Use of latex at Noble's

Authority	Department of Health and Social Care
Date received	2017-05-16
Outcome	All information sent
Outcome date	2017-05-19
Case ID	355385

Summary

A request was made for information regarding the use of latex at Noble's Hospital, including policies on medical equipment and gloves. The Department of Health and Social Care disclosed the full information by providing the 'Policy for the Management of Latex Allergy' and the 'Urethral Catheterisation' policy with highlighted latex references.

Key Facts

The request was received on 15 May 2017 and responded to on 18 May 2017.
Two specific documents were provided: the Latex Allergy Management Policy and the Urethral Catheterisation Policy.
The Latex Allergy policy was originally issued in February 2003 and most recently updated in March 2017.
The policy aims to safeguard patients and staff in the perioperative environment from latex exposure.
References to latex in the catheterisation policy are located on pages 3, 6, 11, and 14-16.

Data Disclosed

15 May 2017
18 May 2017
February 2003
March 2017
November 2013
November 2014
June 2015
May 2020
pages 3, 6, 11, 14-16
Health and Safety at Work Act 1974

Data Tables (20)

	Reader Information
Policy Number
Title			Policy for the Management of Latex Allergy
Author/Contact Details			Lynn Reid, Operating Department Manager
Publication Date			February 2003, Up-dated March 2017
Target Audience			All Operating Department Theatre and Medical Staff
Description			This policy identifies actions to be taken if a patient is identified as latex allergic
Changes			June 2015 - Theatre rest time following environmental preparation reduced. May 2017 – specific environmental areas identified in section 7
Cross Reference
Superseded Documents			Latex Allergy Policy

Procedure for Urethral Catheterisation of the Male Urinary Bladder
Procedure for Urethral Catheterisation of the Female Urinary Bladder
Guidance Notes -Appendix	12
Appendix 1 - Decision to Catheterise	13
Appendix 1 - Indications for Catheterisation	13
Appendix 2 - Assessment	14 -15
Appendix 3 - Consent	16
Appendix 4 - Equipment	17
Appendix 5 - Indwelling Catheter Selection	18 -20
Appendix 6 - Catheter Size	21
Appendix 7 - Catheter Length	22 -24
Appendix 8 - Catheter Balloon Volume	25
Appendix 9 - Selecting a Drainage System	26
Appendix 10 - Trouble Shooting / Potential Problems	27 -29
Appendix 11 - Patient Information Leaflet	30
Appendix 12 - Urethral Catheterisation Training Programme	31 - 42
Appendix 13 - Reflective Practice Record	39
Appendix 14 - Declaration of Self Competence	43
References	44 -46

PROCEDURE	RATIONALE
Introduce yourself and any colleagues involved at the contact Screen bed area	To gain patient co-operation To ensure patients privacy and dignity
Verbally confirm the identity of the patient by asking for their full name and date of birth. If patient unable to confirm, check identity by use of patient arm band/ family/carer	To avoid mistaken identity
Explain procedure to patient, including risks and benefits and gain informed verbal consent. If patient unable to give consent, act in patients best interests by following The Noble's Hospital Consent Policy. Appendix 3	To ensure patient understands procedure and enable patient to make informed decisions
Provide written information leaflet to support this discussion (Noble's Hospital You and your Urethral Catheter Booklet). Appendix 11
Offer patient a chaperone and document decision in health records	It is the patients' choice to have a chaperone if wanted. Discuss with line manager if nurse considers a chaperone is needed as part of risk assessment
Adhere to Isle of Man Infection Control Manual , Personal Protective Equipment Policy and Hand Hygiene Policy, DH Infection Prevention and Control Policy	To reduce risk of infection
Check the patient's health records / assess patient for past problems / complication associated with urethral catheterisation. Appendix 2	To assess for previous problems / complications
Check for any allergies e.g. lignocaine, chlorhexidine or latex	To reduce risk of anaphylaxis
Ensure all equipment is gathered before commencing the procedure Clean and prepare trolley, placing all equipment required on the bottom shelf Appendix 4	To prevent contamination of sterile equipment and to ensure the procedure is not commenced without all necessary equipment Top shelf acts as a clean working surface
Select appropriate standard length, ch. size catheter. (40 - 45cm) Appendix 7	Ensure female length catheter IS NOT used in male patient Female only catheters can cause severe trauma and haemorrhage if used in male patients
Wash and dry hands prior to procedure and put on personal protective Equipment (PPE)	To reduce the risk of transfer of transient micro - organisms on the health care workers hands. To prevent cross infection and environmental contamination
Assist the patient into a semi recumbent position. Place incontinence pad underneath patient's buttocks and	To maintain patients dignity and comfort. To avoid soiling of patient or bedclothes

