**3.8.42 Latex:**

I.  BACKGROUND:

    Latex sensitivity is becoming a significant problem for patients and
    health care workers. Latex is made from the sap of a tropical tree.
    The conversion of the natural liquid latex into a finished rubber
    product: i.e. surgical glove requires the addition of multiple
    chemicals to create the desired physical properties. Antibodies to a
    series of natural rubber protein have been detected in people
    sensitive to latex.

    A.  [Reactions]{.underline}**:**

        Reactions can be a mild Type IV immune responses, characterized
        by rash, pruritis, peeling, blisters, swelling of the hands or
        arms or a severe Type I, IgE-mediated response characterized by
        rhinitis, conjunctivitis, hives, wheezing, SOB, hypotension,
        angioedema, or cardiac arrest.

        An individual with mild sensitivity can develop a more severe
        reaction with repeated exposures.

    B.  [Those at Risk]{.underline}:

        The majority of latex sensitivity is seen in healthcare workers
        who wear latex gloves. Patients with chronic conditions that
        allow high exposure to latex (e.g. those born with spina bifida
        necessitating repeated invasive procedures such as
        catheterization of the genitourinary tract, & patients with more
        than 9 surgeries in the past). Latex allergies have also been
        linked to allergies to certain foods including bananas,
        avocados, chestnuts, kiwi fruit, and tomatoes.

    C.  [Products Which Contain Latex in the Hospital, Home and
        Community]{.underline}:

        See Attachment I.

II. RESPONSIBILITY:

    A.  Identify high-risk patients & employees at risk for known
        systemic response. Provide non-powdered, low latex allergen
        gloves as standard issue. \[References: 4, 5, 6, and 10\]

    B.  Substitute latex free products for patients sensitive to latex.

    C.  Educate staff & patients regarding their latex risk.

    D.  The Latex Committee will review, update, and distribute this
        policy every other year to hospital staff. The Infection Control
        Coordinator will be the initial contact for employees and
        patients with latex allergies.

    E.  The Latex committee is a subcommittee of the Infection Control
        committee. The latex committee will consist of Infection Control
        Coordinator, Central Sterile Supply, Dental, Pharmacy, Nursing,
        Surgery Service, Internal Medicine, Human Resources, and PCC
        representative. The Latex Committee will be an educational
        resource for employees and patients.

III. PROCEDURES:

     A.  [Identify Latex Allergy Patients]{.underline}:

         1.  Educate health care providers on latex allergy.

         2.  Have a physician verify a diagnosis of latex allergy in
             those with suspected sensitivities. Draw a serum for a
             Heavea Braziliensis to test for latex sensitivity.

         3.  Notify health care providers caring for the patient of
             latex allergy.

         4.  Initiate in hospital latex precautions.

     B.  [Latex Sensitive Patients]{.underline}:

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1.  Will have a red allergy band placed on their wrist, indicating latex
    allergy.

2.  Will have labeled latex free cart placed outside the door (Obtain
    from CSS).

3.  Will have a sign posted outside the room door, this will be found on
    latex cart.

4.  Will be placed in a private room.

5.  Will have allergy stickers on both the in and out patient charts.

6.  Will have latex allergy documented on the Kardex and medication
    record.

7.  Will have only latex free gloves available in the room.

8.  Will have their room cleaned prior to admission by personnel wearing
    non-latex gloves.

9.  Will have equipment-containing latex removed from the room.
    Equipment that cannot be removed will be covered. See attachment II.

    1.  Surgery will maintain a latex free-labeled cart, which will be
        in the room with the patient and go with the patient to the Post
        Anesthesia Recovery.

    2.  Latex free carts will be available at the following sites:

> a\) Emergency Room
>
> b\) CSS
>
> 12\. Notify Health Information Systems to:
>
> a\) Add a Health Summary entry for latex allergy.
>
> b\) Place a colored label with latex allergy on the front of the
> chart.

13. The various units (Dietary, Housekeeping, CSS, Infection Control,
    Pharmacy, Surgery, Anesthesia, etc.) will receive notification of
    the latex allergic patient per nursing staff.

14. Review with patient the educational handout including non-latex
    alternative products.

15. Instruct the patient to consult their physician for an epinephrine
    kit if indicated.

> C. [Medications and Intravenous Administrations in the Latex Sensitive
> Patient]{.underline}:

1.  Place tourniquet over clothing or over stockinet sleeve and secure
    with a non-latex tape or dressing (on latex free cart).

2.  If you do not use latex free tubing then flush IV tubing completely
    (at least 50cc) to wash out any latex residue. Rinse latex residue
    off exterior of IV tubing with water or NS.

3.  Access ports on IV's will be covered with tape and not used.

4.  In-line stopcock will be used to administer medications.

5.  Do not puncture add ports on IV bags, add medications through the
    spike port immediately prior to hanging the bag.

6.  Do not puncture stoppers on medication vials; withdraw medications
    by removing stopper with hemostats and draw up the medication
    directly from the vial.

7.  Administer medication immediately after preparing to decrease the
    amount of time the medication is in contact with the rubber stopper.

