A Sensitive Issue
Contractors need to know what they can do to reduce the risk of employees developing reactions and what to look for if workers begin to show symptoms.
Defining the problem
Latex is a milky, white fluid produced from the Hevea brasiliensis rubber tree. Allergists call this natural rubber latex, or NRL, to differentiate it from synthetic products. NRL can be found in a variety of items, including gloves, respirators, erasers and even carpeting. Life-saving supplies, including masks, bandages and IV equipment, often are made from NRL.
Latex, for all of its uses, can be harmful or even deadly to some individuals who are sensitive or allergic to its proteins. Although the amount of exposure needed to cause sensitization or symptoms is not known, exposures at even very low levels can trigger allergic reactions in some sensitized individuals.
For instance, very sensitive workers can become ill from the powder from latex gloves circulating in the air, or from residue in food (when foodservice workers use NRL gloves in preparation).
Latex allergy itself has been around since the plant was discovered, but it’s only recently been recognized as a problem.
“Recognition of the hazards of latex did not become significant until the out break of hepatitis, HIV and several other blood- and body-fluid-borne diseases, which significantly increased the need and demand for use of gloves in health care,” says James Speelman, assistant administrator of the American Society of Safety Engineers Healthcare Practice Specialty, Des Plaines, Ill.
Nobody is sure how prevalent latex sensitivity is in the general population, but repeated exposure to NRL is seen as the biggest risk factor. The National Institute for Occupational Health and Safety (NIOSH) estimates about 1 percent to 6 percent of the general population, and 8 percent to 12 percent of the health-care population test positive for sensitivity in a blood or skin test. Among sensitized individuals, a variable proportion have had symptoms or signs of an allergy, such as asthma. Of non-health-care professionals who come into contact with latex regularly at work — including janitors — up to 11 percent could be sensitized.
Accounts vary even from contractor to contractor.
Dick Anderson, safety director for St. Louis-based Mitch Murch’s Maintenance Management , says NRL problems are rare in his company; only a few of the 1,600 employees have mentioned a reaction.
But one BSC in Jefferson City, Mo., says complaints of latex sensitivity were rampant when his company specialized in cleaning health-care facilities, but now that the company has diversified, the complaints have slowed.
Similarly, two of Elgin Fellers’ 17 employees have complained of irritation from using latex gloves, and about half of his staff have switched to synthetic products. Fellers is president of All Ways Service Corp. in Los Alamos, N.M.
“Latex allergy is out there,” says John Van Raalte, MS, CIH, director of industrial hygiene services for the Eastern New York Occupational and Environmental Health Center in Albany. “Janitors in hospitals have had problems, and it’s highly probable that other janitors will have them.”
Signs of trouble
There are three different types of latex-related reactions, according to NIOSH:
• Irritant contact dermatitis is the development of dry, itchy areas on the skin, usually the hands. Although gloves are the most common culprit, hand washing, dry skin and chemicals (including cleaning chemicals) can cause irritant contact dermatitis.
• Allergic contact dermatitis, or delayed hypersensitivity, results from exposure to chemicals added to latex during harvesting, processing or manufacturing. A rash may progress to oozing blisters or spread away from the area of skin touched by the latex.
Dermatitis of either type isn’t a true latex allergy, but it still can be cause for concern because broken skin can promote infection, says Frank Denny, industrial hygienist and safety manager for the U.S. Veterans’ Administration’s Office of Safety and Health in Washington.
• A true latex allergy, called immediate hypersensitivity, can be the most serious reaction. Certain proteins in latex may cause this sensitization. Mild reactions involve skin redness, hives or itching. More severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat and asthma. Rarely, life-threatening shock may occur.
“I’m not aware of any custodian having an anaphylactic reaction, but skin reactions are pretty common,” Denny says.
Symptoms of latex allergies are similar to many other causes, and workers may assume the redness is due to something else, Denny says.
If workers suspect they’re having a reaction to anything, they need to notify their supervisors immediately. The U.S. Occupational Health and Safety Administration (OSHA) considers latex allergy an occupational exposure, so it must be recorded on an OSHA 300 Log, says Speelman. Affected workers also may be eligible for workers’ compensation, he adds.
The employee must see a doctor as soon as possible. The physician will be able to diagnose an NRL allergy, and will try to rule out other causes of the dermatitis, such as chemical exposure or other allergies.
In addition, many people develop rashes simply from wearing gloves — of any kind — for extended periods. In that case, you may need to change routines or add a salve, Denny says.
However, do not use lotions or soaps to try to lessen irritation unless directed to do so by a doctor, Van Raalte warns.
“Lotions will soften the skin and allow the allergen to penetrate and make the reactions worse,” he says.
In the case of a severe anaphylactic reaction (breathing difficulties, swelling, shock), call 911 or a local emergency number. Be sure to let the dispatcher know that the patient may be experiencing a latex reaction.
