To provide a latex-safe environment for patients with a known or suspected latex allergy.

Staff should know the risks of latex in the outpatient settings to protect patients, and assist with identifying patients who require latex precautions (i.e., Spina bifida, congenital urological anomalies, latex allergy, or have been medically advised to avoid latex).

1. Identification

At the time of an outpatient practice visit, patients shall be asked first for a history of allergies. If a patient is identified as having a latex allergy, Spina Bifida, congenital urological anomalies, or has been medically advised to avoid latex the patient shall be placed in the waiting area until a latex free room is prepared. (See Part 111, Section C, 1 & 2)

2. Reaction Prevention & Management

Staff shall observe the following guidelines for all patients that are at risk for latex allergies:

1. The outside of the clinic chart and central medical record (in areas where available) shall be flagged with a "Latex Precaution" sticker.
2. Each outpatient practice area shall order a prepackaged latex safe starter bundle (NOVA # 31395) or develop an area specific latex free tackle box. The starter bundle contains latex-free supplies (i.e., adban for wrapping the B/P cuff and stethoscope, stockinet, 4x4s, and thermometer, etc.) that can be used to provide basic care to a patient.
3. Patients with latex precautions requiring radiology, laboratory, rehab, respiratory therapy, or operative services shall have documentation of latex allergy on requisitions or referral slips. (Whenever possible, patients shall remain in a latex safe exam/treatment room to receive ancillary services such as EKGs, lab work, etc.)
4. Communicate the need for latex precautions to the Outpatient Pharmacy when ordering medications to be administered to the latex sensitive patient.
5. In the event of an anaphylactic reaction, initiate Anaphylactic Reaction Management Guidelines (refer to "Patient Care Manual" #30-04.10, Anaphylactic Reaction Management).
6. A latex free anaphylaxis drug kit shall be stored in a secured area that permits immediate availability for patient use.
7. If contact with a latex product cannot be avoided, consult physician for pre-medication orders.
3. Latex Reaction Intervention
1. Initial assessment/outpatient visit
1. Document latex precautions on clinic chart and central medical record (in areas where available).


2. Remove all latex items (i.e., gloves, resuscitation mask, Band-Aids, tourniquets) from exam room or store in cabinet.


3. Don nitrile or vinyl gloves.


4. Clean patient's room/exam room with a damp cloth or damp wipe to remove dust containing latex-allergens.


5. Remove gloves and wash hands thoroughly.


6. Place latex-free starter bundle in exam room.


7. Post “Latex Precautions” sign on outside of exam/procedure room door.


8. Apply cotton gauze or stockinet to stethoscope, blood pressure cuff cord, or patient's arm to protect skin from exposure.


9. When an injection is required, evaluate the medication vial to determine if latex content is present in rubber stopper. If uncertain of the latex content of the stopper, contact outpatient pharmacy. If medication is not available with a latex free stopper, open a new vial and remove the stopper to prevent latex particles from contaminating medication. (Consult with pharmacy on stopper removal technique.) Using a latex-free syringe (syringes with rubber plungers may not be used), draw up proper amount of medication to be administered and discard unused portion.


10. Communicate the need for latex precautions to all staff who will have contact with patient.


2. Invasive procedures
1. Whenever possible, schedule procedures for patients requiring latex precautions as first procedure of the day.


2. Communicate to physician that patient requires latex precautions.


3. Latex-proof the procedure/exam room and wipe table, counter surfaces, and equipment with a moistened towel, using latex-free gloves.


4. Restock room with latex free supplies needed to provide care for the latex sensitive patient.


5. Instruments for the procedure should be sterilized in a latex-free load.


6. If pads are used on procedure table, cover completely with sheet.


7. Follow procedure outlined in Section III. C- e - i.


4. PRODUCT INFORMATION

Stock supplies

1. Call the Product Hotline at 343-4006 for questions regarding the latex content of a particular product or additional information on a latex free product.


2. Contact the VMG Inventory Department at 343-9319 to request a latex free starter bundle or separate latex free supplies. The VMG Inventory Management Department will place the first order and add the request to the clinic's PAR list so staff may order the supplies as needed.
5. EDUCATION
1. Patient and Family Education

Education shall be provided for patient/family at the following intervals:


1. At the time the latex allergy/risk is identified.


2. When the treatment of the patient requires changes in the patient care products that are being used.
2. Educational Resources

Provide educational resources on the following topics:


1. Signs/symptoms of allergic reaction and the importance of reporting latex allergy/precautions to health care providers.


2. Level of latex sensitization.


3. Use of only non-latex products at home and in the community setting.


4. Risk of certain foods to trigger latex allergic reactions.


5. Provide patient with information on how to obtain medical alert bracelet.
   (See web site- http://www.mc.vanderbilt.edu/pcs/quality/latex/index.html).


6. DOCUMENTATION
1. The staff member shall document the following:


1. The use of latex free supplies and precautionary measures taken.


2. Any latex reaction and management/treatment.


2. Latex precautions are to be documented on the following:


3. Clinic chart and central medical record (if available).


4. Referral forms.


5. Ancillary service requisition.


6. Nursing medication & allergy form.

1. Patient Care Resource Manual
   Procedure #30-04.10, "Anaphylactic Reaction Management",
   Kanton, G., Smith, M., and Kalhan, S.
2. “Population at Risk for Development of Latex Allergy”
   http://gasnet.med.yale.edu/gta/latex/risk.html.
3. “Latex Allergy: Protect Yourself, Protect Your Patients”
   http://www.nursingworld.org/dlwa/osh/wp12.html.
4. The ABC's of Latex Allergy
   Henry Ford Health System (1995)

/s/ Mary Gaines
Chair of Latex Committee

/s/ Marilyn Dubree
Director of Patient Care Services and Chief Nursing Officer