incontinence pad I protective towel across the patient's thighs and under penis. Do not leave the patient unduly exposed at this stage of the procedure
Follow aseptic principles, wash hands prior to touching sterile materials, open outer cover of sterile dressing pack, and slide the pack onto the top shelf of the previously cleaned dressing trolley. Place all sterile single use equipment within sterile field including catheter and drainage system	To maintain asepsis and prevent contamination of sterile equipment.
If not first catheterisation, remove existing catheter attach empty syringe to catheter port. Do not draw back on the syringe; allow the catheter balloon to deflate using gravity. When catheter balloon is deflated, support the penis, place a piece of sterile gauze around the catheter and slowly withdraw the catheter. Remove and dispose of PPE	To avoid vacuuming of bladder mucosa PPE must be changed in between different tasks on the same patient
If first catheterisation, remove cover that is maintaining patient's dignity, expose the area to be catheterised
Wash hands and continue procedure with PPE and sterile gloves
Arrange sterile clinical sheet in place so that the penis passes through the opening in the sheet Position the sterile receiver to catch the urine	To create sterile field
Use a sterile gauze swab to lift the penis with non-dominant hand, retract the foreskin (if not circumcised), and clean with normal saline 0.9% beginning with the foreskin, the glans and urethral meatus at the end. Cleanse away from the urethral meatus down the shaft of the penis. Use a new swab for each part of the procedure If tight phimosis evident and the meatus is not visible seek senior advice.	To help minimise risk of urinary tract infection Inadequate preparation of the urethral meatus is a major cause of infection following catheterisation.
Following cleansing, Use sterile gauze to hold penis gently behind the glans. Slowly insert single use anaesthetic gel into the urethra. Gently compress penis behind the glans to retain anaesthetic gel and massage the gel downwards. Advise the patient slight stinging may be experienced. Wait the recommended manufacturer's time I 5 minutes for anaesthetic gel to take effect	Adequate lubrication helps prevent urethral trauma, reduces risk of infection and minimises discomfort experienced by patient.
Remove gloves, decontaminate hands and apply new sterile gloves	To reduce the risk of transfer of transient micro - organisms on the health care workers hands
Examine, prepare and check expiry date of catheter	To ensure patient safety
Wrap sterile folded gauze around the penis and use to support the penis at a 90 degree angle	This straightens out the first curve of the urethra; the gauze will contain any excess gel.
Whilst maintaining an angle of 90 degree angle, insert the catheter slowly 2-3 cm at a time into urethra. There may be a slight resistance at the external sphincter, ask the patients to cough or try to pass urine and the catheter should pass through the prostatic urethra easily. If resistance is felt at the external urethra, change the position of the penis to a 45 degree angle. If resistance continues to be evident and you unable to progress the catheter, stop, do not forcefully advance the catheter. Seek senior advice.	Avoid handling the catheter tip and length, use of forceps or plastic catheter sleeve will help reduce risk of catheter contamination To aid insertion This will help relax the pelvic floor and sphincter muscle To prevent trauma as there could be an obstruction

