Download UHSM Policy on latex allergy

UHSM Policy on latex allergy
Version:
Ratifying Committee:
Date ratified:
Name of originator/author/job title:
Name of responsible
committee/individual:
2.0
Infection Control Committee
September 2012
Deborah Hughes, Allergy Specialist
Nurse Susana Marinho, Consultant
Allergist
Judith Allen (Occupational Health
Advisor)
Jay Gardner-Turner ( Head of Nursing
–Infection Prevention & Control )
Date published on intranet:
Review date:
Target audience:
September 2015
Trust wide, Including all PFI partners
EQUALITY IMPACT
University Hospital of South Manchester NHS Foundation Trust (‘UHSM’) strives to
ensure equality of opportunity for all service users, local people and the workforce.
As an employer and a provider of health care UHSM aims to ensure that none are
placed at a disadvantage as a result of its policies and procedures. This document
has therefore been equality impact assessed by the (Safety Committee) to ensure
fairness and consistency for all those covered by it regardless of their individuality.
The results are shown in the Equality Impact Tool at Appendix E.
Don’t rely on paper copies, review the latest version on intranet.
Date of this review Sept 2012
Date of this review Sept 2015
University Hospital of South Manchester NHS Foundation Trust
VERSION CONTROL SCHEDULE
Version
number
Issue Date
2
1
Revisions from previous
issue
Full Review
Date of Ratification by
Committee
September 2012
May 2008
DOCUMENT CONTROL
Summary of consultation
process
Control arrangements
Safety Committee, Occupational Health ,Infection Control
UHSM policy site
Minimum requirement to be monitored
Process for monitoring Annual audit carried out by Latex Allergy specialist
Allergy Service to monitor Policy.
3 yearly review of the policy
Allergy Service /Safety committee for review of results
Deborah Hughes will be responsible individual for development of action plan
Deborah Hughes / Dr Susana Marinho will be responsible for monitoring of
action plan
Associated documentation
and references
Health and Safety at Work Act 1974
Management of Health and Safety at Work Regulations 1999
Control of Substances Hazardous to Health Regulations 2002
Disability Discrimination Act 1995
Latex Sensitisation in the Health Care Setting, MDA DB 9601 1996
Policy for the prevention and Management of Natural Rubber Latex Allergy,
Health & Safety Executive, 2003
NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine.
Latex allergy: occupational aspects of management. A national guideline.
London, 2008
CONTENTS
1 Policy .................................................................................................................................. 3
2 Aims .................................................................................................................................... 3
3 Purpose............................................................................................................................... 3
4 Responsibilities and duties .............................................................................................. 4-5
5 Definitions .......................................................................................................................... 6
6 Natural rubber latex (NRL) and associated products ......................................................... 6
7 Latex allergy .................................................................................................................. 7-10
8 Patient Screening ............................................................................................................. 10
9 The provision of a latex-safe environment ................................................................ 10-15
10 Latex allergic members of staff ................................................................................... 15-16
11 References ................................................................................................................... 16-17
15 Appendix A -Screening questionnaire ......................................................................... 18-19
16 Appendix B - List of common medical and household products that contain latex ........ 20
17 Appendix C – UHSM Allergy Centre Referral Forms for Allergic Reactions during General
Anaesthesia ......................................................................................................................... 21-31
18 Appendix D- Dissemination ……………………………………………………………………………………….. 32
19 Appendix E-Equality Impact............................................................................................. 33
UHSM Policy on latex allergy
The Management of Latex Allergy
Minimising the Risk of Latex Exposure and Allergy for
Patients and Staff
1
Policy
University Hospital of South Manchester NHS Foundation Trust recognises its duty under the
Health and Safety at Work Act, the Controls of Substances Hazardous to Health Regulations
and the Management of Health and Safety at Work Regulations to provide a safe
environment for both its employees and patients, and to protect them from hazards that
may arise in the course of health care activities against latex sensitisation and allergic
reactions due to latex allergy.
2
Aims
The Trust recognises that Natural rubber latex (NRL) is a hazard to patients and staff in
hospital and that it is a potent sensitiser that may give rise to serious allergic reactions in
those that have Type I latex allergy. The aim of this policy is to provide guidance and raise
awareness of the latest issues which affect patients and staff. The Trust recognises the
general duties imposed by the Health and Safety at Work Act, and the COSHH regulations
apply. The Trust has an obligation to minimise latex exposure so far as reasonable
practicable. The Trust encourages the adoption of a proactive approach to prevent and
minimise latex allergy amongst patients and staff.
3
Purpose
3.1
To develop procedures for diagnosis, prevention and management of Type I latex
allergy (immediate type, IgE-mediated reactions) within the Trust.
3.2
To provide guidelines for all Trust employees on minimising and managing Type I latex
allergy and disseminate information.
3.3
To provide guidelines for the safe management of patients in the outpatient clinics,
wards, departments and in peri-operative and procedure period.
3.4
To initiate screening of high risk patients for signs and symptoms of Type I latex allergy
at the earliest opportunity. Thereafter, treat them in a safe, latex-free environment.
3.5
To ensure prompt recognition and diagnosis of employees with Type I latex allergy. An
appropriate referral will be sent to the relevant Department (Allergy/Dermatology or
Occupational Health) to distinguish immediate-type responses (Type I) and delayed
type hypersensitivity or irritant responses (Type IV) as per Appendix A.
3.6
To provide a safe workplace for staff sensitised to latex, in collaboration with the
Occupational Health Department.
3.7
To ensure that the latex content of equipment and disposables is reviewed in each
directorate and alternative products used where possible without causing another risk.
3.8
When purchasing new products, the latex content will be reviewed and latex-free
products purchased where possible without causing another risk.
3.9
To ensure all staff have access to the reporting, legislation and guidance on latex issues
and polices within the Trust.
3.10 To use the universal assessment format to allow tasks or conditions presenting a
significant hazard to be entered on the Risk Register for Review.
3.11 The provision of a primary preventative programme as further aetiology is known.
4
Responsibilities and duties
4.1
Chief Executive and Trust Board bear ultimate responsibility and will give their
authority to the introduction of this procedure into the working arrangements of the
Trust and monitor via the Risk Register.
4.2
Executive and Directorate Directors will ensure that the Trust’s safety policy, strategy
