Latex and Occupational Dermatitis Policy Incorporating Glove Selection DOCUMENT CONTROL: Version: 3 Ratified by: Risk Management Sub Group Date ratified: 17 July 2013 Name of originator/author: Health and Safety Lead Name of responsible Risk Management Sub Group committee/individual: Date issued: 23 July 2013 Review date: July 2016 Target Audience All staff
CONTENTS SECTION PAGE NO 1. INTRODUCTION 3 2. PURPOSE 4 3. SCOPE 4 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 5 5. PROCEDURE/IMPLEMENTATION 6 6. TRAINING IMPLICATIONS 7 7 MONITORING ARRANGEMENTS 7 8. EQUALITY IMPACT ASSESSMENT SCREENING 8.1 Privacy, Dignity and Respect 8.2 Mental Capacity Act 8 9. LINKS TO ANY ASSOCIATED DOCUMENTS 9 10. REFERENCES 9 11. APPENDICES 9 Page 2 of 11
1. INTRODUCTION 1.1 Allergy to latex protein has emerged as a significant health problem for hospital staff and patients due to the increased use of latex in clinical environments. Latex is used in the manufacture of many medical products commonly used in healthcare settings such as gloves, catheters, tubing, tourniquets, bandages and resuscitation equipment. 1.2 Latex is recognised as a sensitiser and a substance hazardous to health as defined by the Control of Substances Hazardous to Health 2002 (COSHH) Regulations. Associated health problems include Immediate Type 1 Latex Allergy and allergic contact dermatitis which will require Health Surveillance. 1.3 The Health and Safety Executive (HSE) consider that work related dermatitis is a significant cause of work related ill health particularly in the NHS. An independent survey conducted by the HSE suggested that up to 100,000 nurses consider themselves to have work related skin damage. This can include dermatitis due to known sensitisers such as latex as well as irritant dermatitis which can be caused by frequent hand washing and frequent contact with soaps, detergents and other agents. 1.4 The glove of first choice in the Trust will be non-latex. The reasons staff need to wear gloves is: To provide a protective barrier To prevent contamination of the hands To prevent transmission of disease To protect against harmful substances 1.5 As a result of knowledge and developments connected with the use of latex gloves in consultation with the Trust Infection Prevention and Control Team a review was undertaken into the type and range of Trust activities where glove use occurs. As a result a decision was made to cease the use of latex gloves in the Trust. 1.6 The Purchasing (Procurement) Department has therefore placed a block to prevent the ordering of any supplies of latex gloves unless there is a justified clinical requirement. See 1.7. 1.7 In exceptional circumstances, where there is clinical requirement to use latex gloves, the use of such gloves must be justified through the risk assessment process; the risk of contracting dermatitis must also be assessed as part of this COSHH risk assessment process. Any latex gloves used must be low protein and un-powdered. Staff at risk must be identified and placed under appropriate health surveillance as outlined in this policy. 1.8 Definitions: Latex (Natural Rubber Latex) is the fluid contained beneath the bark of the rubber tree. The latex collected from the rubber tree is Page 3 of 11
composed of rubber particles, protein, water and other substances. Certain types of protein in latex products are responsible for causing allergic reactions Type 1 latex allergy is an immediate hypersensitivity reaction characterised by urticaria, conjunctivitis, rhinitis, asthma and occasionally difficulty in breathing and life threatening anaphylaxis Type IV latex allergy is characterised by an eczematous rash often developing hours after exposure. It may be due to latex proteins or chemical residues added in latex processing. This reaction predisposes individuals to developing Type 1 allergy Powdered and powder free latex gloves. Powder is added to the moulds for easy removal of the gloves during the manufacturing process. Washing the powder away removes some of the proteins that causes latex allergy. Powder when present in the gloves can absorb the protein and aerosolise it during donning and thereby increase the absorption in a person s airway. Therefore, washed gloves without powder are much safer 2. PURPOSE 2.1 The purpose of this policy is establish procedures to: Minimise the risk to staff of latex allergy, allergy to chemicals in gloves, soaps and disinfectants used in healthcare provision Support staff with latex allergy and dermatitis with information and a safer working environment In exceptional circumstances where there is a requirement to use latex gloves have a skin and health and surveillance programme in place to recognise latex allergy early among staff and report and control harm relating to dermatitis Promote the appropriate choice and use of gloves, detergents, disinfectants and good hand hygiene to reduce dermatitis and the incidence of healthcare acquired infections to staff and patients To provide such training and education to link all applicable staff in the recognition of dermatitis and other skin sensitisers as appropriate 3. SCOPE 3.1 This policy is applicable to all staff who in the course of their work are required to wear gloves to undertake particular and necessary types of activities. The policy also supports the Trust Infection Prevention and Control arrangements and associated policies. 3.2 In clinical settings gloves are classed as Medical Devices and usually deemed low risk. All procedures relating to gloves should therefore be undertaken in line with the requirements set out in the Trust Medical Devices Management Policy Page 4 of 11