Insert catheter until urine has started to drain, then insert a further 2-3cm or almost up to the bifurcation point. If no urine drains gently apply pressure over the symphysis pubis area.	Ensures the catheter is within the bladder.
Do not inflate the catheter balloon unless urine is freely draining into the kidney dish If Prefilled balloon: Release clamp of balloon and allow slow release of water. Observe for verbal and non-verbal signs of pain. If not prefilled balloon: Slowly inflate the balloon with 10mls of sterile water according to manufacturer's instructions.	Balloon inflation should be pain free. If the paUent is experiencing any pain or discomfort during balloon inflation, the balloon may be positioned in the urethra. Deflate the balloon and advance the catheter a few more centimetres before trying again. Over inflation of the balloon may cause irritation of the bladder trigone inducing bladder spasm which in turn causes "by passing" of urine around the urethral orifice.
Once the balloon is inflated withdraw the catheter gently until resistance is felt	To confirm positioning of the catheter
Collect catheter specimen of urine, preform urinalysis and forward this specimen to microbiology if appropriate. Ensure results of CSU are reviewed and appropriately acted on if necessary.
Attach the catheter to a previously selected closed drainage system	To reduce infection and maintain closed circuit system
Ensure foreskin (if present) is replaced over the glans (if not replaced it is not unusual of the patient to need an A&E admission due to Phimosis) Patient may end up requiring emergency surgical care to reduce Paraphimosis	Constriction and oedema of the foreskin behind the glans penis (paraphimosis) may occur if fore skin is not replaced
Secure catheter tube to medial thigh Ensure catheter does not become taught when patient is mobilising or when penis becomes erect	To maintain patient comfort and to reduce the risk of urethral and bladder neck trauma
Place drainage bag below the level of the bladder and off the floor	To aid bladder drainage To reduce risk of infection
Help the patient into a comfortable position. Ensure that the patient's skin and bedding is clean and dry and patient's dignity is maintained prior to leaving the bed area.	If the area is left wet or moist, secondary infection and skin irritation may occur
Measure and document urine output on fluid balance chart if indicated. After 15 minutes of catheter insertion measure and document the amount of urine drained	To be aware of bladder capacity for patients who have presented with urinary retention. To monitor renal function and fluid balance
On completion of procedure, clear away equipment into a plastic clinical waste bag or sharps box as appropriate. Seal before moving the trolley. Dispose of PPE to comply with Nobles Hospital Health Care Waste Management Policy.	To prevent cross infection and environmental contamination
Decontaminate hands following removal of PPE	To remove any accumulation of transient skin flora that may have built up under gloves and possible contamination following removal of PPE
Record information in patient's health records Refer to "catheter label' and stick in patient's health records Insertion date and time · Catheter material! expiry date · Charriere size and length · Balloon size · Batch number · Cleansing and anaesthetic agents	To document event and have a permanent record for reference and monitoring of future care planning. Catheter plan or date of catheter removal I change is essential for safety of patient

. . Urine drainage system
Document catheter plan or plan date for the next catheter change or removal Document and review need for catheter daily Plan for early removal of catheter
Ensure patient / carer is fully acquainted with all aspects of catheter care. Patient catheter booklet explained. "You and your Urethral Catheter" Appendix 11.	Promotes independence and reduces incidence of problems/infections Promoting self-care

PROCEDURE	RATIONALE
Introduce yourself and any colleagues involved at the contact Screen bed area	To gain patient co-operation To ensure patients privacy and dignity
Verbally confirm the identity of the patient by asking for their full name and date of birth. If patient unable to confirm, check identity by use of patient arm band/ family/carer	To avoid mistaken identity
Explain procedure to patient, including risks and benefits and gain informed verbal consent. If patient unable to give consent, act in patients best interests by following The Noble's Hospital Consent Policy. Appendix 3	To ensure client understands procedure and enable patient to make informed decisions
Provide written information leafiet to support this discussion Appendix 11
Offer patient a chaperone and document decision in health records	It is the patients' choice to have a chaperone if wanted. Discuss with line manager if nurse considers a chaperone is needed as part of risk assessment
Adhere to Department of Health Infection Prevention and Control Policy, Personal Protective Equipment Policy and Hand Hygiene Policy	To reduce risk of infection
Check the patient's hea~h records / assess patient for past problems / complication associated with urinary catheterisation Appendix 2	To assess for previous problems / complications
Check for any allergies e.g. lignocaine, chlorhexidine or latex	To reduce risk of anaphylaxis
Ensure all equipment is gathered before commencing the procedure Clean and prepare trolley, placing all equipment required on the bottom shelf Appendix 4	To prevent contamination of sterile equipment and to ensure the procedure is not commenced without all necessary equipment Top shelf acts as a clean working surface
Select appropriate Female length, ch. size catheter. (20 - 26cm females only) Appendix 7	Female length catheters (shorter length) are for females only. Pooling of urine in a loop of catheter is likelv in

