Transcript Regulatory Issues in Managing Natural Rubber Latex

Health and Safety
Executive
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
– Health surveillance, what form should it
take?
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
Risk Assessment for NRL
1. Identify the hazard
2. Who may harmed and how
3. Evaluate risks and decide on
precautions
4. Record findings and implement
them
5. Regularly review and update risk
assessment
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 be
low-protein and powder-free
•
•
Health Surveillance for those still exposed
Instruct, inform and educate staff on
risks and control measures
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
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
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)
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
Valid Techniques
• Precise enough to detect
something wrong
• Safe and practicable in the
workplace setting
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
Range of specific techniques
•
•
Checks by a responsible person
•
Clinical examination by a doctor (medical
surveillance)
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•
•
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Biological or biological effect monitoring
Inspection or symptom questioning by a qualified
person
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
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
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
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
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
Acting on the results
•
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Prevent further harm to that individual
•
Reduce exposure by improving control
measures
•
Regularly review how health surveillance
programme is working
Prevent further harm to others still
exposed by re-examining the riskassessment and decide what action to
take to reduce exposure