With incidences of allergic reactions to latex gloves continuing to trouble
many organisations, research by Nottingham Trent University has allowed the
institution to develop a latex-free policy for all employees, by Nia Harris and
James Roper
The use of latex gloves provides a challenge for many occupational health
professionals because of the incidence of latex allergies with continuous use.
Many organisations have been forced to compromise between financial restraints,
pressures from staff suffering latex-related problems and the unrivalled
protection offered by latex products.
However, Nottingham Trent University has been able to develop a latex-free
policy for use across the institution, following careful consideration of the
options available.
Literature search
Before developing the policy, a literature search was carried out to gain
support and guidance about the best approach to take. The available literature
does provide a solid basis to work from when compiling a policy.
The majority of published articles on the subject concentrate on reduction
of latex use within healthcare settings. Although the focus of the two leading
Medline and the Cinahl databases (see links) involves healthcare environments,
evidence available on both these sources was useful in providing a basis for
the aims of the policy. The main concern was whether latex gloves should be
completely removed or their use limited by introducing strict regulations.
Latex has, and continues to be used widely in healthcare environments for
several reasons. Christopher Packham1 states that natural rubber latex offers a
high level of biological protection that other types of glove cannot match, has
good stretch qualities and is reasonably priced. This high level of protection
indicates that the total removal of latex from healthcare settings is not
appropriate. Many institutions have attempted to create ‘latex-safe
environments’ by reducing glove use to powder-free varieties and providing
alternatives for sensitive staff.
Research papers by Bowyer2 and Brehler3 assess the implications of latex
hypersensitivity on the healthcare environment and give examples of reducing
latex use in healthcare. Almost all literature available on the subject of
managing hypersensitivity states how latex is uniquely invaluable in
maintaining adequate biological protection in order to meet required
legislation, such as the Personal Protective Equipment (PPE) Regulations 19924.
Gathering data
The next stage of the process was an enquiry to determine what types of glove
were being used and for what purpose the university staff used them.
This task could have proved difficult as the institution has 2,519
employees. To gather as big a response as possible, a specific ‘glove use
questionnaire’ was designed, which consisted of closed questions, thus
restricting responses to just the information that was required.
The questions put to the user requested the type of gloves used in their
particular area to be specified, asked what tasks they were required for and
the frequency of use.
The questionnaire also asked the respondent to state the company from which
the gloves were purchased (as the use of more expensive gloves would have a
different economic impact on each department involved) and whether students
were required to put on the gloves to complete certain tasks. This question was
important as the university had a duty of care towards its students under
health and safety legislation. Because students did not receive services from
occupational health but used an onsite surgery when seeking health advice, this
meant very little information was available regarding students with possible
allergies.
To minimise repetitive responses, the questionnaire was sent by e-mail to
the principal technician in each university department. This produced
comprehensive and concise overviews of glove use. In total, 13 out of 15
questionnaires sent out were returned within the time specified. Although the
other two were returned after the time date set, these were from departments
that did not use protective gloves.
Developing the policy
A large variety of gloves were shown to be in use at the university – almost
all were made from latex. Only one department offered nitrile gloves as an
alternative.
The tasks for which gloves were required were also extremely varied, ranging
from using specific chemical-grade nitrile gloves for chemical handling to the
use of powdered latex gloves for handling pottery products. There were only two
instances where the use of gloves to protect against biological products was
evident. These were in the provision of first aid facilities and were within
the Occupational Health Department itself.
The lack of biological risk throughout the organisation prompted the next
stage of developing the policy. The decision was made that all single-use latex
protective gloves should be replaced with a suitable alternative, thus
minimising the risk of hypersensitivity among staff.
Following the survey, a decision was made to include all types of protective
glove into the policy – chemical strength gloves and textile gloves, for
example, with the aim of creating an equal level of health and safety across
all departments. The classification of glove suppliers and their products was
also to be specified to ensure the risks of incorrect glove choice were
minimised.
The main area of concern for the development of safe glove use was in
chemical laboratories and in art and design areas, as these were the
departments that required the greatest levels of glove use. However, they required
very different approaches.
Gloves are used in art and design departments to protect users from paints
and pottery dust. Some areas also use textile dyes on a regular basis. As none
of these activities expose users to biological risk, latex gloves were not
required. The material used to replace latex in this area was nitrile because
these gloves offer high levels of chemical impermeability5.