If an employee is diagnosed with a latex allergy, the only cure is avoidance, says Van Raalte.
The easiest way to eliminate NRL is to switch to a synthetic glove. The U.S. Food and Drug Administration has established a labeling requirement, and latex-free products will be labeled as such, so there shouldn’t be too much guesswork for BSCs.
Nitrile, vinyl and polyurethane gloves all are alternatives to NRL. For the most part, protection against chemicals is equivalent to that of latex, but protection against viruses may not be as good with synthetics, Speelman says.
Also, be sure to check the glove manufacturer’s instructions against the products the janitors will be using to make sure the gloves are appropriate, Van Raalte explains. For instance, oil-based chemicals can degrade latex, so NRL shouldn’t even be used in those situations.
Alternative gloves do fit OHSA requirements for personal protective equipment; in fact, the OSHA bloodborne pathogens standard states alternative equipment must be provided for people with sensitivities. The standard does not recommend any alternative materials.
Unfortunately, there is a perception that alternatives may be prohibitively expensive. While some synthetics cost more than NRL, premium prices usually come into play for synthetic products that have the “look and feel” of latex, Speelman points out. Basic vinyl usually is cheaper than latex.
However, eliminating NRL might not entirely eliminate irritation.
“You still could have dermatitis, especially if there is poor manufacturing quality,” Van Raalte explains. “If people are looking at price, and buy from off-brand or low-cost manufacturers, you get inferior gloves.”
Also, allergic employees may continue to have reactions if areas are contaminated with latex dust. Identify those areas, such as upholstery, carpets and air ducts, and clean them frequently, Speelman suggests. Also, be sure to change ventilation filters and vacuum bags frequently in latex-contaminated areas.
BSCs don’t necessarily have to transfer affected employees into other areas; both Anderson and Fellers say they have never had to reassign a sensitive worker. Still, contractors should work with their employees and with medical professionals to determine the best possible placement.
In some workplaces, NRL is banned entirely. For instance, at the Veterans Administration, the policy states that unless there is a reason to specifically use NRL, find another alternative.
Other health-care professionals also encourage the public to phase out their use of latex.
“We discourage latex use for the entire population,” says Van Raalte. That’s because sensitivity increases with exposure. “Every day, thousands of pairs of gloves get used in a hospital. It’s just like a bee sting — one sting might not have any effect, but multiple stings can kill someone.”
| Latex and the law |
|Do BSCs really have to accommodate allergic employees? For now, it’s unclear. |
The jury’s still out as to whether latex allergy is subject to the Americans with Disabilities Act. For instance, a federal jury in December ruled that a nurse’s allergy is not a disability under the ADA. In Jennifer Scanlon vs. Temple University, Philadelphia nurse Jennifer Scanlon alleged she suffers from a life-threatening latex allergy, and her employment was terminated because of it. Temple University contends it tried to find Scanlon a latex-safe unit in which to work, and when it couldn’t, it terminated Scanlon, advised her to apply for workers’ compensation and told her she could reapply for a position when her medical condition improved. The court found that Scanlon was able to control her condition with medication and latex avoidance, and thus, her major life activities weren’t severely limited.
On the other hand, BSCs will want to watch Chevron USA vs. Echazabal, which currently is pending under U.S. Supreme Court review. Mario Echazabal worked as a contract worker in a Chevron refinery for 20 years, and was offered a direct-hire position contingent upon a physical exam. But the company physician found Echazabal unfit for work due to liver disease; the toxins produced at the refinery could pose a threat to his health. He was later terminated, per Chevron’s directive, from his contract position because of this threat. He sued, charging that Chevron’s action violated the ADA. He contends that a company shouldn’t deny a person employment based on threats to his or her own health.
This case could set the standard for whether employers are allowed to discriminate based on potential harm to the employee in other circumstances, including latex allergy.
For now, assume ADA and equal-opportunity laws do apply to latex allergy, and don’t do anything that will make a claim of discrimination likely. To ask a prospective employee about a latex sensitivity might bring charges of discrimination against people with allergies.
It is permissible, however, to state the conditions of the job and ask an applicant if he or she will need any accommodation.
Also, Jim Speelman, assistant administrator of the American Society of Safety Engineers Healthcare Practice Specialty, suggests discussing latex allergies during a pre-employment health screening, and also during required hazard communication training. That way, employees will know what symptoms to recognize, and will know to come forward if they have a history of allergy or develop any symptoms.
Even if there’s no legal concerns, it’s a good idea to work with a sensitive employee to find a solution, especially since gloves make up only a small part of an average BSC’s supply costs.
“A smart employer will accommodate a good employee, especially when it’s so simple,” says John Van Raalte of the Eastern New York Occupational & Environmental Health Center.