8.  Do not use pre-mixed medication syringes, because their stoppers are
    rubber, instead withdraw medication from multi-dose vials supplied
    by pharmacy.

9.  The PCA anti-reflux tubing has an Y-port with a lurelock connection
    that can be used by removing the y-port and attaching second tubing.

10. The pump IV tubing should not be used in latex sensitive patients
    since it contains latex.

> D. [Additional Precautions]{.underline}:

1.  Place BP cuff over clothing or stockinet sleeve.

2.  Wrap stethoscope tubing with gauze; latex free cart contains a latex
    free stethoscope.

3.  Place plastic wrap over finger for oximeter monitoring.

4.  Remove elastic from oxygen masks and tie on with cloth ties, which
    should be found in the latex free cart.

5.  Do not use ted hose.

6.  Do not allow balloons in patient's room.

7.  Do not give the patient rubber soled or non-slip slippers.

8.  Place tourniquets for drawing blood over clothes or stockinet
    sleeve.

9.  Nutrition and Food Service: Enter latex allergy into dietary
    computer program. Dietary will not serve these patients kiwi,
    bananas, chestnuts, water chestnuts, avocados, papaya, fig, passion
    fruit, nectarine, plum, cherries, melons, tomato or celery.

> E. [Latex Sensitive Employees]{.underline}:
>
> 1\. Have all employees fill out a latex allergy questionnaire. (See
> Attachment Three)
>
> 2\. Employees who present with symptoms, which may be related to
> latex, must report to Employee Health.
>
> 3\. Employees will be referred to Family Medicine for definitive
> testing & recommendations.
>
> 4\. Employee Health and Supervisors will monitor recommendations
> regarding changes in the employees' work environment.
>
> 5\. Employees can expect that [reasonable]{.underline} accommodations
> will be made to assure their safe job performance.
>
> 6\. All recommendations/ limitations reported on a CA II form will be
> reported to Human Resources & their immediate supervisors.
>
> 7\. Notify Health Information Systems to:
>
> a\) Add entry to the Health Summary for latex allergy.
>
> b\) Place a colored label with latex allergy on the front of the
> charts.
>
> F. [Education]{.underline}:
>
> 1\. New employees will be oriented to ANMC's Latex Allergy Guideline
> during new employee orientation.
>
> 2\. All employees will be updated on this policy during annual
> training.

IV. REFERENCES:

    A.  Hunt, Thomas K. Goodson, W. MD, "Starch Powder Contamination of
        Surgical Wounds." Arch Surg, 1994; 129: 825-828)

    B.  Tario, Susan, Sussman, Gordon MD "Control of Airborne Latex by
        Use of Powder Free Latex Gloves" J. Allergy Clinic Immunology
        Vol. 93, #6 p 985-989

    C.  Truscott, Mava. Glove Powder & Nosocomial Infections: "Is there
        a Connection?" Infection Control & Sterilization Technology, Jan
        1996, Vol. 2 #1.

    D.  Swanson, Mark C. Bubak, Mark. "Quantification of Occupational
        Latex Aeroallergens in a Medical Center" J. Allergy Clinic
        Immuol, Vol. 94, \# 3, Part 1, pp. 445-451.

    E.  Jaffray, David. "Does Surgical Glove Powder Decrease the
        Inoculum of Bacteria Required to Produce an Abscess": Journal of
        the Royal College of Surgeons of Edinburgh, July 1983, Vol. 28
        \# 4 pp. 219-222.

    F.  Hurst, Loren. "A Medical-Center-Wide Multidisciplinary Approach
        to the Problem of Natural Rubber Latex Allergy" (Mayo Clinic)
        JOEM Vol. 38 \# 8, Aug 96, pp. 765-770.

    G.  American Association of Nurse Anesthetists "Latex Allergy
        Protocol," April 1993.

    H.  American Health Consultants, Hospital Employee Health, "Latex
        Allergies Spur Hospital to Develop Protection Policies,"
        September 1005, Vol.14, No.9 PP. 109-115.

    I.  Lavella, A.J. RN, MN, Turner Helen, RN, MSN, CCRN, "A New
        Dilemma: Latex Sensitivity".

    J.  Reuse, Joyce Good, RN, "Latex Sensitivity, Controlling Health
        Care Workers\', Patients Risk", AORN, March 1994, Vol.59, NO.3.

    K.  Safeskin Corporation, "Important: Differentiation of Reactions
        to Natural Rubber Latex Gloves", 1994.

    L.  Smith, Sue, RN, Tyndall, Judi, RN, Young, Alaine, RN**.** "Do
        You Have A Latex Protocol?" Canadian Operating Room Nursing
        Journal-September/October, 1993.

    M.  Spina Bifida Association Of America, "Latex In the Home and
        Community" and "Latex In The Hospital Environment," November
        1994.

