause swelling or itching of the lips, mouth or throat, or wheezing or hives? Avocado Banana Kiwi Melon Tomato Sweet chestnut If the patient answers YES to any of the above URGENT CASES - treat in latex-safe environment NON-URGENT CASES - postpone surgical procedure Y N In all cases, please arrange for blood to be sent to Immunology at Ninewells Hospital for total and latexspecific IgE levels AND refer to the Dermatology Department Contact Dermatitis Unit at Ninewells Hospital for formal investigation. Policy Manager: Dr Sharizan Abdul Ghaffar Page 14 of 3 0 Review Date: March 2018

15 APPENDIX 5 CARE OF LATEX ALLERGY IN THE PERI-OPERATIVE ENVIRONMENT Preparation for a latex-safe environment for patients known to be allergic to natural rubber latex (NRL) or suspected of being so at pre-assessment ACTION RATIONALE All staff throughout the theatre suite including surgeon and anaesthetist should be notified in advance of the date and time of surgery Clear and effective communication is paramount in providing a safe patient care environment The patient should if possible be scheduled as first on the list The theatre / recovery area hard surfaces / equipment must be wiped free of dust (e.g. Clinitex Wipes) in advance of patient s arrival by staff wearing NON-LATEX-GLOVES To prevent NRL contamination of nondisposable anaesthetic equipment that might be used inadvertently later on a latexallergic individual Non-powdered latex gloves still have a little powder present which can circulate in the air, carrying with it NRL proteins, and land on surfaces If it is not possible to schedule the patient as first on the list, an interval of 20 minutes should elapse following the previous operation (standard theatre ventilation) or 10 minutes (laminar flow ventilation) Local arrangements are required for the following areas with non standard theatre ventilation: Room 8 Ninewells Area 2A Ninewells Theatre 15 WBT Ninewells Procedure Rooms DSU Ninewells Day Case Area WBT Ninewells Satellite areas (ECT, MRI, X-ray, etc.) The patient wears a red identification band at all times Standard theatre ventilation (20 air changes per hour) should eliminate most latex aeroallergen in this time Laminar flow theatres, due to the significant increase in air changes, will require a shorter timeframe between cases 40 minutes 40 minutes 20 minutes 20 minutes 20 minutes No data available for these areas 40 minutes minimum recommended Red identification bands are NHS Tayside policy for any allergy Policy Manager: Dr Sharizan Abdul Ghaffar Page 15 of 3 0 Review Date: March 2018

16 ACTION RATIONALE All medical and nursing records, theatre lists, drug charts and any other documentation are clearly marked LATEX ALLERGY Good communication is paramount for the safe care of patients with latex allergy from arrival of patient to departure from the theatre suite. The drugs should ideally be checked prior to theatre Non-latex gloves and medical equipment must be used during anaesthesia, surgery and recovery To prevent exposure to NRL NRL items (gloves, masks, etc) must not be stored in close proximity to non latex items To prevent contamination of non-latex items with NRL The latex-free trolley or box should follow the patient throughout their stay in the theatre suite The trolley or box must be checked regularly according to local requirements Each area must maintain a list of equipment or supplies still in use that DO contain latex So that latex-free equipment is always readily available, particularly in an emergency situation It is important that staff in a particular area are aware of equipment or supplies that still contain latex, and avoid the use of these for patients with NRL allergy Signs should be placed on all doors of the designated theatre To prevent contamination of the safe environment from staff inadvertently entering Staff should change into clean theatre clothing and carry out thorough hand washing immediately prior to caring for patient Traces of NRL protein can transfer to skin and clothing from prior contact with latex gloves or medical equipment All non-essential staff should be excluded from the designated theatre The fewer people present, the less chance of inadvertent human error All latex gloves and non-essential medical equipment should be removed from the designated theatre environment To prevent inadvertent use of NRL equipment Policy Manager: Dr Sharizan Abdul Ghaffar Page 16 of 3 0 Review Date: March 2018