4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 The Chief Executive has overall responsibility to provide a safe working environment ensuring compliance with the requirements of the Health and Safety at Work etc. 1974, relevant regulations and the requirements of this policy. 4.2 All Directors have corporate responsibility to provide a safe working environment and to ensure adequate arrangements and resources are provided to implement the requirements of this policy and that all Safety Regulations, Approved Codes of Practice and any associated safe systems of work and ensure all are applied within their respective Directorate. 4.3 Assistant Directors / Business Divisions / Designated Managers / Heads of Departments / Matrons must ensure those activities which require the use of gloves are identified through risk assessment. 4.3.1 Managing all procedures relating to glove use in line with the requirements set out in the Medical Devices Management Policy, Hand Hygiene Policy and the Standard Infection, Prevention and Control Precautions Policy 4.3.2 Ensuring that staff in areas where glove use is required are aware of and comply with the Trust requirements for glove use through local induction, information, instruction and training, supervision and audit. 4.3.3 Maintaining adequate supplies of the type of gloves required which are appropriate to the tasks being carried out identified through risk assessment (see Appendix 2). 4.3.4 Ensuring staff are aware of the hazards of latex sensitisation based on the information contained within this policy and glove use (see Appendix 1) 4.3.5 Contacting the Trust Occupational Health Provider for advice as required or referral of staff should any allergic reactions occur relating to glove use and updating staff records accordingly. 4.4. Staff are responsible for complying with this policy and wearing the correct glove appropriate to the task being carried out and in line with any risk assessment control measures. 4.4.1 Avoiding the use of gloves where risk assessment control measures has identified gloves are not required e.g. no contact with blood / body fluids bed making. 4.4.2 Carrying out strict and proper hand washing techniques before / after all procedures. Gloves are not a substitute for good hand hygiene. 4.4.3 Informing managers if any sensitivity is being experienced or becoming sensitive to the use of gloves so that advice can be sought from Occupational Health and / or the staff members GP. Page 5 of 11
4.4.4 Reporting any reactions / incidents related to glove use via the Trust Safeguard IR1 Incident Reporting System. 4.5 The Purchasing (procurement) Department is responsible for ensuring a block on any orders for latex gloves unless for exceptional circumstances where there is a clinical need and notifying the relevant department of any orders which have been raised for latex gloves. 5. PROCEDURE/IMPLEMENTATION 5.1 Prior to any intervention, procedure or task the choice of glove should be made as result of risk assessment including the risk to the patient and consideration given to the following factors: The likelihood of exposure to blood, bodily fluids, secretions and excretions The potential for contact with broken skin Potential infectious agents The length of the procedure Whether or not a sterile glove is required Sensitisation of the patient / health care worker Contact with chemicals or drugs The need for dexterity and tactility Whether latex gloves is required or a safer alternative could be used 5.2 Based on the risk assessments factors and the following guidance the appropriate type of glove can be selected for the particular intervention, procedure or task: Glove selection in general clinical settings- Vinyl examination gloves should not be used in a clinical setting Non-sterile nitrile glove should be worn for procedures where there is risk of exposure to blood or body fluids Sterile nitrile gloves should be used for procedures where a sterile field and high barrier protection is required Further information on the types of gloves available is detailed in Appendix 1. 5.3 All gloves are single use only and as such must be discarded after use. Gloves must not be washed between being used as damage may go undetected. Alcohol hand gel / rub must not be used to decontaminate gloves. 5.4 All gloves have a use by date and this must be checked prior to the use of gloves. Gloves that have gone beyond their use be date must be disposed of and not used. Page 6 of 11
