The use of Latex gloves is not allowed unless justified by a suitable and sufficient latex risk assessment

Transcription

1 Policy Title: Latex Policy Reference and Version No: C17 Version 5 Author and Job Title: Jude Cooper Head of Occupational Health and Wellbeing Lesley Wharton Assistant Director of Nursing Infection Prevention and Control Executive Lead Director of Nursing Patient Safety and Quality Process The use of Latex gloves is not allowed unless justified by a suitable and sufficient latex risk assessment Policy Flowchart Guidance There is a corporate Latex risk assessment on DATIX for assistance ID: 1627 Validated By: Health, Safety and Welfare and Committee Ratified By: Patient Safety Committee Date Issued: 30 November 2017 Date for Review: 10 October 2020 Related Documents RM10 Health and Safety Policy RM8 Hazard Identification, Risk Assessment, Risk Categorisation and Risk Treatment Policy RM16 COSHH Policy RM15 Policy for Incident Reporting and Investigation IC2 Hand Hygiene Policy RM26 Prevention and Management of Occupational Skin Disease This Policy is Intended for: All staff Ordering of latex gloves and other latex products must be via the CARDEA system Where latex gloves are in use a skin care monitoring programme must be implemented, including skin checks and health surveillance Ensure all incidents of latex problems are reported on the DATIX system and to Occupational Health Raise awareness of staff regarding the risk of latex The Procurement policy provides guidance or you can contact the Procurement department for assistance Guidance is provided within the Trust Occupational Skin Disease Policy and from Occupational Health It is important to catch symptoms early to prevent more serious problems This can be done via appraisals, regular briefings at team meetings, posters etc. The Trust is committed to the fair treatment of all, regardless of age, colour, disability, ethnicity, gender, gender reassignment, nationality, race, religion or belief, responsibility for dependants, sexual orientation, trade union membership or non membership, working patterns or any other personal characteristic. This policy and procedure will be implemented consistently regardless of any such factors and all will be treated with dignity and respect. To this end, an equality impact assessment has been completed on this policy. 1 of 15 (Date for review 10 October 2020)

2 CONTENTS 1. Introduction 2. Scope of Policy 3. Objectives 4. Strategy 5. Responsibilities 6. Policy/Process 7. References 8. Consultation details 9. Review and details of revision 10. Monitoring Appendices Appendix 1 - Risk Factors for Latex Allergy Appendix 2 - Adverse Health Affects of Latex Appendix 3 - Glove Matrix and Guidelines Appendix 4 - Latex Allergy Guidelines for the Perioperative Patient 2 of 15 (Date for review 10 October 2020)

3 1. Introduction Natural rubber latex (NRL) is a durable flexible material composed of natural proteins and added chemicals. NRL is present in gloves and may also be present in other products which are commonly found in the healthcare environment. Allergic reactions following exposure to natural rubber latex (NRL) have increased significantly over the last twenty years, particularly within healthcare occupations as a consequence of the increased usage of latex gloves, and in particular powdered latex gloves. Latex allergy results from a reaction to one or more of the components of NRL or residues from the manufacturing process. Certain factors place individuals at increased risk of developing an allergic response when exposed to latex (Appendix 1). Allergic reactions can vary in severity from a localised allergic rash to rare cases of anaphylaxis (Appendix 2.) 2. Scope of Policy This policy is adopted to ensure that risks to health associated with exposure to latex rubber proteins are assessed and adequate controls are in place for both staff and patients of the Trust. 3. Objectives 3.1 To ensure compliance with relevant health and safety legislation. 3.2 To provide a safe and suitable environment for the delivery of healthcare to patients within the Trust. 3.3 To provide a suitable and safe working environment for all staff. 4. Strategy The above objectives will be achieved by : 4.1 Undertaking suitable and sufficient risk assessments. 4.2 The provision of suitable equipment and products for the delivery of the required healthcare. 4.3 The provision of appropriate advice and training of staff. 4.4 The provision of suitable personal protective equipment. 4.5 Devising and implementing suitable processes to identify patients with possible latex allergy. 4.6 Devising and implementing suitable protocols and care plans for patients with known latex allergy. 4.7 The investigation of possible and confirmed cases of latex allergy occurring in both patients and staff. 4.8 The provision of suitable occupational health services, including pre-employment assessment and health surveillance programmes. 4.9 The adoption and following of agreed monitoring arrangements. 3 of 15 (Date for review 10 October 2020)