17 ACTION RATIONALE Staff must ensure that any theatre attire used (theatre hats, theatre scrubs, PPE, etc) are latex-free Theatre hat for the patient must be latex-free Staff must use disposable surgical gowns where practicable Preparation of specific equipment and instrument trays should be carried out by staff wearing non-latex gloves Autoclave tape should be removed out-with the theatre environment where practicable All drugs, where possible, should be drawn up from glass ampoules only Staff must ensure any drugs or intravenous infusion solutions are latex-free. Staff should, where practicable pre-check the NRL content of any drug or infusion likely to be needed The NRL status of drugs & infusions can be checked via your ward pharmacist who can access the Medicines Information Service If trolley mattresses contain latex, cover with a plastic sheet followed by a cotton sheet. Lithotomy leg supports are covered with pillowcases A recovery nurse should be allocated to care for the patient in a suitably prepared area within theatre or the recovery room until departure from the theatre suite To prevent exposure to NRL To prevent exposure to NRL Disposable gowns eliminate the risk of latex content in the autoclave tape attached to non disposable gowns. Staff must confirm any disposable equipment is latex-free To prevent transfer of NRL allergens To exclude NRL fibres from the theatre environment. There is no guarantee that the Autoclave tape is NRL-free Bungs on standard vials may contain NRL - systemic administration could be catastrophic. Individual items can change NRL content as this can vary from supplying companies The Medicines Information Service is open 9am to 5pm Monday to Friday on ext Out of hours, the on call pharmacist can be contacted via switchboard To prevent contact with NRL The patient should be attended at all times during the stay in theatre to maintain safe care vigilance in case an allergic reaction suddenly develops Each patient must be risked assessed and a suitable course of action taken Regular multi-disciplinary teaching about latex allergy during in-service training should be mandatory for all theatre staff Ongoing education is of utmost importance for provision of safe care Policy Manager: Dr Sharizan Abdul Ghaffar Page 17 of 3 0 Review Date: March 2018

18 APPENDIX 6 MANAGEMENT OF LATEX ALLERGY WITHIN THE DENTAL SETTING Patients with natural rubber latex (NRL) allergy have often been treated in a General Dental Practice without significant problems when adjustments have been made by the dental team to manage the patient s allergy. However if the dentist is in doubt or lacks confidence (eg managing a highly reactive patient), the patient may need to be referred for appropriate management, possibly in a community CDS or PDS or in a hospital setting. All dental practices should obtain a copy of and be familiar with the contents of the FGDP(UK) Good Practice Guidelines Guidance for the Management of Natural Rubber Latex Allergy in Dental Patients and Dental Healthcare Workers available from The Faculty of General Dental Practitioners (UK), Lincoln s Inn Fields, London WC2A 3PE (fgdp@rcseng.ac.uk) KEY POINTS Appoint one member of the dental team to be responsible for the organisation and implementation of the latex allergy protocol This individual should also be responsible for the education and training of other dental staff so that they are aware of and understand the implications of treating a latex-allergic patient Ensure staff are trained to provide emergency and resuscitation treatment by means of regular practices / scenarios Powdered latex gloves and latex balloons should NOT be allowed within the dental practice at any time these are a major risk for latex-allergic patients All equipment used for treating allergic patients must be latex-free, and these items must be stored away from NRL products Check NRL content of local anaesthetics, emergency drugs and parenteral antibiotics with the manufacturer at regular intervals, and maintain a stock of latex-free preparations at all times Policy Manager: Dr Sharizan Abdul Ghaffar Page 18 of 3 0 Review Date: March 2018

19 NHS TAYSIDE - POLICY/STRATEGY APPROVAL CHECKLIST APPENDIX 7 POLICY/STRATEGY AREA: Clinical POLICY/STRATEGY TITLE: Natural Rubber Latex (NRL) Policy Section A- LEAD OFFICER Dr Sharizan Abdul Ghaffar Consultant Dermatologist Why has this policy/strategy been developed? Has the policy/strategy been developed in accordance with or related to legislation? Please give details of applicable legislation. Has a risk control plan been developed? Who is the owner of the risk? Who has been involved/consulted in the development of the policy/strategy? Has the policy/strategy been assessed for Equality and Diversity in relation to:- Race/Ethnicity Gender Age Religion/Faith Disability Sexual Orientation Please indicate Yes/No for the following: Yes Yes Yes Yes Yes Yes Does the policy/strategy contain evidence of the Updating existing Policy No Yes Dr Sharizan Abdul Ghaffar NHS Tayside Latex Advisory Group 26 members covering all relevant disciplines Has the policy/strategy been assessed For Equality and Diversity not to disadvantage the following groups:- Please indicate Yes/No for the following: Yes Minority Ethnic Communities (includes Gypsy/Travellers, Refugees & Asylum Seekers) Women and Men Religious & Faith Groups Disabled People Children and Young People Lesbian, Gay, Bisexual & Transgender Community Yes Yes Yes Yes Yes Yes Equality & Diversity Impact Assessment Process? Is there an implementation plan? Which officers are responsible for implementation? When will the policy/strategy take effect? Who must comply with the policy/strategy? How will they be informed of their responsibilities? Is any training required? If yes, attach a training plan Are there any cost implications? If yes, please detail costs and note source of funding Who is responsible for auditing the implementation of the policy/strategy? What is the audit interval? Who will receive the audit reports? When will the policy/strategy be reviewed and by whom? (please give designation) Through Line Managers, Staffnet, induction sessions and other educational avenues Line Managers When approved All NHS Tayside staff Through Staffnet and Line Managers Yes, Level 2 delivery/training (raising awareness) Policy tracker, Awareness of policy update to be sent out via Tayside communications. No NHS Tayside Latex Advisory Group To be determined Executive Team NHS Tayside Latex Advisory Group next meeting Name : Dr Sharizan Abdul Ghaffar Date : 21 April 2017 Policy Manager: Dr Sharizan Abdul Ghaffar Page 19 of 3 0 Review Date: March 2018