	women catheterised with a standard length catheter, which can lead to an increased risk of infection. Some women with very large thighs or obese may find the female catheter too short, and may require the longer standard length.
Wash and dry hands prior to procedure and put on personal protective Equipment (PPE)	To reduce the risk of transfer of transient micro- organisms on the health care workers hands. To prevent cross infection and environmental contamination
Place incontinence pad underneath patient's buttocks. Do not leave the patient unduly exposed at this stage of the procedure
If not first catheterisation, remove existing catheter attach empty syringe to catheter port. Do not draw back on the syringe; allow the catheter balloon to deflate using gravity. When catheter balloon is deflated place a piece of sterile gauze around the catheter and slowiy withdraw the catheter. Remove and dispose of PPE (Personal Protective Equipment) Wash hands.	To avoid vacuuming of bladder mucosa PPE must be changed in between different tasks on the same patient
Follow aseptic principles, open outer cover of sterile dressing pack, and slide the pack onto the top shelf of the previously cleaned dressing trolley. Place all sterile single use equipment within sterile field including catheter and drainage system	To maintain asepsis and prevent contamination of sterile equipment.
Assist the patient into supine position, with knees bent and hips flexed and feet comfortable apart (if able l.	To maintain patients dignity and comfort. To avoid soiling of patient or bedclothes
Wash hands and continue procedure with PPE and sterile gloves
Arrange sterile clinical sheet in place Separate the labia and identify urethral meatus, Using sterile gauze soaked with 0.9% normal saline, clean the meatus: labia majora, then the labia minor and finally the urethral meatus. One swab one wipe anterior to posterior	To help minimise risk of urinary tract infection Inadequate preparation of the urethral meatus is a major cause of infection following catheterisation.
Separate the labia with one hand and give gentle traction upwards	To have a good view of the meatus and to minimise the risk of contamination of the urethra
Apply a little of the anaesthetic lubricating gel to the meatus and then insert the nozzle of the syringe with anaesthetic lubricating gel in the meatus and slowly instil 6 mls of the gel into the urethra. Advise the patient slight stinging may be experienced. Wait the recommended manufacturer's time I 5 minutes for anaesthetic gel to take effect	Adequate anaesthetic and lubrication helps prevent urethral trauma, reduces risk of infection and minimises discomfort experienced by patient.
Remove gloves, decontaminate hands and apply new sterile gloves	To reduce the risk of transfer of transient micro - organisms on the health care workers hands
Examine, prepare and check expiry date of catheter	To ensure pa~ent safety
Arrange sterile towel to cover the surrounding area and maintain dignity Position the sterile receiver to catch the urine	To create sterile field and help prevent contamination
Insert the catheter in to the meatus; gently advance the catheter along the urethra until it reaches the bladder. (ApprOXimately 5 - 6 cm). Once urine has started draining insert the catheter a further 2 -3 cm deeper. If no urine drains gently apply pressure over the symphysis pubis area.	Avoid handling the catheter tip and length, use of forceps or the plastic catheter sleeve will help reduce risk of catheter contamination To ensure catheter balloon is in the bladder

