Q:

1/11/2014
How long does an operating room need to be latex free before a patient with latex allergy can use it? Our hospital currently has a policy of 8 hours. What do you suggest?

A:

Thank you for your inquiry.

I am not aware of any consensus in regards to your question, and I could find none with a literature search. Therefore, I am going to contact Dr. Jonathan Katz, who is Professor of Anesthesiology at Yale Medical School, and has been Head of Committee on Occupational Health of Operating Room Personnel for the American Society of Anesthesiologists, to respond to your inquiry. As soon as we hear from Dr. Katz, we will forward his response to you.

In the meantime, the report of that committee is available to you free of charge online here.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We have received a response from Dr. Jonathan Katz. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Jonathan Katz:
It has been a number of years since I last researched the topic. It has become less of an issue in many OR's because most of the supplies now routinely come latex free.
 
In the OR where I work, we rely on a thorough cleansing and an otherwise routine turnover prior to a latex sensitive patient. We do not routinely insist upon any additional delay. I am unaware of any instances or published reports claiming that an allergic reaction was triggered as a result of the materials or supplies used in a previous case.
 
Considering that any aerosolized particles (such as those carried on powder in latex gloves) should dissipate quickly in the high airflow OR environment, it seems to me that 8 hours is a bit conservative.
 
Allow me to repeat that I haven't researched the topic in several years and am not current on the literature.
 
I am copying into this correspondence my colleague Dr. Robert Holzman at Harvard who may have some additional thoughts
 
Jonathan D. Katz, M.D.
Clinical Professor of Anesthesiology
Yale University School of Medicine'

As indicated in the response from Dr. Katz, he requested comments from Dr. Robert Holzman. We have now received those comments.

Thank you again.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Robert Holzman:
I agree very much with Jonathan. You are absolutely right about the general principles of latex allergen exposure in the OR setting.

The room air turnover issue is basically a math challenge more than a standard - with somewhere between 20 - 27 (at least in our OR in Boston Children's) room air turnovers / hour in our regular rooms, and up to 500 exchanges / hour in laminar flow rooms, at least for the average room, you would expect 30 minutes (at the most) would be enough to clear particulates; faster in the laminar flow rooms. Of course, it depends on the size of the room (for which there are no standards), and other physical room features like shape, positioning of vents, etc. Since most case turnovers in the average operating room, even in private practice, take about 20 minutes, it's not really much of a clinical issue. Also depends on the level of antigen load required to trigger a sensitized patient.

All of that said, I think you feel confident that the 8 hour rule is unwarranted, and most of the time, it will be safe to proceed within usual clinical practice guidelines.

Here are links to the ASA's brochure on latex allergy, 2nd edition, which we circulated to our members in 2005, and a copy of the 2005 MMWR guidelines for the prevention of transmission of tuberculosis, a (small) portion of which makes reference to the operating room, and is important because it addresses other preoperative areas of concern, like the Post Anesthesia Recovery Room or procedural areas (which may or may not have evacuation systems).

I hope this has helped.

Best regards,
Robert S. Holzman M.D., M.A. (Hon), FAAP
Senior Associate in Perioperative Anesthesia
Program Director, Fellowship in Pediatric Anesthesiology
Children's Hospital Boston
Professor of Anesthesia
Harvard Medical School
Boston, MA

AAAAI - American Academy of Allergy Asthma & Immunology