and this procedure are implemented throughout the areas they control so that latex
sensitisation and allergic reactions are minimised.
4.3
Medical Director shall ensure that appropriate practices are in place for maintaining a
latex-free environment and ensuring that this complies with safety regulations.
4.4
Clinical Directors and Head of Services will oversee the application of this procedure
into their services and shall ensure its implementation is undertaken within their
management structure and necessary controls are put into place to achieve the Trust’s
policy and aim.
4.5
General Managers will ensure their local managers provide for incident investigations
and regular safety inspections to identify tasks and situations where patients may be
exposed to latex. They will review risks forwarded from wards and departments for the
risk register and verify that significant risks are controlled so far as reasonably
practicable. They shall also liaise with Estates and Facilities to ensure, whenever
services are established or significantly amended, that consideration is given to the
work process for each task to ensure that factors contributing to latex contact are
controlled within reasonable.
4.6
Heads of Nursing and Modern Matrons will liaise closely with their General Managers,
Wards and Department Managers and Risk Advisors to ensure the identification,
assessment, and control of latex allergy risks. They will also review controls following
incidents and ensure day to day adherence to safe working practices.
4.7
Medical staff will ensure that all patients clearly identified as latex-allergic or
suspected latex-allergic have an appropriately filled patient red alert record in the
front of their notes. This information must be communicated to all parties caring for
the latex-allergic patient. Using the screening questionnaire, ensure an appropriate
referral is sent to the Allergy Department.
4.8
Ward and Departmental Managers will ensure that this policy is implemented within
their area of control. They are responsible for staff to ensure that latex-free
environments are maintained when a latex-sensitive/allergic patient attends their
area. They will ensure that Patient Alert Records are completed within the notes, once
an entry has been on the Patient Alert Record. The ALERT box on the front cover of the
case note folder must be ticked to indicate that an alert exists. The manager will
ensure that staffs communicates with colleagues in their own department and others
when a latex-sensitive/allergic patient is to be treated .They are responsible for
ensuring that latex-free products and drugs are available within the clinical area. Ward
and Departmental mangers are responsible for referral of staff to Occupational Health
when they suspected that an employee may have latex allergy or when the employee
reports their suspicion to their manager that they have a latex-related health issue.
Managers should ensure that suitable alternative equipment is available for staff with
latex allergies to use within their area of practice.
4.9
All staff will report to their manager situations where latex exposure arises and is likely
to require control. It is all staff responsibility to ensure they are aware of this policy
and content and procedures of reporting mechanisms for patients with latex allergies.
They are responsible to ensure that a latex-free environment is maintained when
caring for a patient with a latex allergy and, where reasonably practical, suitable
alternative equipment is used that will not cause another risk.
4.10 Occupational Health Department shall assist managers in the management of staff
with latex related health problems. The Occupational Health Team will fully assess the
nature of the employee’s health problem, ensuring that all necessary steps are taken
to obtain an accurate diagnosis and advise both the employee and the manger on the
steps to be taken to manage the employee’s health problem at the work place. Under
RIDDOR, latex allergy is reportable to the Health and safety Executive (HSE) .These
reports will be made on the Trust’s behalf by the Occupational Health Department,
who will ensure that the Trust’s risk manager is informed when such a report is made.
4.11 Supplies department will assist departments in ensuring that latex-free disposables
and equipment are available.
4.12 The Medicines Information Centre in the pharmacy will advise on the possible latex
content of medicines that will /may be used during the hospital stay on an individual
basis as lists of latex-free medicines are difficult to maintain and update.
4.13 Infection Prevention Control Department will ensure that there is an appropriate glove
policy within the infection prevention control policy manual that allows for Glove
choices other then latex.
4.14 Resuscitation Officer shall be responsible in ensuring that there is latex-free
resuscitation equipment available where reasonably practical. They should also ensure
that resuscitation training is available to latex-allergic staff and equipment available
for them to participate in training.
4.15 Allergy Service will provide advice and guidance regarding diagnosis and management
of suspected latex-allergic patients and staff.
4.16 Patients will be seen in the Allergy Clinic, held in the outpatient setting. A diagnosis
and a detailed management plan will be given to the patient. A letter with the relevant
information will be sent to the referring practitioner, the patient, and the General
Practitioner (GP). This letter must be communicated to all parties.
4.17 The Allergy service will review and update the latex policy and ensure the policy is
implemented within the Trust.
4.18 Authors, Debbie Hughes (Clinical Allergy Nurse Specialist)/Dr Susana Marinho
(Consultant Allergist), will disseminate and implement this policy and support the
promotion of continuing educational programs on latex allergy.
5
Definitions
5.1
Natural rubber latex (NRL) is a milky fluid obtained from the Hevea brasiliensis tree,
which is widely grown in South East Asia and in other countries. NRL is an integral part
of thousands of everyday consumer and healthcare items.
5.2
Type I hypersensitivity (immediate type) reactions are immediate reactions mediated
by specific IgE antibodies to latex, characterised by urticaria, conjunctivitis, rhinitis,
asthma and occasionally anaphylaxis, which can be life-threatening.
5.3
Type IV hypersensitivity (delayed type) reactions are characterised by an eczematous
rash – allergic contact dermatitis, often developing hours after exposure; they may be
due to latex proteins or, much more commonly, other chemical additives used in NRL
processing.
5.4
Latex sensitisation is the presence of specific IgE to latex, documented by either skin
prick test or serum specific IgE.
5.5
Latex allergy is the term used to describe the elicitation of an immediate-type (type I)
allergic symptoms by contact with latex in a sensitised individual.
5.6
While the majority of sensitised individuals will develop allergic reactions when
exposed to latex, a proportion will not – these are considered to have asymptomatic
sensitisation and are a target for secondary prevention (to prevent development of
latex allergy).
5.7
‘Latex –free’ is the term used to describe products that are not manufactured from
NRL.
5.8
‘Latex –safe’ is the term used to describe an environment that minimises the risk of a
reaction occurring in sensitised or allergic individuals. This is achieved by removing the
NRL products that are most likely to cause a reaction.
6
Natural rubber latex (NRL) and associated products
6.1
Natural rubber latex (NRL) is produced by the Hevea brasiliensis tree. The cloudy liquid
latex is collected by ‘tapping’ the tree. It then goes through a complex manufacturing
process, involving the addition several chemicals. It can be used to produce dry rubber
products (e.g. tyres, shoes) or latex concentrate products (e.g. dipped latex products
such as gloves, and adhesives, latex foam) that have different manufacturing