If at any point patient experiences any undue pain or there is resistance when passing the catheter, stop and seek senior advice
Do not inflate the catheter balloon unless urine is freely draining into the kidney dish If Prefilled balloon: Release clamp of balloon and allow slow release of water. Observe for verbal and non-verbal signs of pain. If not prefilled balloon: Slowly inflate the balloon with 10mls of sterile water according to manufacturer's instructions.	Balloon inflation should be pain free. If the patient is experiencing any pain or discomfort during balloon inflation, the balloon may be positioned in the urethra. Deflate the balloon and advance the catheter a few more centimetres before trying again. Over inflation of the balloon may cause irritation of the bladder trigone inducing bladder spasm which in turn causes "by passing" of urine around the urethral orifice.
Once the balloon is inflated withdraw the catheter gently until resistance is felt	To confirm positioning of the catheter
Collect catheter specimen of urine, preform urinalysis and forward this specimen to microbiology if appropriate. Ensure results of CSU are reviewed and appropriately acted on if necessary.
Attach the catheter to a previously selected closed drainage system	To reduce infection and maintain closed circuit system
Secure catheter tube to medial thigh Ensure catheter does not become taught when patient is mobilising	To maintain patient comfort and to reduce the risk of urethral and bladder neck trauma
Place drainage bag below the level of the bladder and off the floor	To aid bladder drainage To reduce risk of infection
Secure catheter tube to medial thigh with appropriate catheter fixation device	To maintain patient comfort and to reduce the risk of urethral and bladder neck trauma
Help the patient into a comfortable position. Ensure that the patient's skin and bedding is clean and dry and patient's dignrty is maintained prior to leaving the bed area.	If the area is left wet or moist, secondary infection and skin irritation may occur
Measure and document urine output on fluid balance chart if indicated. After 15 minutes of catheter insertion measure and document the amount of urine drained	To be aware of bladder capacity for patients who have presented with urinary retention. To monitor renal function and fluid balance
On completion of procedure, clear away equipment into a plastic clinical waste bag or sharps box as appropriate. Seal before moving the trolley. Dispose of PPE to comply with Nobles Hospital Health Care Waste Management Programme	To prevent cross infection and environmental contamination
Decontaminate hands following removal of PPE	To remove any accumulation of transient skin flora that may have built up under gloves and possible contamination following removal of PPE
Record information in patient's health records Refer to "catheter label" and stick in patient's health records · Insertion date and time · Catheter materiall expiry date · Charriere size and length · Balloon size · Batch number · Cleansing and anaesthetic agents · Urine drainage system	To document event and have a permanent record for reference and monitoring of future care planning. Catheter plan or date of catheter removal I change is essential for safety of patient

Document catheter plan or plan date for the next catheter change or removal Document and review need for catheter daily Plan for early removal
Ensure patient I carer is fully acquainted with all aspects of catheter care. Pabent catheter booklet explained. ·You and your Urethral Catheter" Appendix 11	Promotes independence and reduces incidence of problemslinfections Promoting self-care

Type of Catheter	When Used	Maximum Time to be left insitu	Advantages	Disadvantages
Silicone 100%	Management for patients with: Retention of urine, incomplete bladder emptying, intractable urinary incontinence ....	"Long Term catheter" Maximum 12 week duration Change every 12 weeks or before	. Reduces tissue irritation and encrustation. • Suitable for patients with latex allergy. • Thin walled catheter with a larger lumen than coated catheters.	• May predispose to internal encrustation • Silicone is semi-permeable, which may lead to deflation of balloon and premature failure of the catheter • Formation of a "cuff" on deflation of the balloon
Hydrogel coated latex	Long term management for patients with: Retention of urine, incomplete bladder emptying, intractable urinary incontinence	"Long Term catheter" Maximum 12 week duration Change every 12 weeks or before	• Biocompatible • Low surface friction • Minimises bacterial adherence and encrustation.	• Unsuitable for patients who latex allergy
Hydrogel coated silicone	Management for patients with: Retention of urine, incomplete bladder emptying, intractable urinary incontinence	"Long Term catheter" Maximum 12 week duration Change every 12 weeks or before	• Inert material SUitable for patients with latex allergy • Reduced irritation • Thin walled catheter with a larger lumen than coated catheters • Hydrogel coatin enhances patient comfort and may reduce resistance to blockage.	• Crescent shaped lumen may predispose to internal encrustation • Silicone is semi-permeable, which may lead to deflation of the balloon and premature failure of the catheter g. Formation of a "cuff" on deflation of the balloon of all silicone catheters causes difficulty in removal.
PTFE (Poly Tetra Fluroethyl ene) Teflon coated latex core.	• To monitor urine output, to treat urinary retention for post- operative and critically ill patients • To instil solutions to	"Short Term catheter" Maximum 28 days duration Change before 28 days	• Flexible shaft gives uniform, strong walls that resist collapse and kinking. • Round drainable lumen ensures maximum flow rate and lessens the risk of blockage of debris.	• Do not use if latex allergy • Coating is likely to wear off if left longer than manufacturers recommendations (28 day) • Not suita ble for long term use.

