INFECTION CONTROL NEWSLETTER

December 1998
written by and for Long Term Care Infection Control Nurses

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619)656-7887 Voice/FAX
jmarx@concentric.net

Latex Allergies

Latex is an naturally occurring product from the sap of a tropical tree. When stabilizers are added, latex can be used to make may items, now common and essential in health care. Latex proteins, also called allergens, can cause an allergic reaction.

TYPES OF REACTIONS
There are three types of reactions to latex: Irritant Contact Dermatitis, Allergic Contact Dermatitis (delayed hypersensitivity or Type IV), and Latex Allergy (immediate hypersensitivity or Type I). The Type I reaction is the most serious and can cause a life-threatening reaction.

Type I, Immediate Hypersensitivity
Symptoms include abdominal cramping, nausea, anaphylaxis, angioedema, tachycardia, hypotension, diarrhea, dyspnea, headaches, disorientation, itching/burning eyes, and rhinitis. Treatment is urgent. This condition should be confirmed by an allergist and dermatologist.
Type IV, Delayed Hypersensitivity
Symptoms include hives or a rash on the hands or arms (usually associated with use of latex gloves), onset occurs after recent glove removal delayed by 6-72 hours, there will be clustered bumps, itching (which become painful upon scratching), peeling, scales, blisters and red/dry skin.
Irritation Contact Dermatitis
Symptoms include hives or a rash which appear to be chronic and extend beyond the border of the glove. Simple irritation can also be accompanied with itching, swelling and blisters on the skin.

PREVENTION STRATEGIES
Preventing latex allergies begins with an evaluation of all products with latex in the facility. This includes rubber bands, erasers, balloons, disposable briefs, paint, rubber toys, pads on crutches, elastic clothing (bras, pants, stockings), and cushions. If a resident or employee has a latex allergy, careful evaluation of latex use must be done.

SCREENING
Latex screening should be done on all current employees and new hires. Screening can be done by questionnaire. Examples of screening tools are available in many up-to-date commercially available employee health manuals. Contact Broad Street Solutions if you need help setting up a screening program.

Food allergies have been related to latex allergy. A history of allergy to avocados, bananas, kiwi fruit and chestnuts have been linked to latex allergy. Reactions frequently occur after a dental appointment.

LATEX SAFE ENVIRONMENT
Consider eliminating latex gloves in you facility. Vinyl gloves are now competitively priced and afford protection from infectious pathogens, including hepatitis B and HIV.

Begin your latex allergy prevention program today!

Infection Control in the Laundry

The infection control program extends beyond nursing. This article is the first in a series on infection control considerations in ancillary departments.

This month we focus on the laundry. The introduction of Universal Precautions has eliminated the need to segregate linen as infectious and non-infectious. This measure will save the facility the cost of yellow linen isolation bags and special handling.

Laundry workers who handle soiled linen should be given and required to use personal protective equipment: gloves, long sleeve gowns (to cover the arms and torso). Masks are not required unless splashing or spraying of body fluids are anticipated. Handwashing facilities need to be in close proximity to the work area. Alcohol handwashing substitute can be used until soap and water is possible.

Cloth briefs are still used in long term care. They provide many opportunities for stool contamination of the environment and the worker. Diaper rinsing should only occur in areas specifically set aside for that purpose. Stool contains many human pathogens, including enterococcus. Enterococcus that is resistant to the antibiotic vancomycin is called VRE. This relatively new pathogen poses difficulties in treatment and the potential for causing more antibiotic resistant bacteria, vancomycin resistant MRSA.

There are no microbiological standards for the laundry process, which is designed to remove organic matter and render the linen incapable of transmitting human disease. Water temperatures of 160 degrees F for 25 minutes has been a standard. Further studies have found that lower temperatures can be used in conjunction with laundry chemicals, including bleach. Properly washed linen has not been linked with disease transmission in skilled nursing facilities.

Clean linen should be transported and stored to prevent becoming soiled. You may be familiar with the 3 foot rule, separating clean and soiled linen. This is a common myth that is not supported by science. The physical distance is not as important as the work practices that keep clean and soiled items separate.

Soiled linen containers need to be labeled and use for this sole purpose. A liner can help keep the container clean but is not required. The container must be kept clean by regular, scheduled cleaning. The soiled linen container can be brought to the room to decrease the distance linen is carried. Some facilities require that soiled linens be bagged in the room and then brought to the container. Personal clothing hampers can be stored in the residents room and emptied regularly.

Infectious agents such as MRSA and VRE are inactivated during the regular laundring process. No special linen handling is requied.

Your facility's infection control plan should included ways to prevent worker illness in the laundry.