4 5. Responsibilities 5.1 Chief Executive has responsibility Under the Health and Safety at Work Act 1974 to ensure compliance with this policy and delegate authority appropriately. 5.2 General Managers have responsibility To ensure this policy is implemented within their area of responsibility. To ensure suitable and sufficient risk assessments have been undertaken in their areas of responsibility for both patients and staff. To ensure that suitable accommodation and equipment is available to deliver clinical care to patients identified with latex allergy. To ensure that adverse reactions to latex products involving staff or patients are fully investigated and reported in accordance with the Trust s Policy for Incident Reporting and Investigation (RM15) and Reporting of Injuries Disease and Dangerous Occurrences Regulations (RIDDOR) Clinical Directors have responsibility To implement within their areas of responsibility protocols to ensure identification of patients who may be allergic to latex and those in high risks groups (Appendix 1, and 4). To devise and review clinical guidelines to provide safe clinical care to patients with known latex allergy (Appendix 4 ). To ensure medical staff are provided with suitable information and training to enable them to comply with this policy. 5.4 Clinical/Department Managers have responsibility To undertake suitable and sufficient risk assessments for the use of equipment or products containing latex, for both patients and employees To ensure compliance with all relevant guidelines and devise appropriate safe care plans for patients with known or suspected latex allergy (Appendix 4). To ensure staff have ready access to appropriate latex free resuscitation equipment. To provide suitable and sufficient personal protective equipment to minimise the usage of latex gloves. It should be ensured that powdered latex gloves are not used. (Appendix 3). To provide suitable skin cleansing, decontamination and conditioning products to reduce the risk of irritant dermatitis from hand washing. To investigate and document incidents of suspected allergic reaction to latex in both patients and staff in accordance with the Policy for Incident Reporting RM15 and RIDDOR Regulations To ensure staff are provided with suitable information and training to enable them to comply with this policy 4 of 15 (Date for review 10 October 2020)

5 To work with Human Resources and Occupational Health to facilitate the provision of a latex safe working environment for staff experiencing any adverse health effects from latex. To follow a proactive approach in considering possible latex allergy in their staff by referring them to the Occupational Health Department, should any relevant concerns arise. 5.5 Head of Procurement has responsibility To monitor all products which have the potential to contain latex by liaising with manufacturers/suppliers. To advise management through the Trust s Purchasing Committee to ensure the purchase of products with the least risk of adverse health affects from latex. To advise on the availability of alternative products. To be a source of advice to managers and clinical staff on the latex content of products and equipment. To restrict and monitor the purchase/usage of latex gloves in the Trust and to liaise with the Control of Infection Department/Occupational Health in the purchase and provision of suitable alternatives (non-latex) gloves for agreed usage (Appendix 3). Only areas where the use of latex gloves has been deemed necessary may be allowed to order latex gloves. 5.6 Head of Pharmacy has responsibility To be a source of advice to clinical staff on latex containing products/containers provided from Pharmacy. To ensure a supply of commonly used emergency drugs is available in latex free containers. 5.7 Clinical Staff of the Occupational Health Department have responsibility To be familiar with the symptoms of latex allergy (Appendix 2). To ensure the pre-employment health assessment process includes specific enquiry regarding possible adverse health effect of latex. To implement suitable programmes of health surveillance where risk assessments identify potential health risks. To co-operate with General Practitioners to facilitate referral of employees for specialist assessment and latex allergy testing or to refer to Dermatology Department.. To advise Human Resources and line management when workplace restrictions are required and advise on redeployment. To investigate with management all concerns relating to possible adverse health affects of latex to staff. To be a source of support and advice to staff with proven latex allergy. 5.8 Human Resources have responsibility To support HCWs who may have developed latex allergy by facilitating their temporary or permanent relocation, taking advice from the Occupational Health Department. 5 of 15 (Date for review 10 October 2020)

