What Safety Precautions Should Be Implemented When a Client Reports an Allergy to Latex

Perioperative nurses should have a expert understanding of the science of latex allergies and how to protect patients and healthcare professionals (HCPs) when updating hospital policies and guidelines. (See What is latex?)

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Who is at take a chance for latex allergy?

Individuals who have been exposed to latex through a history of multiple surgeries confront a higher risk of developing a latex allergy. According to the American Latex Allergy Association (ALAA), children born with spina bifida are included in this loftier-risk group.ane In fact, approximately 68% of spina bifida patients have a sensitivity to latex.i Individuals built-in with long-term genitourinary abnormalities also may become sensitized to latex because of repeated urinary catheter usage.2 HCPs every bit well face an increased adventure because of repeated exposures to latex products. People with food allergies are another group who may notice themselves reacting with an allergic response to latex.3

The ALAA lists four foods with the highest risk of cross-reaction to latex equally banana, avocado, anecdote, and kiwi.iii A moderate take a chance of latex cross-sensitivity occurs with foods such as apples, carrots, celery, tomatoes, potatoes, papayas, and melons.3

Hazard factors for latex allergy too include individuals who have contact dermatitis of the hands, hives, and itching later wearing latex gloves or contact with a natural safety latex production.ii Individuals who develop generalized symptoms of rhinitis, hay fever, and asthma may have an undiagnosed allergy to latex proteins.2

Allergy testing tin can exist washed for individuals suspected of having a latex allergy. Diagnosis of latex allergy must exist done past a licensed medical professional person who obtains a medical history, performs a physical exam, and may utilize both skin testing and blood tests to diagnose a latex allergy.4

Pare prick testing for latex sensitization gives results inside 20-30 minutes and can detect latex antigens.5 Routinely, a skin prick test involves a tiny amount of allergen being dropped onto the skin (often the inner arm) and and so a lancet is used to introduce the allergen beneath the skin. A "positive" skin prick test would show an itchy, cherry wheal. A radioallergosorbent blood examination for latex allergy measures the immunoglobulin Eastward (IgE) antibody in blood. This test takes 7 to 14 days to deliver results. It might be utilized when an private suffers from eczema and skin issues or is unable to stop taking antihistamine medication before testing.6 (Meet History of latex allergy.)

Routes of exposure

Direct exposure to skin happens when HCPs clothing latex gloves. Airborne latex/cornstarch particles can be inhaled and cause respiratory reactions. Straight exposure to mucous membranes occurs when a patient has a latex urinary catheter inserted. If the patient is allergic to latex and the HCPs vesture latex gloves during surgery, the patient could suffer an internal exposure. Some other internal exposure would occur if a latex device such equally a bleed was placed during surgery.2

Latex allergy/anaphylaxis symptoms

Three types of reactions to natural latex rubber are: an irritant contact dermatitis, a type Iv (prison cell-mediated) hypersensitivity, and a type I (IgE-mediated) hypersensitivity reaction.eight

An irritant contact dermatitis is non an allowed organization response to an allergen and should not be called a latex allergy. An irritant contact dermatitis results from frequent manus washing, sweating, and irritation from pulverisation lubricants. This dermatitis can easily occur in HCPs. Symptoms of an irritant contact dermatitis include: itchy, dry out reddened, cracking skin. The symptoms practise not extend past the contact surface area. For instance, if surgical gloves are the irritant, the symptoms are just where the gloves touch on skin. Irritant dermatitis rarely results in papules, vesicles, or oozing skin.viii

Blazon 4 hypersensitivity (prison cell-mediated), also known as delayed cutaneous hypersensitivity, is an allergic response to an allergen. Type IV hypersensitivity is a delayed immune reaction mediated by T-cell lymphocytes. This dermatitis occurs with exposure to the chemicals used in manufacturing. The reaction may take 24-48 hours to develop.8 Symptoms include: erythema with papules, vesicles, and oozing skin areas. If an HCP repeatedly comes in contact with the allergen, this rash may become a chronic problem. This delayed allergic reaction may also occur in combination with a type I (IgE-mediated) reaction.8

