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Frequently Asked Questions (FAQs) on Dental Infection Control


Top|Occupational Allergies


Does OSAP have a reference or rationale that could be used to explain to an affirmative action officer about the "absence of type IV latex allergy" in the dental world?
What role does cornstarch play in latex allergies?
Should we use powder-free vinyl or nitrile gloves for patients with latex allergies?

It has come to our attention that we need a written policy for latex sensitive employees. Does OSAP have any guidelines for such a policy?

I am looking for information concerning the management of latex allergic patients. Can OSAP send me information or point me in the right direction on how to find it?

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Does OSAP have a reference or rationale that could be used to explain to an affirmative action officer about the "absence of type IV latex allergy" in the dental world?
The National Institute for Occupational Safety and Health (NIOSH) has an extensive list of recent publications regarding occupational latex allergy (1). This should provide you with a reliable source of information for a variety of occupational latex allergy issues.

References:
(1) NIOSH. Occupational Latex Allergies. Available at http://www.cdc.gov/niosh/topics/latex.
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What role does cornstarch play in latex allergies?
While the cornstarch often used as a powder to aid in donning gloves is not allergenic, it can carry latex proteins and allergenic chemicals from the glove material. The National Institute for Occupational Safety and Health (NIOSH) provides this caution related to powdered latex gloves (1): "when powdered gloves are worn, more latex protein reaches the skin. Also, when gloves are changed, latex protein/powder particles get into the air, where they can be inhaled and contact body membranes … (2). In contrast, work areas where only powder-free gloves are used show low levels or undetectable amounts of the allergy-causing proteins (3,4)."

References:
(1) DHHS. NIOSH Alert. Preventing Allergic Reactions to Natural Rubber Latex in the Workplace. June 1997. Publication No. 97-135
(2) Heilman DK, Jones RT, Swanson MC, Yunginger JW. A prospective, controlled study showing that rubber gloves are the major contributor to latex aeroallergen levels in the operating room. J Allergy Clin Immunol 1996;98(2):325-330.
(3) Tarlo SM, Sussman G, Contala A, Swanson MC. Control of airborne latex by use of powder-free latex gloves. J Allergy Clin Immunol 1994;93: 985-989.
(4) Swanson MC, Bubak ME, Hunt LW, Yunginger JW, Warner MA, Reed CE. Quantification of occupational latex aeroallergens in a medical center. JAllergy Clin Immunol 1994;94(3): 445-551.
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Should we use powder-free vinyl or nitrile gloves for patients with latex allergies?
The key to managing latex-allergic individuals is to avoid contact with latex proteins. Since vinyl and nitrile do not contain natural rubber latex protein, the presence of powder on these gloves poses no risk of latex exposure. The powder used in latex products may carry particles of the latex protein and cause exposure to sensitive or allergic individuals. Generally, it is not the powder itself that is of concern.
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It has come to our attention that we need a written policy for latex sensitive employees. Does OSAP have any guidelines for such a policy?
OSAP would like to refer you directly to the Centers for Disease Control and Prevention's Infection Control Guidelines for Dental Healthcare Settings. In part, the guidelines state the following:

Contact Dermatitis and Latex Hypersensitivity

Occupationally related contact dermatitis can develop from frequent and repeated use of hand hygiene products, exposure to chemicals, and glove use. Contact dermatitis is classified as either irritant or allergic. Irritant contact dermatitis is common, non-allergic, and develops as dry, itchy, irritated areas on the skin around the area of contact. By comparison, allergic contact dermatitis (type IV hypersensitivity) can result from exposure to accelerators and other chemicals used in the manufacture of rubber gloves (e.g., natural rubber latex, nitrile, and neoprene), as well as from other chemicals found in the dental practice setting (e.g., methacrylates and glutaraldehyde). Allergic contact dermatitis often manifests as a rash beginning hours after contact and, similar to irritant dermatitis, is usually confined to the area of contact. (1)

Latex allergy (type I hypersensitivity to latex proteins) can be a more serious systemic allergic reaction, usually beginning within minutes of exposure but sometimes occurring hours later and producing varied symptoms. More common reactions include runny nose, sneezing, itchy eyes, scratchy throat, hives, and itchy burning skin sensations. More severe symptoms include asthma marked by difficult breathing, coughing spells, and wheezing; cardiovascular and gastrointestinal ailments; and in rare cases, anaphylaxis and death. The American Dental Association (ADA) began investigating the prevalence of type I latex hypersensitivity among DHCP at the ADA annual meeting in 1994. In 1994 and 1995, approximately 2,000 dentists, hygienists, and assistants volunteered for skin-prick testing. Data demonstrated that 6.2% of those tested were positive for type I latex hypersensitivity. Data from the subsequent 5 years of this ongoing cross-sectional study indicated a decline in prevalence from 8.5% to 4.3%. This downward trend is similar to that reported by other studies and might be related to use of latex gloves with lower allergen content. (1)

Natural rubber latex proteins responsible for latex allergy are attached to glove powder. When powdered latex gloves are worn, more latex protein reaches the skin. In addition, when powdered latex gloves are donned or removed, latex protein/powder particles become aerosolized and can be inhaled, contacting mucous membranes. As a result, allergic patients and DHCP can experience cutaneous, respiratory, and conjunctival symptoms related to latex protein exposure. DHCP can become sensitized to latex protein with repeated exposure. Work areas where only powder-free, low-allergen latex gloves are used demonstrate low or undetectable amounts of latex allergy-causing proteins and fewer symptoms among HCP related to natural rubber latex allergy. Because of the role of glove powder in exposure to latex protein, NIOSH recommends that if latex gloves are chosen, HCP should be provided with reduced protein, powder-free gloves. Non-latex (e.g., nitrile or vinyl) powder-free and low-protein gloves are also available. Although rare, potentially life-threatening anaphylactic reactions to latex can occur; dental practices should be appropriately equipped and have procedures in place to respond to such emergencies. (1)