processes, characteristics and allergenicity.
6.2
Allergy to natural rubber latex products emerged as an important clinical condition
following an increase in the use of latex gloves for barrier protection in the early
1980’s.
6.3
Latex gloves are currently preferred to synthetic alternatives on the grounds of their
impermeability to small viruses, excellent elasticity and low cost [1, 2].
6.4
Routes of exposure
6.4.1 A list (non exhaustive) of latex-containing products is detailed in Appendix B
6.4.2 The possible routes for exposure are:
Cutaneous – via gloves, tapes, masks, urine drainage bags;
Mucous membranes- via products in dentistry, anaesthesia, intubation, rectal,
urological and gynaecological examinations (including intra-uterine devices), eye
and ear droppers
Inhalation – via aerosolisation of latex glove powder;
Internal tissue/organs - via latex products used in surgery;
Intravascular- via latex products used in intravascular devices (e.g IV cannulae),
devices used to deliver IV fluids and injectables (syringes and IV administration
sets) or products stored or drawn up through rubber bungs or devices containing
latex.
6.4.3 In the hospital setting, latex gloves are the most important source of latex.
Cornstarch-powdered gloves represent the highest risk as the starch powder
concentrates the allergenic latex protein and allows it to become airborne and
dispersed into the environment. Respirable particles can also be shed from powderfree latex gloves[3] but to a much lesser extent.
7
Latex allergy
7.1
Risk factors for latex allergy and high risk populations
7.1.1 Latex exposure, particularly if significant and frequent, is one of the major risk factors
for sensitisation and development of allergy.
7.1.2 Atopy. NRL allergy is more common among patients with allergic diseases. There is an
association between allergy to certain fruits and vegetables and latex allergy (latexfood syndrome), particularly avocado, banana, kiwi, chestnut, tomato, potato; this is
a co-phenomenon due to cross-reactivity rather than a true risk factor but patients
reporting allergy to these foods need to be enquired about problems with NRL.
7.1.3 Dermatitis, especially hand dermatitis.
Risk factors for natural rubber latex allergy
Risk Factor
Latex
exposure
Atopy
Dermatitis
Detail
Occupational groups
Healthcare workers, laboratory workers, food handlers,
rubber industry workers, security personnel, greenhouse
workers, construction workers, electronics manufacture
workers, hairdressers and domestic workers[1, 4-6]
Increased exposure due to repeated surgical procedures,
chronic intravenous and urinary catheterisations[7, 8],
repeated placement of ventriculo-peritoneal shunts.
Spina bifida; congenital
nephro-urological or
neurological
malformations;
multiple surgical
procedures
Asthma, eczema, allergic rhinoconjunctivitis (‘hay fever’)[1]
Hand eczema (possibly through absorption of allergens through broken skin)[1]
7.2
Prevalence of latex sensitisation
7.2.1 General population: the prevalence of latex sensitisation in the general population is
not very well documented but ranges between 5% and 10 %[9].
7.2.2 Healthcare workers: healthcare workers, particularly those who are atopic, show an
increased prevalence of sensitisation to NRL (0.5 to 17%), up to 3.5 times higher than
in the general population[9].
7.2.3 Patients with Spina Bifida: these patients are at increased risk of latex sensitisation
due to repeated surgical procedures or early repeated contact with latex through
catheters and gloves. The prevalence of NRL sensitisation in this group varies from
18% to 64%[9].
7.3
Clinical manifestations of latex allergy
7.3.1 NRL exposure can elicit three different types of reactions (due to its proteins, rubber
accelerators and other chemicals used during its manufacture):
7.3.2 Type I (immediate hypersensitivity) – also known as latex allergy
Associated with the production of specific IgE antibodies to NRL. These reactions
occur usually within a few minutes, or occasionally up to two hours, after exposure to
NRL. Typical symptoms include urticaria, angioedema, wheezing,
rhinitis/conjunctivitis and, in severe cases, anaphylaxis.
Contact urticaria is the most common early manifestation of latex allergy,
particularly in healthcare workers, of whom 60-80% report contact urticaria
involving the hands. Symptoms appear 10-15 minutes after the gloves are
donned are often mistakenly attributed to glove powder or hand washing[10].
Patients may also have more widespread urticarial rashes (hives).
Angioedema (swelling of the deep skin/subcutaneous/submucosal tissue,
particularly lips, tongue, and face); laryngeal oedema may lead to difficulty
swallowing, speaking and breathing.
Respiratory symptoms including rhinitis/conjunctivitis (runny-itchy nose, redwatery-itchy eyes and sneezing) and asthma (with shortness of breath, wheeze,
cough and chest tightness) particularly after the inhalation of latex allergencoated cornstarch particles from powdered gloves.
The most serious problem is anaphylaxis, e.g. generalised and potentially fatal
allergic reaction, requiring speedy and skilful resuscitation. Latex-sensitive
persons can experience anaphylaxis during a variety of medical care situations
including bladder catheterisation, surgery, or childbirth. Latex-induced
intraoperative anaphylaxis is particularly common in spina bifida patients.
7.3.3 Type IV (delayed hypersensitivity) – also known as latex allergic contact dermatitis
Occurs within 24- 48 hours of exposure to natural rubber products, such as gloves,
shoes, sports equipment and medical devices due to cell-mediated hypersensitivity to
the additives (accelerators, antioxidants and other chemicals) used in the
manufacture of natural rubber products, and rarely due to latex proteins. It classically
presents as contact dermatitis with dry skin, redness, itching, scaling, cracking,
chapping, excoriation and blister formation on areas where the natural rubber
product is in contact with the skin/mucosa. These patients need advice as to
appropriate synthetic rubber or plastic alternatives.
7.3.4 Irritant contact dermatitis
The most common reaction to NRL products is the development of dry, irritated,
scaling areas on the skin, especially on the hands of glove wearers. This is not a true
allergic reaction but is easily confused as one, particularly as the skin lesions are
similar to those of allergic contact dermatitis (it s is distinguished by patch testing).
Irritant reactions are caused by the effects of repeated hand washing, use of
detergents or sanitisers, or the alkaline pH of cornstarch-powdered gloves; this
affects the skin barrier causing loss of its integrity and lipids (when natural oils are
stripped from the skin it can become dry and more susceptible to external agents).
The Occupational Health Department offer private and confidential advice and
support to members of staff with dermal irritation; a skin questionnaire is available
on request.
7.4
Diagnosis of latex allergy (type I)
7.4.1 This is carried out by the UHSM Allergy Centre.
7.4.2 History
Diagnosis of Type I latex allergy should only be made in the presence of a clear and
characteristic history (with attention to type and timing of reactions) together with
evidence of specific IgE to latex (from either skin prick testing, bloods or latex glove
challenge).
7.4.3 Skin testing
Skin prick testing (SPT) with natural rubber latex is done with commercial extracts
and sometimes by pricking through latex gloves (if there are doubts with former
results). NRL SPT solutions has a sensitivity close to 100 % and a specificity of 92 %
(which means that not all individuals with positive SPT will be allergic to latex –
asymptomatic sensitisation)[11].
7.4.4 Measurement of latex-specific IgE antibodies
Latex-specific IgE antibodies may also be demonstrated by immunoassay with serum
from patients. The performance of these assays vary and their sensitivity is not 100%,
so a negative latex-specific IgE test does not rule out latex allergy.
