How to make the switch
This article examines some of the issues around latex allergies in hospital operating rooms (O.R.), the rationale for going latex-free, the substantial cost-savings of having an entirely latex-free O.R. and some potential approaches to making the switch.
Latex and latex allergies – the role of surgical gloves
There is little dispute as to the integral role that surgical gloves play in the infection control process in the O.R., both in terms of preventing surgical site infections for the patient and in protecting the healthcare team from exposure to blood-borne pathogens.[i] Natural rubber latex has been a staple in surgical glove manufacture for many years. Recently, latex-free materials have been developed as a much-needed alternative as latex allergies become more prevalent. The most important factor influencing an individual’s likelihood of being sensitized to latex is the degree of exposure to the substance.[ii]
Latex allergies may cause reactions ranging in severity from skin redness or a rash to sneezing or even anaphylaxis, a potentially life-threatening condition.[iii] If unmanaged or not prepared for, latex allergies can have a profound and unnecessary impact on hospital resources due to post-operative complications or operating room teardown costs.
Moving towards a latex-free O.R.
While staff members will be well aware if they have a latex allergy, patients may not be, or may forget to inform staff until the last minute. Due to the possibly life-threatening outcomes, precautions must be taken even for a patient who is not completely certain whether he/she is allergic to latex.
If latex gloves are worn even during the set-up of the O.R., a last minute discovery of a patient’s latex allergy will require a teardown of the O.R. Latex proteins may be deposited on all items touched and the O.R. should therefore be considered contaminated. All disposable items must be discarded, reusable items re-sterilized and the O.R. needs a complete new set-up. This clearly has huge cost implications for hospitals – not only in terms of wasted materials but also in terms of staff time, re-sterilization costs and a potentially idle O.R.
“Turnover time is the most important thing for the O.R.,” says Donna McDaniel, OR Manager, Director Surgical Services, Rockford Memorial Hospital, Rockford, Illinois. “A quick breakdown and clean up post surgery is essential for O.R. efficiency”.
One hospital’s estimated losses due to O.R. teardowns:[iv]
- Contaminated disposables: $30,000 annually ($300 per case, 100 teardowns recorded in 12 month period)
- Cost of an idle O.R.: $156,000 annually ($26 per minute, $1,560 per hour excl. staff and other costs)
- Re-sterilization of reusable items: >30 minutes per teardown (<30 instrument trays for a total hip revision, 10 minutes for flash sterilization of instrument trays, six sterilizing machines, two trays at a time)
The implementation of a latex-free O.R. should therefore be considered an essential step in managing the growing issue of latex allergies in the hospital setting. The time and cost efficiency savings for hospital teams are clear – reduced teardown time and costs, optimized storage and, importantly, higher puncture resistance compared to latex surgical gloves.[v]
There may be some resistance among hospital staff to switching from trusted latex gloves – the key concern being compromised dexterity and sensitivity of the latex-free gloves. However, research shows that most physicians find latex-free gloves as effective and comfortable as their latex equivalents.
A well-planned program should be put in place to ensure the switch to latex-free goes as smoothly as possible. Helping staff members understand the rationale for the move to a latex-free O.R. will help ensure optimal compliance with the changes.
Latex-free case histories
More and more hospitals in the US have successfully implemented latex-free O.R.s. The approaches of two of these hospitals are outlined here.
Johns Hopkins Hospital, Baltimore, Maryland
The John Hopkins Hospital opened in 1880 and today has 34,000 employees, with 1,710 full time physicians and 46,000 annual patient admissions.
The Johns Hopkins Hospital approach:
- The team at Johns Hopkins recognized the need to switch from latex to latex-free and put together a program to ensure a smooth and effective switch
- Due to some skepticism about the clinical acceptability of latex-free products a multidisciplinary team evaluated and selected latex-free products, including gloves, for the operating rooms
- This process was accompanied by an effective communications program to help the surgical team understand the risks of the growing latex allergy issue
- Biogel® polyisoprene (PI) gloves were selected for evaluation as they have documented lower in-use failure rates when compared to competitor gloves
- The Biogel surgical glove team offered an extensive education program to communicate the issues related to latex allergy
- Daily support was provided by Mölnlycke Health Care, manufacturers of Biogel surgical gloves, throughout the subsequent two-week trial to ensure the center’s needs were matched with the most appropriate Biogel surgical glove products
- The trial period was successful, resulting in full operating room conversion to latex-free Biogel surgical gloves providing improved safety to staff and patients
- The conversion process to a completely latex free O.R. took a few years to be fully implemented
Rockford Memorial Hospital, Rockford, Illinois
The Rockford Memorial Hospital is a 396 bed health care facility with state of the art patient facilities, including 14 O.R.s which are used to undertake 12,000 surgical procedures annually.
The Rockford Memorial Hospital approach:
- Due to a concern with the frequency of last-minute teardowns of the O.R. due to suspected latex allergy, and the associated costs and delays, a multi-discipline OR team was formed and was the driving force behind the switch to latex-free gloves
- The hospital used latex Biogel surgical gloves so the proposed switch was to use latex-free Biogel PI Indicator Undergloves
- The proposed approach was that staff would wear the latex-free undergloves to set up the O.R. to eliminate all latex contamination from the start
- There was initial resistance from some staff who were used to wearing latex gloves, however the transition was completed within a couple of weeks
- Since the switch there has only been one O.R. teardown in 14 months (unrelated to latex allergy) compared to 100 teardowns in the 12 months before the switch, saving the hospital several thousands of dollars (see ‘One hospital’s estimated losses’ box-out above)
Switching to latex-free: key learnings
- Ensure the commitment to create a latex-free O.R. environment is in line with the hospital’s overall mission
- Secure the support of the hospital management team
- Form a multi-disciplinary consultation committee including a good cross-section of O.R. and administrative staff – surgeons, scrub nurses, surgical chiefs of staff, nursing management and supply chain professionals – to select and evaluate appropriate latex-free products for the O.R.
- Communicate frequently with the staff of the affected areas regarding the serious issues associated with latex allergy and the benefits of use of latex-free products
- Select suppliers/partners with a clinical orientation to help with the communication, education and evaluation process
- Conduct post-switch staff assessment to monitor product acceptance and to identify any remaining issues to resolve
The increasing prevalence of latex allergies means surgical teams will need to consider implementing a switch from latex to latex-free in the near future. Moving to latex-free surgical gloves in the O.R. setting significantly reduces the potential health risk to patients and staff and delivers time and cost efficiencies to the hospital. The process should involve consultation and education of staff involved to help facilitate acceptance of the changes implemented.
[i] Tanner J, Parkinson H. Double gloving to reduce surgical cross-infection. Cochrane Database Syst Rev 2006;(3):CD003087.
[ii] Poley GE and Slater JE. Current reviews of allergy and clinical immunology. Journal of Allergy and Clinical Immunology 2000;105:PT6:P3.
[iii] Latex allergy http://www.mayoclinic.com/health/latex-allergy/DS00621, accessed August 2011.
[iv] Estimates from Donna McDaniel, Director Surgical Services and Carol Miller, Peri-operative Services Educator, Rockford Memorial Hospital. Face-to-face interview, June 2011.
[v] Edlich R F et al. Reducing Accidental Injuries During Surgery. Journal of Long Term Effects of Medical Implants 2003;13:2.