6. TRAINING IMPLICATIONS 6.1 There are no specific training needs in relation to this policy as the Trust Infection Prevention and Control Awareness and Hand Hygiene training include the correct use of gloves. 6.2 Records are also maintained of all Trust staff attending Hand Hygiene, glove use, universal precautions and skin care. 6.3 As a Trust policy all staff need to be aware of the key points that the policy covers. Staff can be made aware through: A number of a variety of means such as; Team Brief Trust wide mail drop Team meetings One to one meetings / Supervision Posters CPD sessions Weekly Newsletter Trust wide email Special meetings Group supervision Practice Development Days Local Induction 7. MONITORING ARRANGEMENTS Area for Monitoring How Who by Reported to Frequency The correct use of gloves Non Latex glove purchasing Observation & audit Monitoring of Orders All designated managers & Infection Prevention and Control Team Purchasing (procurement) Department Trust Infection Prevention and Control Team All designated managers / Heads of Departments Random and as directed by the Trust Infection Prevention and Control Team On receipt of latex gloves orders Page 7 of 11
8. EQUALITY IMPACT ASSESSMENT SCREENING - The completed Equality Impact Assessment for this Policy has been published on the Equality and Diversity webpage of the RDaSH website click here 8.1 Privacy, Dignity and Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care around the individual, not just clinically but in terms of dignity and respect. Indicate how this will be met As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided). 8.2 Mental Capacity Act Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the Court Indicate How This Will Be Achieved. All individuals involved in the implementation of this policy should do so in accordance with the Guiding Principles of the Mental Capacity Act 2005. (Section 1) Therefore, the Trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible. Page 8 of 11
9. LINKS TO ANY ASSOCIATED DOCUMENTS 10 REFERENCES Standard Infection and Control Precautions Policy Hand Hygiene Policy Medical Devices and Management Policy Control of Substances Hazardous to Health Policy First Aid Policy Personal Protection Equipment Policy Incident Reporting Policy Ordering and Receipting of Goods and Services Procedure This policy and procedures are based on the requirements of: The Health and Safety at Work Act The Management of Health and Safety Regulations The Control of Substances Hazardous to Health Regulations The Reporting of Injuries Diseases and Dangerous Occurrence Regulations Latex sensitivity in healthcare settings MDADB 9601 Medical Device Agency Occupational aspects of management / national guideline Latex Allergy Royal College of Physicians 2008 Medical aspects of occupational skin disease guidance note MS24 2 nd Edition HSE website 11 APPENDICES Appendix 1 Glove Materials Appendix 2 Glove Use Page 9 of 11
Appendix 1 GLOVE MATERIALS NITRILE Nitrile is the accepted material choice for gloves used in healthcare due to the strength barrier properties. A concern for many years has been the risk if impaired dexterity due to muscle fatigue where gloves are worn for a prolonged period of time but the stretch ability of these gloves has continued to be improved by manufacturers. Residual accelerants in nitrile may also cause Type IV allergic response in some wearers. LATEX only to be used in the Trust in exceptional circumstances Natural rubber latex (NRL) provides excellent protection against blood borne viruses which for many years has made it the material of choice for gloves when dealing with blood and blood stained body fluids. The use of latex gloves in healthcare and therefore staff exposure to NRL has increased since the mid 1980 s With this increased exposure to the hazard associated with NRL have also increased. Although allergy to natural NRL remains rare it can produce reactions ranging from non-allergenic irritation to allergy which is key disadvantage. There will be areas of healthcare where it continues to be appropriate to use NRL gloves and mainly be where invasive surgery takes place. In such circumstances a risk assessment would be required on the choice of glove. VINYL Vinyl gloves are looser fitting that either Nitrile or NRL but due to degradation with use they have a higher degree of leakage rate and therefore skin contamination. It should also be noted disposal of vinyl gloves by incineration can lead to pollution through release of toxins. POLYTHENE Only used in catering GLOVE SELECTION Glove selection is to decided based on risk assessment of the activities to be undertaken and therefore the correct choice of glove can be decided. Page 10 of 11
Appendix 2 GLOVE USE LATEX GLOVES ARE NOT USED IN THE TRUST NITRILE (synthetic glove) Sterile: All aseptic procedures potential exposure to blood or body fluids and Sterile pharmaceuticals Preparations Non Sterile: Non aseptic procedures with with a high risk of exposure to blood or body fluids. Procedures involving sharps Handling cytotoxic materials Handling chemicals and disinfectants Aseptic non touch technique procedures VINYL (non-sterile): Tasks which are short and non-manipulative Tasks which will not pull or twist the glove Tasks where contact with blood or body fluids is unlikely Cleaning with detergent POLYTHENE Only used in catering Page 11 of 11