Credited as the first hospital to introduce latex gloves, Johns Hopkins Hospital is now among the first to banish them.
A famed Hopkins surgeon ushered in the latex era more than a century ago to protect his surgical nurse's hands from harsh detergents used to disinfect them. Now, in an announcement yesterday, the hospital said it has gone latex-free to prevent rare but severe allergic reactions - called anaphylaxis - that can include wheezing, rapid heartbeat and a sudden drop in blood pressure.
"They occurred on the operating tables, but they can also occur in the clinics and on the floors," said Dr. Robert H. Brown, an anesthesiologist who headed the hospital's latex task force. "You don't need to see many kids with anaphylaxis to be concerned."
Some of the reactions occurred among children with spina bifida and bladder exstrophy, two birth defects that can require many surgical procedures early in life. As with most allergies, the worst latex reactions often occur with the second exposure to the offending substance.
While such reactions can be fatal, Brown said he knows of no such deaths at Hopkins. Still, he said, the problem warranted a solution, which has taken the form of gloves made from synthetic materials that do not trigger allergies.
Decision to ban
The allergies had been observed over the 1990s, when a change in the processing of latex caused an upsurge in latex reactions. The hospital leadership decided in 1997 to move toward an outright latex ban, and a year later it eliminated them from exams.
Then last May, the hospital took the final step: eliminating latex gloves from the operating room. Change came more slowly to that arena because surgeons, who rely so much on their sense of touch to perform intricate procedures, needed a replacement that wouldn't diminish their manual dexterity.
Surgeons now have their pick of gloves made from two different materials - polyisoprene and neoprene. Many found them awkward at first, but most adjusted to their feel within a few weeks.
"Some people don't like change," said Dr. Julie Freischlag, director of surgery. "When we first had the change, some people said they didn't think it was OK. Now they think it was fine."
Other hospitals are making the move as well. In October 2006, Harbor Hospital in Baltimore announced that it had eliminated latex exam gloves. Shriners Hospital for Children in Sacramento, Calif., is now 98 percent latex-free after implementing latex controls about two years ago.
Sir William Halsted, a founding physician at Johns Hopkins Hospital, was among the first to introduce rubber gloves into the operating room. According to an account in the Journal of the Royal Society for the Promotion of Health, Halsted commissioned the Goodyear Rubber Co. of New York to make a pair of gloves for his scrub nurse in 1890.
She had complained of skin irritation from constantly washing her hands in a harsh antibacterial soap.
Latex allergies were not seen widely until the 1990s, when a sudden rise in demand and a scarcity of rubber trees led to a change in the rubber used to make latex products, according to Robert Hamilton, a Hopkins immunologist who has studied latex allergies.
Previously, the sap of rubber trees had been collected much like maple syrup, then stored in ammonia to prevent the growth of bacteria.
The AIDS crisis of the 1980s and 1990s spurred rising demand as doctors, dentists and nurses sought to protect themselves and their patients from infection. This coincided with a tree disease that made rubber scarce.
As a result, manufacturers rushed newly tapped rubber into production - forgoing the ammonia that coincidentally had rendered harmless the proteins that trigger allergies.
"The first major recognition of the problem in the U.S. was a number of deaths associated with barium enema tubes in hospital settings," Hamilton said.
Allergies appeared among health care workers who repeatedly donned latex gloves and patients who had numerous operations, Hamilton said.
"The poster children were those with spina bifida who had multiple surgeries early in life," Hamilton said.
Contrary to popular belief, the skin acts as an excellent barrier against the allergens found in latex, Hamilton said. Severe reactions are caused instead by the inhalation of latex particles and contact between latex and tissues inside the body.
To track the problem, Hopkins conducted several studies, including one in 1998 that found that 12 percent of the hospital's anesthesiologists had developed latex allergies. Others documented patients with severe reactions. In the meantime, allergy researchers uncovered many of the rubber proteins that, in various combinations, trigger the allergies.
Brown estimates that Hopkins, which conducts 40,000 to 50,000 operations a year, sees about one severe latex reaction in surgery over the same period of time.
"They weren't always life-threatening, but they were documented reactions," Brown said.