The rationale for using different gloves in the chemical laboratories was
due to many of the strong chemicals interacting with latex. The solution was to
ensure the effective use of chemical labelling as the safety precautions on
many simply states ‘use appropriate gloves when handling this product’. As a
result many staff were using the first gloves that came to hand, regardless of
their suitability. This meant that, for every area using gloves on a regular
basis, a mass staff education programme was required.
Education programme
To plan how to educate the many staff working in areas of high glove use,
advice was gathered from a variety of sources.
Several glove companies were contacted for the most up-to-date product
information. Visits from representatives were arranged, to enlighten staff from
the departments that would be most affected by a policy change. These meetings
were extremely important as they began to shape the methods that would be used
to inform all staff and students of the potential dangers of incorrect glove
use. Many glove manufacturers were able to supply guidelines detailing the
types of glove suitable for handing different chemicals.
Another invaluable source of advice came from other occupational health
departments who were contacted about reviews of glove use carried out at their
institutions. By using some of the advice from these sources, Nottingham Trent
University was able to draw up an education scheme that provided advice on the
methods that would be most suited to the working environment of each given
department.
Following consultations with staff from all departments, it became apparent
that formal teaching sessions on the subject of glove use and skin care would
be inappropriate, as most staff would only be present during term time, so
formal training days would remove staff from the college when their help in
supervising students was most needed.
Therefore, as an initial point of contact, it was decided to set up a poster
campaign to display information from glove manufacturers, relating only to the
chemicals actually used in any specific location. In addition to the practical
information, the displays were strategically located around the campus.
The displays focused on skin care and how to spot potential problems
associated with prolonged glove use; and contact details for the occupational
health service were reinforced, along with information sources to use when
staff found it necessary to carry out risk assessments on chemicals that
required glove use.
To ensure staff adhered to the new requirements, trials took place using
gloves from a variety of sources to help determine which products were most
favoured. Stock supplies of gloves were reduced, with stock maintained in
proportion with the gloves’ required levels of use. And more posters were
displayed in the storage areas to act as reminders to staff about the selection
of gloves.
Following the implementation of the poster campaign, the types of glove
preferred by the staff were assessed.
Staff and students in the art and design areas were found to be more content
with powder-free, nitrile gloves. Because the laboratory staff used many types
of glove, comments on their comfort and ease of use were requested.
The staff involved stated how, with the changes to the risk assessing
process, glove choice had become much more simple and all gloves used were
found to be comfortable to wear, with no skin irritation problems being
reported to the occupational health department.
Conclusion
The implementation of a policy controlling the use of different types of
protective gloves has been very successful. In the initial period prior to
researching and implementing the new policy, several types of glove and several
different suppliers were being used. Once the policy had been implemented,
along with the poster campaign, glove use had become much more controlled.
The risk of hypersensitivity had been reduced by making available only the
correct type of gloves for the particular use. The staff working in the areas
of most prevalent glove use were more aware of the potential dangers of
incorrect usage, such as exposure to chemicals or the development of
glove-related skin problems.
Overall, the development of the policy has created a more equal level of
safety in each area of the university.
References
1. Packham C (2000) Technical Bulletin No.6: Thoughts on Latex Allergy, Enviroderm
Services – www.enviroderm.co.uk
2. Bowyer R (1999) The implications of latex allergy in healthcare settings.
Journal of Clinical Nursing, 8(2) 139-143
3. Brehler R (2001) Natural Rubber Latex Allergy: A Problem of
Interdisciplinary Concern. Archives of Internal Medicine, 161(8)
1057-1064
4. Health and Safety Executive (1992) Personal Protective Equipment (PPE)
Regulations 1992. London, HMSO
5. Korniewicz, Denise M (2002) Performance of latex and non latex medical
examination gloves during simulated use. American Journal of Infection Control
30 (2) 133-138
Acknowledgements:
– Graham Ayers, sales representative, Bestglove Ltd
– Eileen Black, occupational health specialist, Astrazeneca R+D Charnwood,
Leics
– Jane Braithwaite, senior technician, Life Sciences, Nottingham Trent
University
James Roper is a student nurse at the University of Nottingham. Nia
Harris BmedSci (Hons), DipOSH, is a RGN occupational health specialist, at
Nottingham Trent University
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The
law surrounding occupational health is incorporated in a number of general
duties under the Health and Safety at Work Act 1974 etc, and in various
regulations made under this Act, such as the Control of Substances Hazardous to
Health (COSHH) Regulations 1999. The PPE Regulations (5) advise that every
employer shall ensure that where the presence of more than one risk to health
or safety makes it necessary for an employee to use simultaneously more than
one item of personal protective equipment, such equipment is ‘compatible and
continuous to be effective against the risk or risks in question’.
