Download 9. equality impact statement - Portsmouth Hospitals NHS Trust

Latex Allergy & Dermatitis: Prevention and Management in
Health Care Workers
Version
2
Name of responsible (ratifying) committee
Health and Safety Committee
Date ratified
05 November 2014
Document Manager (job title)
Consultant Occupational Health Physician
Date issued
04 December 2014
Review date
04 November 2016
Electronic location
Health and safety policies.
Related Procedural Documents
Key Words (to aid with searching)
Latex allergy; irritant dermatitis; allergic contact
dermatitis.
Version Tracking
Version
Date Ratified
Brief Summary of Changes
Author
2
05.11.14.
Clarification dermatitis health surveillance arrangements.
Removal of dermatitis handcare leaflet to OH web site
only.
Dr S. Harvey
Policy: Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers.
Version 2. Issue Date: 04 December 2014
Review date: 2 years after ratification (unless requirements change)
Page 1 of 7
CONTENTS
Quick Reference Guide…………………………………………………………………………..page 3
Introduction………………………………………………………………………………………….page 4
Purpose……………………………………………………………………………………………..page 4
Scope…………………………………………………………………………………………………page 4
Definitions……………………………………………………………………………………………page 4-5
Duties and responsibilities………………………………………………………………………...page 5
Process………………………………………………………………………………………………page 5
Training requirements………………………………………………………………………………page 5
References and Associated Documentation……………………………………………………..page 6
Equality and Diversity Statement………………………………………………………………….page 6
Monitoring Compliance with and the effectiveness of procedural documents…………………page 7
Policy: Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers.
Version 2. Issue Date: 04 December 2014
Review date: 2 years after ratification (unless requirements change)
QUICK REFERENCE GUIDE
This policy must be followed in full when developing or reviewing and amending Trust procedural
documents.
For quick reference the guide below is a summary of actions required. This does not negate the need
for the document author and others involved in the process to be aware of and follow the detail of this
policy. The quick reference can take the form of a list or a flow chart, if the latter would more easily
explain the key issues within the body of the document
1. Latex is recognised as a ‘sensitiser’ and a substance ‘hazardous to health’ as defined by the
Control of Substances Hazardous to Health 2002 (COSHH) Regulations. Associated health
problems include Immediate Type 1 Latex Allergy and allergic contact dermatitis.
2. The Health and Safety Executive (HSE) consider that work related dermatitis is a significant
cause of work related ill health in the NHS. It can be related to the use of latex gloves (contact
dermatitis) or to irritant substances in the workplace. Irritant dermatitis is associated with
frequent hand washing and frequent use of soaps, gels and other irritants.
3. A HSE report following a Portsmouth Hospitals NHS Trust inspection in 2008 stated that there
are very few clinical areas where continued use of latex is justified. Therefore the glove of first
choice in the Trust should be non-latex. In circumstances where there is a clinical requirement
to use latex gloves, this must be justified with a risk assessment.
4. Latex use and dermatitis risk from other substances, including regular use of any gloves and
frequent hand washing with soaps and gels, must be assessed as part of regular COSHH and
general risk assessments and appropriate health surveillance undertaken where indicated.
5. Dermatitis Health Surveillance is required on an annual basis for all healthcare workers who
regularly wear gloves of any kind and use soaps and hand gels. The Health and Safety
Advisor will liaise with senior managers in clinical areas to organize distribution of dermatitis
questionnaires to be completed by employees. These will be followed up and managed in OH
where indicated.
6. Any employee with suspected latex allergy or contact/ irritant dermatitis should inform their
manager and the Occupational Health Department for further advice on management.
Policy: Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers.
Version 2. Issue Date: 04 December 2014
Review date: 2 years after ratification (unless requirements change)
1. INTRODUCTION
Latex allergy came to prominence in the United Kingdom in the 1980s and has become a
significant issue both for Health Care Workers (HCW) and patients. Natural Rubber Latex is the
sap of the tree Hevea Braziliensis. Latex products are widespread within the medical and social
environments. The increase in sensitivity to latex is thought to be due to the widespread
adoption of infection control procedures (including glove use) to prevent infection with blood
borne viruses, as well as to changes in the production and manufacturing processes to allow
for increased demand.
Latex is recognised as a ‘sensitiser’ and a substance ‘hazardous to health’ as defined by the
Control of Substances Hazardous to Health 2002 (COSHH) Regulations. Associated health
problems include Immediate Type 1 Latex Allergy and allergic contact dermatitis (see section 4
for definitions).
