Biology Safety - Powdered latex gloves. Why their use is being phased out.

What are disposable gloves used for in laboratory situations?
Essentially for 1 of 2 purposes;

Allergic reactions to exposure to natural rubber latex (NRL) have increased significantly over the last ten years, particularly within healthcare occupations. In January 2005 the Health and Safety Executive (HSE) updated their information and advice on http://www.hse.gov.uk/latex/index.htm including a page for lab workers (http://www.hse.gov.uk/latex/labs.htm). The HSE have published a useful leaflet "Latex and You" available on the web in .pdf format at http://www.hse.gov.uk/pubns/indg320.pdf

For a detailed and excellent review of the latex glove allergy problem readers are referred to the American NIOSH Alert ; Preventing Allergic Reactions to Natural Rubber Latex in the Workplace (DHHS (NIOSH) Publication No. 97-135, June 1997) and available on the web at http://www.cdc.gov/niosh/latexalt.html

Another useful page from the American Chemical Society; http://pubs.acs.org/hotartcl/chas/97/novdec/latex.html. This describes the sobering chemical exposure incident through a latex glove which lead to the death of lab worker Karen Wetterhahn in 1997.

What is latex and why does it cause a problem?

Latex products are manufactured from a milky fluid derived from the rubber tree.
Some proteins in natural rubber latex can cause a range of mild to severe allergic reactions. Total protein serves as a useful indicator of the exposure of concern [Beezhold et al. 1996a].
Several types of synthetic rubber are also referred to as "latex," but these do not release the proteins that cause allergic reactions.
A wide variety of products contain latex: medical supplies, personal protective equipment, and numerous household objects.
Most people who encounter latex products only through their general use in society have no health problems from the use of these products.
Workers who repeatedly use latex products are the focus of this document.

Types of reactions to latex.
Three types of reactions can occur in persons using latex products:

Irritant Contact Dermatitis. This is the most common reaction to latex products -- the development of dry, itchy, irritated areas on the skin, usually the hands, caused by using gloves. The reaction can also result from repeated hand washing and drying, incomplete hand drying, use of cleaners and sanitisers, and exposure to powders added to the gloves. Irritant contact dermatitis is not a true allergy.

Allergic contact dermatitis (delayed hypersensitivity) results from exposure to chemicals added to latex during harvesting, processing, or manufacturing. The rash usually begins 24 to 48 hours after contact and may progress to oozing skin blisters or spread away from the area of skin touched by the latex.

Latex Allergy (or immediate hypersensitivity) can be a more serious reaction to latex than irritant contact dermatitis or allergic contact dermatitis. Certain proteins in latex may cause sensitisation (positive blood or skin test, with or without symptoms). Although the amount of exposure needed to cause sensitisation or symptoms is not known, exposures at even very low levels can trigger allergic reactions in some sensitised individuals. Reactions usually begin within minutes of exposure to latex, but they can occur hours later and can produce various symptoms. Mild reactions to latex involve skin redness, hives, or itching. More severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat, and asthma (difficult breathing, coughing spells, and wheezing). Rarely, anaphylactic shock may occur, but such a life-threatening reaction is seldom the first sign of latex allergy. Such reactions are similar to those seen in some allergic persons after a bee sting.

Levels and routes of exposure.
Studies of other allergy-causing substances provide evidence that the higher the overall exposure in a population, the greater the likelihood that more individuals will become sensitised [Venables and Chan-Yeung 1997]. The amount of latex exposure needed to produce sensitisation or an allergic reaction is unknown; however, reductions in exposure to latex proteins have been reported to be associated with decreased sensitisation and symptoms [Tarlo et al. 1994; Hunt et al. 1996].
The proteins responsible for latex allergies have been shown to fasten to powder that is used on some latex gloves. When powdered gloves are worn, more latex protein reaches the skin. Also, when gloves are changed, latex protein/powder particles get into the air, where they can be inhaled and contact body membranes [Heilman et al. 1996]. In contrast, work areas where only powder-free gloves are used show low levels or undetectable amounts of the allergy-causing proteins [Tarlo 1994; Swanson et al. 1994].
Wearing latex gloves during episodes of hand dermatitis may increase skin exposure and the risk of developing latex allergy. The risk of progression from skin rash to more serious reactions is unknown. However, a skin rash may be the first sign that a worker has become allergic to latex and that more serious reactions could occur with continuing exposure [Kelly et al. 1996].