20 APPENDIX 8 EQUALITY AND DIVERSITY RAPID IMPACT ASSESSMENT Name of Function/Policy/Strategy Latex Policy Workstream All clinical staff Location of Function/Policy/Strategy Across NHS Tayside What are the main aims of your function/policy/strategy 1 Raise awareness of health care workers to latex allergy, its implications and its management 2 Encourage the development of an environment that minimises the risk of patients and healthcare staff acquiring latex sensitivity or allergy 3 Encourage the development of an environment that will provide latex-safe care for sensitised and allergic patients, and that will enable if possible for continuing employment of sensitised and allergic staff Is this a new/existing policy/function/strategy? Existing Policy being updated What are the intended outcomes from the proposed function/policy/strategy? Better awareness of staff to optimise safe employment and safe care for patients Priority: state whether high/low High Review Team: who is assessing or considering the assessment? NHS Tayside Latex Policy Group Names and titles of team members 26 members across all relevant NHS Tayside disciplines Role of assessment team Advisory to Chair relevant to areas of specific responsibility / practice When completed please attach to the policy prior to endorsement/approval at the relevant committee. Policy Manager: Dr Sharizan Abdul Ghaffar Page 20 of 3 0 Review Date: March 2018

21 Item No Considerations Detail Impact and Identify Groups Affected 1. Which groups of the population will be affected by the function/policy? Document the Evidence/Research Actions Taken/To be Taken 1.1 Will it impact on the whole population? 1.2 If not which groups of the population do you think will be affected by this function/policy? Minority ethnic population (including refugees, asylum seekers & gypsies/travellers) Women and men People in religious/faith groups Disabled people Older people, children and young people Lesbian, gay, bisexual and transgender people People with mental health problems Homeless people People involved in criminal justice system staff Yes, potentially, as not all sensitised or allergic individuals are currently diagnosed Estimate 1% of population have latex sensitivity Implement Policy to improve staff awareness Policy Manager: Dr Sharizan Abdul Ghaffar Page 21 of 3 0 Review Date: March 2018

22 Item No Considerations Detail Impact and Identify Groups Affected 2. What impact will the function/policy have on lifestyles? For example will the changes affect: Diet & nutrition All clinical staff Exercise & physical activity Improved awareness Substance use: tobacco, alcohol or drugs Better patient management Risk taking behaviours Education & learning or skills Other Document the Evidence/Research UK survey of latex-allergic individuals shows lack of awareness in healthcare staff NPSA reports show continuing substandard documentation and communication between healthcare staff Actions Taken/To be Taken Improve education of staff through Policy, Line Managers, Staffnet, induction sessions, etc Policy Manager: Dr Sharizan Abdul Ghaffar Page 22 of 3 0 Review Date: March 2018

23 Item No Considerations Detail Impact and Identify Groups Affected 3. Does your function/policy consider the impact on the social environment? Things that might be affected include: Social status Encourage continuing Employment employment of latex-sensitised / (paid/unpaid) allergic staff if possible Social/family support Stress Income Document the Evidence/Research Most are able to work alongside colleagues who wear powderfree latex gloves Actions Taken/To be Taken Risk-assess work environment for each individual as degree of sensitivity can vary Policy Manager: Dr Sharizan Abdul Ghaffar Page 23 of 3 0 Review Date: March 2018

24 Item No Considerations Detail Impact and Identify Groups Affected 4. Will the proposal have any impact on: Discrimination Equality of opportunity Relations between N / A groups Other Document the Evidence/Research Actions Taken/To be Taken 5. Will the function/policy have an impact on the physical environment? For example will there be impacts on: Living conditions Working conditions Pollution or climate change Accidental injuries/public safety Transmission of infectious diseases Other Continue to build on the gradual transition from latex to synthetic medical equipment Industry has gradually been moving this way in recognition of the latex allergy problem Use latex-free medical equipment where practicable Policy Manager: Dr Sharizan Abdul Ghaffar Page 24 of 3 0 Review Date: March 2018