7.4.5 Component Resolved Diagnosis (CRD) in latex allergy
Latex allergy can be a severe problem and there are various sources of NRL exposure,
so there has been pressure to develop reliable diagnostic methods and to define the
clinically important allergenic components of latex precisely[2]. To date, 13 latex
proteins (designated Hev b 1 to Hev b 13) have been identified as latex allergens.
These can be detected by immunoassays and are useful in clarifying latex allergy
7.4.5.1 Several latex allergens show sequence homology with fruit and vegetables with
clinical cross-reactivity, which explains the latex–food syndrome[2]. In patients with
latex allergy there is a ~35% risk of reaction to at least one of banana, avocado, and
kiwi; conversely, there is an ~11% chance of latex allergy in patients allergic to the
above fruits[12].
7.4.6 Latex glove challenge – use test
Latex allergy may be confirmed by the use test, in which a latex glove (or fingers only)
is applied to a wet hand. The usefulness of this test is limited by the widely varying
allergen content of gloves from different manufacturers.
7.5
Primary prevention of latex sensitisation and allergy
7.5.1 Primary prevention should be directed to the risk groups detailed in section 7.1,
particularly those with spina bifida or congenital nefro-urological or neurological
malformations and hand dermatitis.
7.5.2 Efforts should be made to avoid latex exposure from birth in all children with spina
bifida or other medical conditions requiring early and repeated surgical interventions
or instrumentation.
7.5.3 Patients and staff with hand dermatitis should avoid exposure to latex products,
particularly gloves.
8
Patient Screening
8.1
Latex-allergic and high risk patients (as per section 7.1 and including those with
unexplained allergic/anaphylactic reactions or peri-operative events) must be
identified upon admission or attendance to hospital for any procedure/treatment.
8.2
The screening questions listed in Appendix A and detailed in the back of the RED ALERT
CARD must be asked to all patients attending for elective surgery, endoscopy or
maternity or any other interventional procedure. In addition, it would be desirable for
these questions to be asked for all patients admitted to hospital and outpatient clinics
where latex gloves are commonly used, e.g. gynaecology.
8.3
Patient assessment must be undertaken in the outpatient or pre-assessment unit prior
to any elective surgery or interventional procedures using the screening tool in
Appendix A (RED ALERT CARD) to identify allergic/at risk individuals.
8.4
For patients with known latex allergy, ideally, the GP will have informed the hospital
doctor in the referral letter. This should be clearly marked in the RED ALERT CARD.
These patients should also carry a MedicAlert bracelet or necklace with this
information.
8.5
Use of the screening questions on the back of the RED ALERT CARD on patients and/or
carers on admission should identify the allergic/high risk patients.
9
The provision of a latex-safe environment
9.1
Preparation of a latex-free environment
9.1.1 All equipment and disposable items used for the cleaning procedure, including gloves
worn by the domestic staff, must be latex-free.
9.1.2 Remove all unnecessary equipment and materials from the room.
9.1.3 A terminal clean must be undertaken following discharge of the previous patient,
before the latex-allergic patient uses the room. Where barrier cleaning is required,
high-level cleaning must be undertaken prior to routine cleaning tasks.
9.1.4 The ward manager must:
9.1.4.1 Inform the estates departments to arrange the high-level clean;
9.1.4.2 Inform the domestic supervisors of estimated completion time;
9.1.4.3 Ensure nursing staff carries out their cleaning tasks before domestic assistants’
duties.
9.1.5 Nursing staff must use latex-free gloves and an apron to:
9.1.5.1 Strip and clean the bed and mattress;
9.1.5.2 Clean all medical equipment that is to be located in the room, e.g. drip-stands;
9.1.5.3 Clean any other equipment, which is likely to come into contact with the patient
(refer to the Infection Control Policy).
9.1.6 The role of the domestic staff is to:
9.1.6.1 Empty waste bins;
9.1.6.2 High dust blinds, walls and fittings;
9.1.6.3 Damp-dust all furniture and fittings with a solution of neutral detergent and water
using the correct colour-coded cleaning equipment (when Terminal -cleaning
Chlorclean 1000ppm solution should be used instead of neutral detergent and
water solution; for suspected or confirmed Chlorhexidine-allergic patients, cleaning
can be done with .Chlor-Clean as it contains Chlorine and detergent(no
Chlorhexidine involved).
9.1.6.4 Suction clean the floor;
9.1.6.5 Scrub the floor, using standard speed scrubber-polisher machine with a solution of
warm water and neutral detergent;
9.1.6.6 Burnish the floor using a standard speed scrubber-polisher machine;
9.1.6.7 Static mop the floor;
Mop heads that are used for every specialised Terminal clean must be laundered
following completion of the task; All reusable equipment that has been used to clean
the room should be cleaned in accordance with the Infection Prevention Policy.
9.1.7 Disposable cleaning items are disposed of in a clear Domestic waste bag.
9.2
This involves a team approach to:
9.2.1 provide a latex-safe environment for latex-allergic patients and staff (containing only
non-latex materials, e.g. gloves, catheters, IV equipment, surgical tape, tourniquets,
ventilation and airway equipment and medication containers without latex stoppers).
9.2.2 It should be recognised that hospitals can be made latex-safe (through the guidance
detailed below) but not totally latex-free; there is still a risk of reaction that can be
minimised by increased awareness and vigilance among health care workers and use
of latex-safe substitutes;
9.2.3 develop a database of all latex products and latex substitutes, which needs to be
regularly updated;
9.2.4 select and introduce use of latex-free alternative products where possible; these
should be readily available to health care workers. Resus trolleys with latex-free
medical products should be available on the wards and A+E;
9.2.5 centralise the purchasing system for NRL-containing devices and supplies and identify
high-use areas;
9.2.6 As latex gloves are the most common medical product implicated in latex allergy in
hospital, a facility-wide review of glove usage should be undertaken to determine the
appropriateness of use (degree of risk, level of protection, compliance with universal
precautions) and thereby prevent the unnecessary use of latex gloves. Purchase and
use of powdered latex gloves should be stopped and non-powdered low-protein latex
gloves should be used instead, preferably limited to health care workers involved
with direct contact with potentially infectious fluids; non-latex gloves can be used in
all other instances (this needs to be assessed as latex is still superior to its synthetic
alternatives in respect to barrier characteristics against transmissible diseases);
9.2.7 Catering staff should use non-latex gloves when preparing food for latex-allergic
patients;
9.2.8 promote continuing educational programs on latex allergy with support provided by
the UHSM Allergy Centre;
9.2.9 All Trust members to adhere to the Latex policy.
9.3
Ward management of the latex-allergic patient
9.3.1 Patient notes should be marked with an ALERT and details of the Latex Allergy
CLEARLY described inside on the RED ALERT CARD filed the front of the notes.
9.3.2 It is expected that most latex allergic patients will have been diagnosed prior to
admission to a ward or department and their management carefully planned.
9.3.3 Latex-allergic patients require their investigation and treatment to be planned and
managed by senior staff.
9.3.4 It is the duty of the admitting team to inform the appropriate ward manager, theatre
team manager and anaesthetic or department of anaesthesia as early as possible
about the potential admission of a latex-allergic patient, to enable planning of
