+--------------------------------+----------------------+-------------+
| **BROOKHAVEN NATIONAL          | NUMBER:IC- 18.0      | PAGE 1 OF 2 |
| LABORATORY**                   |                      |             |
|                                |                      |             |
| *                              |                      |             |
| *GENERALCLINICALRESEARCHCENTER |                      |             |
| POLICY**                       |                      |             |
+================================+======================+=============+
|                                | PREPARED BY: B.      |             |
|                                | Pyatt Infection      |             |
|                                | Control              |             |
+--------------------------------+----------------------+-------------+
| SUBJECT: Latex Gloves and      | REVIEWED BY: W.      |             |
| Other Gloves                   | Gunther GCRC Manager |             |
+--------------------------------+----------------------+-------------+
|                                | APPROVED BY:G. J.    |             |
|                                | Wang Medical Dept.   |             |
|                                | Chair                |             |
+--------------------------------+----------------------+-------------+
|                                | EFFECTIVE DATE:      |             |
|                                | 11-09-07             |             |
+--------------------------------+----------------------+-------------+
|                                | REVISION HISTORY: 3  |             |
+--------------------------------+----------------------+-------------+

**PURPOSE AND SCOPE**

This document defines general infection control policies and procedures
regarding latex gloves.

**GENERAL**

Latex is a component of many products used in health care and the
community. The major route of occupational exposure has been postulated
as an absorption of the latex protein through the skin. Allergens in or
on gloves can be absorbed by the wearer or transferred to the subject's
tissue during procedures. The diagnosis of latex allergy relies on a
careful history and in some instances an environmental survey with the
only effective mode of therapy being avoidance. At risk for latex
allergy are health-care workers, employees who use latex gloves (for
example custodians) and those with a history of natural rubber latex
sensitivity, congenital urinary anomalies, multiple medical and/or
surgical procedures or sensitivity to banana, avocado, kiwi, chestnuts,
pineapple, or passion fruit.

### SYMPTOMS

1.  Edema and itching around the eyes

2.  Generalized pruritus

3.  Sneezing

4.  Urticaria

5.  Dermatitis

6.  Wheezing

7.  Shortness of breath

8.  Asthma

9.  Airway obstruction as a result of bronchospasm

10. Anaphylactic shock

### THREE TYPES OF REACTIONS ASSOCIATED WITH NATURAL RUBBER LATEX GLOVES

1.  Irritant contact dermatitis (nonallergic, nonlife threatening)

> a\) Symptoms

\(1\) Acute: Redness, burning, itching

\(2\) Chronic: Dry, thickened skin; cracking, sores, spaced bumps

b\) Extent: Stops at glove boundary

c\) Causes

1.  Unrinsed scrubs, soaps, and disinfectants

2.  Excessive powders

3.  Occlusion, hyperhydration, excessive chemical additives

d\) Susceptibility: Anyone

2.  Allergic contact dermatitis (delayed type of hypersensitivity: Type
    IV, non-life threatening)

> a\) Symptoms

1.  Acute: Small, clustered bumps; itching, redness, pain

2.  Chronic: Dry, thickened skin; cracking, sores, spaced bumps

b\) Extent: My extend beyond glove boundary

c\) Causes

(1) Scrubs, soaps, disinfectants

(2) Glove chemicals: Accelerators, preservatives

d\) Susceptibility: Genetic predisposition (individuals prone to
allergies)

3\. Urticaria (immediate type of hypersensitivity: Type I, life
threatening)

a)  Symptoms: Hives, swelling, watering eyes, running nose, difficulty
    breathing, abdominal cramps, dizziness, low blood pressure, rapid
    heart rate, anaphylactic shock

b)  Extent: May extend beyond glove boundary and become systemic

c)  Causes: Protein in the natural rubber latex "sap" from the rubber
    tree *Hevea brasiliensis*

d)  Susceptibility

    1.  Occupational exposure

    2.  Genetic predisposition

**[LATEX FREE GLOVES MUST BE USED BY LATEX ALLERGIC EMPLOYEES OR ON
LATEX ALLERGIC SUBJECTS]{.underline}**

### RECOMMENDED PRECAUTIONS FOR LATEX-SENSITIVE PERSONS 

1\. Subjects:

