Policy No: RM15 Version: 5.0 Name of Policy: Latex Policy Effective From: 19/06/2014 Date Ratified 15/05/2014 Ratified Health & Safety Committee Review Date 01/05/2016 Sponsor Director of Estates and Facilities Expiry Date 14/05/2017 Withdrawn Date This policy supersedes all previous issues. Latex Policy v5
Version Release Author/Review er Version Control Ratified by/authorised by 1.0 Dec 1998 Trust Policy Forum 1.1 Oct 2002 Risk Management Committee 2.0 March 2006 Health and Safety Committee Date 09/12/1998 04/10/2002 14/03/2006 Changes (Please identify page no.) 3.0 30/09/2009 J Hill Health and Safety Committee 4.0 01/08/2012 C. Traill Health and Safety Committee 5.0 19/06/2014 C. Traill Health and Safety Committee 14/07/2009 3,4,5,6,7,8,10,11 10/07/2012 3,4,5,6,7,8,9, 15/05/2014 Latex Policy v5 2
Contents Section Page 1 Introduction... 4 2 Policy scope... 4 3 Aim of policy... 4 4 Duties (Roles and responsibilities)... 4 5 Definitions... 6 6 Main Body of the policy... 6 6.1 Routes of Exposure to Latex... 6 6.2 Identifying Patients at Risk... 7 6.3 Identifying Staff at Risk... 7 6.4 Identifying Individuals with Latex Sensitisation... 7 6.5 High Risk Individuals... 7 6.6 Reporting of Incidents Involving Latex... 8 6.7 Maternity... 8 6.8 Latex Gloves... 8 7 Training... 9 8 Equality and diversity... 9 9 Monitoring compliance with the policy... 9 10 Consultation and review... 9 11 Implementation of policy (including raising awareness)... 10 12 References... 10 13 Associated documentation (policies)... 10 Appendices Appendix 1... 11 Appendix 2... 13 Appendix 3... 14 Latex Policy v5 3
GATESHEAD HEALTH NHS FOUNDATION TRUST LATEX POLICY 1 Introduction Natural rubber latex (NRL) is found in the healthcare setting in disposable gloves, medical devices and equipment, and in many household or clothing items such as elasticated cuffs. Allergy associated with latex can result from contact with the residue of chemicals used in the manufacture of latex products and presents as a red scaly rash (allergic contact dermatitis). Contact with natural rubber latex itself can cause a more immediate reaction with symptoms such as local or generalised urticaria ('hives'), swelling, rhinitis, conjunctivitis or asthma. In rare cases it can lead to life threatening respiratory difficulties and anaphylactic shock. Contact with latex may be direct e.g. skin contact or indirect e.g. exposure to airborne particles. Some tropical fruits are also known to cause a pre disposing sensitivity such as banana or kiwi fruit. The National Patient Safety Agency (NPSA) and the Health and Safety Executive (HSE) require Trusts to protect the health of their staff and patients with respect to exposure to natural rubber latex. 2 Policy Scope This policy is trust wide and applies to all members of staff employed/working within Gateshead Health NHS Foundation Trust. It relates to the expected practices involved in the planning, admission, care and discharge of patients with latex alergies, and the protection of staff with latex allergies. 3 Aim of the Policy The aim of the policy is to ensure safe treatment for patients and a safe environment for staff by reducing the risk of exposure of sensitized individuals to NRL. 4 Duties (Roles and responsibilities) 4.1 Trust Board The Trust Board is responsible for ensuring the Trust meets its legal obligations under Health & Safety legislation. The Board will ensure, so far as is reasonably practicable, that there are suitable and sufficient funds and resources available to meet the requirements of the legislation and to enhance the health of staff at work. 4.2 Chief Executive The Chief Executive is responsible to the Trust Board for the effective implementation of the Latex Policy 4.3 Director of Nursing and Midwifery The Director of Nursing and Midwifery is responsible to the Chief Executive for the overall co ordination and implementation of the policy within Gateshead Health NHS Foundation Trust. Latex Policy v5 4
4.3 Divisional Directors and Divisional Managers The Divisional Directors and Division Managers have a joint responsibility to ensure this policy is implemented within the Division. 4.4 Matrons or equivalent manager Matrons or equivalent manager will take responsibility for ensuring this policy is implemented locally within their area of responsibility; and for Identifying Latex allergy risks within wards and departments. Where a case of Latex allergy is positively identified, responsible for carrying out a full risk assessment of the environment of that staff member/patient. Receiving, investigating and initiating appropriate action for the management of Latex allergy. Liaison with other departments, the Health and Safety Advisor and the Occupational Health Department in reporting incidents of latex allergy, using the Datix reporting system. A proactive approach to recognising potential Latex allergy in staff and referring them to the Occupational Health Department. A proactive approach to recognising Latex allergy in patients and ensuring that this is recorded and communicated to other healthcare professionals as appropriate. Maintaining a list of all Latex sensitive staff members. Ensuring that Latex free gloves are always available, and that staff are aware of all Latex free products. 