theatre or other procedures, if required.
9.3.5 Although these patients are not generally suitable for day case admission, it is
important that they remain in hospital for as short a time as possible, to minimise the
risk of latex exposure.
9.3.6 For advice on latex content of drugs contact Medicines Information on extension
3331. As active ingredients change over time, this must be checked on each
admission.
9.3.7 A latex-safe sideward must be prepared for the patient (preferably with bathroom
and entrance lobby without a carpet). This is achieved by following the procedure for
preparation of latex-safe environment. Standard cleaning products may be used, but
no rubber or latex gloves should be worn. The room should then be clearly labelled
“Latex-safe area”
9.3.8 Personnel entering the room should be kept to a minimum. They should wash their
hands, wear a plastic apron and, when it is necessary to examine or treat the patient,
use latex-free gloves.
9.3.9
A Latex-free trolley (trolley that contains latex free items) should be available for
urgent or emergency use; this should be checked regularly by a latex link
nurse/theatre practitioner.
9.3.10 A designated Registered Nurse must be responsible for the patient’s care on each
shift. The Registered Nurse must liaise with any other departments, e.g. X-ray, MRI
and Theatre, to allow these areas to prepare latex-free conditions for the patient’s
investigations or treatment.
9.3.11 All forward planning and documentation should inform future carers of the patient's
sensitisation by effective recording in notes although patient confidentiality must be
taken into account.
9.4
Emergency and newly diagnosed latex-allergic patients
9.4.1 When a patient is admitted with a high suspicion of latex allergy during normal
working hours, the Consultant is responsible for the management of the patient and
co-coordination of care between departments.
9.4.2 Out-of-hours, if, in the opinion of the admitting Consultant, a patient requires
EMERGENCY SURGERY, the On Call Consultant Anaesthetist for that section should be
contacted and the latex policy implemented – Latex Theatre protocol (see section
9.5). If the emergency surgery, treatment, or investigation is not required, the patient
should be admitted to a latex-safe side ward, prepared according to section Error!
Reference source not found. and admitted as per protocol.
9.5
Operating Theatre management of latex-allergic patients
9.5.1 Latex-allergic patients are not generally suitable for Day Case Surgery or Endoscopy
or other procedures, but where a reasonable case of need for such a procedure can
be demonstrated, it may be possible, after consultation with the Lead Clinician for
the Day Case Unit, to organise a day case procedure.
9.5.2 The surgical team responsible for the patient must inform theatre staff, the
anaesthetist and ward staff of a patient with known or suspected latex-allergy or
sensitivity before admission to hospital, whenever possible, and always with
sufficient time in advance of surgery to make effective preparation. All members of
the healthcare team involved in care delivery, must be made aware of this so that the
necessary precautions may be taken.
9.5.3 Any suspected latex-allergic patient should be treated as “NRL allergy; at risk of
anaphylaxis” within a completely latex-safe environment.
9.5.4 Risk-assessments should be undertaken for specific department/theatres dependent
upon the number of air changes within the room. As each department/theatre may
have a unique environment, ideally, a local protocol should describe the
management of latex allergy within the specific department/theatre.
Recommended exposure limits for latex exposure[13]
Relative Risk
Low
Moderate
High
Airborne Exposure
< 10ng/m3
10-50ng/m3
>50 ng/m3
Dust contaminated
< 10ug/g
10-100 ug/g
>100ug/g
9.5.5 Pre-operative theatre planning
9.5.5.1 The patient should be first on the operating list (if elective) and the theatre
prepared (as per guidance below) at least an hour in advance or the night before, if
practical (to minimise exposure to airborne latex proteins). Depending on the
number of air changes within the room, sufficient time should be allowed to reduce
any aerosolised latex proteins.
9.5.5.2 When this is not possible, all latex-containing products must be removed and all
equipment and the theatre should be cleaned by staff with latex-free gloves, the
doors must be closed and the ventilation allowed to work undisturbed for one hour
9.5.5.3
9.5.5.4
9.5.5.5
9.5.5.6
to remove airborne latex particles. The complete processes will likely take
approximately 2 hours.
Induction of anaesthesia and recovery should both take place in the operating room
to minimize risk.
Working with the information from the local database of latex- and latex-free
products and substitutes, all items containing latex should be removed from theatre
and recovery bay (if recovery in operating theatre is not possible) and any area
where the patient may be treated. When removal of such items is not possible, they
should be covered and sealed with latex-free tape and a notice attached: “DO NOT
REMOVE- CONTAINS LATEX”. Sterile Services Departments will need to be involved
to ensure that there is no latex on or used for the preparation of instrument sets or
accessories.
All equipment used while caring for the patient in peri-operative areas should be
free from latex, to reduce time in checking and cross-contamination from items
containing latex. Items/equipment containing latex must be removed and replaced
with latex-free items/equipment from the ‘latex-free box’. This is kept covered in a
designated area in the department; a latex-free box specific to paediatric patients
should be shared between appropriate areas. An identified individual must be
designated responsibility for maintaining the contents of this box.
In case of emergency situations, the patient can be questioned pre-operatively if
conscious and a risk-assessment made given the responses to the screening tool
(Appendix A). If the patient is unconscious, then best practice would suggest that
latex exposure should be minimized and as far as is reasonably practicable, latexcontaining products should be removed or covered.
9.5.6 Other sources of peri-operative latex exposure
9.5.6.1 The antigen content of various latex products can vary significantly. Latex products
manufactured with a dipping process (e.g. gloves) have the highest amount of latex
allergens, whereas those made from dry, moulded, or extruded rubber (e.g. tyres,
rubber seals, vial stoppers and syringe plungers) are thought to be less
allergenic[14].
9.5.6.2 The risk of exposure to latex from multi-dose vials with rubber stoppers, syringes
with rubber plungers, and intravenous tubing is unclear. Small quantities of latex
allergens can be present in the drugs/products and therefore the recommendation
is to eliminate natural rubber from pharmaceutical vial enclosures[15].
9.5.6.3 Drugs in vials with rubber bungs/stoppers should have the bung removed and the
drug prepared in the vial. BUNGS-STOPPERS MUST NOT BE PIERCED. Some Pre-filled
syringes should not be used, as there is the possibility of leach out of latex into the
solution from the rubber bung. Suitable alternatives should be sought. Ensure all IV
equipment is latex-free.
9.5.6.4 Some medical equipment that once contained latex has been replaced with suitable
latex-free alternatives (e.g. anaesthesia bags).
9.5.7 Transferring patient to theatre
9.5.7.1 Portering staff should wash trolley with latex-free gloves and cover with a linen
sheet. The trolley should be then be labelled ‘Latex –free’ and used only for the
named patient. Portering staff should be educated to avoid latex protein transfer to
the patient.
9.5.7.2 Minimum numbers of staff should be present in the Operating Theatre.
9.5.7.3 All staff must wash their hands following contact with latex-containing products. If it
is necessary for gloves to be worn, they should be non-latex – synthetic rubber
