|
Rubber Gloves 'Born' — and Now
Banished — at Johns Hopkins
Hospitalwide move addresses potentially fatal allergy to
latex
By Eric Vohr
Johns Hopkins Medicine
William Stewart Halsted, The Johns Hopkins Hospital's
first surgeon in chief, is widely credited as the first
to develop and introduce rubber surgical gloves in the
United States. That was in 1894, five years after the
institution opened.
Now, in an effort to make medical care safer for
patients and health care workers, the hospital has
become the first major medical institution to become
"latex safe" by ending all use of latex gloves and
almost all medical latex products.
"Latex hospital gloves were invented here, so it's only
fitting that Johns Hopkins takes the initiative to
promoting alternatives," said anesthesiologist Robert H.
Brown, chair of the Johns Hopkins Hospital Latex Task
Force and one of many Johns Hopkins faculty and staff
members who have contributed to making the hospital
latex-safe.
It was at Johns Hopkins that immunologists Robert
Hamilton and Franklin Adkinson conducted early key
research related to the problems of natural rubber latex
as an allergen. Furthermore, Brown points out, the
nurses and other frontline hospital workers have been
instrumental in implementing the latex-safe policy and
educating the staff.
Studies show that roughly 6 percent of the general
population and up to 15 percent of health care workers
are allergic to latex, with the higher rate among
medical personnel due to longer periods of contact with
natural rubber. In addition to surgical gloves, latex is
used in numerous medical devices such as tourniquets,
blood pressure cuffs and stethoscope tubes. The
anaphylactic reactions, similar to those caused by foods
such as peanuts or by bee sting allergies, can include a
drop in blood pressure, an irregular heartbeat, swelling
in the hands and feet and constriction of the airways.
In extreme cases, anaphylactic shock, which can occur
minutes after the exposure, can lead to death.
Allergic reactions generally result from exposure to
natural proteins, in this case proteins specific to
natural rubber latex, a product from rubber trees.
Currently available replacement gloves are made of one
of three synthetic products — neoprene, polyisoprene or
vinyl, none of which contains natural plant proteins.
Johns Hopkins is now using sterile neoprene and
polyisoprene gloves in the operating room because they
have a more sensitive feel.
Julie Freischlag, professor and chair of surgery, said,
"The sensitivity and fit of the new gloves are the same
as what you get with latex gloves. Unless someone told
you, you wouldn't know the difference. The only downside
is that they are a little more expensive."
Sterile neoprene and polyisoprene gloves cost 30 percent
to 50 percent more than latex gloves. Nonsterile
neoprene and vinyl examine gloves cost approximately the
same as those made from latex. Johns Hopkins uses mostly
neoprene gloves for all nonsterile procedures that
require glove protection.
Brown says the risk of developing an allergic reaction
to latex is higher if contact is made with broken skin
or mucous membranes, such as when hands are raw from
multiple scrubbings or when health care workers breathe
in the powder that makes the gloves easier to put on.
Patients for whom latex medical products are commonly
used for treatment, such as children with conditions
like bladder exstrophy or spinal bifida, can have as
high as an 80 percent chance of developing an allergic
reaction to the natural rubber latex.
Halsted is reported to have developed the latex glove to
protect the hands of his scrub nurse from the harsh
antiseptics in widespread use as disinfectants. By 1966,
disposable latex gloves were the norm in operating rooms
nationwide, and in the 1980s, the need for "universal
precautions," prompted by the AIDS epidemic, increased
their use outside the operating room and among health
care workers everywhere. As glove use proliferated, so
did the rate of allergic reactions, and by the
mid-1990s, latex allergies were considered a major
health issue. Brown says he prefers the term "latex
safe" to "latex free" because removing all sources of
natural rubber remains a bit of a challenge.
"We are still searching the hospital for the few
remaining medical latex products that we might have
overlooked, although we can safely say that all major
latex products that are a clear risk to health care
workers and patients have been eliminated," he said.
PodCast
To hear Robert Brown and
Julie Freischlag talk about the transition to latex-free
surgical gloves and a latex-safe environment at Johns
Hopkins, go to
www.hopkinsmedicine.org/mediaII/Podcasts/latex.html.
Visit
http://www.jhu.edu/~gazette/2008/22jan08/22gloves.html
for original article. |
