Objectives-To determine the prevalence of latex sensitisation among a large group of healthcare workers, study the occupational and non-occupational factors associated with latex allergy, and characterise latex exposure in air and by gloves.Methods-All 2062 employees of a general hospital in Hamilton, Ontario, Canada who regularly used latex gloves were invited to participate in a cross sectional survey, representing the baseline phase of a prospective cohort morbidity study. Attempts were made to recruit employees who were diagnosed with latex allergy before the survey. Glove extracts were assayed for antigenic protein, and area and personal air samples were obtained on two occasions (summer and winter) to estimate exposure to airborne latex protein. A questionnaire on medical and occupational information was administered by an interviewer. Skin prick tests were performed with latex reagents, three common inhalants, and six foods. Results-The mean (SD) latex protein concentrations were 324 (227) yg/g in powdered surgical gloves and 198 (104) ug/g in powdered examination gloves. Personal latex aeroallergen concentrations ranged from 5 to 616 nglm3.There was a total of 1351 (66%) participants. The prevalence of positive latex skin tests was 12 1% (95% confidence interval (95% CI) 10-3% to 13.9%). This prevalence did not vary by sex, age, hospital, or smoking status but subjects who were latex positive were significantly more likely to be atopic (P < 0-01). Participants who were latex positive were also significantly more likely to have positive skin tests to one or more foods (Mantel-Haenszel odds ratio (OR) adjusted for atopy 12-1, 95% CI 7-6 to 19-6, P < 10-9). Work related symptoms were more often reported among latex positive people, and included hives (OR 6-3, 95% CI 3-2 to 12.5), eye symptoms (OR 1-9, 95% CI 1-2 to 2.8), and wheezy or whistling chest (OR 4 7, 95% CI 2-8 to 7.9). The prevalence of latex sensitivity was highest among laboratory workers (16.9%), and nurses and physicians (13-3%). When the glove consumption per healthcare worker for each department was grouped into tertiles, the prevalence of latex skin test positivity was greater in the higher tertiles of glove use for sterile (surgical) gloves (P < 0.005) but not for examination gloves. Conclusions-In this large, cross sectional study of healthcare workers, the prevalence of latex sensitisation was 12-1% (9-5% among all those eligible), and there were significant associations with atopy, positive skin tests to certain foods, work related symptoms, and departmental use of gloves per healthcare worker. This cohort is being followed up prospectively and will be retested to determine the incidence of development of latex sensitivity. (Occup Environ Med 1997;54:335-342)

Whereas increasing knowledge should enhance competence, strategies to improve adherence to recommended use of FPE in a busy and complex health care setting should focus on ready availability of equipment, training and fit testing, organizational support for worker health and safety, and good communication practices.

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We carried out a follow-up study of employment outcome for 230 workers with a diagnosis of occupational skin disease who were at least 2 years postdiagnosis. Seventy-eight percent of the workers were working, but 57% of those working had changed jobs, 67% because of their skin problem. Thirty-one percent had lost no time from work because of their skin disease, while 35% had lost at least 1 month. Forty-three percent had applied for workers' compensation benefits, and 87% of those who had applied were successful in their claims. Older workers were more likely to be unemployed and to have applied for workers' compensation benefits. Women were less likely to have lost time from work and to have applied for workers' compensation. Those who had changed their jobs tended to have a better outcome with respect to active dermatitis, though they had lost more time from work and had more often applied for workers' compensation benefits.