    N.  Elastic-Education for Latex Allergy Support-Team and Information
        Coalition.

    O.  Henry Ford Health System, Asthma and Allergy Foundation of
        America, "The ABC's of Latex Allergy".

+---------------------------+------------------------------------------+
| **LATEX IN THE HOSPITAL   |                                          |
| ENVIRONMENT\              |                                          |
| UPDATED Spring 1999**     |                                          |
+---------------------------+------------------------------------------+
| ***Frequently contain     | ***Examples of LATEX-SAFE                |
| LATEX***                  | alternatives/barriers***                 |
+---------------------------+------------------------------------------+
| Adhesives, skin           | Mastisol (Ferndale)                      |
| (Smith+Nephew)            |                                          |
|                           | Neoprene (Anesthesia Associates, Ohmeda  |
| Anesthesia circuits,      | adult), *some* Vital Signs               |
| bags, oxygen masks        |                                          |
+---------------------------+------------------------------------------+
| Bandaids                  | Active Strip (3M), CURAD flexible Neon,  |
|                           | Readi-Bandages                           |
| Blood pressure cuff,      |                                          |
| tubing (J&J)              | Cleen Cuff (Vital Signs), nylon (*some*  |
|                           | Trimline)                                |
| Bulb syringe              |                                          |
|                           | *selected* Davol, Medline, Rusch,        |
|                           | Premium,Baxter                           |
+---------------------------+------------------------------------------+
| Casts: Delta-Lite         | Scotchcast soft,Delta-Lites,*recent*     |
| Podiatry, Orthoflex (J&J) | Conformable(J&J), Caraglas               |
|                           | Ultra,liners(Gore)                       |
| Catheters, condom         |                                          |
|                           | Clear Advantage (Mentor), ProSys NL      |
| Catheters, indwelling &   | (ConvaTec), *selected* Coloplast,        |
| systems, UDS              | Rochester                                |
|                           |                                          |
| Catheters, cardiac,       | *some* Am BioMed, Argyle,Bard,Cook,      |
| vascular, pulmonary       | Dale, Kendall,Lifetech,Mentor,           |
|                           | Rochester,                               |
| Catheters, straight,      |                                          |
| coude                     | Rusch, Vitaid. Adapters & plug (Addto)   |
|                           |                                          |
| Catheters, feeding        | *some* World Medical, Am BioMed,         |
|                           |                                          |
| CPR manikins & Medical    | Mentor, RobNel (Sherwood),Coloplast,     |
| training aids             | *selected* Bard, Rusch catheters         |
|                           |                                          |
|                           | Accumark feeding catheter (Sims Portex)  |
|                           |                                          |
|                           | *most* Laerdal products                  |
+---------------------------+------------------------------------------+
| Dressings: Dyna-flex,     | Duoderm (Squibb), Reston foam (3M),      |
| butterfly closures (J&J)  | Opsite, Venigard, Comfeel (Coloplast)    |
|                           |                                          |
| BDF Elastoplast, Action   | Xeroform(Sherwo                          |
| Wrap, Coban (3M)          | od),PinCare(Hollister),Bioclusive,Montg. |
|                           | ry strap(J&J),Webril                     |
| Lyofoam (Acme), Spandage  |                                          |
| (Medi-tech)               | (Kendall),                               |
|                           | Metalline,Selopor,Opraflex(Lohmann),     |
|                           | Centurion brief,*some* Airstrips         |
+---------------------------+------------------------------------------+
| **NOTE: latex in package  |                                          |
| only:** Steri-strip wound |                                          |
| closure system, Tegaderm, |                                          |
| Tegasorb,Active Strips    |                                          |
| (3M), Nu-Derm (J&J),      |                                          |
| CURAD                     |                                          |
+---------------------------+------------------------------------------+
| Elastic wrap: ACE,        | E-Cotton,CEB elastic(coNco),Champ        |
| Esmarch, Zimmer           | (Carolon),Adban Adhesive,X-Mark(Avcor)   |
|                           |                                          |
| Dyna-flex, Elastikon      | Co-Flex, PowerFlex(Andover), Comprilan   |
| (J&J)                     | (Jobst), Esmark (DeRoyal, NHP)           |
|                           |                                          |
| Electrode bulbs, pads,    | *some* Baxter,Dantec EMG, Conmed,        |
| grounding                 | ValleyLab, Vermont Med,Staodyn,Neotrode  |
|                           |                                          |
| Endotracheal tubes,       | *selected* Berman, Mallinckrodt,         |
| airways                   | Polamedco, Portex, Rusch, Sheridan,      |
|                           | Shiley                                   |
| Enemas, Ready-to-use      |                                          |
| (Fleet Pediatric and      | BabyLax,*some* Adult (Fleet), Theravac,  |
|                           | Bowel Man. t Tube (MIC), Pharmaseal      |
| Mineral oil have latex    |                                          |
| valve- will soon change)  | set (Baxter), cone irrigation set        |
|                           | (Convatec), silicone retention cuff      |
|                           | tip(Lafayette)                           |
