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Latex - management of a patient at risk of or with a known latex allergy

  • Introduction

    Aim

    Definition of terms

    Assessment

    Key principles for inpatient management of patients with a known latex allergy

    Prevention and Management of exposure to latex

    Considerations for individual clinical areas

    Important Points

    Documentation

    Companion Documents

    Links

    References

    Evidence Table

    Introduction

    Latex allergy is an immune mediated reaction to either the latex protein or chemicals used in the processing. Frequent exposure to latex may lead to the development of a latex allergy. A person is considered to have a latex allergy if there is a history of adverse reactions following contact with latex or latex containing products. Common reactions include swelling of the lips and tongue after blowing up a balloon, or rash and swelling after contact with latex gloves etc. The diagnosis may be made in absence of formal allergy testing. 

    Latex reaction thresholds in the allergic patient can vary. Some patients will tolerate latex skin contact, while others may have anaphylaxis to the residual latex powder in a ward. This means that while for some patients these guidelines are excessively cautious, they may not prevent serious reactions in all patients. 

    At The Royal Children's Hospital all efforts are made to eliminate latex containing equipment, consumables and products. 

    Aim

    The aim of this guideline is to provide all staff at The Royal Children's Hospital with appropriate knowledge and skills to identify and manage patients who have a known latex allergy or those at risk of developing latex allergy.
    This guideline is related to the management of patients. For further information regarding staff management please refer to the policy Latex Risk Management for Staff.

    Definition of Terms

    • Known latex allergy: A person is considered to have a known latex allergy if one or both of the following criteria are fulfilled: A verifiable history of latex allergy. A previous positive test result to serum latex antibody test or skin prick and a history of adverse reaction following contact with latex or latex containing products.
    • Latex Alert/ (High risk) person is labelled a latex alert if they are at a HIGH risk of developing latex allergy in the future including patients requiring multiple surgical operations or repeated bladder catheterisation e.g. patients with spina bifida and/or other congenital anomalies.
    • Increased Risk: Patients with hand eczema or healthcare workers. Certain food allergic patients are also at an increased risk for latex sensitisation due to cross-reactive plant proteins. These include but are not restricted to avocado, banana, chestnut, kiwi fruit, peach, papaya

    Assessment

    Screening for latex allergic/latex alert patients should occur:

    • Prior to admission for elective patients.
    • On admission for all non-elective patients.

    Patients with a known latex allergy or a latex alert (high risk) should have this documented in the Allergies section of the EMR.

    Key principles for inpatient management of patients with a known latex allergy

    • Patients with a known latex allergy must have a Red identification (ID) band on admission, as per the Patient Identification Procedure.
    • Patients who are known latex allergic where possible should be cared for in a single room that is latex free, if this is not possible every effort should be made to reduce latex in the room creating a safe environment.(1)
    • A referral to the Allergy department should also be made in newly suspected latex allergy cases or where diagnosis is uncertain. 
    When a patient with a known latex allergy is admitted to RCH relevant staff must be alerted to the patient’s latex allergy status. These include:
    • Treating Medical team
    • Nursing
    • Allied health
    • Environmental
    • Domestic services

    Patients with latex allergy will be identified by Medical, Nursing, and Allied health teams via EPIC allergy alert. All other relevant staff are notified at a ward level. 

    Allergy list is visible to menu monitors and supervisors who are responsible for ensuring safe and appropriate meals are provided to patients. Main kitchen is latex free.

    The following staff should also be informed prior to having contact with the patient:

    • Volunteer staff
    • Starlight team
    • Clown doctors

    Ensure all relevant staff are aware of patients with a known latex allergy prior to transferring or transporting them to another clinical department (i.e. theatre, medical imaging)

    Prevention Management of exposure to latex

    Further detail is provided by the Australian Society of Clinical Immunology and Allergy. The most effective prevention strategy is to avoid exposure to latex.  Patients with a known history of reactions to latex products will be placed on latex allergy precautions and should be managed in a latex safe environment as outlined below.(1)

    Immediate latex allergy precautions include:

    • Ensure latex gloves are not stocked in the area.  In the unlikely event that latex gloves are present replace with:
      • Non sterile latex free examination gloves where exposure to blood or body fluids are anticipated should be worn to protect the staff member. Vinyl gloves should be worn for food service only.
      • Sterile latex free gloves for sterile procedures. It is important to note some clinical areas at RCH do stock latex containing surgical gloves so nursing staff must be vigilant to select latex free surgical gloves.
    • Remove all items containing latex. Any item of equipment to be used on or near the patient needs to be checked for any latex content prior to use.
    • Adhesive tapes including Tegaderm™, Surgical Micropore™ and waterproof surgical plaster Sleek™ are all latex free and can be used in securing Intravenous cannulas and wound dressings. It is important to note other brands of tapes may contain latex, including but not limited to, Leukoplast rigid™, Leukoplast elastic™, Tensoplast™. 
    • The RCH standard issue ward stethoscope is latex free and is recommended for use with latex allergic/latex alert patients at RCH. Littman Stethoscopes are Latex Free. Other brands of Stethoscope may contain latex, please check the product information supplied with your stethoscope, or contact the manufacturer.
    • Latex allergy/alert signs are to be appropriately displayed at the door of the patient's room, at the patient's bedside. These signs can printed here.