Blazon I hypersensitivity (IgE-mediated) allergic reactions are life-threatening, potentially anaphylactic reactions. This reaction is triggered by pare or mucosal contact or inhalation of latex proteins. The trunk reacts to the latex allergen (usually within 1 hour of exposure) by releasing the antibody called IgE. Symptoms vary greatly, merely may include the following:

* pare symptoms: itching, redness, and urticaria

* oral symptoms: itching and swelling of lips and/or tongue

* pharynx symptoms: itching, scratchy throat, tightness, and hoarseness

* lung symptoms: cough, wheezing, difficulty breathing, and bronchospasm

* gastrointestinal symptoms: vomiting, diarrhea, and cramps

* cardiac symptoms: weak pulse, dizziness, and fainting.10

Treatment of latex allergy/anaphylaxis

Therapy is individualized for each of these conditions, just essentially involves avoidance of the offending source that causes the reaction.8

Individuals who have developed a blazon I hypersensitivity (IgE-mediated) response to natural rubber latex face a risk from airborne (aerosolized) exposure if latex glove cornstarch pulverisation is present in the environment.

Treatment of the patient in the OR with a blazon I hypersensitivity reaction/anaphylaxis involves immediate intervention. A severe acute reaction to latex should be treated as any other case of anaphylaxis. The initial steps include:

* stopping the procedure and removing all sources of latex in the immediate vicinity

* irrigating the area with copious amounts of sterile water

* securing the patient'south airway, resuscitating the patient equally necessary, and stabilizing cardiovascular function

* administering drugs for resuscitation and handling of anaphylaxis (typically epinephrine, diphenhydramine, ranitidine, dopamine, and glucocorticoids, as prescribed and indicated)

* changing gloves and instruments, one time the patient is stabilized and completing the surgery, avoiding all latex products.4

Providing a latex-safe environment

A preoperative patient assessment should include questions about latex allergy.2 Any patient who is latex allergic should be identified per the institution's allergy protocol. For example, a facility may document latex allergy in the following ways: in the patient's electronic health tape, with an allergy bracelet and with signage within the patient'south room. Communication regarding a patient'due south latex allergy begins with preadmission testing and continues throughout the patient's hospital experience. At each phase of intendance, latex-free supplies should be utilized to avoid an allergic reaction.

Working in a latex-safety surround

HCPs face up an increased take chances of developing a latex allergy. According to the U.S. Occupational Safety and Health Administration, eight% to 12% of HCPs are latex sensitive.16 Even so, the ALAA estimates this number to be closer to 17%.1 For some of those workers, the reaction involves a contact dermatitis. For other HCPs, exposure to latex triggers a type I hypersensitivity reaction.

HCPs are at increased take chances of developing a latex allergy if they frequently wear latex gloves. At-take a chance HCPs involve more than surgeons, lab technicians, and nurses. This group besides includes: housekeepers and laundry workers, gardeners and grounds keepers, pharmacists, nutrient service workers, and reprocessing workers in central supply. I way to subtract their exposure to latex is to switch to latex-costless gloves. In add-on to latex exam gloves, the glove inventory can include low powder, latex-costless test gloves made from nitrile, vinyl, neoprene, or polymer. The sterile gloves inventory can also be adjusted to include different types of gloves. Utilize of low-poly peptide, powder-free natural safe latex gloves or latex-gratuitous gloves tin can minimize latex exposure and the risk of reactions in both HCPs and patients. Quality-of-life scores improved for HCPs with latex allergies later on latex products were removed from the workplace.2 The ALAA provides a database of latex-costless medical devices at http://latexallergyresources.org/medical-products.

Updating a latex allergy policy and procedure

Perioperative nurses writing or updating a latex allergy policy and process should begin with the near recent edition of Clan of periOperative Registered Nurses' (AORN) Perioperative Standards and Recommended Practices. Several perioperative standards apply to the latex allergy issue. The 2014 edition includes a recommendation to provide a latex-safe surround for patients through each stage of the perioperative experience and for (HCPs).ii

Standard 1: Assessment: The perioperative nurse will appraise the patient for risk of latex allergy.17

During this stage, the perioperative nurse(s) conducts a preoperative interview with the patient and his or her back up person/south and a review of the patient's medical records. This assessment includes the patient'due south current wellness status (both concrete and psychological), electric current medical diagnoses, his or her needs, proposed surgical procedure, and the patient's medical history including allergies.

