Effects of clozapine and haloperidol on baseline levels of vacuous jaw movements in aged rats

BACKGROUND: IgE-mediated hypersensitivity to latex proteins has become a significant clinical problem over the last decade. Nursing and medical staff are at risk because of their occupational exposure to latex. AIMS: To determine the prevalence of type I hypersensitivity to latex allergens in the nursing staff of an Australian hospital. METHODS: A questionnaire which asked about symptoms associated with the use of latex gloves was completed by 140 nurses working in the Alfred Hospital (72 in general medical wards, 68 in intensive care units). Skin prick tests with eluates of five different types of latex glove as well as common aeroallergens (rye pollen and house dust mite) and banana extract were performed. RESULTS: Thirty-one nurses (22%) were skin prick test positive to at least one of the five latex glove eluates. All of these nurses were atopic, having positive skin prick tests to rye pollen or house dust mite. Symptoms of local dryness, itch and erythema associated with glove use were reported by more than half the study group, but not more frequently by those who were skin prick test positive to latex. Urticaria associated with glove use was reported more frequently by those with positive latex skin prick tests (13% vs 4%, p = 0.05). Eighty-seven per cent of the nurses who were latex skin test positive were also positive to banana extract. CONCLUSIONS: IgE-mediated hypersensitivity to latex is common in nurses working in an Australian hospital. Glove associated symptoms were frequently reported, but in most cases the symptoms were more typical of irritant or contact dermatitis rather than type I hypersensitivity reactions. However, the extent of subclinical sensitisation to latex found in this study suggests that symptomatic latex allergy is likely to emerge as an increasing problem for nursing staff in this country.     

Management of latex reactions in the occupational setting

1. The increased use of natural rubber latex barrier protection to prevent exposure to bloodborne pathogens has led to an increase in latex related health reactions, particularly associated with glove use. 2. The three types of reactions to latex in order of frequency include irritant contact dermatitis, allergic contact dermatitis, and immediate systemic/anaphylaxis reactions. 3. The management goal for all reactions is to avoid unnecessary restriction from the appropriate use of latex (gloves) which provides the best barrier protection, while protecting individual workers from exposure that results in sensitization or causes sensitized individuals to have serious reactions. 4. Choose non-latex gloves when barrier protection from bloodborne pathogens is not an issue. When selecting a latex glove, choose a glove that is low in proteins and powder free to control airborne latex exposure.     

Transverse laparotomy closed with continuous absorbable loop sutures

The use of latex gloves in the health care setting dates back to the 1800s, when these products were introduced as a means of preventing the passage of microorganisms to operating room patients. Today, fear of human immunodeficiency virus transmission and other blood-borne diseases has led to implementation of standardized guidelines for glove use for health care professionals. Because of the unique combination of strength, flexibility, and elasticity of natural rubber, latex is typically the material of choice for a variety of medical products, including examination gloves. Unfortunately, routine use of latex in the health care setting may be detrimental to patients and caregivers with a history of natural rubber latex hypersensitivity reactions.     

Examination gloves as barriers to hand contamination in clinical practice

OBJECTIVE: To test the effectiveness of vinyl and latex gloves as barriers to hand contamination with gram-negative organisms and enterococci during routine hospital procedures. DESIGN AND INTERVENTIONS: We studied 137 procedures during which a health care worker's gloved hand contacted a patient's mucous membrane and was thus potentially contaminated with gram-negative rods or enterococci. Quantitative hand cultures were obtained from each health care worker before and after the gloved contact using a modified glove juice method, and the exterior glove surface was also quantitatively cultured after patient contact. Used gloves were then tested for leaks using the American Society for Testing and Materials' watertight test. SETTING: Harborview Medical Center, a 330-bed city-county hospital and level I regional trauma and burn center, is both a teaching facility affiliated with the University of Washington and the major provider of care to indigent and uninsured persons in Seattle-King County, Washington. PATIENTS AND OTHER PARTICIPANTS: Respiratory therapists performing endotracheal tube care on intubated intensive care unit patients, registered nurses performing digital rectal stimulation for bowel training on patients with spinal cord injury in the rehabilitation ward, and dentists performing routine dental examinations and procedures on healthy outpatients in the dental clinic. MAIN OUTCOME MEASURE AND RESULTS: Eighty-six of the 135 gloves cultured had gram-negative rods or enterococci on the external surface after use and were thus sources of potential hand contamination. Microbial contamination of the health care worker's hands occurred in 11 (13%; 95% confidence interval, 6% to 20%) of these 86 events, and was more frequent with vinyl (10 of 42) than latex (one of 44) gloves (P < .01). After use, glove leaks were also more frequent in vinyl gloves (26 of 61) than with latex gloves (six of 70) (P < .001). Even when leaks were present, gloves prevented hand contamination in 77% of instances and quantitative counts of microorganisms contaminating hands were 2 to 4 logs less than counts on external glove surfaces. Health care workers reported awareness of the presence of glove leaks in only seven (22%) of the 32 events in which leaks were subsequently demonstrated. CONCLUSIONS: Under conditions of routine use, gloves effectively function as a protective barrier even when leaks are present. Latex gloves were less frequently associated with leaks and hand contamination. Since hand contamination occurred after 13% of exposures and cannot be readily identified by health care workers, routine hand washing should be done after each patient contact.     