(either ‘Nitrile sterile’ or Examination‘) for body fluid interaction.
9.5.7.4 The patient should remain on the anaesthetic trolley throughout the theatre
journey.
9.5.7.5 The latex-free box must contain latex-free alternative products.
9.5.7.6 Visible notices that the patient has latex-allergy should be placed in close proximity
of the patient at all times whilst in the theatre department.
9.5.7.7 Prior to transfer to the ward/ITU, communication must have taken place well in
advance to inform of the patient status if latex allergy recognised within the
peri-operative area in order to allow time for ward preparation.
9.5.8 T.S.S.U/C.S.S.D
9.5.8.1 Notes on ventilation and airway management
9.5.8.2 A new latex-free anaesthetic breathing circuit and re-breathing bag should be used
(the old having been removed the night before surgery, if possible). Anaesthetic
filters should be used at the patient end of the circuit.
9.5.8.3 A clear facemask should be used.
9.5.8.4 The anaesthetic machine should be investigated and assured as being latex-free. All
other equipment should be checked for their NRL content and replaced or covered
as appropriate.
9.5.8.5 Remove any latex Bougies from the anaesthetic machine: alternatives from the
‘latex-free box’ should be used.
9.5.8.6 If gloves need to be worn for intubation, ensure that these are latex-free. Some
stethoscopes and sphygmomanometers have latex tubing; these should be covered
with stockinette and sealed with latex-free tape.
9.5.8.7 Monitoring. Sufficient non-latex monitoring equipment is available to use for
monitoring in the clinical setting. The same equipment should be used throughout
the patient journey through theatres
9.5.9 Recovery
9.5.10 If the patient cannot be recovered in theatre, a designated area should be prepared
in recovery with all latex equipment removed. A screen should be placed around the
patient displaying ‘Latex-allergic patient’ signs .Drugs for the treatment of
anaphylaxis must be immediately accessible.
9.5.11 If the patient with known latex allergy has a suspected anaphylactic reaction during
anaesthesia, the guidelines of the Association of Anaesthetists of Great Britain and
Northern Ireland, ‘Suspected anaphylactic reactions associated with anaesthesia’
(2009) must be followed[16]. A copy of this document should be kept in every
theatre. Any such patient must be referred to the UHSM Allergy Centre for
investigation and management using the form in Appendix C.
9.6
Discharge of the latex-allergic patient
9.6.1
When a latex-allergic patient is discharged to the care of the GP or other hospital,
copies of the notes and management, including details of any adverse reactions,
which occurred during the in-patient stay, must be sent promptly. It is important to
include such details in any communication with District Nurses, Health Visitors, and
Physiotherapists.
9.6.2 In the same way, if latex-allergy is diagnosed or occurs in an outpatient or clinic
setting, full details must be sent to the patients GP and any other hospital where the
patient is being investigated/treated. These patients must be referred to the Allergy
Service prior to discharge (as per Appendices A and C).
10
Latex allergic members of staff
10.1 If staff are identified as sensitised or allergic to latex, the Occupational Health
Department must work with the individual responsible for health and safety/latex in
the ward or department to undertake a risk-assessment and ensure that the working
environment is safe for the employment of the prospective or continuing member of
staff.
10.2 When the risk-assessment has determined that the level of sensitivity makes it safe to
do so, in many clinical areas, staff with latex allergy can successfully work with the
following precautions: latex-allergic members of staff should use only non-latex gloves
and other products and avoid all latex-containing products. Other individuals in the
same work environment should use non-powdered low-protein latex gloves or,
preferably, non-latex gloves.
10.3 However, if the risk-assessment determined that the allergy is particularly severe,
other arrangements must be made as appropriate; e.g., the working area must be
made latex-safe.
10.4 Additional precautions if latex allergy is confirmed and symptoms are present:
10.4.1 Avoid contact with latex gloves and other latex-containing products in the work place
and at home;
10.4.2 Avoid areas where the powder from latex gloves worn by other workers might be
inhaled – though powdered-glove use should be stopped;
10.4.3 Inform employers and healthcare providers (doctors, nurses, dentists, etc) about the
latex allergy and consider wearing a MedicAlert bracelet;
10.4.4 Change protective clothing after any latex contact. Carefully follow physicians'
instructions for dealing with allergic reactions to latex;
10.4.5 Inform the Occupational Health Department.
11
References and Bibliography
1. Cullinan, P., et al., Latex allergy. A position paper of the British Society of Allergy and
Clinical Immunology. Clin Exp Allergy, 2003. 33(11): p. 1484-99.
2. Rolland , J.M. and R.E. O'hehir Latex allergy : a model for therapy Clinical and
Experimental Allergy 2008. 38 p. 898-912.
3. Phillips, M.L., C.C. Meagher, and D.L. Johnson, What is "powder free"?
Characterisation of powder aerosol produced during simulated use of powdered and
powder free latex gloves. Occup Environ Med, 2001. 58(7): p. 479-81.
4. Hnizdo E, E.T., Rees D,Lalloo UG, Occupational asthma as identified by the
surveillance of work-related and occuaptional respiratory disesases programme in
South Africa Clin Exp Allegry 2001. 31: p. 32-39.
5. McDonald JC , K.H., Meredith SK, Reported incidence of occupational asthma in the
United Kingdom. Environ Med, 2000. 57: p. 823-9.
6. Fett Ahmed, D., Sobczak ,S C, Yunginger ,J W. , Occupational allergies caused by
latex. Immunol Allergy Clin N Am, 2003. 23: p. 205- 219.
7. Porri F, P.M., Lemiere C et al Association between latex sensitization and repeated
latex exposure in children. Anesthesiology 1997. 86: p. 599-602.
8. Faust K, S.C., Zaglaniczny, K, Jarrett ,M. , Comparative analysis of latex allergy in the
healthy versus high-risk pediatric population. AANA J. , 1999. 67(5): p. 461-6.
9. Yunginger, J.W., Chapter 58 - Natural Rubber Latex Allergy, in Middleton's Allergy
Principles & Practice, B.S.B. N F Adkinson , W W Busse ,S T Holgate , R F Lemanske , F
E Simons Editor. 2009, Elsevier Inc.: Philadelphia.
10. Heese A, v.H.J., Peters KP,Koch HU ,Hornstein OP., Allergic and irritant reactions to
rubber gloves in medical health services.Spectrum,diagnostic approach, and therapy.
J Am AQcad Dermatol, 1991(25): p. 831-9.
11. van Kampen V, R.-H.M., Sander I, Merget R; Stad 1-Gruppe., Diagnostics of
occupational type I allergies--comparison of skin prick test solutions from different
manufacturers for selected occupational allergens. May;64(5), 2010: p. 271-7.
12. Sicherer, S.H., Clinical implications of cross reactive food allergens. J Allergy Clin
Immunol., 2001. 108(6): p. 881-890.
13. Reiter, J., Latex sensitivity : An industerial hygeine perspective. J Allergy Clin Immunol
2002(110): p. s121-8.
14. Yunginger , J.W., Allergy to natural rubber latex Minn Med, 1998. 81: p. 27-30.
15. Primeau, M.N., Adkinson ,N.F Jr, Hamilton, R.G., Natural rubber pharmaceutical vial
closures release latex allergens that produce skin reactions. J Allergy Clin Immunol,
2001. 107(6): p. 958-62.
16. Harper, N.J., et al., Suspected anaphylactic reactions associated with anaesthesia.
Anaesthesia, 2009. 64(2): p. 199-211.
Appendix A
SCREENING QUESTIONNAIRE FOR IDENTIFICATION OF
LATEX / CHLORHEXIDINE ALLERGIC OR HIGH RISK PATIENTS
Name ________________________________
RM Number_____________________________
Date of Birth _____/_____/_____
Referring Consultant____________________
1.
History of typical allergic problems (type I) after contact with latex/natural rubber- or
chlorhexidine-containing products?
Yes  No 
1.1 Latex-containing products/exposures/high risk groups; list not exhaustive (tick all that apply):