The perioperative nurse should identify high-risk groups: patients with repeated exposures to latex, a history of spina bifida, and a history of long-term urinary catheter care; those with multiple food allergies, asthma, and contact dermatitis; and patients who are exposed to latex through their work such as HCPs and those in the food service industry.

Questions almost potential latex allergy should be included in the preadmission testing interview. Broad screening questions near whatever allergies, including latex and food allergies, can be increasingly more than specific if the patient answers yes. During this procedure, the nursing staff should identify whatever patient recognized to be high adventure for latex allergy and, depending on hospital protocol, contact the admitting surgeon with this information. The surgeon may choose to proceed with surgery using latex-safe protocol or he may choose to have the patient tested for latex allergy.

The staff should also notify the OR of a patient'southward latex allergy and so latex-safe precautions will be used during preparations for that patient's surgery.

Standard 2: Diagnosis: The perioperative nurse will decide advisable nursing diagnosis based on patient's assessment.17

The perioperative nurse uses nursing diagnoses (intendance practice guidelines) to prioritize the patient's needs and individualize the care. If a patient says he or she has a latex allergy or answers the questions pointing toward a latex allergy, the perioperative nurse should recognize this patient faces a serious risk. An advisable nursing diagnosis would be "risk for allergic reaction to natural rubber latex."18 A latex-safe environment meets the goal for this patient's intendance. Environmental preparation includes latex-free supplies and equipment. After the 1997 FDA labeling directive, OR staff can check for latex content as they pick and open up packages. Scheduling patients with a latex allergy as first surgery of the 24-hour interval decreases the risks from airborne exposure. Latex-prophylactic last cleaning of the room should be done the night earlier the surgery. This practice and the air exchanges overnight should reduce the aerosolized latex particles. If scheduling the patient with a latex allergy as the first case is not possible, as much time as possible for air exchanges should be allowed.

Another recommended practice is that all personnel should remove latex gloves, wash their easily, and don latex-free gloves earlier inbound the room of a patient with a known or suspected latex sensitivity or allergy.2

The perioperative nurse should obtain signage to hang on the OR doors; this alerts personnel entering the room of latex-condom precautions. Postoperatively the patient with a latex allergy is transported to a latex-safety postanesthesia intendance surface area. At each phase of this patient's infirmary experience, staff caring for the patient communicates the latex allergy during handoff communication.

Standard 3: Outcome identification: The perioperative nurse identifies expected outcomes for each patient.17

The perioperative nurse uses the patient'south cess and nursing diagnoses to develop expected outcomes. The nurse utilizes ethical principles such as beneficence (doing practiced) when he or she recognizes the adventure of a latex allergic reaction and makes latex-safe care a priority.

Successful management of a patient with a latex allergy involves the absenteeism of signs and symptoms of either type IV (cell-mediated ) or a type I (IgE-mediated allergic) reaction.

Standard 4: Planning: The perioperative nurse plans individualized care for each patient.17

The perioperative nurse uses the cess of each patient, the appropriate nursing diagnoses, and expected outcomes to individualize the patient's intendance. Planning and preparing for the patient helps the perioperative staff reach a latex-safe environment. When notified of a patient's latex allergy, the perioperative staff assigned to that patient will begin removing latex products from the OR and replacing them with latex-safe products. For instance, latex-free nonsterile examination gloves are used by the circulating nurse and anesthesia care provider. According to the AORN recommended practices, if no latex-safe equipment is available, either eliminate the latex-containing equipment or embrace the equipment with a protective stockinette (for example, cover the BP cuff tubing) and keep it away from the patient'southward skin/mucous membranes to foreclose a reaction.2

Standard 5: Implementation: The perioperative nurse provides the planned care for each patient.17

The perioperative nurse will utilise the prior steps (cess, diagnoses, expected outcome, and planning) to individualize nursing interventions. Currently many latex-costless products tin be purchased to replace products that formerly contained latex. Supplies such every bit gloves, catheters, elastic wraps, and pulse oximetry probes can be purchased in latex-gratis form. The availability of latex-free products and labeling have made providing a latex-safe OR surround easier to attain.