Setting standards for product selection: allergy prevention

It is axiomatic to state that if products made of natural rubber latex were not used in health care settings then there would be no problems of acquired hypersensitivity from such products. Although synthetic materials are available they do not currently possess the same technical qualities of elasticity and comfort, nor do they deliver the desired degree of protection against biological agents as gloves made out of natural rubber latex. Selection of gloves either for non-sterile procedures or sterile surgical use should be based on this understanding, and gloves with minimal levels of extractable latex proteins should be used.     

The protective effect of a cut-resistant glove liner. A prospective, randomised trial

We performed a prospective, randomised study comparing the rates of glove perforation using double latex gloving with or without a disposable protective glove liner (Paraderm) on 118 patients undergoing primary or revision arthroplasty of the hip or knee by one surgeon (FRH). The patients were randomly allocated into two groups: in group 1 an inner and outer pair of latex gloves were worn as double gloves and in group 2 the glove liner was worn between the two latex gloves. There was glove perforation in at least one outer glove in 99 operations (84%). The operating surgeon was aware of the perforation in 21 of these. There were 22 perforations of the inner glove. Group 1 had a significantly higher perforation rate per operation (p < 0.05) than group 2. Our findings show that protective glove liners significantly reduce the rate of perforation of the inner glove during hip and knee arthroplasty.     

Latex allergens in tire dust and airborne particles

The prevalence and severity of latex allergy has increased dramatically in the last 15 years due to exposure to natural rubber products. Although historically this health risk has been elevated in hospital personnel and patients, a recent survey has indicated a significant potential risk for the general population. To obtain a wide-spread source for latex exposure, we have considered tire debris. We have searched for the presence of latex allergens in passenger car and truck tire tread, in debris deposited from the atmosphere near a freeway, and in airborne particulate matter samples representative of the entire year 1993 at two sites in the Los Angeles basin (California). After extraction of the samples with phosphate buffered saline, a modified-ELISA inhibition assay was used to measure relative allergen potency and Western blot analyses were used to identify latex allergens. The inhibition studies with the human IgE latex assay revealed inhibition by the tire tread source samples and ambient freeway dust, as well as by control latex sap and latex glove extracts. Levels of extractable latex allergen per unit of protein extracted were about two orders of magnitude lower for tire tread as compared to latex gloves. Western blot analyses using binding of human IgE from latex-sensitive patients showed a band at 34-36 kDa in all tire and ambient samples. Long Beach and Los Angeles, California, air samples showed four additional bands between 50 and 135 kDa. Alternative Western blot analyses using rabbit IgG raised against latex proteins showed a broad band at 30-50 kDa in all samples, with additional bands in the urban air samples similar to the IgE results. A latex cross-reactive material was identified in mountain cedar. In conclusion, the latex allergens or latex cross-reactive material present in sedimented and airborne particulate material, derived from tire debris, and generated by heavy urban vehicle traffic could be important factors in producing latex allergy and asthma symptoms associated with air pollution particles.     

A hereditary chiasmal optic neuropathy

The purpose of this study was to examine hand sensibility of surgeons wearing single and double latex gloves. Evaluation of hand sensibility, including cutaneous pressure thresholds, moving two-point discrimination, and static two-point discrimination, was performed on 25 surgeons (mean age 45 years). The dominant hand index finger was assessed with no glove, single glove, and double glove. The majority of surgeons had a moving and static two-point discrimination of 2 or 3 mm. The lowest cutaneous pressure thresholds were found when measured with no gloves and increased with single and double gloves. Statistically significant differences in cutaneous pressure thresholds using Semmes-Weinstein monofilaments were found for gloves versus no gloves (p < 0.0003) and single versus double gloves (p = 0.0003). Statistically significant differences in moving two-point discrimination were found for no gloves versus double gloves (p = 0.05) and single versus double gloves (p = 0.02). In conclusion, we found significant differences in hand sensation when measured with single and double gloves.     