6 5.9 Employees have responsibility To be familiar with and comply with this policy. To report immediately to their line manager and the Occupational Health Department if they experience any possible adverse health affects from latex (Appendix 2). To be familiar with all risk assessments relevant to this policy. To co-operate with the appropriate usage of personal protective equipment (Appendix 3). To co-operate with health surveillance programmes. To report immediately to their line manager any possible adverse health affects from latex experienced by patients to whom they are providing care. To co-operate in the completion of critical and incident report forms/datix. To comply fully with patient documentation and guidelines related to possible or known latex allergy (patient information leaflets). 6. Policy/Process 6.1 To reduce the risk of staff and patients becoming allergic to latex and to protect those with latex allergies the Trust will aim to control and minimise the use of latex throughout the organisation. This will be carried out following a clear procurement policy, risk assessment process and monitoring of controls as follows. 6.2 Ordering of latex gloves and other latex products will be controlled via the procurement policy and monitored by the procurement department. Any identified issues will be reported to the Occupational Health department and the Corporate H&S and Non Clinical Risk Service. 6.3 The trust has adopted a policy of not allowing latex gloves to be used unless justified via a suitable and sufficient latex risk assessment which details adequate controls and monitoring systems. The corporate Latex risk assessment on the DATIX system details controls and is a useful guide for managers. 6.4 Where latex gloves are used a skin care monitoring programme is needed which will include regular skin checks and health surveillance, further guidance is provided within the Trust s Occupational Skin Disease Policy. 6.5 All incidents and potential incidents of latex allergies or reactions to latex must be reported following the Trust incident reporting policy and also where it is a member of staff they should be referred to Occupational Health. 6.6 Information, instruction and training will be provided to all relevant staff. This will include leaflets, awareness sessions and responsible person training where required. 7. References 7.1 HSE website on latex allergy at Latex and You INDG 320 April 2000, Health and Safety Executive. 6 of 15 (Date for review 10 October 2020)

7 7.3 Latex Allergy. Occupational Aspects of Management. A National Guideline. NHS Plus 2008 ISBN Consultation Details This policy has been revised following consultation with: Clinical Directors and Modern Matrons Theatre Users Group Infection Prevention and Control Team Health, Safety, Welfare and Environment Committee 9. Review and Details of Revision This policy will be reviewed every three years by the Patient Safety Committee. 10. Monitoring 10.1 Monitoring of purchase and usage of latex gloves throughout the Trust by the Assistant Director of Supplies and Procurement Review of latex specific incidents involving staff undertaken by Occupational Health Consultant and reported to Health and Safety Committee. Latex specific incidents MUST be reported on Datix and Occupational Health will receive a trigger and follow these up Review of latex specific incidents involving patients undertaken by Clinical Governance Committee Audit undertaken annually by Occupational Health of Trust staff who are identified at Pre Employment as having a diagnosed latex allergy. This audit will ensure that these individuals are monitored and that appropriate health surveillance and use of PPE is undertaken Health surveillance programme - undertaken by Occupational Health Department. Managers to undertake suitable and sufficient risk assessments and identify staff groups where health surveillance required. 7 of 15 (Date for review 10 October 2020)

8 Appendix 1 RISK FACTORS FOR LATEX ALLERGY The reported prevalence of latex allergy varies widely across occupational groups from 3% to 17% in healthcare workers. It is agreed that certain factors place individuals at increased risk of developing an allergic response: a. People/patients who have undergone multiple operations and instrumentation resulting in repeated mucosal exposure. b. Individuals who are atopic or who have had dermatitis have an increased likelihood of developing a Type I allergy. c. Individuals who are allergic to certain foods e.g. bananas, avocados and chestnuts, figs, kiwi fruits, tomatoes, papaya and pineapple due to a shared antigenic similarity with latex. d. Occupational groups who in the course of their work are likely to be exposed to frequent and large doses of the antigen, including HCWs. e. Users of powdered gloves. The powder absorbs latex antigens which can be disseminated into the air when the gloves are handled. 8 of 15 (Date for review 10 October 2020)