+---------------------------+------------------------------------------+
| G-tubes, buttons          | Silicone (Bard, Flexiflo, MIC, Rusch,    |
|                           | Stomate)                                 |
| Gloves: sterile, clean,   |                                          |
| surgical, orthodontic     | Allergard (J&J),dermaprene (Ansell),     |
|                           | N-DEX (Best), Safeskin Nitrile, Neolon,  |
|                           | SensiCare,Tru-touch (Maxxim), Nitrex,    |
|                           | Tactyl 1,2 (SmartPractice), Duraprene,   |
|                           | Triflex (Baxter), Elastyren (Hermal,     |
|                           | Center Labs), Boston Medical, Masel      |
+---------------------------+------------------------------------------+
| Incentive deep breathing  | Voldyne 5000 (Sherwood David & Geck),    |
| exerciser                 | Triflo II                                |
|                           |                                          |
| **IV access**: injection  | Cover Y-sites and bag ports - do not     |
| ports, Y-sites, bags,     | puncture. Use stopcocks for meds.        |
| pumps,                    |                                          |
|                           | Polymer injection caps (Braun), Abbot    |
| buretrol ports, PRN       | nitroglycerin tubing; SAFSITE (Braun),   |
| adapters, buretrol ports, |                                          |
|                           | Walrus, Gemini (IMED), *selected* Baxter |
| PRN adapters, needleless  | (InterLink), Abbott systems, Braun       |
| systems                   |                                          |
|                           | burettes; Clave, Abbott needleless       |
|                           | systems, IV boards (Avcor), Terumo       |
+---------------------------+------------------------------------------+
| OR/Infection Control      | *some* by Kimberly Clark,TECNOL; OR &    |
| masks, hats, shoe covers  | sterile packs (CML, DeRoyal) twill ties  |
+---------------------------+------------------------------------------+
| Medication vial stoppers  | ***some*** AmRegent, Astra, Bedford      |
|                           | Labs, Fujisawa, Gensia,Glaxo, Lilly,     |
|                           | Roche                                    |
+---------------------------+------------------------------------------+
| Miscellaneous items       | Soft-Grip fabric clamp covers(Scanlan),  |
|                           | Precision Dynamics I.D. bracelets        |
+---------------------------+------------------------------------------+
| Penrose drains            | Jackson-Pratt, Zimmer Hemovac            |
|                           |                                          |
| Pulse oximeters,          | Nonin oximeters, *selected* Nellcor      |
| thermometer probes        | sensors, Diatec probe covers             |
+---------------------------+------------------------------------------+
| Reflex hammers            | Cover with plastic bag                   |
|                           |                                          |
| Respirators               | Advantage (MSA), HEPA-Tech (Uvex), PFR   |
|                           | 95 (Tecnol), 3M 1860                     |
| Resusitators, manual      |                                          |
|                           | *certain* Ambu,Armstrong,Laerdal,        |
|                           | Puriton Bennett, Vital                   |
|                           | Blue,Respironics,Rusch                   |
+---------------------------+------------------------------------------+
| Spacer (for metered dose  | ACE spacer (Center Labs), OptiHaler      |
| inhalers)                 | (HealthScan)                             |
|                           |                                          |
| Stethescope tubing        | PVC (*some* Littman) cover with          |
|                           | ScopeCoat or latex-free stockinette      |
| Suction tubing            | (**Alba**health)                         |
|                           |                                          |
| Syringes, disposable      | PVC (Davol, Laerdal, Mallinckrodt,       |
|                           | Superior, Yankauer) Medline, Ballard     |
|                           |                                          |
|                           | Terumo Medical, Abbott PCA Abboject,     |
|                           | Norm-Ject (Air-Tite),EpiPen, *selected*  |
|                           |                                          |
|                           | BD syringes, AdvantaJet (Activa)         |
+---------------------------+------------------------------------------+
| Tapes: pink, Waterproof   | Dermicel (J&J), Durapore, Microfoam,     |
| (3M), Zonas,Moleskin,     | Micropore, Transpore (3M)                |
|                           |                                          |
| cloth, Waterproof (J&J),  | Cath-Strip (Genetic Labs), Ice Tape      |
| adhesive felt (Acme)      | (P.O.Pak), All-Felt (Universal Foot      |
|                           | Care)                                    |
| Tonopen disposable covers |                                          |
| (glaucoma tester)         | Children. s Medical,Grafco,VelcroPedic,  |
|                           | X-Tourn straps(Avcor),Free-Band(KLP)     |
| Tourniquets               |                                          |
|                           | REP Bands & Cords (OPTP), Exercise putty |
| Theraband (also strip,    | (Rolyan)                                 |
| tube), Other OT supplies  |                                          |
|                           | plastic tubing -Tygon LR-40 (Norton),    |
| Tubing, sheeting          | elastic thread, sheets (JPS              |
|                           | Elastomerics)                            |
+---------------------------+------------------------------------------+
| Vascular stockings        | Compriform Custom (Jobst)                |
| (Jobst)                   |                                          |
+---------------------------+------------------------------------------+

