|FAQ - Regulatory - Archived Through 2012
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:
The CDC provides further information at:
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:
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
1) CDC: Infection Control Guidelines for Dental Healthcare Settings:
2) Infection Control & Management of Hazardous Materials for the Dental Team, 3rd. Edition. by
Miller & Palenik. Elsevier/Mosby Publisher. Copyright 2005.