	investigate bladder abnonmalities		• Smooth outer surface to facilitate ease of insertion, reduces incidences of urethritis and encrustation.
Plastic, PVC	• Post- operatively for urological procedures • Bladder irrigation	Maximum 7 days duration Change before 7 days	• Large internal diameter, allows good drainage of dots and debris • Post-operative drainage	• Rigid and infiexible • causes urethral pain, spasm and leakage.
Intermitte nt Nelaton	• Intenmittent bladder drainage. • Instillation of drugs • Urethral dilatation	• Once only use • Refer to manufacturer's instructions.	• Reduced Urinary Tract Infections • Promotes independence • Promotion of continence by ensuring complete bladder emptying.

Charriere (Ch)	Indication
Ch 12 - 14	Clear urine, no debris, no grit, no haematuria
Ch 16	Slightly cloudy urine, light haematuria, with or without small clots, none or mild grit, none or mild debris
Ch 18 - 20	Haematuria with moderate clots. Moderate to heavy grit, moderate to heavy debris. Usually post urological surgery. Seek advice from Urology Department

Length em	Indication for use
20 -26cm	Female Length Catheter - Females only
40- 45cm	Standard Length Catheter - Males or obese or chair bound females

Balloon size
30ml balloon 10ml balloon

SELECTING THE DRAINAGE SYSTEM	ADVICE
Urine drainage bags "Leg Bags", "Day Bags"	Available in 500mls and 750mls Will normally be leg bags for people who are ambulant to use in the day. Follow manufacturer's instructions that indicate that the bag will normally be changed every 5 - 7 days.
For overnight drainage use a link system	A 2-litre night bag is attached to the leg bag.
Catheter valves	Used following individual patient assessment guidance in relation to manufacturer's instructions and following clinical assessment. Seek advice from Urology Department

	Procedure	Assessor's signature
		and date
Patient	• Establishes patient identity. • Explains procedure and allows questioning (where appropriate) - gaining informed consent. • Maintains patients comfort, dignity and privacy. • Checks for allergies.
Eguil!ment	• Prepares and collects all equipment: (As listed in appendix 4)
Princil!les of infection	• Demonstrates correct hand washing technique and the use of alcohol rub. • Maintains universal precautions.
control
Prel!aration	• Maintains patients comfort, dignity and privacy • Equipment opened, checked and assembled
Procedure	• As described in Policy titled, Urethral Catheterisation of the Male and Female Urinary Bladder
Safety	• Explanation and care of urinary catheter explained to patient. Appendix 11 • Maintains patient comfort. • Answers questions appropriately. • Specimens and forms correctly labelled if CSU needed. • Specimens forwarded to lab. • Sharps disposed of correctly.
Records	• Documents procedure and relevant information in patient's health care records. Insertion date and time Size of Catheter Balloon volume Reason for catheterisation Local anaesthetic used All batch number Any problems negotiated during the procedure Catheter plan - plan for change or removal.

No	Date	Male or Female	Assessor's Signature
1
2
3
4
5
6
7
8

How well did I prepare myself?
Did the patient experience any discomfort and I or pain? How did I minimise this?
What care, advice and information did I give to my patient post procedure?