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	Powdered latex gloves. Why their use has been phased out.
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Safety home page Our system of managing safety Safety policies Safety A-Z index Risk assessments Useful information Powdered latex gloves. Why their use is being phased out. Legal requirements	Latex allergy in the workplace can result in potentially serious health problems for workers, who are often unaware of the risk of latex exposure. Such health problems can be minimised or prevented by following the recommendations outlined in this document. Following a decision of the University Health and Safety Committee (meeting of 11^th July 2000) the University phased out the use of disposable POWDERED latex gloves from the end of December 2000.
	What are disposable gloves used for in laboratory situations?
	What is latex and why does it cause a problem?	Background to the latex problem
	Types of reactions to latex.	Levels and routes of exposure
	Who is at risk?	How common is latex allergy?
	Is there any need for anyone to insist on using latex gloves?
	Recommendations ;	For Departments For individual workers
	Using the correct glove material	Commercial sources of disposable gloves
	References

What are disposable gloves used for in laboratory situations? Essentially for 1 of 2 purposes; To protect the wearer from contact with potentially damaging chemical or biological materials. For chemical protection the wearer should determine the appropriate glove material to provide the desired protection. Some chemicals will rapidly penetrate some glove materials, negating any perceived protection. Reference to the University of Bristol Chemistry page (http://www.chm.bris.ac.uk/safety/gloves.htm) will introduce readers to the subject. to protect sensitive work (e.g. biological material or electronic components) from contamination emanating from the worker (e.g. sweat and sloughed skin cells). Background to the latex problem. Allergic reactions to exposure to natural rubber latex (NRL) have increased significantly over the last ten years, particularly within healthcare occupations. In January 2005 the Health and Safety Executive (HSE) updated their information and advice on http://www.hse.gov.uk/latex/index.htm including a page for lab workers (http://www.hse.gov.uk/latex/labs.htm). The HSE have published a useful leaflet "Latex and You" available on the web in .pdf format at http://www.hse.gov.uk/pubns/indg320.pdf For a detailed and excellent review of the latex glove allergy problem readers are referred to the American NIOSH Alert ; Preventing Allergic Reactions to Natural Rubber Latex in the Workplace (DHHS (NIOSH) Publication No. 97-135, June 1997) and available on the web at http://www.cdc.gov/niosh/latexalt.html The Ansell Edmont site also has some information; http://www.ansell-edmont.com/download/Ansell_7thEditionChemicalResistanceGuide.pdf These pages were produced for the nursing profession; http://diannebrownson.tripod.com/latex.html and http://medi-smart.com/anes4.htm Another useful page from the American Chemical Society; http://pubs.acs.org/hotartcl/chas/97/novdec/latex.html. This describes the sobering chemical exposure incident through a latex glove which lead to the death of lab worker Karen Wetterhahn in 1997. Disposable powdered latex gloves have been widely used for some time in medical and laboratory applications. Latex was the first material developed for use in disposable gloves. Latex proteins can cause sensitisation in exposed individuals. This allergic response can, in rare cases, lead to the life-threatening condition known as anaphylactic shock. According to the American FDA statistics, anywhere from 5 to 20 percent of health care workers have developed some sort of allergy to latex, thanks in part to repeated contact. Non-latex alternatives are available but have a shorter shelf life. Their pros and cons are described in an attached table. The powder (often cornstarch) used in powdered gloves is there to facilitate easier donning and removal of the gloves. When powdered gloves are removed from the workers hands, the cornstarch containing the allergenic latex proteins is scattered into the air. The sensitized person does not even need to be wearing the gloves to be exposed - just being near someone who is removing gloves could cause a reaction. Unpowdered latex gloves are available. There are other types of disposable glove material commonly available (such as vinyl (PVC) and nitrile). What is latex and why does it cause a problem? Latex products are manufactured from a milky fluid derived from the rubber tree. Some proteins in natural rubber latex can cause a range of mild to severe allergic reactions. Total protein serves as a useful indicator of the exposure of concern [Beezhold et al. 