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

• Note: This guideline is currently under review.

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

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.

There is difficulty in preparing guidelines for latex allergies as the sensitivity to latex varies from patient to patient. 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.

## 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 allergyA 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:

1. Prior to admission for elective patients.
2. On admission for all non-elective patients.

### Action Required

Known latex allergy

A health alert for know latex allergy should be recorded on all medication charts, prescriptions and admission forms, patient Administration System (PAS/IBA) contact Health Information Services (HIS) on 6107 to create an alert.

A health alert for latex alert should be recorded on all medication charts, prescriptions and admission forms, patient Administration System (PAS/IBA) contact Health Information Services (HIS) on 6107 to create the alert.

Increased Risk

An increased risk of latex allergy does not require a health alert.

## 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.  The latex allergy needs to be clearly documented on the ID Band as per the RCH patient Identification policy.
• Patients who are known latex allergic or / latex alert where possible should be cared for in a single room that is latex reduced, if this is not possible every effort should be made to reduce latex in the room creating a safe environment.(1)
• Patients with a known latex allergy (with or without a history of an allergic reaction) should be notified to the Allergy / Immunology Fellow / Consultant on-call upon admission. A referral should also be made in newly diagnosed 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 patients latex allergy status. These inlclude:
• Medical
• Nursing
• Allied health
• Environmental
• Domestic services
• Volunteer staff
• Starlight team
• Clown doctors

## Prevention and Management of exposure to latex

Further detail is provided by the 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.(1)

• Latex alert patients will be managed in a latex safe environment in an effort to minimise risk of sensitivity.
Immediate latex allergy precautions include:
1. Remove all latex gloves from the area a replace with:
1. Non sterile latex free gloves or vinyl gloves for non sterile procedures and food service.
2. Sterile latex free gloves for sterile procedures.
3. Latex free boxes are available in all areas, these should be checked upon patients admission, placed at the patient's bedside and utilised during the admission.
2. Remove all items containing latex.
3. Latex allergy/alert signs are to be appropriately displayed at the door of the patient's room, at the patient's bedside, an on the front of the bed chart. These signs can be found in the latex free boxes or alternatively signs can be printed.
4. Any item of equipment to be used on or near the patient needs to be checked for any latex content prior to use.
5. Be prepared to manage an acute allergic reaction.

## 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 emergency department at The RCH are cared for in the designated latex reduced bay. If this is not possible, immediate latex prevention/management precautions should be initiated.

## Pre, intra and post operative periods

• Prior to the admission of a latex allergic and latex alert patient to the operating theatres, staff should implement immediate latex prevention/management precautions. 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. (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)

## RCH@Home

• It is recommended that any patients referred to RCH@Home have it well documeted 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 the community according to the immediate latex prevention/management precautions.(1)

## 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.
• 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)
• 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.  For further information regarding latex free products please refer to the RCH stock catalogue.
• The RCH standard issue ward stethoscope is latex free and is recommended for use with latex allergic/latex alert patients at RCH.  It is important to note other brands of stethoscopes such as Littman® contain latex.
• Where patients are planned /elective admissions, suitable planning for the patients 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 food sensitivity consult with a dietician via the Nutrition and Food services department ext 5663 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.
• Latex safe boxes are stocked and checked by individual departments according to the standard list utilising the  RCH stock ordering information for latex free boxes.

## Documentation

• A patient's latex allergy status should be clearly identified and documented on the medication chart (MR52) and admission form (MR51A).
• A patient's latex allergy status should be clearly documented by medical staff on all referral and booking forms e.g. Admission Clinical Details (MR71C).
• A patient's latex allergy status should be recorded on the theatre HAS system by theatre booking clerical staff.
• A health alert for latex allergy/latex alert should be recorded on Patient Administration System (PAS/IBA) contact Health Information Services (HIS) on 6107 to create the alert.
• The patient should also have their latex allergy/latex alert recorded on the Emergency department alert  .
• A red warning sticker should appear on the front of the patient record.  This sticker will remind staff that the medical record contains important alert information on the essential particulars form e.g. latex allergy.  Red warning stickers can be obtained from the latex free boxes, ward and outpatient clerical staff and Health Information Services.

## References

1. Australian Society of Clinical Immunology and Allergy (2004) Guidelines for the management of latex-allergic individuals in health care facilities and for the minimisation  of continuing latex sensitisation.
2. Association of Perioperative Nurses (2006) ACORN STANDARDS. Standard 9 Management of latex sensitivity. ACORN Board.
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