Latex or rubber gloves, balloons, condoms, adhesives, rubber bands

Patient with spina bifida, other nephro-urological or neurological congenital problems, or other
conditions requiring multiple surgeries or interventional procedures, particularly if from early
childhood (high risk patient – REFER TO THE UHSM ALLERGY CENTRE)

Allergic reaction during medical/dental procedure (e.g. urological, dental, cardiological
procedures, surgeries, dental, rectal or pelvic examinations, other)

Occupation involving frequent use of latex gloves or contact with rubber products

Food allergy to any of the following foods: avocado, banana, kiwi, chestnut, tomato
1.2 Chlorhexidine-containing products/exposures; list not exhaustive (tick all that apply):

Sterile wipes, hand scrub, skin disinfectants (e.g. Savlon ), lubricant gels (e.g. Instillagel ),
mouthwashes (e.g. Corsodyl )

Allergic reaction during medical/dental procedure (e.g. urological, dental, cardiological
procedures, surgeries, dental, rectal or pelvic examinations, other)
1.3 Allergic reactions (type I) experienced (tick all that apply):

urticaria (hives) or swelling

itchy-runny nose and sneezing; red-itchy-watery eyes

shortness of breath, cough, wheeze

abdominal cramps, nausea, vomiting, diarrhoea

mouth/tongue/throat tingligling, itching, swelling

anaphylaxis (severe life-threatening generalized or systemic hypersensitivity reaction with
rapidly developing airway and/or breathing and /or circulation problems, usually associated
with skin or mucosal changes)
2.
History of typical delayed hypersensitivity problems (type IV) after contact with
latex/natural rubber- or chlorhexidine-containing products?
Yes  No 
2.1. Latex-containing products/exposures/high risk groups (see 1.1)
2.2. Chlorhexidine-containing products/exposures (see 1.2)
2.3. Delayed hypersensitivity reactions (type IV) experienced (tick all that apply):
Dry skin, redness, itching, rash, cracking, chapping, scaling, excoriation, weeping and blister formation in
skin areas exposed to:
 latex/natural rubber-containing products
 chlorhexidine-containing products
ACTIONS
 If answered NO TO ALL QUESTIONS:
Patient unlikely to have latex or chlorhexidine allergy
No further action required
 If answered YES to any question in SECTION 1. or SECTION 2.3 for chlorhexidine products
Patient may have latex or chlorhexidine allergy
Refer to the UHSM Allergy Centre (Dr S Marinho) including the following:
Copy of this screening questionnaire
Send a blood sample for total + specific IgE to chlorhexidine and latex, add any foods
causing symptoms (Immunology, 10ml in yellow or red capped tube; please request
serum save).
If patient presenting with allergic reaction, also send ideally 3 timed samples for mast
cell tryptase (as per Anaphylaxis Policy) and include the completed Allergy referral
proforma (in Appendix C of the Latex and Chlorhexidine Policies)
 If answered YES to any question in SECTION 2
Patient may have delayed hypersensitivity to latex or chlorhexidine
Refer to the UHSM Dermatology Service (Dr J.E Ferguson) with a copy of this questionnaire
 FOR UHSM STAFF, if answered YES to any question, refer to the Occupational Health Department
in addition to the above.
12
Appendix B - List of common medical and household products
that contain latex
13 Medical products
15 Gloves
16 Blood pressure cuffs
17 Catheters
Wound drains
Adhesive tape
Elastic bandages
Electrode pads
Endotracheal tubes and airways
Bulb syringes
Enema syringes
Ventriculo-peritoneal shunts
Finger cots
IV access injection ports and IV tubing
Manual resuscitators
Penrose surgical drains
Pulse oximeters
Stethoscope tubing
Stretcher mattresses
Surgical masks
Tourniquets
Vascular stockings
Rubber tops of multi-dose vials
Bite blocks
Dental coffer dams
List is not exhaustive
14 Household products
Adhesives
Balloons
Carpet backing
Condoms
Contraceptive diaphragms
Elasticated fabrics
Feeding nipples
Household gloves
Diapers and incontinence pads
Infant pacifiers
Rubber bands
Erasers
Shoes
Bicycle helmets
18
Appendix C – UHSM Allergy Centre Referral Forms for Allergic
Reactions during General Anaesthesia
INVESTIGATION OF ALLERGIC REACTIONS DURING
GENERAL ANAESTHESIA
PATIENT REFERRAL FORM
PATIENT DETAILS
Name
DoB
Age
Hospital/NHS No.
Sex
Date
Ethnic group
Address
Telephone
REFERRING CLINICIAN (ADDRESS FOR CORRESPONDENCE)
Name
Address
Email
Telephone
Fax
ANAESTHETIST (IF DIFFERENT FROM ABOVE)
Name
Address
Email
Telephone
Fax
SURGEON
Name
Address
Email
Telephone
Fax
PATIENT’S GP
Name
Address
Email
Telephone
Fax
1. Clinical history – reaction during general anaesthesia
Source of referral:
_______________
Anaesthetist 
Surgeon 
GP

Other

Referring Institution: ________________________________________________________________________
Contact number or email: ___________________________________________________________________
1.1.
Reaction details
Proposed surgical procedure: ______________________________________________________________
Was surgery completed? Yes  No 
If not, has another surgery been scheduled? Yes

No 
Urgency of future surgery: ___________________________________________________________________
Date of reaction ____/___/______
Timing of reaction:
Time of onset of reaction: _____/______h (24h clock)
Occurring within 1h of the procedure 
Occurring more than 1h after the procedure

Suspected cause (if any): 1)___________________; 2)___________________; 3)___________________
Details of the reaction
Symptom/Sign
Hypotension
Onset Time
(00:00h)
Time resolved
(00:00h)
Severity
(Mild/Moderate/Severe)
Lowest BP: ____/_____mmHg
Tachycardia
Bronchospasm
Cyanosis/desaturation
Angioedema
Lowest SpO2: ___%
Area(s) affected:
(specify distribution)
Urticaria
(specify distribution)
Arrhythmia
Flushing
(specify distribution)
Other (specify)
Generalised / Localised, where?
1.2. Drugs / IV fluids / Procedures administered BEFORE the onset
of the reaction (please include time of tracheal intubation, LMA insertion, and
any other relevant event)
Drugs / Procedures before onset of reaction
Drug/Procedure
Dose
Route
Time over which
administered
(‘STAT’ or min:sec)
Time
(00:00h, 24h clock)
IV Fluids given before onset of reaction
IV Fluid
Approximate time started (00:00h,
24h clock)
Volume
1.3. Drugs / IV fluids administered AFTER the onset of the reaction
Drugs / IV Fluids after onset of reaction
Drug/Procedure
Dose
Route
Time over which
administered
(‘STAT’ or min:sec)
Time
(00:00h, 24h clock)
Comments on response to treatment:
Complications and sequelae
Event
Duration
Outcome – survived?
Transferred to: ICU
Yes


No 
HDU

Ward

Other
 ______________
1.4. Anaesthetic techniques and procedures
1.4.1.
LATEX-free environment:
1.4.2.
Central venous access:
Yes  No 
Time: ____:_____h
Skin Prep: _______________________________
Type of CVC: ________________________________________
Was a coated catheter used (chlorhexidine/silver sulfadiazine)?
1.4.3.
Neuraxial blockade:
Yes

No 
Spinal  Epidural 
Epi-spinal 
Skin Prep: ____________________________________________________
Neuroaxial blockade
Drug
1.4.4.
Dose
Peripheral nerve blockade:
Route
Time over which
administered
(‘STAT’ or min:sec)
Time
(00:00h, 24h clock)
Type of block(s): ______________ Skin Prep: ________________
Peripheral nerve blockade
Drug
Dose
Route
Time over which
administered
(‘STAT’ or min:sec)
Time
(00:00h, 24h clock)
1.4.5.
Urethral catheterisation:
Time ____:____h
Antiseptic solution: ________________________
Urethral lubrication/local anaesthetic: _________________________
Type of catheter (eg latex, silastic etc): ________________________
1.4.6.
Skin preparation for surgery and start of surgery:
Time surgery commenced: ____:____h
Time surgery completed: ____:____h
Skin Preparation
Antiseptic
Time (00:00h, 24h clock)
1.5. Investigations performed prior to referral (please give results if
known)
Were blood samples taken for Mast Cell Tryptase measurement? Yes
First sample
Time___:___
Date___/___/____
Result_____________________
Second sample
Time___:___
Date___/___/____
Third sample
Time___:___
Date___/___/____
Other blood tests:
Test: _________________
Test: _________________