DHCP and dental patients with latex allergy should not have direct contact with latex-containing materials and should be in a latex-safe environment with all latex-containing products removed from their vicinity. Dental patients with histories of latex allergy can be at risk from dental products (e.g., prophylaxis cups, rubber dams, orthodontic elastics, and medication vials). Any latex-containing devices that cannot be removed from the treatment environment should be adequately covered or isolated. Persons might also be allergic to chemicals used in the manufacture of natural rubber latex and synthetic rubber gloves as well as metals, plastics, or other materials used in dental care. Taking thorough health histories for both patients and DHCP, followed by avoidance of contact with potential allergens can minimize the possibility of adverse reactions. Certain common predisposing conditions for latex allergy include previous history of allergies, a history of spina bifida, urogenital anomalies, or allergies to avocados, kiwis, nuts, or bananas. The following precautions should be considered to ensure safe treatment for patients who have possible or documented latex allergy: (1)

Be aware that latent allergens in the ambient air can cause respiratory or anaphylactic symptoms among persons with latex hypersensitivity. Patients with latex allergy can be scheduled for the first appointment of the day to minimize their inadvertent exposure to airborne latex particles.
Communicate with other DHCP regarding patients with latex allergy (e.g., by oral instructions, written protocols, and posted signage) to prevent them from bringing latex-containing materials into the treatment area.
Frequently clean all working areas contaminated with latex powder or dust.
Have emergency treatment kits with latex-free products available at all times.
If latex-related complications occur during or after a procedure, manage the reaction and seek emergency assistance as indicated. Follow current medical emergency response recommendations for management of anaphylaxis. (1)

The authors of Infection Control & Management of Hazardous Materials for the Dental Team state that provision of dental care for a latex allergic patient should be done in an environment with latex as low as reasonably possible (known as ALARP). The following will help the dental team achieve this:

1) Provide treatment in a specially prepared room as the first patient of the day.

a. Staff members are not to wear latex while preparing treatment room.

b. Staff members are to handle all items that will contact patient with nonlatex gloves.

c. No one who has worn latex gloves that day should enter the treatment room.

2) Minimize previous contact of patient care items with latex-containing materials.

3) Prevent latex from directly contacting the patient during treatment (use latex alternatives).

4) Eliminate patient exposure to airborne latex protein in glove powder.

5) Have dental team members wear non-latex-containing items that may contact the patient.

The Centers for Disease Control and Prevention's (CDC) Oral Health Division provides additional latex allergy information for dentistry, including patients. The information may be viewed at:

http://www.cdc.gov/oralhealth/infectioncontrol/faq/latex.htm

The CDC provides further information at:

http://www.cdc.gov/search.do?action=search&queryText=Managing+dental+patients+with+latex+allergies

The Institute for Occupational Safety and Health (NIOSH) provides information that may be viewed at: http://www.cdc.gov/niosh/topics/latex

The American Dental Association (ADA) has information that may be viewed at:

http://www.ada.org/public/topics/latex_allergy_faq.asp

http://www.ada.org/public/topics/latex_allergy.asp

OSAP provides links to other latex information at: OSAP links: http://www.osap.org/displaycommon.cfm?an=1&subarticlenbr=314

Additional resources include:

Latex Allergy Resources: Links For Dentistry: http://www.latexallergylinks.org/dental.html
American Latex Allergy Association (List Of Latex Free Dental Products): http://my.execpc.com/~alert/dentalprod.html
Pub Med Abstract: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12572185&dopt=Abstract

Resources:

1) CDC: Infection Control Guidelines for Dental Healthcare Settings:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

2) Infection Control & Management of Hazardous Materials for the Dental Team, 3rd. Edition. by
Miller & Palenik. Elsevier/Mosby Publisher. Copyright 2005.


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I am looking for information concerning the management of latex allergic patients. Can OSAP send me information or point me in the right direction on how to find it?

OSAP can provide you with links to several latex allergy resources.

The Centers for Disease Control and Prevention's (CDC) Oral Health Division provides latex allergy information for dentistry, including patients. The information may be viewed at:

http://www.cdc.gov/oralhealth/infectioncontrol/faq/latex.htm

The CDC provides additional information at:

http://www.cdc.gov/search.do?action=search&queryText=Managing+dental+patients+with+latex+allergies

The Institute for Occupational Safety and Health (NIOSH) provides information that may be viewed at: http://www.cdc.gov/niosh/topics/latex

The American Dental Association (ADA) has information that may be viewed at:

http://www.ada.org/public/topics/latex_allergy_faq.asp

http://www.ada.org/public/topics/latex_allergy.asp

OSAP provides links to other latex information at: OSAP links: http://www.osap.org/displaycommon.cfm?an=1&subarticlenbr=314

Additional resources include:

Latex Allergy Resources: Links For Dentistry: http://www.latexallergylinks.org/dental.html
American Latex Allergy Association (List Of Latex Free Dental Products): http://my.execpc.com/~alert/dentalprod.html
Pub Med Abstract: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12572185&dopt=Abstract


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