The Health and Safety Executive (HSE) consider that work related dermatitis is a significant
cause of work related ill health, particularly in the NHS. An independent survey, conducted by
HSE suggested that up to 100,000 nurses (19%) consider themselves to have work-related
skin damage. This can include dermatitis due to known sensitisers such as latex, as well as
irritant dermatitis which can be caused by frequent hand washing and frequent contact with
soaps and other irritants.
A Health and Safety Executive (HSE) report following a Portsmouth Hospitals NHS Trust
inspection in 2008 stated that there are very few clinical areas where continued use of latex is
justified. Therefore the glove of first choice in the Trust should be non-latex. In circumstances
where there is a clinical requirement to use latex gloves, this must be justified with a risk
assessment. Latex use and dermatitis risk must both be assessed as part of regular COSHH
and risk assessments. Appropriate health surveillance is required. Any latex gloves used must
be low protein and unpowdered.
2. PURPOSE
Provide guidance on issues relating to the use of latex and the problems of dermatitis of the
hands in health care workers (HCW); encourage adoption of a proactive approach to prevent and
minimise latex allergy and dermatitis in HCW; reduce the risk of HCW developing latex allergy
and dermatitis and ensuring safe employment of those who become affected.
3. SCOPE
This policy applies to all employees within the Trust and in all areas within the Trust where
regular hand-washing and glove wearing takes place.
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises
that it may not be possible to adhere to all aspects of this document. In such circumstances,
staff should take advice from their manager and all possible action must be taken to
maintain ongoing patient and staff safety’
4. DEFINITIONS
Immediate Type 1 Latex Allergy: allergy to the latex protein which occurs quickly after
exposure, usually within 15 minutes. Symptoms include: itchy skin with urticarial rash (‘hives’); lip
and tongue swelling; shortness of breath or wheeze. Anaphylactic reactions are rare. Allergy may
also occur with other latex containing products e.g. balloons and condoms and reactions can
occur to other substances with cross-reacting antigens, e.g. avocados, kiwi fruits and bananas.
Powdered gloves are particularly problematic as the powder is coated with latex and on removal
of gloves forms a cloud of latex particles, which can be inhaled. However, powdered latex gloves
have not been used in the National Health Service for several years now. Blood (RAST) testing
for latex specific IgE may assist in confirming the diagnosis of latex allergy, but is not always
positive.
Allergic Contact Dermatitis: an allergic reaction (Type IV, Delayed) to chemical additives used
in the latex manufacturing process (e.g. thiurams and dithiocarbamates) rather than to the latex
Policy: Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers.
Version 2. Issue Date: 04 December 2014
Review date: 2 years after ratification (unless requirements change)
protein itself, although this does occur in rare cases. Presentation is with an eczema-like rash
(dry, itchy, cracked skin) on the back of the hand and wrist where gloves may be tightest. The
reaction occurs 4-6 hours after wearing latex gloves. There is no urticaria, lip swelling or
breathing difficulties. Skin patch- testing will aid diagnosis.
Irritant dermatitis:
This is a common problem affecting the skin of the hands in Health Care Workers (HCW). It is
caused by frequent hand washing, incomplete hand drying and frequent contact with soaps and
other irritant substances. It presents as dry, itchy, cracked skin between the fingers, which
spreads to involve the rest of the hand. Treatment is by avoidance of irritants on the hands,
careful hand drying and the use of emollients.
Health Care Worker: Includes all staff working in hospitals and General Practice who have direct
patient contact, e.g. cleaners on wards, some catering staff, ambulance staff, some reception and
clerical staff, as well as medical and nursing staff.
5. DUTIES AND RESPONSIBILITIES
Managers: ensure that risks associated with latex allergy and dermatitis are managed in
accordance with this policy; provide information and training about latex allergy and dermatitis to
new and existing employees; perform appropriate risk assessments and COSHH assessments;
identify and implement actions or controls that are subsequently identified; ensure employees
undergo appropriate health surveillance; refer suspected cases of latex allergy and dermatitis to
Occupational Health.
Occupational Health: Work Health Assessment process and provision of relevant information on
latex allergy and dermatitis to new employees; investigation of suspected cases with referral to
dermatology via GP where indicated; organisation of health surveillance programmes.
Health & Safety: advice and assist in performance of relevant risk and COSHH assessments;
report confirmed cases of latex allergy and work related dermatitis to HSE under RIDDOR to
allow national monitoring of the problem among HCW.