Surgeon protection: early recognition of glove perforation using a green under glove

This paper reports the use of a double gloving system, which consists of a standard latex over glove and a green latex under glove, and aids recognition of intra-operative glove perforation during trauma surgery. Recognition of perforation is possible due to the colour of the under glove becoming more visable following ingress of fluid between the glove layers. The gloves were used in 40 consecutive operative procedures for lower limb fracture fixation. Glove perforations occurred in 48% of operations. The outer glove was perforated on 26 occasions and the under glove on two. There were no false positive colour changes but on one occasion no indication of perforation was visible. The rapidity and accuracy of colour change allowed identification of the cause of glove damage intra-operatively. This was most often due to powered instrumentation (58%).     

Practitioner and student latex exposure and allergy

Greater application of universal precautions has increased practitioner exposure to chemicals present in personal protective equipment. Of prime concern is the latex present in examination and surgical gloves. A survey concerning latex exposure, allergies, and handwashing was administered to three advanced classes of dental students and was sent to 300 private practitioners in Central Indiana. Results indicate that adverse skin reactions to latex start while in dental school. Problems due to latex gloves were reported by 18.6 percent of the students. Student handwashing materials and methods were adequate, except for inadequate washing time. Adverse skin reactions were reported by 24.1 percent of practitioners wearing latex gloves. Two handwashing problems were noted--inadequate washing time and the common use of water instead of an antimicrobial soap after glove removal. Both students and practitioners reported relatively high levels of personal and family histories of allergy to a variety of sources.     

Malassezia furfur in infantile seborrheic dermatitis

This study was conducted to evaluate the effect of normal use on latex glove integrity in a flow cytometry laboratory. The gloves were tested using the 1,000 microL water-tight test and met industrial standards (less than 4% leakage) before, but not after use. More durable gloves, or more frequent changes of gloves, may be needed to ensure adequate barrier protection for laboratory workers during routine procedures.     

Latex allergy in health services workers

The studies were performed in 20 workers from the Health Service (13 women and 7 men in the age 25-57) suffering from hand urticaria (6 persons) and hand dermatitis (14 persons) suspected of the allergy to latex gloves. In all patients the familial and personal predispositions to allergy were evaluated by the anamnesis, the estimation of total IgE serum level and the skin prick tests (SPT) with inhalant allergens. The latex allergy was diagnosed by SPT and contact test with standardized extract of the natural latex allergen in the concentration 1000 PNU/ml (Nexter-Allergopharma) and by estimation of specific to latex IgE serum level. In addition to this, contact tests with glove's material as well European standard contact allergens (Hermal) were done and the one with antiseptic substances to which the patient was exposed at his work. The allergy type I to latex gloves was confirmed in all 6 cases with contact urticaria. The SPT with standard extract of the natural latex was more valuable than latex specific IgE in the serum. Contact allergy (type IV) to latex gloves was confirmed in 10 from 14 suspected cases. In the next 4 the allergy to antiseptic substances was the reasons of the illness. The allergy to latex gloves appears more often in women. No case showed the familial predisposition to allergy and only 4 patients additionally suffered from the allergy to pollen and mites. Moreover in both groups of patients we showed the presence of the additional contact allergy to different allergens (to metals and antiseptic substances).     

Powder contamination of extradural catheters and implications for infection risk

Previous papers in this supplement have addressed contamination of the peritoneal cavity by powder from the surgeon's gloves, or via airborne starch particles. This paper examines the possibility that medical devices placed inside patients may also become contaminated with powder from gloves during handling and insertion. In this way, glove powder may subsequently find its way into body cavities.     

Latex allergens: review of current knowledge

Both health care workers and spina bifida patients are at risk to develop type I latex allergy since allergenic proteins of natural rubber latex are present in a variety of latex products. Natural latex contains more than 250 polypeptides and approximately 60 of them show IgE-binding characteristics. A multitude of these latex allergens has been identified, and their sensitization potency for both risk groups has been determined. While hevein (Hev b 6.02) is the major allergen in latex-allergic health care workers, 80% of latex sensitized-spina bifida children have IgE antibodies to the "rubber elongation factor" (Hev b 1). Almost all relevant latex allergens have been identified in natural latex products: however, no data on the allergen profiles of individual latex products exist. The knowledge of the major latex allergens enables improved diagnosis and to monitor the success of prevention strategies for decreasing the high prevalence of latex allergies.     

Improving glove barrier effectiveness

Perioperative staff members depend on surgical gloves to prevent disease transmission between themselves and patients, but these gloves frequently fail during use. Three approaches can make surgical gloves more effective barriers: preventing glove failures, monitoring glove integrity, and improving glove quality. Failure prevention includes modifying surgical techniques, improving instruments and equipment, streamlining teamwork, selecting the most appropriate gloves, double gloving, and performing preventive glove changes. Glove integrity monitoring can be performed visually or by feel, by wearing glove pairs with color-puncture indicators, or by using electronic monitoring devices. Glove quality improvements must be accompanied by testing methods that reflect in-use conditions. A glove rating system that is based on in-use performance may enhance glove safety substantially.     