No 
Result_____________________
Result_____________________
Time___:___
Date___/___/____
Result_____________________
Time___:___
Date___/___/____
Result_____________________
N.B. It is the anaesthetist’s responsibility to obtain the results from the laboratory
Case discussed at a multidisciplinary meeting?
Yes  No 
Reported to the MCA (Medicines Control Agency)?
Date___/___/____
Reported to the AAGBI National Anaphylaxis database?
Date___/___/____
Please send the completed form together with the following:
Photocopy of the anaesthetic record and any other previous anaesthetic
records
Photocopy of the prescription record
Photocopy of the recovery room documentation
Photocopy of any relevant ward documentation
For the attention of:
Dr Susana Marinho
Allergy Department
Wythenshawe Hospital
M23 9LT
INVESTIGATION OF ALLERGIC REACTIONS DURING
CARDIAC/RADIOLOGICAL/UROLOGICAL PROCEDURES
REFERRAL FORM
PATIENT DETAILS
Name
DoB
Age
Hospital/NHS No.
Sex
Date
Ethnic group
Address
Telephone
REFERRING CLINICIAN (ADDRESS FOR CORRESPONDENCE)
Name
Address
Email
Telephone
Fax
PATIENT’S GP
Name
Address
Email
Telephone
Fax
2. Clinical history – reaction during or related to
cardiac/radiological/urological procedure
Source of referral:
_______________
Cardiologist 
Radiologist 
GP

Other

Referring Institution: ________________________________________________________________________
Contact number or email: ___________________________________________________________________
2.1. Reaction details
Proposed procedure: ______________________________________________________________
Was the procedure completed? Yes

No 
If not, has another been scheduled? Yes

No

Urgency of future procedure: _______________________________________________________________
Date of reaction ____/___/______
Time of onset of reaction: _____/______h (24h clock)
Timing of reaction:
Occurring within 1h of the procedure 
Occurring more than 1h after the procedure

Suspected cause (if any): 1)___________________; 2)___________________; 3)___________________
Details of the reaction
Symptom/Sign
Onset Time
(00:00h)
Time resolved
(00:00h)
Hypotension
Severity
(Mild/Moderate/Severe)
Lowest BP: ____/_____mmHg
Tachycardia
Bronchospasm
Cyanosis/desaturation
Lowest SpO2: ___%
Area(s) affected:
Angioedema
(specify distribution)
Generalised / Localised, where?
Urticaria
(specify distribution)
Arrhythmia
Flushing
(specify distribution)
Other (specify)
2.2. Drugs / IV fluids / Procedures administered BEFORE the onset
of the reaction
Drugs / Procedures before onset of reaction
Drug/Procedure
Dose
Route
Time over which
administered
(‘STAT’ or min:sec)
Time
(00:00h, 24h clock)
IV Fluids given before onset of reaction
IV Fluid
Volume
Approximate time started (00:00h,
24h clock)
2.3. Drugs / IV fluids administered AFTER the onset of the reaction
Drugs / IV Fluids after onset of reaction
Drug/Procedure
Dose
Time over which
administered
(‘STAT’ or min:sec)
Route
Time
(00:00h, 24h clock)
Comments on response to treatment:
Complications and sequelae
Event
Duration
Yes 
Outcome – survived?
Transferred to:
ICU

HDU
No 

Ward

Other
_______________
2.4. Techniques and procedures
2.4.1.
CONTRAST MEDIUM used:
Yes 
No 
2.4.2.
LATEX-free environment:
Yes 
No 
2.4.3.
Central venous access:
Yes 
No 
Which? _________________________________
Time: ____:_____h Skin Prep: ____________________________
Type of CVC: __________________________________________
Coated catheter used? No
2.4.4.
Neuroaxial blockade:
Yes 
Spinal 

Yes  Which? ____________
No 
Epidural 
Epi-spinal 
Skin Prep: ____________________________________________________
Neuroaxial blockade
Drug
Dose
Route
Time over which
Time
administered
(‘STAT’ or min:sec)
2.4.5.
Peripheral nerve blockade:
(00:00h, 24h clock)
Type of block(s): ______________ Skin Prep: ________________
Peripheral nerve blockade
Drug
2.4.6.
Dose
Urethral catheterisation:
Route
Time ____:____h
Time over which
administered
(‘STAT’ or min:sec)
Time
(00:00h, 24h clock)
Antiseptic solution: ________________________
Urethral lubrication/local anaesthetic: _________________________
Type of catheter (e.g. latex, silastic etc): _______________________
2.4.7.
Skin preparation for procedure:
Time procedure commenced: ____:____h Time procedure completed: ____:____h
Skin Preparation
Antiseptic
Time (00:00h, 24h clock)
2.5. Investigations performed prior to referral (please give results if
known)
2.5.1.
Were blood samples taken for Mast Cell Tryptase measurement?
1st sample
Time___:___
(taken as soon as possible after the reaction)
2nd sample
Time___:___
(taken 1-2h after the reaction)
3rd sample
Time___:___
(taken ≥24h after the reaction)
2.5.2.

Yes 
Date___/___/____
Result______
Date___/___/____
Result______
Date___/___/____
Result______
Other blood tests:
Test: _________________
Test: _________________
Test: _________________
2.5.3.
No
Time___:___
Date___/___/____
Result_____________________
Time___:___
Date___/___/____
Result_____________________
Time___:___
Date___/___/____
Result_____________________
If patient had a cutaneous reaction, were pictures taken? No
2.6. Other medication

Yes  (please enclose)
Please list all drugs the patient is currently taking or was taking at the time of the
procedure and when started.
Patient’s regular medication
Drug
Date started
Please send the completed form and copies of any relevant supporting documentation
to:
Dr Susana Marinho
Allergy Department
Baguley Outpatients Building
University Hospital of South Manchester NHS FT
M23 9LT
APPENDIX D
(UHSM policy on latex allergy)
PLAN FOR DISSEMINATION
Title of document:
UHSM policy on latex allergy
Date finalised:
Jan 2012
Previous document
already being
used?
If yes, in what
format and where?
Dissemination lead:
Print name and contact
details
Dr Susanna Marinho
Electronic on Trust Policy Website
Proposed action to retrieve out-of-date
copies of the document:
Remove from Trust Policy website and upload new
document
Describe the plans for dissemination of the document to specific people / groups in
specified formats and if appropriate with relevant training
Through induction lectures and Trust training sessions.
Dissemination Record - to be used once document is ratified.
Date put on register /
library of policy or
procedural documents
Notes
HIRS/ANNUAL
REPORT/SAFETY
COMMITEE
Date due to be reviewed
March 2015
APPENDIX E (UHSM policy on latex allergy)
EQUALITY IMPACT ASSESSMENT of UHSM policy on latex allergy
Yes/No
1.
Does the policy/guidance affect one
group less or more favourably than
another on the basis of:
Race
Ethnic origins (including gypsies
and travellers)
No
No
Nationality
No
Gender
No
Culture
No
Religion or belief
No
Sexual orientation including
lesbian,
gay,
bisexual
and
transgender people
No
Age
No
Disability
No
2.
Is there any evidence that some
groups are affected differently?
No
3.
If you have identified potential
discrimination, are any exceptions
valid, legal and/or justifiable?
No
4.
Is the impact of the policy/guidance
likely to be negative?
No
5.
If so can the impact be avoided?
No
6.
What alternatives are there to
achieving the policy/guidance
without the impact?
No
7.
Can we reduce the impact by taking
different action?
No
Comments