4.5 Occupational Health Department The Occupational Health Department are ultimately responsible for advising employees who have developed an allergy to NRL about working safely within the workplace and for ensuring that clear procedures are in place for the following: Pre employment health checks for new staff Assessment and confirmation of Latex allergy where this is suspected. Monitoring of staff with confirmed Latex allergy. Maintenance of Trust Latex Allergy Register Recording of statistical information with regard to latex allergy monitoring to be included in the Occupational Health Service Annual Report. The Occupational Health Department will provide any further advice or information to managers regarding, risk assessment, Latex allergy, or non latex products as necessary. 4.6 Infection Control Infection Control will liaise with Occupational Health and Members of staff regarding appropriate use of gloves and products in relation to protection against blood borne viruses, other infectious diseases and chemicals, and educate employees regarding basic hand hygiene. 4.7 Supplies The supplies department will ensure that all stock items are purchased in compliance with the Latex Policy. Non Stock items will be jointly assessed with Latex Policy v5 5
appropriate specialist input prior to purchase and where ever possible a Latex free product will be chosen. The NHS Supply Chain web site can be accessed for information. 4.8 Staff All employees have a duty to co operate with the Trust management in achieving compliance with this policy and for reporting all incidents connected with Latex allergy. 5 Definitions Staff should comply with the Trust's policies for glove usage see RM 17 Personal Protective Equipment at Work, IC02 Personal Protective Equipment in Clinical Practice and IC03 Standard Precautions for the Prevention and Control of Infection Where a member of staff experiences a suspected reaction to Latex they should inform their manager, complete an Datix accident/incident form and contact the Occupational Health Department for advice. Where a patient experiences a reaction to Latex, a Datix accident/incident form should be completed by a member of staff. Natural rubber latex (NRL) Natural rubber latex (NRL) proteins have the potential to cause asthma and urticaria. More serious allergic reactions, such as anaphylaxis, are also possible. NRL proteins are substances hazardous to health under COSHH (Control of Substances Hazardous to Health Regulations). Therefore, COSHH and the COSHH ACOP (Approved Code of Practice) apply, including the specific requirements for the control of substances that cause occupational asthma. Latex free is the term used to describe products that are not manufactured from natural rubber latex (NRL). Latex safe is the term used to describe an environment that minimises the risk of a reaction occurring in sensitised or allergic individuals. This is achieved by removing the NRL products that are most likely to cause a reaction. 6 Implementation of the policy 6.1 Routes of Exposure to Latex The potential routes of exposure to latex allergens are: 1. Cutaneous via gloves, tapes, masks, urine drainage bags, elastic bands; 2. Mucous membranes via products used in dentistry, anaesthesia and rectal examinations, including eye and ear droppers; 3. Intra uterine devices 4. Inhalation via aerosolisation of glove powder; 5. Internal tissue via latex products used in surgery; Latex Policy v5 6
Intravascular via latex products used in intravascular devices (e.g., IV cannulae) or devices used to deliver IV fluids and injectables (syringes and IV administration sets). 6.2 Identifying Patients at Risk pre admission/on admission assessment During pre admission or admission assessment, patients will be asked specific questions to identify previous reactions, known or suspected latex allergy and managed in accordance with the procedure for managing sensitised patients (Appendix1). This includes emergency admissions to A&E, MAU, etc. Where patients are unable to provide this information NoK or hospital records will be used to try to ascertain this information. This process will be supported by the Positive Patient ID and Theatre Management Information Systems. 