+---------------------------+------------------------------------------+
| **LATEX IN THE HOME AND   |                                          |
| COMMUNITY\                |                                          |
| UPDATED Spring 1999**     |                                          |
+---------------------------+------------------------------------------+
| ***Frequently contain     | ***Examples of LATEX-SAFE                |
| LATEX***                  | alternatives/barriers***                 |
+---------------------------+------------------------------------------+
| Art supplies: paints,     | Elmers (School                           |
| glue, erasers, fabric     | Glue,Glue-All,GluColors,Carpenters Wood  |
| paints                    | Glue,Sno-Drift paste)                    |
|                           |                                          |
|                           | FaberCastel erasers, Crayola (**except** |
|                           | stamps, erasers),Liquitex paints,        |
|                           | DickBlick                                |
|                           |                                          |
|                           | tempera & acrylic paints & soap erasers, |
|                           | Play-Doh                                 |
+---------------------------+------------------------------------------+
| Balloons                  | Mylar balloons, self-sealing *Myloons*   |
|                           |                                          |
| Balls: Koosh balls,       | PVC (Hedstrom Sports Ball)               |
| tennis balls, bowling     |                                          |
| balls                     |                                          |
+---------------------------+------------------------------------------+
| Carpet backing, gym       | Provide barrier - cloth or mat           |
| floor, basement sealant   |                                          |
|                           | Warner-Lambert, Wrigley gums             |
| Chewing gum               |                                          |
|                           | Cloth-covered elastic, neoprene (Decent  |
| Clothes: applique on      | Exposures, NOLATEX Industries)           |
| Tees, elastic on socks,   |                                          |
|                           | Buster Brown elastic-free socks (Vermont |
| underwear, sneakers,      | Country Store)                           |
| sandals                   |                                          |
|                           | Polyurethane (Avanti), female condom     |
| Condoms, contraceptive    | (Reality)                                |
| sponges, diaphragm        |                                          |
|                           | Cover with cloth, tape                   |
| Crutches: tips, axillary  |                                          |
| pads, hand grips          |                                          |
+---------------------------+------------------------------------------+
| Dental dams, cups, bands, | PURO/M27 intraoral elastics (Midwest     |
| root canal material       | Orthodontic),wire springs,sealant        |
|                           | (Delton)                                 |
| orthodontic rubber bands  |                                          |
|                           | dams (Meer Dental, Hygenic Corp), John O |
| Diapers, Incontinence     | Butler, Earloop masks (Richmond)         |
| pads, rubber pants        |                                          |
|                           | Huggies, First Quality,Gold Seal,        |
|                           | Tranquility, Always, *some* Attends,     |
|                           | Drypers                                  |
|                           |                                          |
|                           | diapers (not training pants), Confidence |
|                           | (Paper-Pak)                              |
+---------------------------+------------------------------------------+
| Feeding nipples           | Silicone, vinyl (***selected*** Gerber,  |
|                           | Evenflo, MAM, Ross, Mead Johnson)        |
| Food handled with latex   |                                          |
| gloves                    | Synthetic gloves for food handling       |
+---------------------------+------------------------------------------+
| **NOTE: associated        |                                          |
| allergies are reported to |                                          |
| banana, avocado,          |                                          |
| chestnut, kiwi and other  |                                          |
| fruits**                  |                                          |
+---------------------------+------------------------------------------+
| Handles on racquets,      | Vinyl, leather handles, or cover with    |
| tools                     | cloth or tape                            |
+---------------------------+------------------------------------------+
| Infant                    | Soft bristle brush or cloth, Gerber/NUK  |
| toothbrush-massager       |                                          |
+---------------------------+------------------------------------------+
| Kitchen cleaning gloves   | PVC MYPLEX (Magla), cotton liners        |
|                           | (Allerderm)                              |
+---------------------------+------------------------------------------+
| Miscellaneous items       | *some* medical stickers by MediBadge,    |
|                           | UAL, Cushie Tushie Potty Seat            |
+---------------------------+------------------------------------------+
| Newsprint, ads, coupons,  |                                          |
| lottery scratch tickets   |                                          |
+---------------------------+------------------------------------------+
| Pacifiers                 | Soothies (Children. s Med Ventures),     |
|                           | ***selected*** Binky, Gerber, Infa, Kip, |
|                           | MAM                                      |
+---------------------------+------------------------------------------+
| Rubber bands, bungee      | Plasti bands                             |
| cords                     |                                          |
+---------------------------+------------------------------------------+
| Toys - Stretch Armstrong, | Jurassic Park figures (Kenner), 1993     |
| old Barbies               | Barbie, Disney dolls (Mattel), many toys |
|                           | by                                       |
|                           |                                          |
|                           | Fisher Price, Little Tikes, Playschool,  |
|                           | Discovery, Trolls (Norfin), Silly-putty  |
+---------------------------+------------------------------------------+
| Water toys & equipment:   | PVC, plastic, nylon                      |
| beach thongs, masks,      |                                          |
|                           | Jay, ROHO cushions, Use leather gloves,  |
| bathing suits, caps,      | Sof Care bed/chair cushions (Gaymar)     |
| scuba gear, goggles       |                                          |
|                           |                                          |
| Wheelchair cushions,      |                                          |
| tires                     |                                          |
+---------------------------+------------------------------------------+
| Zippered plastic storage  | Waxed paper, plain plastic bags          |
| bags                      |                                          |
+---------------------------+------------------------------------------+