a)  Include questions about latex sensitivity when taking all subjects
    histories

b)  Place latex allergy bracelet on subject

c)  Put clean, visible signs on the doors to subjects and procedure
    rooms stating that there is a latex-sensitive subject in the room

d)  Use nonlatex gloves (vinyl, thermoplastic elastomer, nitrile)

e)  Substitute latex-free products for those containing latex whenever
    possible

f)  Place stopcock in intravenous IV lines for injection of drugs and
    tape over latex ports

g)  Avoid multidose medication

h)  Wrap blood pressure measurement connecting tubing with gauze or
    place cotton batting on areas of contact with subject skin

i)  Use Velcro tourniquets or place gauze under latex tourniquets

j)  Notify personnel (doctors, nurses, pharmacy etc.) that the subject
    is latex sensitive so they can use the appropriate procedures when
    preparing items for the subject

2\. Healthcare Workers

a)  Irritant contact dermatitis

    1.  Rinse hands thoroughly after washing

    2.  Dry hands thoroughly before putting on gloves

    3.  Select a different lot of gloves (nitrile, vinyl etc.)

    4.  Select a glove low in chemical additives or post-processed for
        chemical neutralization

    5.  Report your condition to OMC

b)  Allergic contact dermatitis

    1.  See a dermatologist

    2.  Select a glove proven low in chemical contact sensitizers
        (nitrile, vinyl, etc.)

c)  Urticaria

    1.  See an allergist

    2.  Work in a powder-free environment

    3.  Select a nonlatex glove (e.g., polyvinyl chloride, polyethylene,
        plastic, neoprene, nitrile)

    4.  Wear low-protein-allergen, non-powdered gloves

**[HCW'S must remember that hand hygiene should be performed following
glove removal]{.underline}**

It is essential that all HCW's understand that wearing gloves does NOT
eliminate the need for appropriate hand hygiene.

1.  Gloves cannot provide complete protection against bacterial
    contamination of HCW's hands.

2.  Wearing gloves cannot completely guard against acquiring infections.

3.  Glove manufacturing guidelines are designed to eliminate most glove
    defects, however, a limited percentage of gloves will have small
    holes that could provide a passageway for microbial transfer.

4.  Glove removal may be a source of hand contamination, if gloves are
    not removed correctly.

As a result, it is crucial for HCW's to wash hands following glove
removal when hands are visibly soiled. Hands should also be washed when
the integrity of the gloves has been compromised(torn, etc.) during use.
In the absence of visible (or any perceived) contamination of hands,
hand hygiene with alcohol handrubs is appropriate, following glove
removal.

**ADDITIONAL GLOVE CONSIDERATIONS**

1\. Medical gloves should **NEVER** be washed or reused (An exception
may be heavier reusable gloves such as those used in

housekeeping, x-ray, and when handling hazardous chemicals).

2\. Wear the correct size gloves

3\. Promote proper fingernail length (1/4 inch) to minimize glove tears
and maintain glove integrity.

4\. Avoid use of petroleum-based lotions or creams with latex gloves, as
they may adversely affect the integrity of latex gloves.

5 Barrier integrity may be impacted by storing gloves near heat or cold
extremes, sunlight, UV, fluorescent lights, or X-rays.

6\. Heavily-fragranced lotions may precipitate hand irritation if worn
under gloves.

7\. Consider healthcare personnel lotions that are compatible with hand
hygiene products.

8\. If powdered gloves are used, followed by hand hygiene with certain
alcohol handrubs, powder residue may interact with the

alcohol, producing a "gritty feeling' on hands. This is an essential
issue to address, both when selecting gloves as well as when

choosing alcohol products for hand hygiene.

9.  Select and appropriate glove for use when exposure to chemicals is
    anticipated.

10. Both examination (non-sterile) gloves and surgical (sterile) gloves
    must be available for specific healthcare tasks.

> The only official copy of this file is the one online at the Medical
> Department website under "Clinical Research Center Policy Manual."
> Before using a printed copy, verify that it is the most current
> version by checking the document effective date on the website.