6.3 Identifying Staff at Risk pre employment checks The Occupational Health Department carry out pre employment checks with staff and ask specific questions to identify previous reactions, known or suspected Latex allergy. Where an individual is know or suspected to be at risk a specific risk assessment will be completed for the individual by their line manager, and measures introduced where necessary to protect them from the risk of Latex exposure. The Occupational Health Department will provide any further advice or information to managers regarding, risk assessment, Latex allergy, or non latex products as necessary. 6.4 Identifying Individuals with Latex Sensitisation Exposure may cause a variety of allergic reactions ranging from minor skin irritations to anaphylactic shock. Whilst attention has mainly been directed towards gloves, the risk of allergic reaction within the healthcare setting exists with other products, medical devices and also many domestic items. Early identification of Latex sensitivity is important, therefore any member of staff showing signs of a reaction to Latex products either at home or at work, should discontinue contact and report to their manager who will seek advice from the Occupational Health Department. 6.5 High Risk Individuals This is not an exhaustive list and guidance can be found on the HSE web site. An atopic individual eg hay fever, asthma, eczema Those with multiple allergies, especially to fruit eg banana, kiwi fruit, avocado and nuts/chestnuts. Where multiple invasive procedures have been performed e.g. Children with Spina Bifida or urological abnormalities. Previous reaction to latex Unconscious Patients Latex Policy v5 7
Patients with poor or low communications e.g. medical or cognitive conditions. See Appendix 1 for the Management of Sensitised Patients. See Appendix 2 for the Management of Sensitised Staff See Appendix 3 for the Patient Transfer Procedure 6.6 Reporting of incidents involving Latex All incidents involving Latex, or suspected of being a result of Latex exposure, must be reported on Datix to enable monitoring and tracking of incidents. Under the requirements of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR), the Trust has to report incidents of occupational dermatitis and asthma attributable to latex, to the appropriate Enforcing Authority (ie the Health and Safety Executive or the local authority) and keep a record of any such incidents. There is also a voluntary scheme in place for reporting cases of latex sensitisation, both to staff and patients, to the Medical Devices Agency (MDA). The MDA is an Executive Agency of the Department of Health. 6.7 Maternity Maternity has been designated a Latex Free area and all Latex products have been replaced with non latex. Where pregnant patients are admitted to Main Theatre the Midwife from Maternity who attends the patient will ensure that any items used that are liable to be transferred to Maternity with the patient will be Latex free. 6.8 Latex Gloves The Health and Safety Executive issued guidance on the use of Latex gloves. Because of the high risk of allergy from the use of Latex gloves and the possible serious health consequences the use of Latex should be limited to circumstances where suitable substitutes are not available. At present there is not a total ban on the use of Latex gloves but there is a need to justify use based on risk assessment. To comply with the legal regulations the assessment should consider: Eliminating the risk where appropriate gloves should only be worn where there is a risk of infection. Substituting to other glove materials where appropriate nitrile, vinyl, synthetic. Limiting exposure HSE s policy for this: Single use, disposable natural rubber latex gloves may be used where a risk assessment has identified them as necessary. When they are used they must be low protein and powder free. Latex Policy v5 8
7 Training Occupational Health Staff who might be involved in assessing employees who have, or might have a Latex allergy, will be suitably qualified and trained. Information for staff on the signs and symptoms of Latex allergy is available on the Occupational Health Intranet site, and Occupational Health can provide training to staff if necessary. 8 Equality and Diversity The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds. For example children with Spina Bifida and individuals with cognitive conditions who are in the high risk group for NRL allergy, will be provided protection through implementation of the policy. 9 Process(s) for monitoring compliance with the policy Standard / process / issue NHSLA criterion 4 Standard 1 Risk Management Process Risk of people with a Latex allergy being exposed to products containing Latex Monitoring and audit Method By Committee Frequency Report of Incidents of reactions to Latex involving staff Reports of Incidents of reactions to Latex involving Patients Occ Health Health and Safety Advisor H&S Committee H&S Committee Annually Annually NB Any incidents involving latex should be investigated in accordance with the RM04 Trust s Incident Reporting and Investigation Policy and where necessary a Root Cause Analysis (RCA) undertaken. 10 Consultation and review The policy has been reviewed with comments being sought from Risk Managers, the Occupational Health Department, Theatre Staff, Supplies, Maternity Staff and staff side Health and Safety Reps. The Health and Safety Committee were involved in the review of the previous versions of the policy. Latex Policy v5 9