Occupational asthma due to latex in health care workers

Immediate hypersensitivity reactions ranging from mild urticaria to life threatening anaphylaxis after exposure to natural rubber latex have been reported frequently in health care workers while occupational asthma due to latex exposure is less well studied. The results of specific challenge tests and immunological tests in four health care workers with work related respiratory and skin disorders induced by the use of latex gloves are described. Occupational asthma was confirmed in three subjects by specific challenge tests. All had a positive skin test reaction to the latex extract; specific IgE antibodies were detected in only one subject. The fourth subject had a negative specific inhalation and skin test reaction to the latex extract. Peak expiratory flow monitoring at work and away from work showed a pattern consistent with work related asthma. These findings confirm that latex is a cause of occupational asthma in health care workers.     

Understanding latex allergy

Latex allergy is an increasingly important problem in both health-care workers and patients. Predisposing factors to development of latex allergies include a history of atopy or allergy and frequent exposure to latex products. Identified allergens include latex proteins from the rubber tree that remain in manufactured products, as well as smaller molecules that remain from the latex purification and manufacturing process. Latex proteins absorbed to powder in latex surgical and examination gloves may be aerosolized and inhaled. Powder-absorbed latex proteins are thought to be important in triggering of sensitization in susceptible individuals, as well as in elicitation of symptoms in previously sensitized patients. Allergic reactions to latex can include local dermal reactions or generalized immediate hypersensitivity (anaphylactic) reactions. Pathophysiology, signs and symptoms, and treatment of each type of reaction are discussed. Measures to address latex allergy, however, must include measures to decrease exposure to latex antigens both in latex-allergic subjects, to prevent symptoms, and in naive subjects, to prevent sensitization. These measures may include finding, acceptable substitutes for latex in many products.     

Glove powder--a risk factor for the development of latex allergy?

Studies are described which compare the prevalence of sensitisation against latex proteins in medical personnel in different hospitals. The objective of these studies was to find out whether the use of powdered or unpowdered gloves could be related to the prevalence of latex allergy. Employees of one of the investigated hospitals (Germany) were using only powdered latex gloves, and in the other two hospitals (Great Britain) low protein powder-free latex gloves were used. Methods by which latex allergy can be avoided are suggested.     

Evaluating the effectiveness of gloves in reducing the hazards of hand-transmitted vibration

OBJECTIVES: A method of evaluating the effectiveness of gloves in reducing the hazards of hand-transmitted vibration is proposed. METHOD: The glove isolation effectiveness was calculated from: (a) the measured transmissibility of a glove, (b) the vibration spectrum on the handle of a specific tool (or class of tools), and (c) the frequency weighting indicating the degree to which different frequencies of vibration cause injury. With previously reported tool vibration spectra and glove transmissibilities (from 10-1000 Hz), the method was used to test 10 gloves with 20 different powered tools. RESULTS: The frequency weighting for hand-transmitted vibration advocated in British standard 6842 (1987) and international standard 5349 (1986) greatly influences the apparent isolation effectiveness of gloves. With the frequency weighting, the gloves had little effect on the transmission of vibration to the hand from most of the tools. Only for two or three tools (those dominated by high frequency vibration) did any glove provide useful attenuation. Without the frequency weighting, some gloves showed useful attenuation of the vibration on most powered tools. CONCLUSIONS: In view of the uncertain effect of the vibration frequency in the causation of disorders from hand-transmitted vibration, it is provisionally suggested that the wearing of a glove by the user of a particular vibratory tool could be encouraged if the glove reduces the transmission of vibration when it is evaluated without the frequency weighting and does not increase the vibration when it is evaluated with the frequency weighting. A current international standard for the measurement and evaluation of the vibration transmitted by gloves can classify a glove as an antivibration glove when it provides no useful attenuation of vibration, whereas a glove providing useful attenuation of vibration on a specific tool can fail the test.     

Delayed and immediate orofacial reactions following contact with rubber gloves during dental treatment

Allergic reactions during or after dental examination are uncommon. However, such reactions may be serious and distressing. Allergy to local anaesthetics and dental materials may be considered, but reactions to rubber in gloves worn by the dentist should be remembered. Two patients are reported who experienced symptoms following contact with rubber gloves worn by their dentists, with skin tests subsequently showing an allergic reaction to glove constituents, and in one case latex. With the increasing use of rubber gloves by dental and medical personnel, reactions in sensitised patients are likely to become more common. In patients with a history of symptoms related to dental work, it is important to remember delayed and immediate reactions to rubber.