How did I assess and choose a suitable catheter/equipment? Was my choice limited?
Action Plan / further developments What do I now need to: • Know • See • Do

Full Response Text

Department of Health and Social Care

Rheynn Slaynt as Kiarail y Theay

Page 1 of 2 FOIA/DHSC/rvsd/01

Chief Executive: Malcolm Couch Miss

By email:

Freedom of Information Team Department of Health & Social Care Chief Executive’s Office Crookall House Demesne Road Douglas Isle of Man, IM1 3QA Tel: Email: Website: Date: FOI Reference: (01624) 642621 foi.dhsc@gov.im www.gov.im/dhsc 18 May 2017 IM88-170i

Dear REQUEST UNDER THE FREEDOM OF INFORMATION ACT 2015 (“the Act”) Thank you for your request to the Department of Health and Social Care, dated 15 May 2017 Your request You asked for: Question 01: “Use of latex within Noble's Hospital policy. i.e. medical equipment, gloves, balloons etc.”

Response to your request We are pleased to be able to provide a response to your request with answers to your questions: Question 01: Use of latex within Noble's Hospital policy. i.e. medical equipment, gloves, balloons etc.” In response to Question 01, the following documents have been provided:  Appendix 01 - “Noble’s Hospital Policy for the Management of Latex Allergy” – The purpose of this policy is to ensure all Operating Department Practitioners are aware of the policy to follow and safeguard patents and staff exposed to latex in the perioperative environment.  Appendix 02 - “Noble’s Hospital Urethral Catheterisation of the Male and Female Urinary Bladder” – The purpose of this document is to provide a policy for health care professionals that reflects best practice and safeguards the safety of patients who require catheterisation of the urinary bladder. References to latex can be found on pages 3, 6, 11, 14-16; the sections have been highlighted to assist you.

Page 2 of 2 FOIA/DHSC/rvsd/01 Your right to request a review
If you are unhappy with this response to your Freedom of Information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post to the FOI Co-ordinator, Department of Health & Social Care, Chief Executive’s Officer, Crookall House, Demesne Road, Douglas, Isle of Man, IM1 3QA. An electronic version and paper version of our complaint form can be found by going to our website www.gov.im/about-the-government/freedom-of-information/how-to- make-a-freedom-of-information-request/ . Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.
If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on:

Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act; or
Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision.
Further information about Freedom of Information requests can be found on the Information Commissioner’s website at: www.inforights.im/information-centre/freedom-of-information. Should you have any queries concerning this letter, please do not hesitate to contact us. Yours Sincerely

Freedom of Information Team Department of Health and Social Care

Noble’s Hospital, Isle of Man Policy For The Management of Latex Allergy
Originator: Lynn Reid, Operating Department Manager Date of Issue: February 2003
Date of Review: November 2013 / November 2014 / June 2015 / May 2017 to be reviewed May 2020 Ratified by: Patient Safety and Quality Committee Noble’s Hospital

Policy for the Management of Latex Allergy

Reader Information

Policy Number

Title Policy for the Management of Latex Allergy
Author/Contact Details Lynn Reid, Operating Department Manager Publication Date February 2003, Up-dated March 2017 Target Audience
All Operating Department Theatre and Medical Staff Description
This policy identifies actions to be taken if a patient is identified as latex allergic
Changes June 2015 - Theatre rest time following environmental preparation reduced. May 2017 – specific environmental areas identified in section 7 Cross Reference

Superseded Documents Latex Allergy Policy

Purpose

The purpose of this policy is to ensure all Operating Department Practitioners are aware of the policy to

follow and safeguard patients and staff exposed to latex in the perioperative environment.
Under the Health and Safety at Work Act 1974 employers have a responsibility to reduce or remove NRL sensitivity risk as far as is reasonably practicable. Therefore the working environment should be safe at all times, with facilities available to create an NRL-free environment as necessary.