9 Appendix 2 Adverse Health Affects of Latex The frequent wearing of gloves at work can cause irritation of the skin of the hands. There are two types of allergy related to NRL. One is due to sensitisation to latex specific proteins and the other to the chemical additives in rubber products. They are respectively called Type I and Type IV allergy. 1. Irritation Dryness, itching, flaking of the skin sometimes associated with a rash, where there has been direct skin contact with latex. This effect is usually reversible, and is not an allergic response. The irritation of the skin may be due to excessive sweating (under gloves), the glove powder, poor skin care, and/or skin cleansing/decontamination products. This irritant dermatitis can predispose an individual to progress to allergy. 2. Type I Allergy (Immediate Hypersensitivity) This can cause: a. Itching and weals (urticaria) on the skin which has had contact with the latex. b. Systemic symptoms which may include itchy eyes (conjunctivitis), nasal irritation (rhinitis), tingling around the mouth, generalised swelling of the face, a cough, wheezing, and asthma. c. Though very rare, anaphylaxis may occur, which in the most extreme cases could result in death. Months or even years of exposure without symptoms may precede the onset of Type I allergy. The symptoms can then become progressively severe, so it is important for sensitised individuals to minimise further contact with latex specific proteins. Confirmation of Type 1 allergy requires skin prick testing. The taking of an accurate occupational and medical history and referral to a Dermatologist or Immunologist will ensure correct interpretation of the history and results. 3. Type IV Allergy (Delayed Hypersensitivity) This causes an eczematous rash with reddening of the skin, itching and vesiculation on those areas of skin which have had direct contact with products containing the accelerator chemicals used in the manufacturing process. This cannot be distinguished visibly from an irritant dermatitis. The skin response is a delayed hypersensitivity that can occur 6 to 48 hours after contact. Patch tests will aid the diagnosis, which will require referral to a Dermatologist or Immunologist. This condition also predisposes the affected individual to Type I allergic reactions. 9 of 15 (Date for review 10 October 2020)

10 Glove Matrix and Guidelines Appendix 3 Activity Preferred option Alternative option Surgical procedure in theatre Sterile nitrile procedure glove Sterile low protein latex procedure glove Procedure involving entry into sterile body site Sterile nitrile procedure glove Sterile low protein latex procedure glove Procedure involving risk of exposure to blood or blood stained fluid Or Activity requiring personal protection and high level of manual dexterity Sterile or non-sterile nitrile glove * ** Sterile or non-sterile low protein latex glove * ** Pharmacy Aseptic Unit Sterile nitrile procedure glove Sterile low protein latex procedure glove Aseptic Preparation Area Sterile nitrile procedure glove Sterile low protein latex procedure glove Pathology Handling high risk specimens and other specified activities (except those indicated below) Non-sterile nitrile glove ** Non-sterile low protein latex glove ** (i) Intricate manual work in histopathology (ii) Post mortem procedure Cleaning surfaces and objects in clinical area Sorting soiled linen Handling waste Non-sterile low protein latex procedure glove Non-sterile nitrile glove Non-sterile nitrile procedure glove Non-sterile low protein latex glove Food preparation Cleaning surfaces and objects in non-clinical area Washing crockery and kitchenware Gardening work Maintenance work Vinyl glove Non latex household gloves Heavy duty gloves Please seek advice Please seek advice *choice between sterile or non-sterile type depends on probability of contact with normally sterile anatomical structure **choice between procedure and examination glove depends on dexterity required NB. All gloves powder-free 10 of 15 (Date for review 10 October 2020)

