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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

Regulatory Issues in Managing Natural Rubber Latex Exposures in Healthcare

Dr Anne Raynal Senior Medical Inspector HSEMarch 2007

purpose of this talk
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
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
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
precautions control measures
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
legal duty to provide health surveillance
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
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
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 appropriate1
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
Valid Techniques
  • Precise enough to detect something wrong
  • Safe and practicable in the workplace setting
validity of screening tests
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
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
self checks by employees
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
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
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
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
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