1996a]. Several types of synthetic rubber are also referred to as "latex," but these do not release the proteins that cause allergic reactions. A wide variety of products contain latex: medical supplies, personal protective equipment, and numerous household objects. Most people who encounter latex products only through their general use in society have no health problems from the use of these products. Workers who repeatedly use latex products are the focus of this document. Types of reactions to latex. Three types of reactions can occur in persons using latex products: Irritant Contact Dermatitis. This is the most common reaction to latex products -- the development of dry, itchy, irritated areas on the skin, usually the hands, caused by using gloves. The reaction can also result from repeated hand washing and drying, incomplete hand drying, use of cleaners and sanitisers, and exposure to powders added to the gloves. Irritant contact dermatitis is not a true allergy. Allergic contact dermatitis (delayed hypersensitivity) results from exposure to chemicals added to latex during harvesting, processing, or manufacturing. The rash usually begins 24 to 48 hours after contact and may progress to oozing skin blisters or spread away from the area of skin touched by the latex. Latex Allergy (or immediate hypersensitivity) can be a more serious reaction to latex than irritant contact dermatitis or allergic contact dermatitis. Certain proteins in latex may cause sensitisation (positive blood or skin test, with or without symptoms). Although the amount of exposure needed to cause sensitisation or symptoms is not known, exposures at even very low levels can trigger allergic reactions in some sensitised individuals. Reactions usually begin within minutes of exposure to latex, but they can occur hours later and can produce various symptoms. Mild reactions to latex involve skin redness, hives, or itching. More severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat, and asthma (difficult breathing, coughing spells, and wheezing). Rarely, anaphylactic shock may occur, but such a life-threatening reaction is seldom the first sign of latex allergy. Such reactions are similar to those seen in some allergic persons after a bee sting. Levels and routes of exposure. Studies of other allergy-causing substances provide evidence that the higher the overall exposure in a population, the greater the likelihood that more individuals will become sensitised [Venables and Chan-Yeung 1997]. The amount of latex exposure needed to produce sensitisation or an allergic reaction is unknown; however, reductions in exposure to latex proteins have been reported to be associated with decreased sensitisation and symptoms [Tarlo et al. 1994; Hunt et al. 1996]. The proteins responsible for latex allergies have been shown to fasten to powder that is used on some latex gloves. When powdered gloves are worn, more latex protein reaches the skin. Also, when gloves are changed, latex protein/powder particles get into the air, where they can be inhaled and contact body membranes [Heilman et al. 1996]. In contrast, work areas where only powder-free gloves are used show low levels or undetectable amounts of the allergy-causing proteins [Tarlo 1994; Swanson et al. 1994]. Wearing latex gloves during episodes of hand dermatitis may increase skin exposure and the risk of developing latex allergy. The risk of progression from skin rash to more serious reactions is unknown. However, a skin rash may be the first sign that a worker has become allergic to latex and that more serious reactions could occur with continuing exposure [Kelly et al. 1996].
Who is at risk? Workers with ongoing latex exposure are at risk of developing latex allergy. Such people include laboratory workers who frequently use latex gloves. Atopic individuals (persons with a tendency to have multiple allergic conditions) are at increased risk for developing latex allergy. Latex allergy is also associated with allergies to certain foods especially avocado, potato, banana, tomato, chestnuts, kiwi fruit, and papaya. [Blanco et al. 1994; Beezhold et al. 1996b]. People with spina bifida are also at increased risk for latex allergy.
How common is latex allergy? Reports about the prevalence of latex allergy vary greatly. This variation is probably due to different levels of exposure and methods for estimating latex sensitisation or allergy. Recent reports in the scientific literature indicate that from about 1% to 6% of the general population and about 8% to 12% of regularly exposed health care workers are sensitised to latex [Kelly et al. 1996; Katelaris et al. 1996; Liss et al. 1997; Ownby et al. 1996; Sussman and Beezhold 1995]. Among sensitised workers, a variable proportion have symptoms or signs of latex allergy. For example, one study of exposed hospital workers found that 54% of those sensitised had latex asthma, with an overall prevalence of latex asthma of 2.5% [Vandenplas et al. 1995]. Prevalence rates up to 11% are reported for non-health care workers exposed to latex at work [van der Walle and Brunsveld 1995; Nasuruddin et al. 1993; Orfan et al. 1994; Tarlo et al. 1990].