This list is offered as a guideline to individuals, families and
professionals by the Latex Committee of the Nursing Council, Spina
Bifida Association of America, and is updated twice a year. It is very
difficult to obtain full and accurate information on the latex content
of products, which may vary between companies and product series.

PLEASE NOTE: The companies offering \"alternatives\" often ALSO make
many LATEX products. Checking with suppliers before use with latex
allergic individuals is strongly recommended. The information in this
list is constantly changing as manufacturers improve their products and
as we learn more about latex allergy. For the most current version of
this list, visit the SBAA website at www.sbaa.org or send a SASE with
\$0.33 postage to Spina Bifida Association of America, 4590 MacArthur
Blvd NW, Suite 250, Washington, DC 20007-4226, 800-621-3141. (For the
Latex Allergy Information packet, which includes a current bibliography,
guidelines for writing policies and procedures, and recommendations to
avoid latex reactions, please send \$5.00). Additional information about
Latex Allergy is available from:

Latex Allergy Information Service 860-482-6869 and A.L.E.R.T, Inc
888-972-5378

+-----------------------------------------------------------------------+
| Did you know? Latex-free products can be ordered through these        |
| catalogs:                                                             |
|                                                                       |
| -   Alternative Resource Catalog (latex products, including           |
|     undergarments)                                                    |
|                                                                       |
| 800-618-3129 or 412-486-4476                                          |
|                                                                       |
| -   CETRA products for Latex-free Living 888-LATEX-NO                 |
|                                                                       |
| -   SAFETex Specialized products for a latex safe environment         |
|     (ReliaCare *Express)* 888-225-1941                                |
+-----------------------------------------------------------------------+

  ----------------------------- -----------------------------------------
  Ace wraps-brown (J & J        White Conco E-Cotton Ace wraps
  Dynaflex)                     

  Airway, masks and straps,     Hudson, Vital Signs airways and mask
  Naso-pharyngeal is latex      Concord Postex nasal airway

  Ambu bag                      clear Bag (Respironics, Laerdal,
                                Intertech), vinyl bag

  Anesthesia, ventilator        Neoprene (Anesthesia Associates, Ohmeda
  circuits, bags                adult) well-washed systems

  Anesthetic dental carpules    Use multi-dose vial

  Art supplies: paints, glue,   Elmers (School Glue, Glue-All, Glucolors,
  erasers                       Carpenters Wood Glue, Sno-Drift Paste),
                                Fiber Castel art erasers, Crayola
                                Products (except for rubber stamps,
                                erasers), Liquitex paints, Silly Putty

  Balloons                      Mylar balloons

  Balls: Koosh balls, tennis    PVC (Hedstrom Sports Ball), cover floors
  balls                         

  Band-Aids                     Active strips (3M-Latex in package),
                                Snippy Band (Quantasis, Readi-Bandages),
                                sterile dressing with plastic tape,
                                Stat-Strips (National Patent Medical)

  Bed protectors (washable      Disposable underpads, cover with sheets
  rubber)                       

  Bite blocks                   Use folded gauze, silastic

  Blood pressure cuff, tubing   Cleen Cuff (Vital Signs), Dinamap,
                                Critikon, over clothing, stockinet or
                                Webril

  Bulb syringe                  PVC (Davol)

  Buretrols (have Latex         B. Braun Burettes
  diaphragm)                    

  Cannulas (Acufex blue for     Open an additional scope sheath for an
  arthroscopies)                extra port of entry

  Cardiac custom packs          Pick case items separately

  Casts: Delta-lite Conformable Scotchcast soft cast, Delta-lite S,
  (J&J)                         Fiberglass, Fabric (J&J)

  Catheter prep set (gloves are Open prep set with non-latex gloves,
  latex, so entire kit is       sterile paper barrier, surgilube,
  unsafe                        betadine solution, etc.

  Catheters, condom             Silicone (Coloplast, mentor, Rochester)

  Catheters, indwelling         Silicone (Argyle, Bard, Kendall,
                                Rochester, Vitaid)

  Catheters, leg bags, drainage Velcro, nylon (Dale, Mentor), Bard
  systems                       systems

  Catheters, rectal pressure    Cook, Lifetech

  Catheters, straight, coude    Bard, Coloplast, Mentor, RobNel
                                (Sherwood)

  Catheters, urodynamics        Bard, Cook, Lifetech, Rusch

  Chux (washable under pads)    Disposable underpads

  Clothes, applique on Tees,    Cover elastic with cloth (Decent
  Elastic on Socks, underwear   Exposures-covered elastic)

  Colostomy pouch               

  Compression stockings (Ted    Wrap with non-latex ace bandage
  hose)                         

  Condoms, contraceptive        Polyurethane (Avanti), female condom
  diaphragm                     (Reality), Polymer male condoms soon on
                                market

  Crutches: tips, axillary      Cover with cloth, tape
  pads, hand grips              

  Dental braces with rubber     Wire springs
  elastics                      

  Dental rubber dams            Sterile plastic bags

  Dental prophylaxis polishing  
  cups                          

  Diapers, Incontinence pads,   Huggies, First Quality, Gold Seal,
  rubber pants                  Tranquillity, Drypers, Attends (some)