According to AORN 2014 standards, rubber stoppers should not be removed from vials but rather punctured in one case as the medication/liquid is drawn up into a syringe or other receptacle and labeled.2 The nurse and anesthesia care provider will monitor the patient'due south responses throughout the operative procedure and watch for any signs and symptoms of latex allergic response and modify the plan of intendance as needed.

The AORN Implementation Standard 5b too includes coordination of care and promoting salubrious behaviors. Individuals diagnosed with a latex allergy and their families will benefit greatly from learning about latex allergy and how to avoid latex and an allergic reaction in the time to come.

Standard half dozen: Evaluation: The perioperative nurse evaluates the patient's status and determines whether the expected result was attained.17

The perioperative nurse will evaluate whether the steps of the nursing process kept the patient with a latex allergy safe by monitoring the patient'due south responses. If a type I response is going to occur, it ofttimes begins within the first hour of surgery. Documentation of latex-safe intendance will exist done and handoff communication volition include the patient's latex allergy hazard.

Moving frontward Today'south HCPs find themselves dealing with latex allergy issues. When HCPs understand the science of latex allergies, they can amend provide prophylactic care for their patients and themselves. Past utilizing the latest edition of the AORN Perioperative Standards and Recommended Practices, perioperative nurses can update their policy and apply this data to their practice. This cognition volition help maintain a safe surround for their patients, coworkers, and themselves.

What is latex?

Natural rubber latex comes from the rubber tree, Hevea brasiliensis. The rubber trees were originally found in Brazil, but the seeds were exported during the late 1800s. Today'south commercial natural safe primarily comes from Thailand, Indonesia, Malaysia, and Sri Lanka.vii

Over the centuries, workers learned to tap the rubber copse and collect sap without damaging trees. This poly peptide-rich liquid sap is then mixed with chemicals during the curing and manufacturing process.

According to the ALAA, the latex products made by a dipping and depression-temperature curing method (balloons, gloves, and condoms) go out the latex poly peptide intact and are most likely to crusade an allergic reaction.eight

Xiii allergenic proteins have been isolated from the H. brasiliensis tree to date. Any 1 of these proteins can cause an allergic response in susceptible people.9

Cornstarch is the second component of the latex allergy. Cornstarch pulverization is added to gloves making them easier to slip onto hands. However, the cornstarch powder absorbs latex proteins and when gloves are removed, this mixture of powder and latex becomes aerosolized latex proteins. People who are sensitive can suffer an allergic reaction when they exhale in these latex-cornstarch particles.two

History of latex allergy

Latex items have been traced back to 1600 BC by archaeologists, but gloves and other latex products did non get routinely used until the 1900s. Even as late as the mid-1800s, physicians did not routinely wear gloves. It was during this time that several physicians recognized that hand washing and wearing gloves could help forbid infections and decease.11

Physicians such as Ignaz Semmelweis and Joseph Lister outset recognized that hand washing helped protect patients from infections and helped to decrease patient mortality.12

During the 20th century, increasing numbers of HCPs began wearing latex gloves and utilizing latex products. Unfortunately, reports of reactions in the grade of irritant contact dermatitis also increased.4

With the identification of HIV in the 1980s, glove usage over again markedly increased. During the 1980s "universal precautions" became the phrase used to encourage HCPs to protect themselves and their patients past wearing gloves and middle protection.13 As latex gloves were worn in increasing numbers, the incidences of type I hypersensitivity (IgE-mediated) reactions also grew.14

In 1984, the beginning anaphylactic reaction traced to latex gloves was reported and HCPs began dealing with patients with latex allergies. Perioperative staff learned about the danger of latex allergy and they struggled to notice out whether products used in their ORs independent latex.xv

During the decade of 1987 through 1997, the FDA received reports of 1,700 severe reactions to latex and sixteen deaths. The deaths all occurred in 1989 among children with spina bifida. A reaction to latex cuffs used on the tip of barium enema catheters was attributed with causing the deaths.15

In 1997, the FDA required labeling of medical devices that contain natural rubber latex. Over the next few years, this labeling helped perioperative staff place latex in products and provide a latex-condom environment. This labeling helped subtract phone calls to vendors asking whether their products were manufactured to comprise latex.15

REFERENCES

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Source: https://www.nursingcenter.com/ce_articleprint?an=01271211-201501000-00004

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