About NRL (Natural Rubber Latex)
Use of Medical equipment
Many items contain NRL but are often not usually labelled to warn of NRL content. Because a much more serious reaction may occur when these items contact internal body surfaces, eg mucosal, parenteral and serosal contact, it is very important for sensitised patients to inform healthcare providers of their allergy so that only NRL-free medical equipment is used.
How can sensitised individuals avoid NRL?
Avoid contact with NRL gloves or products where possibleInform employers and healthcare providers of NRL allergy
Avoid areas where inhalation of powder from NRL gloves worn by others or from balloon displays may occur
Recommend use of Medic-Alert bracelet, stating natural rubber latex allergy
How is NRL used?
Gloves are the single most widely used device containing natural rubber latex. The Health and Safety Executive has stated that, "Single use disposable natural rubber latex gloves may be used where a risk assessment has identified them as necessary. When they are used they must be low-protein and powder-free".In many situations a risk-assessment will suggest that in the presence of a risk of blood-borne pathogen transmission, for example surgery and body fluid contact, NRL is the safest choice of material provided the worker and patient are not sensitised to this. If a person is sensitised to NRL proteins, NRL-free gloves and equipment must be used.
Not all NRL-free gloves afford the same protection against blood-borne pathogens so care must be taken in the choice of substitutes. Some gloves may only be suitable for non-clinical tasks as they may not afford the same level of protection against transmission of blood-borne pathogens. If there is doubt suppliers can be asked to provide test data proving the glove's suitability.
NRL gloves are also often used in catering, domestic services, motor industry, hairdressing and other professions and trades where, if there is no contact with blood or body fluids, they should be substituted by an alternative non-latex product.
Why use NRL?
NRL is a widely-used and cost-effective material, which for the majority of the population is not a clinical risk. The importance of risk-assessment is to make an informed decision as to whether an alternative is effective for the task.NRL has many benefits which are yet to be equalled where there is a requirement for specific tactility and dexterity qualities, for example in surgical practice. Where it is used, the gloves must be low protein (<50mcg/g) and powder
What sort of products contain Latex?
Natural Rubber Latex (NRL) is an ever-present part of daily life. Because it is strong, flexible, elastic, hard-wearing and protective, NRL is used in many thousands of medical and consumer products. Labelling of NRL content in these products is, however, generally poor.NRL is processed into two types of rubber material: dipped rubber and dry rubber goods
Dipped rubber goods
About 10% of tapped NRL that comes from the Hevea brasiliensis rubber tree is made into a ‘latex concentrate’. Most of this is used for ‘dipped’ rubber products, so-called because of the manufacturing process where the porcelain or glass formers, which are in the shape of the item to be made, are dipped into liquid latex.
‘Dipped’ products are the main source of NRL allergens, and those that most commonly cause reactions in people with latex allergy are gloves, balloons and condoms. Latex concentrate is also used in the production of catheters, tourniquets, teats, dental dams, swimming caps, cold seal adhesives, thread for garments, foam for pillows and mattresses (many are synthetic), bathmat backings and carpet backings (most are synthetic).
Dry rubber goods
About 90% of tapped latex is made into ‘dry’ or solid rubber goods. Most dry rubber is used for vehicle tyres, where it is often combined with synthetic rubbers. Other uses include hoses, seals, erasers, car mats, windscreen wipers, sink plugs, medicine vial stoppers, shoe soles, divers’ flippers, rubber bands, hot water bottles, tool handles and cables.
Only a minority of people with latex allergy will have problems with dry rubber goods, as these contain only small amounts of allergen. This is because dry rubber processing uses a higher temperature than for dipped products, and the heat destroys more of the allergens.
There are many medical and consumer products that contain natural rubber latex. Healthcare providers must ensure that latex-free medical supplies are available for use on or by sensitised individuals. Here are some examples of products that may contain natural rubber latex:
Medical Equipment
Examination and Surgical gloves
Oral and Nasal airways
Endotracheal tubes
Intravenous tubing
Surgical masks
Rubber aprons
Catheters
Injection ports
Bungs and needle sheaths on medicines
Wound drains
Dental dams
Anaesthesia masks
Blood pressure cuffs
Syringes
Stethoscopes
Tourniquets
Electrode pads
Surgical masks
Consumer items
Erasers
Rubber bands
Balloons
Condoms
Contraceptive cap
Baby teats
Hot water bottles*
Stress balls
Sports equipment (eg hand grips and gym mats)
Swimming cap and goggles
Washing-up gloves
Carpets
Adhesives
Tyres *
Underwear elastic
Shoe soles*
Calculator/remote control buttons
* dry rubber