Natural rubber latex: ban or plan?
The
arguments for managing the risks associated with use of NRL gloves in
healthcare, rather than banning them, convinced delegates at a recent
A one-day conference at the
Opening the conference, Dr Paul Cullinan, an allergy specialist at Imperial College's Heart and Lung Institute, commented on the decreased incidence of asthmatic and dermal allergies from NRL in recent years. He also drew attention to the difficulties associated with diagnosing latex allergy and the probability that some problems attributed to NRL could be due to other causes. This was further emphasised by Dr Jonathan White, a consultant dermatologist, who discussed some of the problems in diagnosing both type I (contact urticaria) and type IV (allergic contact dermatitis) reactions.
Barrister and leading health and safety legal specialist Diana Kloss reviewed some of the cases where latex allergy had resulted in legal action and drew attention to the differences between criminal and civil law. She explained that under criminal law taking "all reasonable precautions" might provide a defence under reg. 21 of the Control of Substances Hazardous to Health (COSHH) Regulations 2002 but it would not apply where a case was being brought under civil law for compensation.
Dr Anne Raynal, senior medical inspector, Corporate Medical Unit, Health and Safety Executive, explained that - contrary to popular opinion - HSE policy is not that NRL should be banned but that, in view of its potential to cause allergic reactions and occasionally anaphylaxis, it must be treated as a substance hazardous to health. Where NRL is being considered, a risk assessment should be carried out and NRL should be selected only where the risk assessment indicates a definite benefit from it compared with alternatives.
Pete Phillips of the Surgical Materials Testing Laboratory, South Wales, reviewing the alternatives to NRL, stressed that no alternative glove material offers the same performance as NRL, and drew attention to the allergy problems now appearing where NHS trusts have changed from NRL to nitrile. He questioned whether or not the knowledge of potential hazards from other glove materials is sufficient to be confident that changing from NRL, where the hazards are known and can be managed, will not ultimately result in new, and potentially greater, problems in the future. Phillips commented on how one NHS trust, having switched from NRL to nitrile, had experienced a significant increase (>120 cases) in type IV reactions.
In contrast, countries such as Germany and Finland were successfully managing the risk by insisting that only unpowdered, low-free-protein NRL glove types should be used.
The management of risk of NRL exposure in the workplace was discussed in more detail by Dr Anil Adisesh, consultant occupational physician at the Centre for Workplace Health, Health and Safety Laboratory. His talk culminated in listing a series of actions for those concerned with glove selection, namely to:
- develop a policy for prevention, recognition and management of latex allergy;
- establish a purchasing and glove-usage strategy;
- disseminate information to latex-exposed workers;
- provide diagnosis of occupational latex allergy;
- manage and support latex allergic workers; and
- provide advice to management.
Finally Paul Grime, consultant/honorary senior lecturer in Occupational Medicine, Royal Free Hospital, reviewed the presentations and suggested how a general policy on NRL might be developed to manage NRL exposure in an NHS trust.
Several speakers drew attention to the fact that there did not appear to be any documented cases of actual sensitisation from the wearing of unpowdered, low-free-protein NRL gloves and that the move to this type of glove had resulted in a significant reduction in cases of NRL allergy. The success of this strategy in other countries also confirmed that this is a valid strategy for those who have to wear the thin, single-use gloves as protection against biological hazards. However, different considerations apply where chemical protection is required, and here alternatives to NRL may be required.
At the conclusion of the conference, participants were asked to vote on whether to adopt a general "latex-free" policy or to continue to use NRL, albeit with an appropriately structured and managed control strategy in place.
The response was overwhelmingly in favour of maintaining NRL use.
This report was prepared by Chris Packham of EnviroDerm Services, www.enviroderm.co.uk .
