The gloves are off in the war on latex.
Amid mounting concern about allergic reactions, many hospitals are trying to virtually eliminate the rubber-based material, which has long been used to make surgical gloves, catheters and thousands of other medical products.
But getting rid of latex is proving difficult for hospitals, and patients need to remain vigilant. Many hospitals have stopped using the main culprit in allergic reactions -- heavily powdered gloves that release a latex protein into the air when removed. But latex is found in so many products, including adhesive tapes, wheelchair tires, syringes and rubber vial stoppers, that it's easy to miss items that contain trace amounts. And some of the substitutes drive up costs or are less effective, posing new risks for patients, hospitals say.
The push to cut out latex has accelerated in the past year. The U.S. military is calling for latex-free products in a number of new contracts for its medical facilities, and Premier Inc., a large hospital purchasing cooperative, is issuing the group-purchasing industry's most comprehensive latex-free catalog, featuring 16,675 items, ranging from urinary-tract catheters to blood-pressure cuffs, suction devices and syringes. "Hospitals need to know the content of the products they use so they can make sure patients and staff are safe," says Gina Pugliese, a nurse who is vice president of Premier's Safety Institute.
Johns Hopkins Hospital last month announced plans to end the use of all latex gloves and almost all latex medical products. For surgery, it has switched to sterile neoprene and polyisoprene gloves, which cost 30 percent to 50 percent more, but which surgeons have found to have the same sensitivity and fit as latex. "There have been questions about whether the increased cost is worth the benefit," says Robert Hamilton, a professor of medicine and pathology. "But we are erring on the side of conservatism, and the answer we've come to is yes."
Johns Hopkins is also working with Maricopa, Ariz.-based Yulex Inc., which has the exclusive license on a patent from the U.S. Department of Agriculture to make a latex substitute from guayule, a desert plant in the Southwest that doesn't contain the allergy-triggering protein. Yulex Chief Executive Jeffrey Martin says the company has struck agreements with medical-device companies to develop products such as gloves, catheters and condoms and is now in the process of seeking Food and Drug Administration approval for such devices.
Though latex has been around for more than a century, its use exploded in the 1980s with the AIDS epidemic, when billions of surgical and exam gloves were produced to protect health-care workers. Strong enough to hold up after hours of surgery, latex offered the best protection against blood-borne diseases such as AIDS.
But as the gloves' use rose, so did the rate of allergic reactions, as some people who came into prolonged or repeated contact with latex became sensitized to it. A protein in the tropical rubber trees used to make latex has also been shown to trigger allergic reactions in as many as one in 10 people. By some estimates, 15 percent of medical workers are allergic to latex.
Patients, too, are affected, especially those who have been exposed through multiple surgeries. Children and infants can develop a latex allergy at a hospital and then face a lifetime of avoiding the material. Allergic reactions can be mild, such as a skin rash or irritation, but can also include respiratory distress and the severe reaction known as anaphylactic shock, which can lead to a life-threatening drop in blood pressure and death.
Like some other allergens, such as peanuts, latex can spark a reaction even in tiny amounts. Severely allergic people can react, for instance, to blowing up a latex balloon, having a latex dental dam put on for a root canal, or getting injected with a syringe that has punctured a latex port on a medication vial.
Some hospitals, like Vanderbilt University Medical Center, which says it's about 90 percent "latex-safe," have long had a policy of using use latex-free supplies when possible. But eliminating latex completely is a complicated task. The Food and Drug Administration now requires all products containing latex to be labeled, but hospital administrators say labeling practices are all over the map. For example, a label identifying tape that contains latex may be included on a bulk supply box but not on individual rolls of tape, so a nurse might not see it.
"Latex is in so many products used in hospitals, it's unbelievable," says Claire Rupert, division director of value analyses at Norton Healthcare, the largest hospital and health-care system in Louisville, Ky., and a Premier member that helped develop the latex-free catalog. Latex also is used in office supplies, she notes, and items that hospitals have little control over, such as balloons delivered to patient rooms. One of the thorniest problems: finding a substitute for the tape used to secure breathing and feeding tubes on premature infants that doesn't damage their delicate skin when removed. While there are latex-free alternatives, she says, they are more likely to fall off and pull a tube out of an infant's body.
Norton has over the past two years focused on removing latex wherever possible, asking medical staff to examine the products they use every day and pressing vendors to let them know of any available substitutes. But while some suppliers can readily identify products containing latex and offer latex-free versions, others aren't as forthcoming, Rupert says. Norton now tells vendors that don't offer latex alternatives that it will take its business elsewhere, she says.
Southeast Asian producers of latex say they have taken important steps to make the product safer for those with allergies, notably by producing low-powder or powder-free gloves with dramatically reduced protein content. Esah Yip, director of the Malaysian Rubber Export Promotion Council, says studies at a number of hospitals show that the use of low-protein latex gloves has significantly reduced latex sensitization and the incidences of allergic reactions in workplaces. Latex gloves still provide superior barrier protection against infectious agents, he adds, and synthetic substitutes such as vinyl and neoprene are made from petrochemicals that may pose other risks of harm.
St. Joseph Mercy Health System in Ann Arbor, Mich., still uses gloves made of latex because of its effectiveness against blood-borne diseases. It identifies health-care employees and patients who have latex sensitivity and makes alternatives available to them. But some people have proved sensitive to alternative synthetic products as well. As hospitals consider new and often conflicting data on whether to eliminate potentially risky materials, "the question is, are we going to create new problems with other materials we use," says Russ Olmstead, an epidemiologist in infection control services at St. Joseph Mercy.
Sue Lockwood, a former surgical technician from Slinger, Wis., says that more than a decade ago, she noticed her eyes swelling up and her hands itching when she donned medical gloves. A group she co-founded, the American Latex Allergy Association (latexallergyresources.org ), provides resources to consumers, including information on the many latex-free consumer products now available, which range from crayons and children's toys to cosmetics and condoms. She advises anyone concerned about a latex allergy to see a doctor and be tested.
When visiting doctors' offices or hospitals, patients need to be vigilant. Sarah Nelson, a registered nurse in Houston who now works with Lockwood, says that when she herself had surgery a few years ago, she was given a urinary catheter made of latex, even though she was wearing the medical-alert bracelet and staffers knew she had the allergy. "They promptly removed the catheter, but it took me saying something was wrong because I couldn't breathe," says Nelson. In a chaotic hospital environment, she adds, "you need to be your own advocate."