    Staff should be prepared to manage an acute allergic reaction, more information can be found on the Anaphylaxis Guideline.

      It is recommended all resuscitation equipment should be latex-free.  All resuscitation trolleys should routinely have latex-free non-sterile and sterile gloves, circuits, masks, catheter mounts and oral airways.(1)

      Considerations for individual clinical areas

      In addition to the above latex management/prevention precautions consider the following recommendations specific to some individual clinical areas at RCH including: 

      Emergency Department

      It is recommended latex allergic and latex alert patients who present to the RCH Emergency department notify staff as soon as possible. The RCH Emergency Department utilize latex free products where available (latex free list). 
      The patient should also have their latex allergy/latex alert recorded on the Emergency department alert EPIC/EMR alert?  

      Pre, intra and post-operative periods 

      • A patient's latex allergy status should be recorded on the theatre HAS system by theatre booking clerical staff.
      • Prior to the admission of a latex allergic and latex alert patient to the operating theatres, staff should implement immediate latex prevention/management precautions as above. It is preferable for latex allergic patients to be scheduled first on the operating list. If not possible a clean operating theatre should be utilised with all latex products e.g. latex gloves removed from the area. 

      NB: Powdered latex gloves are not used at RCH. However it is recommended that if powdered latex gloves were used that the operating room is cleaned and free of powdered latex gloves for at least 3 hours. (1, 2)

      • Ensure the operating list states latex precautions/latex safe zone.(1,2)
      • Ensure the designated latex free theatre has latex allergy/latex alert signs displayed appropriately.
      • Ensure anaesthetic circuits, masks, oxygen masks and re-breathing bags, oropharyngeal airways, endotracheal tubes and mounts are latex free products. (1,2)
      • Ensure that all members of staff have changed into clean peri operative attire and have washed their hands prior to entering the designated latex free operating theatre. (1,2)
      • It is ideal for the staff to remain in the designated latex precaution/latex safe zone for the duration of the surgical procedure and sufficient staff are available to collect and deliver any additional equipment to the theatre. Care must be taken not to wear the latex gloves or to come into contact with any latex products during collection and delivery. (1,2)
      • Restrict traffic flow in the designated theatre before and during the procedure. (1,2)
      • Latex allergic/latex alert patients should be recovered in a designated latex reduced area with latex prevention/management precautions in place as above. (1,2)
      • Ensure ward nursing staff receiving the patient from recovery are informed of the patient's latex allergy and an appropriate latex precaution/latex safe environment has been prepared prior to transfer. (1,2)

      Outpatients, Pathology, Medical Imaging

      Latex allergic/latex alert patients who attend outpatient areas (e.g. clinics, pathology and medical imaging) should be managed in an area that has been prepared according to the immediate latex prevention/management precautions

      Wallaby

      It is recommended that any patients referred to Wallaby have it well documented on the referral form that they are allergic to latex. Staff must also carry and utilise latex free equipment when managing patients with a known latex allergy/latex; and also alert any subsequent community supports according to the immediate latex prevention/management precautions

      Important Points

      • Not all patients will be identifiable. If anaphylaxis occurs and the cause is not readily identified, the possibility of latex induced anaphylaxis must be considered, especially in patients from high risk groups.
      • Latex balloons are strictly prohibited at RCH as per Balloons in Paediatric Areas policy.
      • For planned /elective admissions, suitable planning for the patient’s entire admission (including discharge) should occur well in advance in collaboration with all members of the multidisciplinary team.
      • In the event a latex allergic/alert patient has a food sensitivity consult with a dietician via the Nutrition and Food services department ext 56690 NB: the current low allergen diet at RCH does not address latex allergy.
      • Patient Service Assistant's need to be informed of patients with latex allergy to ensure appropriate precautions are taken when cleaning the patients' area and serving food to these children e.g. the use of vinyl gloves for food preparation and latex free gloves for cleaning. 

      Documentation

      A patient's latex allergy status should be clearly identified and documented on the patient banner in the EMR.

      Companion Documents

      Links

      ASCIA - Australasian Society of Clinical Immunology and Allergy 

      References

      1. Australian Society of Clinical Immunology and Allergy (2010) Guidelines for the management of latex-allergic individuals in health care facilities and for the minimisation  of continuing latex sensitisation.
      2. Australian College of Perioperative Nurses LTD(ACORN). Standards for Perioperative Nursing in Australia 16th ed: Volume 1-Clinical Standards. Adelaide, South Australia: ACORN; 2020. 
      3. Young, M.A and Myers, M. (1997) Latex allergy: considerations of the care of paediatric patients and employee safety.  Nursing Clinics of North America p: 169-82.
      4. Department of Health New South Wales (2005) Latex Allergy- policy frame work and guidelines for prevention and management.

      Evidence Table

      Management of a patient at risk of or with a known latex allergy evidence table

       

      Please remember to read the disclaimer.


      The revision of this nursing guideline was coordinated by Debra Poole and Lilly Healey, Nurse Consultants, Allergy & Immunology, and approved by the Nursing Clinical Effectiveness Committee. Updated February 2021.