News | May 11, 1999

OSHA Bulletin Provides Latex Guidelines

By: Louis Pilla

As anticipated, the Occupational Health and Safety Administration (OSHA) has released a technical information bulletin alerting OSHA field staff to the potential hazards of the use of natural rubber latex (NRL) products. The bulletin represents the first official warning from OSHA about the dangers of latex.

The 11-page document discusses the reported increase in NRL allergies, routes of exposure, and types of reactions before discussing strategies for reducing risks (see table).

"The majority of health care workers are able to use NRL products to care for most patients," the document says. "Primary prevention," it states, "involves reducing the potential development of allergy by reducing unnecessary exposure to NRL proteins for all workers." It details the following "general administrative procedures" for an institution to use in reducing worker exposure to NRL proteins:

  1. If selecting NRL gloves for worker use, designate NRL as a choice only in situations requiring protection from infectious agents
  2. When selecting NRL gloves, choose those that have lower protein content. Selecting powder-free gloves, the bulletin says, offers the additional benefit of reducing system allergic responses.
  3. Provide alternative suitable non-NRL gloves as choices for worker use.

The bulletin also states that healthcare facilities should develop policies and procedures for reducing the risk of NRL allergies in the workplace. It notes that a prudent risk reduction strategy will involve an initial survey and assessment, with a coordinated effort to identify and catalog all NRL products used in the workplace. It also notes that facilities should establish an ongoing program to monitor the NRL content of incoming products and that mechanisms for reporting and managing cases should be in place.

The practical implication of this document will be twofold, says Leilani Kicklighter, RN, ARM, MBA, assistant administrator of Risk Management Services at North Broward Hospital District (Fort Lauderdale, FL), and immediate past president of the American Society for Healthcare Risk Management. First, it will educate OSHA field staff. Second, it will educate healthcare providers who may not be knowledgeable about latex.

At her organization, she says, the result will be to "continue to identify those patients and employees that might have developed a sensitivity or other allergic reaction to some other component and to educate them that there are some alternatives." Citing some potential confusion between current FDA and OSHA guidelines regarding latex, Kicklighter says that she hopes that the document will be interpreted "as an educational guideline and is not turned around to be used as a standard."

A spokesperson for the American Nurses Association called the release of the technical bulletin a "good first step in protecting nurses. We encourage all nurses to write letters to OSHA to try and push for OSHA to release a standard that will be enforceable," she said.

Type of reaction

Sign and symptoms


Prevention and management

Irritant contact dermatitis

Scaling, drying, skin cracking

Direct skin irritation by gloves, powder, soaps/detergents,incomplete hand drying


Obtain diagnosis, avoid irritant, consider use of cotton glove liners, consider alternative gloves/products

Allergic contact dermatitis (Type IV delayed hypersensitivity or allergic contact sensitivity

Blistering, itching,crusting (similar to poison ivy reaction)


Accelerators (e.g., thiurams, carbamates, benzothiazoles), processing chemicals (e.g., biocides,


Consider penetration of glove barrier by chemicals

Obtain diagnosis, identify chemical. Consider use of glove liners such as cotton. Use alternative glove material without chemical.

Assure glove material is suitable for intended use (proper barrier).


NRL allergy - IgE/histamine-mediated (Type I immediate hypersensitivity)

a)Localized contact urticaria, which may be associated with or progress to

b)Generalized reaction


Hives in area of contact with NRL

Generalized urticaria, rhinitis, wheezing, swelling of mouth, shortness of breath. Can progress to anaphylactic shock.


NRL proteins:direct contact with or breathing NRL proteins, including glove powder containing proteins, from powdered gloves or the environment

Obtain diagnosis, allergy consultation, substitute non-NRL gloves for affected worker and other non-NRL products.

Eliminate exposure to glove powder-use reduced protein, powder-free gloves for coworkers

Clean NRL-containing powder from environment

Consider NRL-safe environment