11 Appendix 4 Latex allergy guidelines for the perioperative patient 11 of 15 (Date for review 10 October 2020)

12 1. Responsibilities 1.1 It is the responsibility of all staff to make themselves familiar with these guidelines and all other relevant Trust policies. 1.2 All staff have a responsibility to report to the theatre manager or nurse/odp in charge any possible reactions to latex experienced by a patient in their care. 1.3 All staff must also report any possible reactions to latex they themselves have experienced. 1.4 The surgical team responsible for the patient must inform the theatre manager or nurse/odp in charge of the patient s status. 1.5 The ward staff are responsible for correctly preparing the patient for theatre and verifying that theatre are aware of the patient s status 1.6 It is the responsibility of the theatre manager to ensure that latex free alternatives are available. 1.7 It is the responsibility of the recovery staff to ensure that the Latex Free Trolley is clean, tidy and contains Emergency airway equipment Resource file Latex Allergy Alert signs Theatre Preparation Forms Latex allergy patient register Anaesthetic and scrub equipment reference guides containing product information 2. Guidelines DCU Ward 2.1 DCU must be informed of any latex allergy patients booked for elective surgery when they are booked. 2.2 Prior to admission a side room must be made available and prepared for the patient. 2.3 All equipment containing latex must be removed from the room and the room cleaned and damp dusted using latex free gloves and cloths. Metal bowls should be used. 2.4 A latex free bed and mattress should be used. 2.5 Use latex free blood pressure cuffs and oximeter probes or cover with stockinette and secure with latex free tape. 2.6 Latex free gloves and aprons should be available by the door. 2.7 Warning signs should be placed on the doors, medical and nursing notes, prescription charts and observation charts. 2.8 Ensure a red allergy band is in situ in addition to the patient s normal identification band. 2.9 Ensure there are no elastic bands around the notes Latex free anti-embolism stockings must be used. 12 of 15 (Date for review 10 October 2020)

13 2.11 If the patient requires further investigations or procedures i.e. X-ray or surgery in main theatre, ensure staff in other departments are aware of the patients status. Theatre scheduling 2.12 When booking a latex allergy patient, the surgical team must liaise with the nurse/odp in charge Theatre must be informed of any elective patients at the earliest opportunity. This should be at least 1 week prior to the scheduled surgery and within a minimum of 24 hours Failure to give adequate notice may result in cancellation and re-scheduling of the patient. Notice of less than 24 hours will result in cancellation and re-scheduling Patients with a life-threatening condition requiring immediate surgery will be assessed on an individual basis by the Consultant Anaesthetist and Consultant Surgeon in charge of their care The Latex Allergy Patient Register should be completed by the nurse/odp in charge of the department The patient will be scheduled as first on the am list wherever feasible to reduce the risk of aerosolised NRL A patient can be scheduled as first on a pm list if there is an empty theatre available in the morning and there is sufficient staff available to prepare the theatre appropriately If all theatres are in use in the morning, sufficient preparation time will still be required pm, which may result in the afternoon list being delayed. Theatre preparation 2.20 A delegated scrub nurse/odp will be responsible for: Liaising with the surgeon to identify exact requirements Ensuring surgeon is aware that patient will be first on the list to facilitate compliance with theatre protocol Ensuring a scrub team has been allocated and informed at least 24hours in advance. Personnel must be kept to a minimum Ensuring that all necessary latex free equipment and drugs are available and in the department by 17.00hrs on the day prior to surgery (please see Appendix 1) Ensuring all relevant details are relayed to night staff 2.21 A delegated anaesthetic nurse/odp will be responsible for: Liaising with the delegated anaesthetist to identify exact requirements for both equipment and drugs Ensuring allocation of an anaesthetic team at least 24 hours prior to surgery Ensuring that all necessary latex free equipment and drugs are available and in the department by 17.00hrs on the day prior to surgery (please see Appendix 1) Checking that all equipment is present within the latex free trolley, that it has been damp dusted and placed in theatre at the appropriate time. Ensuring all relevant details are relayed to the night staff Contacting the ward to ensure that a red allergy band is in situ and that if the patient has their own Epi-pen, that it will accompany the patient to theatre 13 of 15 (Date for review 10 October 2020)

