Pre-assessment / Outpatients Clinic

Natural rubber latex (NRL) products may impact on outpatient and pre-assessment clinic staff (ie doctors, nurses, health care assistants) because:

  1. They are at increased risk of developing NRL allergy through the frequent use of latex gloves.
  2. They may need to manage NRL-sensitive patients, which may be either known in advance or previously undiagnosed.
  3. They have a statutory responsibility to reduce risk of sensitisation in themselves, their colleagues and their patients.

Ensure you have and are familiar with:

  • A written policy on action to protect staff from developing NRL allergy.
  • A written policy on safe accommodation of NRL-sensitive members of staff.
  • A written policy for the safe management of patients with known or suspected NRL allergy.
  • A screening tool for determining the allergic status of your patients/clients.
  • An Education programme to inform new and existing staff.
  • Posters for patient and staff information, clearly displayed and on file.
  • An Occupational Health surveillance programme, which includes pre-employment screening.
  • A named responsible person for managing Health and Safety.

Ensure that NRL-free emergency equipment and medicines are readily available to treat any allergic reaction from mild (eg urticaria and asthma) to severe (ie laryngeal oedema / bronchospasm / cardiovascular collapse from anaphylaxis) and that staff are fully trained in resuscitation techniques*.

* Click here for Resuscitation Council (UK) guidance emergency medical treatment of anaphylactic reactions.

Patient Care - Diagnosis and Communication
If following screening it is established that the patient may be NRL allergic, it is vital to future patient safety both inside and outside of healthcare that an accurate Diagnosis is made by an appropriate diagnostician (i.e. allergist, immunologist or dermatologist) and referral initiated either directly from the clinic or by informing the General Practice of the screening outcome following the outpatient/clinic appointment and asking for an urgent referral to be made. It is vital to impress upon referring clinicians the importance of releasing this information to other clinical teams so that standard NRL-containing equipment can be replaced with designated NRL-free equipment for use on sensitised patients instead and allergic reactions avoided.

Admission for elective surgery or hospital treatment should wherever it is in the patient’s best interest be delayed until a definitive diagnosis is obtained. In the event of there being a delay in achieving diagnosis and the patient requiring earlier admission, all future carers must be notified of the possible diagnosis and those areas prepared to receive a patient who has been assessed as high risk.

For example:

  • GP and Primary Care
  • Wards
  • X-Ray
  • Physiotherapy
  • Occupational Therapy

Management of sensitised workers
If you suspect that you may be allergic to NRL, it is best to seek a referral to a dermatologist or immunologist via your GP or Occupational Health Physician so that this can be appropriately investigated as soon as signs and symptoms develop.

If you are found to be latex-sensitive, then it is essential that your work environment is adapted as soon as possible to avoid unnecessary exposure to NRL, which would increase your sensitivity and put you at risk of more severe reactions.

Protection of Staff

  • Don’t wear jewellery (eg rings);
  • Wash and disinfect hands at the beginning and end of each session, as well as between each glove change;
  • Use cool/tepid water when washing, to keep hand temperature down;
  • Use hand-wash agents sparingly;
  • Rinse thoroughly to remove all traces of hand wash;
  • Pat skin dry rather than rubbing it;
  • Use soft towels (disposable);
  • Ensure hands are dry before putting on gloves;
  • Use non-powdered gloves with low levels of NRL proteins and residual chemicals;
  • Chose the right size of gloves;
  • Minimise contact with other potential irritants/allergens in the surgery (eg acrylic powders/anti-microbial solutions);
  • Outside work, don’t forget to protect hands when gardening/doing household chores etc.

If you or your patient are not NRL-sensitive and you choose to wear NRL gloves to protect yourself from blood-borne pathogens choose Powder-Free and Low Protein (<50ug/g) gloves only.

Reporting agencies for adverse reactions to Natural Rubber Latex products

  • The National Patient Safety Agency (NPSA) is a Special Health Authority charged with improving patient safety in the NHS.  It was created in 2001, following the publication of two reports addressing patient safety incidents in the NHS (An Organisation with a Memory and its follow-up, Building a Safer NHS for Patients).
  • The Medicines and Healthcare Products Regulatory Agency (MHRA) has a voluntary reporting system for reporting cases of latex sensitisation in both patients and staff.