Allmers et al, 200212 German workers covered by the statutory accident insurance company for healthcare (responsible for accident insurance, Workers’ Compensation, and preventive measures) ∼3 million healthcare workers in an unspecified number of hospitals and other healthcare workplaces (Germany) | Primary | Combined policy, education, and regulatory campaign in German healthcare sector, primary focus on substitution of powdered latex gloves to powder-free and low allergen gloves 6 years from first policy recommendations through end of follow-up period | Suspected cases of natural rubber latex (NRL) allergies and occupational asthma (OA) Glove use data projected from a sample of 280 hospitals | Longitudinal, ecologic 3* | Steep decline in usage of powdered NRL gloves in German healthcare sector, especially in acute care hospitals during and following intervention; Steep decline in usage of powdered NRL gloves followed by a steep decline in suspected cases of NRL caused OA after a 2 year lag time Conclusion: substitution of powdered NRL gloves with powder-free and low allergen gloves prevents NRL OA |
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Heilman et al, 19967 One operating room (USA) | Primary | Substitution: Alternating use of low allergen containing (powder-free) gloves versus high allergen containing gloves | Latex aeroallergen levels (ng/m3) and extractable latex glove allergen contents in an operating room measured on 52 consecutive days, including 19 non-surgery days On 33 surgery days, all personnel wore either high allergen gloves (n = 18 days) or low allergen gloves (n = 15 days) Internal comparison (cross-over) | Prospective cross-over trial, with 12 (random) cross-overs between low allergen and high allergen glove use 5* | Aeroallergen levels during low allergen glove use days significantly lower than on high allergen glove use days (mean 1.1 versus 13.7 ng/m3), including after adjustment for operating time and amount of gloves used Aeroallergen levels strongly correlated with total number of gloves used on high allergen glove use days, and there was little carryover of aeroallergen levels from one day to the next Conclusion: operating room levels of latex aeroallergen can be reduced tenfold by the use of low allergen gloves instead of high allergen gloves in a typical OR setting |
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Jones et al, 20048 Cardiff dental school; n = 63 dental students (UK) | Primary 4 years | Powdered latex gloves replaced with low protein powder-free gloves in 1997 | Latex sensitivity determined by skin prick testing with NRL extract, cross-reacting fruits, and other common allergens Skin prick testing done annually over 4 years | Prospective, longitudinal 3* | Initial testing identified 3 incoming students with latex allergy No student who was free of latex allergy at baseline went on to develop latex allergy over the 4 years Conclusion: substitution of nitrile gloves prevents latex sensitisation despite other incidental uses of latex materials in dentistry |
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Lee et al, 20019 Food handlers 30 food stalls in Queen Victoria Market, Melbourne (Australia) | Primary Brief in-person educational intervention following baseline assessment | In-person delivery and explanation of a plain language information sheet advising against the use of latex gloves in food handling, out of concern both for customers with latex allergy as well as for workers | Use of latex gloves (10 of 30 stalls assessed were using latex gloves at baseline) 6 weeks and 10 weeks follow-up No comparison groups | Prospective cohort 3* | 9 of 10 stalls that were using latex gloves at baseline had discontinued use at 10 weeks post-intervention follow-up (p = 0.006) |
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Levy et al, 199913 103 graduating (5th year) dental students (Paris) and 86 clinical dental students (London); n = 189 (France and UK) | Primary | Use of powdered, protein rich natural rubber latex gloves (n = 96) versus use of powder-free gloves exclusively (n = 93) | History of glove use (frequency and type) over preceding 22 months determined by questionnaire Latex sensitivity determined by skin prick testing with NRL extract | Cross-sectional, retrospective 3* | Zero prevalence of latex sensitivity among those without history of regular powdered glove use (n = 93) versus 13% (11/85) among those who used powdered NRL gloves Results suggest that use of powder free gloves prevents sensitisation and thus NRL related OA |
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Saary et al, 200211 and Tarlo et al, 199717 Students (n = 61) and staff (n = 36) of a dental school (Toronto) | Primary Five years | Change from high protein/powdered to low protein/powder-free NRL gloves | Latex sensitivity determined by skin prick testing with NRL extract Asthma symptoms, rhinitis of conjunctivitis, urticaria, and pruritus were determined within minutes of skin-prick NRL exposure | Longitudinal comparison of cross-sectional prevalence at time 117 versus time 211 3* | NRL sensitisation significantly decreased at time 2 (3%) in comparison to time 1 (10%) Overall symptoms consistent with IgE mediated responses to NRL gloves significantly reduced at time 2 (12%) in comparison to time 1 (27%) Reductions could not be explained on the basis of time 1 and time 2 differences in demographics, personal or family history of atopy, or work practice variables Results suggest that glove substitution can lead to significant reduction in both NRL related symptoms and sensitisation |
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Tarlo et al, 200114 and Liss et al, 200110 A large, 2-site teaching hospital 8000 employees, including 2500 nurses, 400 lab technicians, and 350 housekeeping staff (Canada) | Primary 1995 and 1997 Secondary 1994 Tertiary 1985 | Conversion to low protein powder-free natural rubber latex (NRL) gloves Education and voluntary medical surveillance Non-NRL gloves provided to allergic workers | Cases of NRL allergy Patterns of glove use | Retrospective, longitudinal 3* | Cases of NRL allergy rose with powdered NRL glove use and peaked with introduction of medical surveillance programme. Cases dropped steadily following the substitution of powdered NRL gloves with powder-free gloves Conclusions limited: essentially a descriptive case study, with numbers too small to support statistical analysis Anecdotally (not systematically assessed in study), other benefits included no additional glove costs (2–3% increase over 4 years) and reduction in hospital expenses from lost work time and Workers’ Compensation claims (no NRL allergy related claims since 1995) |