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Regulatory Issues in Managing Natural Rubber Latex Exposures in Healthcare

Regulatory Issues in Managing Natural Rubber Latex Exposures in Healthcare . Dr Anne Raynal Senior Medical Inspector HSE March 2007. Purpose of this talk. Clarify: What does HSE require for legal compliance with regard to NRL use in health care? Risk assessment for NRL exposure

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Regulatory Issues in Managing Natural Rubber Latex Exposures in Healthcare

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  1. Regulatory Issues in Managing Natural Rubber Latex Exposures in Healthcare Dr Anne Raynal Senior Medical Inspector HSEMarch 2007

  2. Purpose of this talk • Clarify: What does HSE require for legal compliance with regard to NRL use in health care? • Risk assessment for NRL exposure • Health surveillance, what form should it take?

  3. Legal Requirements • Health & Safety at Work Act 1974 – duty to keep employees and others safe at work • Control of Substances Hazardous to Health Regs. 2002 – Risk Assessment for hazardous substances

  4. Risk Assessment for NRL • Identify the hazard • Who may harmed and how • Evaluate risks and decide on precautions • Record findings and implement them • Regularly review and update risk assessment

  5. Precautions:=Control Measures • Eliminate the risk – gloves should only be worn where there is a risk of infection • Substitute with other suitable materials • Limit exposure – only use where risk assessment has shown is necessary. If used must below-protein and powder-free • Health Surveillance for those still exposed • Instruct, inform and educate staff on risks and control measures

  6. Legal Duty to Provide Health Surveillance • Management of Health and Safety at Work Regulations, Regulation 6, 1999 • Control of Substances Hazardous to Health Regulations, Regulation 11, 2002 • HSE Guidance Series HSG61, Health Surveillance at work

  7. What is health surveillance? • Regular and appropriate procedures to detect early signs of work-related ill health • Acting on the results • Select from a range of specific techniques

  8. When is Health Surveillance Appropriate? • It is part of the overall management of health risks • Where the risk cannot be reduced or controlled to a level that it will not be harmful to health (a residual risk remains)

  9. When is Health Surveillance Appropriate? • The work is known to damage health in some way • Damage to health under particular work conditions • Valid methods exist to detect the disease early • The technique is safe, practical and acceptable • Finding disease early will benefit the employee

  10. Valid Techniques • Precise enough to detect something wrong • Safe and practicable in the workplace setting

  11. Validity of Screening Tests • Sensitivity - the proportion of all diseased patients for whom there is a positive test, determined as the number of true positives divided by the sum of true positives + false negatives • Specificity - the proportion of non-diseased patients for whom there is a correctly negative test, expressed as the number of true negatives divided by the sum of true negatives + false positives

  12. Range of specific techniques • Checks by a responsible person • Inspection or symptom questioning by a qualified person • Clinical examination by a doctor (medical surveillance) • Biological or biological effect monitoring • Keeping individual health records • Self-checks by employees • Baseline health assessment for a new job • Giving information and referring employees to an OH professional where extra checks are needed

  13. Self-checks by employees • Not sufficient on their own • Employees must be trained about the symptoms and signs to report to a responsible person or occupational health professional • Also subject to periodic checks by a responsible person

  14. What is a sensitive test in this context? • Taking a history of reacting to latex gloves and improving when away 1.Itching/irritation of eyes, nose or chest, cough or wheeze 2. Redness, itching, scaling or vesicles on exposed skin

  15. What is a Specific test in this context? • IgE to latex • Skin prick test Visual inspection of skin on its own – Is neither sensitive or specific as most redness/itching is due to drying out of skin from frequent washing

  16. Health Surveillance always requires keeping of individual Health Records • A historical record of jobs involving exposures to substances or processes requiring health surveillance • A record of outcome of health surveillance in terms of fitness to work/restrictions etc • A non-confidential paper or computer based record

  17. Acting on the results • Prevent further harm to that individual • Prevent further harm to others still exposed by re-examining the risk-assessment and decide what action to take to reduce exposure • Reduce exposure by improving control measures • Regularly review how health surveillance programme is working

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