# Presentation: 940811

## Restricting Latex Glove Use in Food Service Establishments in Oregon:        	A Public Health Response 

- Michael A. Heumann, MPH MA
- Oregon Department of Human Services
- Environmental and Occupational Epidemiology
- 800 NE Oregon St., # 827
- Portland, OR 97232-2162

## Outline of testimony

- What did we do?
- How did Oregon become aware if the problem?
- Why did we act?
- The role of our partners in developing a response

**Notes:**
I want to present to you what we felt was a practical approach to a public health problem.
I will to describe how we applied science to policy

To do this I will share with you the actions Oregon took:
--How we became aware of the problem
--What we did to respond
--Why we chose this particular course of action
And
--Who were the key players involved in helping to make it happen.

Then I will be happy to respond to any questions you may have.

## What did we do?

**Oregon Administrative Rules**
- 	**OAR 333-150-0000****1999 FDA Food Code **
**	****Section 3-304.15 **
**	****Glove, Use Limitation.**
**(E) Effective March 1, 2003, the use of latex gloves in food service establishments is prohibited. **

**Notes:**
The 1999 USFDA Food Code was formally adopted in Oregon 
in January 2002.  Included in the Food Code were changes and 
Amendments specific to Oregon.  They included the section on glove 
Use limitation which stated in a simple sentence: 
Effective March 1, 2003, the use of latex gloves in 
food service establishments is prohibited. 

## How did Oregon become aware of the problem?

- Tracking occupational illness & injury in Oregon since 1992
- Workers’ compensation claims
- Occupational skin conditions
- Latex allergy in health care industry

**Notes:**
State Workers’ compensation data is used for tracking

We built partnerships with the largest W.C. Insurers to gain access to detailed information not available in the state system.
  An administrative data base used for accounting and case management is also useful for detailed information about the injury or illness

Especially useful is the narrative data fields with information about the antecedent events.

## Responding to Latex Allergy in Health Care

- Research the science around latex allergy
- Education about hazards & alternatives
- Encourage latex-safe environments
- Partners
- hospitals & other employers
- employees
- workers’ compensation insurers
- NIOSH

## Latex glove use in the food service industry

- 1998 first case reports identified latex glove dermatitis among food workers in W.C. data
- Text of accident description:
- “Allergic reaction to wearing latex gloves”
- “Received severe rash on both hands due to latex gloves”
- Text of injury description:
- “Respiratory disorders lungs”
- “Dermatitis on hands”

**Notes:**
In 1998 we saw our first case reports in Oregon of dermatitis associated with latex glove use among food service workers.

Surprised to see 5 reports of accepted cases

## Latex glove use in the food service industry

## Latex glove use in the food service industry

- 12 cases among workers in 1st two years
- Reports of allergic reactions among restaurant customers with prior history of latex sensitivity
- Range of symptoms
- Anaphylaxis
- throat tightness
- difficulty breathing

**Notes:**
Not all of these cases were accepted claims, some were denied, but we were clearly seeing something different

We also began to receive reports of allergic reactions among restaurants customers.  These were individuals who had a pre-existing latex sensitivity.  Their reactions reportedly happened either while they were still in the restaurant or a short time after eating.

Symptoms varied among people

## Latex glove use in the food service industry  -- DHS response

- Confirm cases with WC Insurer
- Confirm use of latex gloves in restaurants
- Confirm cases among customers
- Identify partners with clear self interest
- Oregon Restaurant Association (ORA)
- United Food & Commercial Workers Union (UFCW)
- Local Health Departments
- Liberty Northwest Insurance

**Notes:**
ORA is the largest industry group that represents about 1⁄4 of all restaurant owners.  Purchase of group insurance, lobbying, communications, etc.

UFCW largest union representing food workers.  Natural interest in worker health and safety.

Local Health Depts inspect restaurants for health and safety of both workers and consumers

Liberty Northwest is the largest private WC insurer in Oregon.  We have worked with them on other Latex issues.

## Latex glove use in the food service industry  -- DHS response

- Liberty Northwest & ORA
- Meeting & agreement to collaborate
- Immediate changes among large restaurants and corporate chains
- Articles in ORA newsletter
- Goal of voluntary change (similar to health care industry)
- UFCW
- Meeting & agreement to collaborate
- Article in union newsletter

## Latex glove use in the food service industry  -- DHS response

- Local Health Departments
- Training about hazards and alternatives
- Developed Latex Alert for restaurants
- 5 Counties collaborated in a pilot intervention
- gather information
- provide education
- distribute Latex Alert in English & Spanish

**Notes:**
Sanitarians in 5 LHDs came forward to join in the work
Assess the extent of latex glove use
Conducting education outreach
Shared goal to  promote voluntary change

##  Why did we act?

- Positive response among restaurants and suppliers contacted
- Potential liability from customer incidents was the greatest motivator to change
- Contact from attorneys looking for cases

##  Why did we act?

- Latex allergy cases continued to be reported
- Sought a way to address latex glove use in food services _statewide_
- Simply way to prevent cases
- Protect customers, employees, employers & suppliers

## Why did we act?

- DHS planned to adopt 1999 FDA Food Code
- Opportunity to act
- Oregon rules require hand washing, not glove use
- Rhode Island & Arizona had latex glove bans
- Complex language
- Proposed simple language
**“ ****The use of latex gloves in food service establishments is prohibited.”**
- Implementation date negotiated with ORA

**Notes:**
We learned that the Office in DHS responsible for restaurant health and safety were preparing to adopt the 1999 FDA Food Code

This provided us an opportunity to add language to restrict latex glove use in food service establishments

Key Issue:  Hand washing required 
Oregon does not promote glove use of any kind.

Glove use is an option, along with other methods of handling prepared foods safely (e.g. tongs, wraps, other glove materials, etc.)

## Why did we act?

- Food Code rule adopted in August 2002
- Major media coverage to announce the ban
- Advised restaurants & suppliers of change
- Letters
- Articles
- Local Health Dept. inspectors provided advice
- Encouraged to adopt prior to implementation date
- Many questions, general support

## The role of our partners in developing a response

- Important to cultivate wide support among affected parties
- Identify who has a stake & what is their interest
- Provide appropriate education about the issue
- Involve them in the decision-making process as much as possible

## Conclusions

- Oregon’s actions
- Based on tracking to identify patterns and problems
- Understand the science underlying the issue
- Apply science to policy in collaboration with key stakeholders
- First attempted voluntary change
- Adopted formal rule change only when needed

## Conclusions

- Natural rubber latex has an important place
- Protection against exposure to blood borne pathogens     –> in health care
- Low protein/powder free gloves safest option for people who are not already latex sensitive
- Many alternative glove materials exist
- Glove selection should be specific to use

## Conclusions

- Powdered natural rubber latex gloves are being promoted in many other settings
- Child care, janitorial, house keeping, agriculture, food processing & nutritional supplements industries
- Latex allergies are real and preventable