11 Policy implementation (including awareness raising) This policy will be implemented in accordance with policy OP27 Policy for the development, management and authorisation of policies and procedures 12 References The Personal Protective Equipment at Work Regulations 1992 The Control of Substances Hazardous to Health Regulations 2002 National Patient Safety Agency (2005) Patient safety information 08, Protecting people with allergy associated with latex. Brigden, R 1998. Operating Department Practice. Edinburgh: Churchill Livingstone. Medical Devices Agency. Latex sensitisation in the Health Care Setting (Use of Latex Gloves) Device Bulletin, May 1996. HSE Publication INDG30 September 2011 13 Associated documentation IC02 Personal Protective Equipment in Clinical Practice IC03 Standard Precautions for the Prevention and Control of Infection by Infection Control RM02 Health and Safety Policy RM08 COSHH Policy RM17 Personal Protective Equipment at Work Latex Policy v5 10
Appendix 1 MANAGEMENT OF SENSITISED PATIENTS 1 Staff must be aware of the potential dangers posed by natural rubber latex devices to the delivery of care of patients in the health setting. This is particularly pertinent to patients in the identified high risk groups as in section 6.5 above. 2 Prior to treatment in hospital or community, known allergies should be identified and recorded prominently, by the identifying professional, in the patients medical records, with specific reference to latex allergy, especially for those patients undergoing treatment or procedures where contact with latex products is possible. 3 Specific questions should include: (a) (b) (c) (d) (e) (f) Past medical history of reactions to any rubber products and associated problems. Past medical history of allergic reactions or intolerance to kiwi fruit, chestnuts, peanuts, bananas or avocados. Previous history of multiple surgical procedures or frequent use of latex products as part of their health care. Current or history of eczema, hayfever, asthma. Occupational history of rubber contact. Family history of atopy. 4 Where latex allergy is suspected further investigation may be necessary for confirmation eg. referral to dermatologist, immunology, dental hospital, specialist allergy clinics. 5 Where there is evidence of high risk or some reaction in the past a risk assessment must be undertaken of the patient that is aimed at managing the potential risk for a full reaction. 6 Patients diagnosed as having a latex allergy should be provided with written advice on latex. The patient's notes should be clearly marked "LATEX RUBBER ALLERGY". 7 Patients known or suspected of having a latex sensitisation must wear the authorised red allergy tab band, marked accordingly. 8 Patients with a latex sensitisation should where possible, be admitted to a single room, with the bed and room clearly marked "Latex Free". To minimise the risk of exposure to latex products or airborne latex allergens, components and aids, as far as possible, should also be latex free or covered to prevent contact with the patient. 9 Cardiac Arrest The tourniquet and pink tape used are considered minimal risk during a cardiac arrest. Latex Policy v5 11
10 For all elective patients of all specialties the latex allergy identification procedures should be incorporated at their pre assessment visit eg Theatres/Endoscopy and Diagnostic Imaging, and appropriate plans/risk assessments performed well in advance of the surgery/anaesthetic procedure and this should be logged on all information management systems being used eg Positive Patient ID and ORMIS. 11 Patients should be scheduled first on lists in order to minimise their exposure to airborne latex allergens. Latex free gloves should be used and steps taken to ensure that patients do not come in contact with products containing latex. 12 All procedures conducted on patients with acute latex sensitisation should be performed in a setting in which anaphylaxis can be treated. 13 Any allergic reaction to latex must be reported by the doctor/nurse in charge via the datix incident reporting system 14 Patients with confirmed latex allergy should be reminded to inform doctors, dentists or other health professionals of this allergy before any examinations or procedures are conducted. 15 If drugs are being prescribed for patients, the prescriptions should indicate "LATEX ALLERGY" as some medications include latex additives. Best practice would be to contact your ward or department Pharmacist. Safety information is available on the Internet in particular on the Health and Safety Executive (HSE) and National Patient Safety Agency (NPSA) web pages www.hse.gov.uk/healthservices/latex/index.htm and www.npsa.nhs.uk respectively. Latex Policy v5 12