Is there any need for anyone to insist on using disposable latex gloves? Yes. The best choice for resistance to some chemicals (e.g. methanol and ketones such as acetone) is latex. However, there are few other chemical applications where latex is the preferred choice. Nitrile gloves are generally the material of choice.
Recommendations The University of Bath Health and Safety Committee decided, on 11^th July 2000, to phase out the use of POWDERED disposable latex gloves as soon as possible and to prohibit their use, as far as possible, from 1^st January 2001. The following recommendations for preventing latex allergy in the workplace are based on current knowledge and a common-sense approach to minimising latex-related health problems. Evolving manufacturing technology and improvements in measurement methods may lead to changes in these recommendations in the future. For now, adoption of the recommendations wherever feasible will contribute to the reduction of exposure and risk for the development of latex allergy.
Recommendations for Departments Departments must; Inform workers of the potential problems with latex allergy and provide them with relevant information. Provide workers with both non-latex gloves and powder-free low-protein latex disposable gloves. Supervisors and workers must determine the most effective glove for the purpose. Ask the university Occupational Health Service (OH@bath.ac.uk, based in the Medical Centre, ext. 6190) to screen high-risk workers for latex allergy symptoms. Detecting symptoms early and removing symptomatic workers from latex exposure are essential for preventing long-term health effects. Evaluate current prevention strategies whenever a worker is diagnosed with latex allergy.
Recommendations for Workers Workers should take the following steps to protect themselves from latex exposure and allergy in the workplace: If appropriate, use non-latex gloves. If latex is the preferred choice then ensure you are using non-powdered low-protein latex gloves. Use appropriate work practices to reduce the chance of reactions to latex. When wearing latex gloves do not use oil-based hand creams or lotions (which can cause glove deterioration) unless they have been shown to reduce latex-related problems and maintain glove barrier protection. PRE-GLOVE is such a commercially-available barrier and is available from Fisher. After removing latex gloves, wash hands with a mild soap and dry thoroughly. Take advantage of latex allergy education and training provided by employer. Become familiar with procedures for preventing latex allergy. Learn to recognise the symptoms of latex allergy: skin rashes; hives; flushing; itching; nasal, eye, or sinus symptoms; asthma; and shock. If you develop symptoms of latex allergy, avoid direct contact with latex gloves and other latex-containing products until you can see a medical practitioner experienced in treating latex allergy. Inform your supervisor and the Departmental Safety Co-ordinator. If you have latex allergy, consult your doctor regarding the following precautions Avoid contact with latex gloves and other latex-containing products. Avoid areas where you might inhale the powder from latex gloves worn by other workers. Tell your employer and your health care providers (doctors, nurses, dentists, etc.) that you have latex allergy. Wear a medical alert bracelet. Carefully follow your doctor's instructions for dealing with allergic reactions to latex.
Using the correct glove material Check the data available at Ansell-Edmont; http://www.ansell-edmont.com/download/Ansell_7thEditionChemicalResistanceGuide.pdf and Best ; http://www.chemrest.com/ Reference to the University of Bristol Chemistry page (http://www.chm.bris.ac.uk/safety/gloves.htm) also has some useful links.
Type	Benefits	Weaknesses
Natural LATEX Rubber	Combines relatively high strength with moderate flexibility and resistance to abrasions and cuts. Generally an economical choice.	Unsuitable for handling mineral-based solvents or some acids.
NITRILE (Acrylonitrile, Butadiene or NBR)	Gloves with higher acrylonitrile (AN) content provide good resistance to aliphatic solvents. Available at two levels of solvent resistance, high and low AN content. High AN offers good resistance to aliphatic solvents and limited protection against some of the chlorinated solvents. Both types have good resistance to oils, grease and animal fats. Good mechanical strength and abrasion resistance.	Rapidly degraded by ketones (MEK, MIBK, Acetone, EK), dichloromethane and some other organic solvents.