14 Ensuring that any relevant information is given to the porters when sending for the patient 2.22 The theatre must be damp dusted, appropriately prepared and left unoccupied for an absolute minimum of 1hour, preferably the night before if possible. This is to allow a reduction in the number of NRL particles in the air If the theatre is prepared the night before there is no need to repeat damp dusting on the morning of surgery Prior to damp dusting all members of the team will ensure they remove all jewellery and watches as per Trust policy HR18 (Uniform and Personal Appearance Policy). Plain wedding rings are permitted Non-elasticised surgeon s caps must be worn Latex free gloves must be worn. Marigold type and latex theatre gloves are not suitable A metal bowl and appropriate latex free cloth must be used for damp dusting Prior to commencement of cleaning and damp dusting the ventilation system in the designated theatre must be switched to operating conditions. A theatre with laminar air flow will be used when available All unnecessary equipment must be removed from theatre An appropriate anaesthetic machine must be used. It must be cleaned, damp dusted and the soda lime, CO2 sample line, T-piece connector, circuit, filter and suction renewed. It must then be covered in a clean cotton sheet The operating lights and all surfaces in theatre and all adjacent rooms must cleaned and damp dusted Immediately following damp dusting, if the operating table is not latex free, it should be covered in a latex free waterproof sheet then clean cotton sheet. These should be securely fastened to minimise the risk of the patient slipping during positioning The equipment required for the case should now be placed in theatre and covered in clean cotton sheets All equipment in adjacent rooms i.e. syringes, needles must be covered with a clean cotton sheet to prevent accidental use of the same. Any latex examination gloves should be removed Staff should then vacate the theatre to allow sufficient time for effective ventilation absolute minimum of 1 hour `Latex Allergy Alert` signs must be displayed at all entrances and exits of the designated theatre and all internal and external doors must be closed. Please see Appendix A `Theatre Preparation Form` will be completed and displayed on the external anaesthetic room doors. Please see Appendix 3. Perioperatively 2.38 Prior to sending for the patient the anaesthetic nurse/odp will: Ensure that the theatre is ready for use Ensure that the operating team is available and in the department 14 of 15 (Date for review 10 October 2020)

15 Telephone the ward to ensure the patient is ready and has a red allergy band in situ and Epi-pen if prescribed The patient should be placed on a canvas with a fully opened cotton sheet overlaying it to facilitate a safe transfer to theatre Ensure the porters collecting the patient have been informed of the patients status and that latex free gloves are available for them if necessary 2.39 On sending for the patient, the operating team will immediately proceed to theatre correctly attired and carefully remove the cotton sheeting, place it in plastic bags and remove from the theatre environment The operating table should have a replacement cotton sheet put on it and staff should ensure that all attachments/additions are secure and appropriately covered if not latex free At this stage all movement in and out of theatre should be avoided The patient will be checked in at theatre reception by the anaesthetic nurse/odp or theatre support worker and transferred to the designated theatre via the anaesthetic room The nurse will ensure the external anaesthetic room doors are closed before the internal doors are opened The patient will be anaesthetised in theatre. For further drug information please consultant Head of pharmacy. The red Latex Free Emergency Pack should be available in theatre Any equipment that is used during the procedure, where it has not been possible to verify its latex status, must be covered appropriately to avoid contact with the patient Depending on equipment, use either stockinette, pillow cases or sheets secured with latex free tape or for sterile equipment i.e. drill leads use sterile camera covers. Recovery 2.47 Patients with Type I allergy must be recovered in theatre and at least 2 members of the anaesthetic team should be present and remain with the patient throughout the recovery period Patients with Type IV or suspected latex allergy should be recovered in theatre if possible but may be recovered in a designated area of the recovery room if necessary The decision as to where to recover the patient lies with the clinicians in charge of the patients care If the patient is not to be recovered in theatre a designated area should be prepared in recovery An area should be screened off and all equipment containing latex should be removed. The area should be damp dusted and Latex Allergy Alert signs should be prominently displayed Ensure all gloves containing latex are removed and replaced with latex free alternatives All monitoring equipment should follow the patient through from theatre. If they are not compatible with the equipment in recovery alternatives must be correctly prepared The latex allergy trolley should follow the patient from theatre. 15 of 15 (Date for review 10 October 2020)