Appendix 2 MANAGEMENT OF SENSITISED STAFF 1 Staff working in high latex exposure areas, who are known to be atopic or who have food allergies should be particularly cautious when contact is made with latex products. 2 Early identification of latex sensitivity is important, therefore any member of staff showing signs of a reaction to latex products either at home or at work, should discontinue contact and report to their manager who will seek advice from the Occupational Health Department. 3 If latex sensitisation is suspected a referral will be made to a dermatologist for confirmation of latex allergy. 4 Depending on the severity of allergy, the member of staff and management will be advised accordingly by the Occupational Health Department as to future management. 5 Members of staff diagnosed as having a latex allergy should be provided with written advice on occurrence of latex in the work and home environment) by the Occupational Health Department and their Occupational Health records marked "LATEX RUBBER ALLERGY" accordingly. Any allergic reaction to latex must be reported by the manager or member of staff on an incident form. Latex Policy v5 13
Appendix 3 PATIENT TRANSFER PROCEDURE Transfer of patients to other departments the transfer trolley should be washed and covered with sheeting and labelled LATEX FREE and should be used only by the named patient. The environment into which the patient is transferred should be latex free as far as possible. Where this is not possible, all necessary precautions should be taken to prevent contact between the patient and natural rubber latex. PATIENT CARE THEATRE Theatre Trolleys are latex free. Beds brought to theatre should be thoroughly washed, covered and labelled "LATEX FREE" and used only by the named patient. If staff have previously been in contact with latex products, hands should be thoroughly washed before handling the patient. (1) Anaesthetic care many anaesthetic products are made form latex, therefore each product should be individually checked for its latex content, and no known latex products used. The Anaesthetic Department should have a detailed procedure identifying suitable latex free products and guidance for handling the patient in a latex free environment. Where there is doubt about the latex content of a product, check with the supplies department. (2) Preparing the operating theatre an operating theatre with lamina air flow will help to keep allergenic particles away from the operative site, but there should still be strict cleaning prior to any operation on an allergic patient. A similar procedure should be adopted as in 1 above to ensure, as far as possible, a latex free environment. Non latex gloves should be used by the entire surgical team (surgeon s assistants, scrub nurses, circulating nurses and anaesthetic staff). (3) The following steps should be taken to provide a low hazard environment for the latex sensitive patient: (a) (b) (c) (d) (e) (f) Schedule the patient first on the list to avoid latex allergens which may persist in the air of the operating theatre for at least 1 hour following the use of latex gloves. Place a warning sign on the operating theatre door. All documentation belonging to the patient should be clearly marked LATEX ALLERGY. All non essential equipment and personnel should be removed from the theatre. All latex gloves should be removed from the theatre and adjacent rooms to avoid accidental use. The operating table mattress should be cleaned and securely covered to prevent contact with any latex components. Latex Policy v5 14
(g) (h) (i) Staff should wash or shower to remove residue of latex coatings from the skin and should change into clean theatre clothing. Particular attention should be given to the possibility of hand transfer of latex coatings. Staff should not wear latex gloves during the preparation of the theatre. Recovery Recovery should be informed in sufficient time prior to the patient being sent to them so that non essential equipment and latex products can be removed and should have been thoroughly cleaned before the patient is placed in the environment. The continual use of non latex products in the recovery area is essential. Latex Policy v5 15