PVC (Polyvinyl chloride or just "VINYL")	Moderate protection against acids, alkalis and aqueous chemical solutions. Resistant to oils and grease and good resistance to abrasion.	Cold weather or contact with mineral solutions makes PVC inflexible and liable to crack. Offers no resistance to ketones and some other solvents.
Commercial sources of disposable gloves (updated 25/01/2005)
Supplier	Brand/Material/Size/Code	Price (box of 100) excluding VAT
Fisher	Safeskin - powder-free purple Nitrile - X-small - SAR-690-010S Safeskin - powder-free purple Nitrile - small - SAR-690-030M Safeskin - powder-free purple Nitrile - medium - SAR-690-050G Safeskin - powder-free purple Nitrile - large - SAR-690-070A Safeskin - powder-free purple Nitrile - X-large - SAR-690-090R	5.20
Fisher	Conform - powder-free Latex - small - SAR-515-010G Conform - powder-free Latex - medium - SAR-515-020D Conform - powder-free Latex - large - SAR-515-030A	3.96
SLS	Semperguard - powder-free Latex - X-small - X12150 Semperguard - powder-free Latex - small - X12130 Semperguard - powder-free Latex - medium - X12135 Semperguard - powder-free Latex - large - X12140	2.65
Fisher	Semperguard - powder-free Vinyl - small -SAR-747-030U Semperguard - powder-free Vinyl - medium - SAR-747-050X Semperguard - powder-free Vinyl - large - SAR-747-070Y	2.27
Central Stores	Marigold yellow - ?- small -3032414 Marigold yellow - ? - medium - 3032420 Marigold yellow - ? - large - 3032437 Marigold yellow - ? - X-large - 3032443	0.66 per pair (VAT incl) 0.76 per pair 0.69 per pair 0.66 per pair
References. Beezhold D, Pugh B, Liss G, Sussman G. [1996a] Correlation of protein levels with skin prick test reactions in patients allergic to latex. J Allergy and Clin Immunol 98 (6):1097-102. Beezhold DH, Sussman GL, Liss GM, Chang NS [1996b]. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy 26:416-422. Blanco C, Carrillo T, Castillo R, Quiralte J, Cuevas M [1994]. Latex allergy: clinical features and cross-reactivity with fruits. Ann Allergy 73:309-314. CDC (Centers for Disease Control and Prevention) [1987]. Recommendations for prevention of HIV transmission in health-care settings. MMWR 36(S2). Heilman DK, Jones RT, Swanson MC, Yunginger JW [1996]. A prospective, controlled study showing that rubber gloves are the major contributor to latex aeroallergen levels in the operating room. J Allergy Clin Immunol 98(2):325-330. Hunt LW, Boone-Orke JL, Fransway AF, Fremstad CE, Jones RT, Swanson MC, et al. [1996]. A medical-center-wide, multidisciplinary approach to the problem of natural rubber latex allergy. JOEM 38(8):765-770. Katelaris CH, Widmer RP, Lazarus RM [1996]. Prevalence of latex allergy in a dental school. Med J Australia 164:711-714. Kelly KJ, Sussman G, Fink JN [1996]. Stop the sensitization. J Allergy Clin Immunol 98(5): 857-858. Liss GM, Sussman GL, Deal K, Brown S, Cividino M, Siu S, et al. [1997]. Latex allergy: epidemiological study of hospital workers. Occup Environ Med 54:335-342. Nasuruddin BA, Shahnaz M, Azizah MR, Hasma H, Mok KL, Esah Y, et al. [1993]. Prevalence study of type I latex hypersensitivity among high risk groups in the Malaysian population. A preliminary report. Unpublished paper presented at the Latex Allergy Workshop, International Rubber Technology Conference, Kuala Lumpur, Malaysia, June. Orfan NA, Reed R, Dykewicz MS, Ganz M, Kolski GB [1994]. Occupational asthma in a latex doll manufacturing plant. J Allergy Clin Immunol 94(5):826-830. Ownby DR, Ownby HE, McCullough J, Shafer, AW [1996]. The prevalence of anti-latex lgE antibodies in 1000 volunteer blood donors. J Allergy Clin Immunol 97(6):1188-1192. Sussman GL, Beezhold DH [1995]. Allergy to latex rubber. Ann Intern Med 122: 43-46. Swanson MC, Bubak ME, Hunt LW, Yunginger JW, Warner MA, Reed CE [1994]. Quantification of occupational latex aeroallergens in a medical center. J Allergy Clin Immunol 94(3): 445-551. Tarlo SM, Sussman G, Contala A, Swanson MC [1994]. Control of airborne latex by use of powder-free latex gloves. J Allergy Clin Immunol 93: 985-989. Tarlo SM, Wong L, Roos J, Booth N [1990]. Occupational asthma caused by latex in a surgical glove manufacturing plant. J Allergy Clin Immunol 85(3):626-631. van der Walle HB, Brunsveld VM [1995]. Latex allergy among hairdressers. Contact Dermatitis 32:177-178. Vandenplas O, Delwiche JP, Evrared G, Aimont P, Van Der Brempt S, Jamart J, Delaunois L [1995]. Prevalence of occupational asthma due to latex among hospital personnel. Am J Respir Crit Care Med 151:54-60. Venables K, Chan-Yeung M [1997]. Occupational asthma. The Lancet 349:1465-1469.
This document was originally drafted by Peter Jewell in July 2000.

Powdered latex gloves. Why their use has been phased out.

Powdered latex gloves.
Why their use has been phased out.