  Dilators-Sherwood Red Rubber  

  Drainage gags-Cysto-flow      Urimeter (avoid patient contact with
  collection bag and tubing     drainage port

  Drains-rubber                 Vinyl Penrose drains

  Drapes-Baxter blue paper      Vidrape
  towel                         

  Dressings: Moleskin (J&J),    Duoderm (Squibb), Reston foam (3M),
  Action Wrap, Coban (3M), BDF  Opsite, Venigard, Comfeel (Coloplast),
  Elastoplast                   Xerofoam (Sherwood), PinCare (Hollister),
                                Bioclusive, Montgomery straps (J&J),
                                Webril (Kendall), Note: Steri-strips,
                                Tegaderm, Tegasorb (3M) have lates in
                                package, Kerlix (Kendall), Kling (J&J)

  Elastic wrap: ACE Esmarch,    Adban Adhesive Compression Bandage
  Zimmer, Dyna-flex, Elastikon  (Avcor), cover skin with cotton barrier
  (J&J)                         

  Electrode bulbs, pads,        Baxter, Dantec EMG, Conmed, ValleyLab,
  grounding                     Vermont Med

  Endodontic file markers       Silicone

  Endotracheal tubes, airways   Berman, Mallinckrodt, Polamedco, Portex,
                                Sheridan, Shiley

  Enemas, ready-to-use          Glycerin, Babylax (Fleet), Theravac,
  (Fleet-latex valve)           Bower Management tube (MIC)

  Eyedropper squeeze bulbs      Do not draw liquid into bulb

  Feeding nipples               Silicone (Gerber, Evenflow, MAM), some
                                Ross, Mead Johnson nipples

  Feminine sanitary pads        Kimberly-Clark products

  Finger cots                   Non-latex glove finger

  Fluid circulating warming     Cover and keep away from patient skin
  blankets                      

  Foam pillows                  Cover, use down pillow

  Food handled with latex       Synthetic gloves for food handling
  gloves                        

  Food related to latex gloves  kiwi, banana, avocado, potato, tomato,
                                chestnuts, peach, papaya, fig, passion
                                fruit, plum, nectarine, cherry, melon,
                                celery

  G-tubes, buttons              Silicone (Bard, MIC, Stomate)

  Gastroscopy tubes             

  Gloves, sterile, clean,       Vinyl, neoprene, polymer gloves:
  surgical                      Allergard (J&J), dermaprene (Anseli),
                                Neolon, SensiCare, Trutouch (B-D),
                                Nitrex, Tactyl 1,2 (Smart Practive),
                                duraprene, Triflex (Baxter)

  Handles on racquets, tools    Vinyl, leather handles, or cover with
                                cloth or tape

  Instrument mats               

  IV access: injection ports,   Cover Y-sites and do not puncture: Use
  Y-sites bags, buretrol ports, stopcocks for meds. Flush all tubing.
  PRN adapters, Needleless      Abbott nitroglycerin tubing; Walrus,
  systems                       Gemini (IMED), some Baxter systems, Braun
                                burettes, Braun, Clave, Abbott needleless
                                systems

  IV med. pumps (cassettes have 
  latex                         

  Infant toothbrush-massager    Soft bristle brush or cloth

  Kitchen cleaning gloves       Vinyl, cotton liners (Allerderm)

  Medication vial stoppers      Eli Lilly, Fujisawa; if not certain,
                                remove stopper

  Mouth gags                    Replace rubber with silastic

  NG tube                       

  Newsprint ads, coupons dusted 
  with latex                    

  OR masks, hats, shoe covers   Replace elastic bands with twill tape
                                ties

  Orthopedic appliances         

  Oxford tubes                  

  Oxygen masks, Cannulas        Remove elastic bands, check content of
                                valves

  Pacifiers                     Plastic, silicone, vinyl (Binky, Gerber,
                                Infa, Kip, MAM)

  Penrose drains                Jackson-Pratt, Zimmer Hemovac, silicone
                                tubing

  Pulse oximeters               Certain Oxisensor (Nellcor), cover digit
                                with Tegaderm

  Reflex hammers                Cover with a baggie

  Respirators-TB (3M9970)       Advantage (MSA), HEPA-TECH (Uvex)

  Resuscitators, manual         Silicone: PMR 2 (Puritan Bennett), SPUR
                                (Ambu) Vital Blue, Respironics, Laerdal,
                                Armstrong

  Rubber bands                  String, Vessiloops, small pieces of
                                non-latex

  Rubber head straps (OR)       

  Slippers-latex bottoms and    Have patient bring slippers from home
  elastic                       

  Stethoscope tubing            PVC tubing, cover with stockinet or
                                ScopeCoat

  Suction catheters, tubing     PVC (Davol, Laerdal, Mallinckrodt,
                                Superior, Yankauer)

  Syringes, disposable          Draw up medication in syringe right
                                before use: Abboject, PCA (Abbott), use
                                glass syringes

  tapes: adhesive, porous, pink Dermaclear, Dermicel, Waterproof (J&J),
  Waterproof (3M)               Durapore, Microfoam, Microprobe,
                                Transport(3M), plastic, silk tape