25 Item No Considerations Detail Impact and Identify Groups Affected 6. Will the function/policy affect access to and experience of services? For example Improved latex allergy Healthcare awareness of healthcare staff to Social services provide safe care for patients Education Transport Housing Document the Evidence/Research UK survey of latex-allergic individuals shows lack of awareness in healthcare staff NPSA reports show continuing substandard documentation and communication between healthcare staff Actions Taken/To be Taken Improve education of staff through Policy, Line Managers, Staffnet, induction sessions, etc 7. Consultation 1) What existing consultation data do we have or need? Existing consultation sources Original consultations Key learning Through close working with Latex Allergy Support Group and Chairing their Medical Advisory Panel for 6 years, Dr Lowe who developed the policy had in-depth knowledge of latex issues. Ongoing work and consultation with patients and colleagues 2) What new consultation, if any, do you need to undertake? NHS Tayside Latex Advisory Group comprises 26 healthcare professionals covering all relevant disciplines Policy Manager: Dr Sharizan Abdul Ghaffar Page 25 of 3 0 Review Date: March 2018

26 Item No Considerations Detail Impact and Identify Groups Affected 8. In relation to the groups identified What are the potential Better healthcare staff impacts on health? knowledge should lead to safer Will the function/policy care for latex-allergic patients impact on access to health care? If yes - in what way? Will the function/policy impact on the experience of health care? If yes in what way? Document the Evidence/Research UK survey of latex-allergic individuals shows lack of awareness in healthcare staff NPSA reports show continuing substandard documentation and communication between healthcare staff Actions Taken/To be Taken Improve education of staff through Policy, Line Managers, Staffnet, induction sessions, etc Policy Manager: Dr Sharizan Abdul Ghaffar Page 26 of 3 0 Review Date: March 2018

27 Item No Considerations Detail Impact and Identify Groups Affected 9. Have any potential negative impacts been identified? If so, what action has been proposed to counteract the negative impacts? (if yes state how) For example: Is there any unlawful discrimination? Could any community get Risk of overloading diagnostic an adverse outcome? system from screening Could any group be questionnaire excluded from the benefits of the function/policy? (consider groups outlined in item 3) Does it reinforce negative stereotypes? (For example, are any of the groups identified at item 3 being disadvantaged due to perception rather than factual information?) Document the Evidence/Research There is no validated latex screening questionnaire in existence. The proposed questionnaire in this Policy has been devised with the assistance of British Association of Anaesthetists Latex Allergy Lead Clinician to maximise detection of at risk patients, without swamping the NHS Tayside diagnostic system Actions Taken/To be Taken Need to pilot this in first instance to assess workload Policy Manager: Dr Sharizan Abdul Ghaffar Page 27 of 3 0 Review Date: March 2018

28 Item No Considerations Detail Impact and Identify Groups Affected 10. Data & Research Is there need to gather further evidence/data? Are there any apparent gaps in knowledge/skills? Yes, ongoing Document the Evidence/Research Threshold level for sensitisation unknown No 100% reliable diagnostic test Actions Taken/To be Taken Await updated National Glove Guidance 11. Monitoring How will the outcomes be monitored? Through NHS Tayside Latex Advisory Group Continuing uncertainties and controversy regarding glove selection Who will monitor? What criteria will you use to measure progress towards the outcomes? 12. Recommendations (This should include any actions required to address negative impacts identified) Line Managers, Occupational Health Adverse incident reporting process Education Identify educational avenues Policy Manager: Dr Sharizan Abdul Ghaffar Page 28 of 3 0 Review Date: March 2018

29 Item No Considerations Detail Impact and Identify Groups Affected 13. Is a more detailed assessment needed? If so, for what reason? N / A Document the Evidence/Research Actions Taken/To be Taken 14. Completed function/policy Who will sign this off? When? Executive Team ASAP 15. Publication Staffnet Policy Manager: Dr Sharizan Abdul Ghaffar Page 29 of 3 0 Review Date: March 2018

30 Rapid Impact Summary Sheet Positive Impacts (Note the groups affected) Negative Impacts (Note the groups affected) Safer environment for staff and patients Better pre-assessment screening None envisaged More-informed healthcare staff Additional Information and Evidence Required All Health Boards are expected to have a Latex Policy in place Recommendations Approve Policy From the outcome of the RIC, have negative impacts been identified for race or other equality groups? Has a full EQIA process been recommended? If not, why not? No Managers Signature: Dr Sharizan Abdul Ghaffar Date: 21 April 2017 Policy Manager: Dr Sharizan Abdul Ghaffar Page 30 of 3 0 Review Date: March 2018