Employees: comply with information provided about latex allergy and dermatitis and with relevant
PHT policies; report symptoms suggestive of latex allergy or dermatitis to managers and
Occupational Health; comply with health surveillance procedures
6. PROCESS
Following the recommendations of an HSE inspection of Portsmouth Hospitals NHS Trust in
2008, the glove of first choice in the Trust should be non-latex. In circumstances where there is
a clinical requirement to use latex gloves, this must be justified with a risk assessment. Any
latex gloves used must be low protein and unpowdered.
Latex is recognised as a ‘sensitiser’ and a substance ‘hazardous to health’ as defined by the
Control of Substances Hazardous to Health 2002 (COSHH) Regulations. Latex use and
dermatitis risks must both be assessed as part of regular COSHH and risk assessments.
Regular health surveillance must be undertaken.
Dermatitis Health Surveillance is required on an annual basis for all HCW who regularly wear
gloves and use soaps and hand gels. This will be arranged by the Health and Safety Advisor,
who will liaise with senior managers in clinical areas to organize distribution of dermatitis
questionnaires to be completed by employees. These will be followed up and managed in OH
as necessary.
7. TRAINING REQUIREMENTS
Information contained within this policy will be made available to new employees at preplacement health assessments (where these are indicated through the Work Health
Assessment process); general staff inductions; junior doctor induction. Information leaflets are
available through OH.
For existing staff, information and training will be available through health promotion activities
such as annual dermatitis screening programmes, Health and Safety updates and in the OH
department.
Policy: Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers.
Version 2. Issue Date: 04 December 2014
Review date: 2 years after ratification (unless requirements change)
8. REFERENCES AND ASSOCIATED DOCUMENTATION
Latex Allergy. Occupational aspects of management. A national guideline. Royal College of
Physicians.2008.
Dermatitis. Occupational aspects of management. A national guideline. Royal College of
Physicians. 2009.
Medical Devices Agency Bulletin. Latex Sensitisation in the healthcare setting (use of Latex
Gloves). 1996
Health Service Circular. Latex medical gloves and powdered latex medical gloves: reducing the
risk of allergic reaction to latex and powdered medical gloves.1999
HSE website on latex allergy at www.hse.gov.uk/latex
9. EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably
practicable, the way we provide services to the public and the way we treat our staff reflects
their individual needs and does not discriminate against individuals or groups on any grounds.
This policy has been assessed accordingly.
All policies must include this standard equality impact statement. However, when sending for
ratification and publication, this must be accompanied by the full equality screening assessment
tool. The assessment tool can be found on the Trust Intranet -> Policies -> Policy
Documentation.
Our values are the core of what Portsmouth Hospitals NHS Trust is and what we cherish. They
are beliefs that manifest in the behaviours our employees display in the workplace.
Our Values were developed after listening to our staff. They bring the Trust closer to its vision
to be the best hospital, providing the best care by the best people and ensure that our patients
are at the centre of all we do.
We are committed to promoting a culture founded on these values which form the ‘heart’ of our
Trust:
Respect and dignity
Quality of care
Working together
No waste
This policy should be read and implemented with the Trust Values in mind at all times.
Policy: Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers.
Version 2. Issue Date: 04 December 2014
Review date: 2 years after ratification (unless requirements change)
10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
Minimum requirement to
be monitored
Dermatitis
Surveillance
health
Lead
Health
and
Safety Advisor
Tool
audit
Frequency of Report
of Compliance
Reporting arrangements
annual
Policy audit report to:
Health and Safety Committee
Lead(s) for acting on
Recommendations
tbc
This document will be monitored to ensure it is effective and to assurance compliance.
The effectiveness in practice of all procedural documents should be routinely monitored (audited) to ensure the document objectives are being
achieved. The process for how the monitoring will be performed should be included in the procedural document, using the template above.
The details of the monitoring to be considered include:






The aspects of the procedural document to be monitored: identify standards or key performance indicators (KPIs);
The lead for ensuring the audit is undertaken
The tool to be used for monitoring e.g. spot checks, observation audit, data collection;
Frequency of the monitoring e.g. quarterly, annually;
The reporting arrangements i.e. the committee or group who will be responsible for receiving the results and taking action as required.
In most circumstances this will be the committee which ratified the document. The template for the policy audit report can be found on
the Trust Intranet Trust Intranet -> Policies -> Policy Documentation
The lead(s) for acting on any recommendations necessary.
Policy: Latex Allergy & Dermatitis: Prevention and Management in Health Care Workers.
Version 2. Issue Date: 04 December 2014
Review date: 2 years after ratification (unless requirements change)