  Ted hose                      Non-latex ace wrap

  Teeth protectors              Use silastic

  Theraband, Therastrip,        Cover with cloth, exercise putty (Rolyan)
  Theratube                     

  Tourniquet                    Children's Med Ventures, Grafco,
                                VelcroPedic, or over clothes

  Toys-Stretch Armstrong, old   Jurassic Park Figures (Kenner), post 1993
  Barbie's, Bowling balls       Barbie's, Disney dolls (Mattel), many
                                toys by Fisher Price, Little Tikes,
                                Playskool, Discovery, Trolls (Norfin)

  Tubing, sheeting              Plastic tubing-Tygon LR-40 (Norton),
                                elastic thread, sheets (JPS
                                Elastometrics)

  Tympanometers-rubber          

  Ureteral stints               

  Waterproof mattress covers on Cover with sheets and avoid any contact
  beds, OR tables, and          with patient skin
  stretchers                    

  Water toys & equipment:       PVC, plastic
  thongs, masks, bathing suits, 
  caps, scuba gear, goggles     

  Wheelchair cushions, tires    Jay, ROHS cushions, Cover seats, Use
                                leather gloves

  Zippered plastic storage bags Waxed paper, plain plastic bags, Ziploc
                                (DOW)

                                
  ----------------------------- -----------------------------------------

ALASKA NATIVE TRIBAL HEALTH CONSORTIUM

SCREENING QUESTIONNAIRE FOR NATURAL RUBBER LATEX SENSITIVITY

IMPORTANT CAUTION: This questionnaire is not intended to be
all-inclusive. Individuals who are uncertain whether they have
sensitivities or allergies to natural rubber latex proteins and/or
chemicals should consult a physician.

Hospital employee position i.e.: RN, MD, LAB TECH etc.:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1\. Has a doctor ever told you that you have an allergy to any latex
product?

Yes  No

######### If yes, to what specifically did the doctor say you were allergic? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. Have you had a reaction to any of the following personal sources of
latex?

> Yes No Yes No Yes No

Balloons   carpet backing   garden hoses  

Rubber gloves   clothing   golf grips  

Hot water bottles   rubber cement   latex cuffs  

Rubber balls   suspender   milking machines  

Rubber bands   teething rings   ostomy bags  

Adhesive tape   condoms   dental masks  

Ace bandages   corsets   pacifiers  

######### Dental bite blocks   dental rubber dams   shoe wear  

Bandages   erasers   tennis grip  

Belts   face masks   weather stripping  

Brassieres   foam pillows   IV tubing  

3\. Do you have a history of the following?

> Yes No Yes No Yes No

Contact dermatitis   hay fever   autoimmune disease  

Rhinitis or conjunctivitis   eczema   asthma  

Hives   unexplained rash  

Please **PRINT** the following:

  --------------------------------- -------------------------------------
  Name:                             Sex:

  Date of Birth:                    Health Record #:

  Position held:                    Supervisor & Dept:

  Office #:                         Date:
  --------------------------------- -------------------------------------

OVER

4\. These foods are associated with latex allergy. Do you have any
reaction to them? Circle the ones to which you react to & indicate the
type of reaction.

Yes  No Type of reaction

> banana milk
>
> avocado peaches
>
> potato tomato
>
> kiwi papaya
>
> chestnuts passion fruit
>
> poinsettia plant

5\. When exposed to latex gloves or any other latex product do you
develop:

> Ig-E Type I reaction
>
>  Hives  Nausea, abdominal cramping
>
>  Dizziness  Itching burning eyes
>
>  Shortness of breath  Runny nose
>
>  Generalized swelling (face, hands)  Generalized itching
>
>  Wheezing  [No]{.underline} Type of Reaction
>
> Type IV reaction
>
>  [Itching]{.underline} of hands  [No]{.underline} Type of Reaction
>
>  [Peeling,]{.underline} scaling of hands
>
>  [Blisters,]{.underline} sores, bumps
>
>  [Swelling]{.underline} of hands
>
>  **Redness**

6\. After dental work have you experienced any of the reactions (Type I
or Type IV) listed above?

> Yes No Yes No
>
> itching   runny nose  
>
> tearing   facial swelling/redness  
>
> sneezing  

Reviewed by
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
MD, DO.

Patient/ Employee signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Employee Health

##### LATEX RISK {#latex-risk .unnumbered}

**BASIC SAFEGUARDS**

All gloves low allergen non-powdered

REFERRAL TO FAMILY MEDICINE CLINIC

MEDICAL RECOMMENDATIONS

MADE TO EMPLOYEE

JOB DESCRIPTION MODIFIED

IF POSSIBLE BY FAMILY MEDICINE CLINC

CONSULTANT BASED ON

TYPE OF SENSITIVITY

MONITORING MONTHLY/

COORDINATED WITH

INFECTION CONTROL

NOTIFICATIONS EMPLOYEE RELATIONS

> SUPERVISORS

TEACHING SUPERVISORS AND EMPLOYEES OF RISK