Any patient who is at risk for having a latex allergic reaction will be so identified and receive latex precautions in the perioperative environment. The goal is to eliminate patient exposure to latex allergy-causing proteins (antigens).
 

1. Latex Allergy refers to a patient with a known or suspected allergy to latex that will require latex precautions at all times. The following patient groups will be considered as having a latex allergy:

1. Any patient with a known latex allergic reaction during prior surgical or medical interventions.
2. Any patient with a history of allergy symptoms during non-medical latex contact (i.e. blowing up balloons).
3. Any patient with spina bifida, including myelomeningocele and sacral or lumbosacral angenis; congenital urological anomalies such as cloaca or bladder extrophy.

2. Latex Risk refers to a patient who may have be at high risk for developing a latex allergy. The following patient groups will be considered as high risk for latex sensitivity and will be closely evaluated to determine the need for latex precautions in the delivery of care:

1. A person involved in the manufacturer of items containing natural rubber latex.
2. Any patient with a history of multiple allergies, especially to foods such as bananas, chestnuts, kiwi, avocados, other tropical fruits.
3. A patient who has undergone multiple surgical procedures, especially during the first year of life
4. Any patient with a history of asthma.
5. Any chronically ill patient
6. Any patient who wears latex gloves on a regular basis ( i.e. healthcare worker, food preparation, etc.).
7. A patient with a history of a spinal cord injury.

1. Identification
1. All patients will be asked about any allergy to medications, food, ETO or latex/rubber preoperatively.
2. Any patient needing latex precautions will have a latex precaution sticker placed at end of information on the regular hospital identification band. The patient's chart will be labeled as "latex Precautions" in addition to a sign being placed on the patient's bed/stretcher and door.
3. A notation will be made on the O.R. schedule whenever a patient has a known latex allergy/risk.

2. Reaction Prevention

1. Patients will be placed in a private exam area/room prepared to provide a latex safe environment. Whenever possible, schedule the known latex sensitive patient as the first appointment of the day when airborne particles are the lowest.

1. Remove all latex containing products (gloves, tourniquets, tape, etc.) from the room. If latex product cannot be removed, items should be located in a closed storage area, such as, cabinets and drawers.
2. Close the cupboards and mark then "do not use-latex allergy".
3. After removing latex items, thoroughly clean patient's room/exam area using Nitrile gloves to remove contaminated latex-containing dust. Do not wear latex or rubber gloves to clean room.
4. Bed mattress, stretcher mattress or exam tables do contain latex and should be covered completely with a sheet.
5. Any patient care item, such as the stethoscope, blood pressure cuff, EKG lead wires, or pulse ox. probe which is not metal, plastic, or nylon could be made of natural rubber latex (NRL). The latex portion of such item should not come in contact with the patient's skin. Wrap latex portion of item with the latex free adhesive compression bandage, gauze, webril or stockinette and secure with LF tape.
6. Restock room with latex free gloves.
7. Place purple Latex precaution sign on patient's door/exam area.
8. Stock room with latex free supplies needed for that patient.

2. Prior to contact with patients requiring latex precautions, personnel will wash hands to remove latex proteins.
3. Communicate the need for latex precautions to all areas and staff involved with patient's care.
4. The Pharmacy and Anesthesiology departments should be given advance notification of at least 24 hours prior to the patient undergoing surgery. It is imperative that Pharmacy knows the latex status prior to the preparation and administration of any antibiotics.
5. For a patient with known latex allergy, the Anesthesiologist will determine if pre-medication is warranted. The Anesthesiologist may wish to medicate patient with antihistamines, H2 blocker, and/or steroids.
6. Anesthesiologist will determine if all latex free products and medications required are available for immediate administration.
7. All vials with medication stoppers will be removed before preparing medication doses unless the vial is clearly labeled latex free or the Pharmacy department has determined the vial stopper to be latex free.
8. The surgical team will review all supplies needed for the latex sensitive patient prior to surgery to determine appropriateness for that procedure.
9. Instruments will be sterilized in a latex-free load.
10. Do not place a bouffant surgical hat or a mask with rubber string on the patient.
11. Restrict traffic flow into latex sensitive patient's rooms/area.
12. Monitoring the patient for any sign/symptom of an allergic or anaphylactic reaction that may include any of the following:

Awake Patient	Anesthetized Patient
Itchy Eyes  Generalized Pruritis  Shortness of Breath Feeling of Faintness Nausea Vomiting Abdominal Cramping Diarrhea Wheezing	Tachycardia Hypotension Wheezing Bronchospasm Flushing Facial Edema urticaria Laryngeal Edema Cardiopulmonary Arrest

3. Reaction Management

1. Anesthesia will be notified immediately when patient experience signs and symptoms of an allergic reaction and will provide management.
2. Provide 100% oxygen; discontinue potent anesthetic agent.
3. Administer a fluid bolus and medications as ordered by the Anesthesiologist.
4. Anaphylaxis medications will be stored in code cart or a secured area that permits immediate availability for patient use.

4. Latex-Free Product Information
1. Identify latex content in supplies using package label, Nova latex Free Smart Screen, OR latex Free list or manufacturer's documentation. Any additional information needed regarding latex content in products will be addressed to the manufacture and written documentation obtained.
2. Latex free IV tubing, syringes, tourniquets and other essential supplies should be used for all patients requiring latex precautions. Any latex free supplies, which have been in direct contact with latex items, should not used (i.e. latex free IV catheters in contact with latex tourniquets or latex gloves).
3. All emergency carts prepared by Central Processing will be maintained as latex free except those items, which do not have a latex free alternative. These items will be labeled as containing latex.
5. Patient/Family Education:

1. Patient/family will verbalize understanding of the following topics:

1. Level of latex sensitization: Latex Risk or Latex Allergy.
2. Need to disclose the risk/allergy information with each healthcare encounter.
3. Signs and symptoms of allergic reaction and appropriate management.
4. Identification and use of non-latex products at home and in community settings (i.e. school)
5. Risk of certain foods to latex allergic reactions.Provide patient with information on how to obtain a medical alert bracelet.

2. If the patient is to be discharged home, provide the patient/family with a Latex Allergy Instruction Sheet obtained from the Holding Room.

6. Documentation

1. Procedures indicating use of latex free supplies along with usual documentation requirements
2. Any latex reaction and its management.
3. All referrals.
4. Patient and family education.

Burt, Sharon (1998). What you need to know about Latex. Nursing 98,28(10), 33-39.

Young, M. (1998). Latex-Safe Enviroment. Surgical Services Management,4(3), 19-24.

O'Boyle, E., & Brochard, B. (1998). Latex Allergy: BE PREPARED. Surgical Services Management, 4(3), 32-38.