Latex Precautions in Obstetrics and Gynecology

By Rosanne Cain, BSN, LHRM, Patient Safety/Risk Manager II

Recognizing latex allergies is an important patient safety precaution.

During the past 30 years, latex allergy has been recognized as a significant problem for both specific patient and provider populations. The incidence of latex allergy in the general population has been estimated to be between 1 and 6 percent. Some adolescents experience incidences as high as 73 percent (notably those individuals with spina bifida and related pathologies). Healthcare workers maintain an incidence of allergic response that ranges from 8 to 17 percent. Adults with spinal cord trauma, neurogenic bladder, or documented history of unexplained intraoperative anaphylaxis can also be affected by frequent exposure to latex supplies.1

Significant facts related to latex allergy arise in the obstetric and gynecologic specialty:2

  • 70 percent of latex-related anaphylactic reactions occur in women.
  • 50 percent of all latex-related reactions occur in the obstetric and gynecological setting.
  • There is a higher prevalence of latex sensitization in the obstetric population (5.1 percent) vs. the non-pregnant undergoing gynecologic surgery (1.7 percent).
  • Neuromuscular blocking drugs are the most common triggering agents of intra-operative anaphylaxis, followed by latex. Anaphylaxis has a potentially devastating effect on fetal oxygenation.
  • Latex anaphylaxis is often misdiagnosed because of delayed symptomatology. During obstetric anesthesia, other conditions may mimic an allergic reaction. Cardio-respiratory collapse may be due to local anesthetic-induced sympathetic block or toxicity, hemorrhage, or amniotic fluid embolism. This can cause a delay in diagnosis of anaphylactic reactions.

Other at-risk populations with repeated exposure to latex gloves include lifeguards, emergency responders, law enforcement professionals, and cosmetologists. In addition, glove powder has been shown to aerosolize latex proteins and increases the risks of a reaction in latex-sensitized patients or staff. The U.S. Food and Drug Administration (FDA) recently announced a ban of the use of powdered gloves in surgery, powdered patient examination gloves, and absorbable powder used on surgical gloves. The ban was issued after an investigation determined that the powdered products present an “unreasonable and substantial risk of illness or injury and that the risk cannot be corrected or eliminated by labeling or a change in labeling.”3

Although most gynecologists and obstetricians are familiar with latex allergies, the infrequency of a severe reaction during a procedure can cause inadequate precautionary measures. Implement the following risk management strategies to reduce latex-related risks.

Risk Management Strategies

  1. Know your patient’s latex allergy status, and note it prominently in the patient’s medical records. Allergy status should be updated on each patient visit.
  2. Remove toys that contain latex from your practice’s common areas and play zones.
  3. Remember that touching any latex object can cause transmission of the allergen by hand to the patient.
  4. Identify products that contain latex, including irrigation tips, bulb syringes, eye protection goggles, tourniquets, rubber stoppers on medicine vials, adhesive tapes and bandages, water tubing, catheters, carts, bandages, reservoir bags, airways, endotracheal tubes, laryngeal mask airways, and ventilator bellows.
  5. Maintain a list of latex-free devices and office products and ensure that it is readily available for staff reference.
  6. Keep emergency medications stocked and current, and ensure that supplies include emergency medications with non-latex syringes and medicine stoppers.
  7. Perform practice drills with your staff so they recognize conscious and unconscious signs of anaphylaxis, and are prepared for latex-related medical emergencies.
  8. Consult a neonatologist and the patient’s allergist for pretreatment recommendations.

For a free brochure on latex allergy, contact the American College of Allergy, Asthma and Immunology (ACAAI) by calling toll-free (800) 842-7777. Additional information is available on the ACAAI website at http://acaai.org/allergies/types/skin-allergies/latex-allergy.


References

  1. American Latex Allergy Association, http://latexallergyresources.org/statistics
  2. Allergic reactions during labour analgesia and caesarean section anaesthesia. Adriaensens, I., Vercauteren, M., Janssen, L., Leysen, J., Ebo, D. International Journal of Obstetric Anesthesia 2013 Jul; 22(3): 231-242.
  3. FDA Rule, Banned Devices; Powdered Surgeon's Gloves, Powdered Patient Examination Gloves, and Absorbable Powder for Lubricating a Surgeon's Glove, 81 FR 91722, December 19, 2016, https://www.federalregister.gov/documents/2016/12/19/2016-30382/banned-devices-powdered-surgeons-gloves-powdered-patient-examination-gloves-and-absorbable-powder

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J10933 4/17

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