Policy

The policy will be adhered to by all Operating Department staff

Standard

Personnel who are employed in the perioperative setting have an understanding of the issues relating to latex allergy, which inform their practice and ensure patient safety. This understanding enables them to assist any patients or colleagues who experience latex allergy.

Scope

This policy applies to any manager (responsible person) or member of staff who:
1) May be responsible for or work in an area where products containing Natural Rubber Latex (NRL) may be used or handled. 2) Involved in the procurement of medical equipment/devices/clothing.
3) Involved in the setting of clinical procedure policies where the policy may have an impact on the use of
products containing NRL.

Background

To manifest latex allergy, patients must have been previously exposed to latex. Patients fall into three main categories:-

Medical Exposure i) Patients who have repeated bladder catheterisations. These include patients with:  Neural tube defects – Myelomeningocele, Meningocele, Spina Bifida.  Spinal Cord Trauma.  Urogenital malformations - Bladder exstrophy.  Neurogenic bladder ii) Patients who have had multiple surgical procedures.
Occupational Exposure Appendix 01 DHSC FOI IM88-170i Noble’s Hospital, Isle of Man Policy For The Management of Latex Allergy
Originator: Lynn Reid, Operating Department Manager Date of Issue: February 2003
Date of Review: November 2013 / November 2014 / June 2015 / May 2017 to be reviewed May 2020 Ratified by: Patient Safety and Quality Committee i) Healthcare workers, especially Operating Department personnel, Dentists and cleaners - mainly because of exposure to latex gloves. ii) Workers in the rubber industry.
Atopic Individuals  These individuals may suffer from asthma, eczema or hay fever;  or they may be allergic to certain types of food

Severe allergic reactions in patients with no apparent risk factors are rare but have been documented.

It is necessary to have a policy reflecting the needs of these individuals. The policy includes procedures which must be followed in order to care for patients with a diagnosed or suspected latex allergy and to reduce the chances of further staff becoming sensitised to latex.

The procedure includes:  Marking allergy status and multidisciplinary communication to ensure awareness of allergy.  Preparation of the environment - including equipment, sterile items, IV equipment, etc.  Preparation of equipment which cannot be replaced.  Preparation of staff.  Availability of latex free equipment.

Policy / Procedure

Allergy Status

6.1 Pre-admission clinic or Medical staff shall provide theatre with advanced notification (where possible) of a patient with a diagnosed or suspected latex allergy. 6.2 Allergy status should be marked on all documentation and a red patient identification bracelet used. 6.3 Staff involved with the patient’s care should be kept to a minimum 6.4 Display “Latex Free Zone” notices prominently on theatre doors in the Operating Theatre and all doors
remain closed.
6.5 Sterile Services Department need a minimum of six hours or preferably the night before to process instrument sets.

Environment:
7.1 The Operating Theatre should be allowed to stand unused for a minimum of 15 minutes in a laminar flow

theatre and 30 minutes in a conventional theatre.
7.2 Protein removing washes should be performed on all theatre surfaces using a detergent solution prior to preparing any equipment. 7.3 Latex gloves should not be worn while preparing any equipment or items used for patient care. 7.4 All Latex containing products and all non - essential equipment should be removed from the environment. 7.5 Ensure emergency equipment is ready and working and emergency drugs are available. 7.6 Patients should be scheduled first on the Operating list and anaesthetised in theatre. Noble’s Hospital, Isle of Man Policy For The Management of Latex Allergy
Originator: Lynn Reid, Operating Department Manager Date of Issue: February 2003
Date of Review: November 2013 / November 2014 / June 2015 / May 2017 to be reviewed May 2020 Ratified by: Patient Safety and Quality Committee 7.7 If personnel have to enter the latex free area then a fresh theatre suit, hat (elastic free, tie on) & mask (if
required) must be donned and a hand wash performed. 7.8 Following the removal of any natural rubber latex and preparatory cleaning the theatre will be safe to use within a minimum of 15 minutes in laminar flow theatres and 30 minutes in conventional theatres.

Pre-anaesthesia: 7.9 At the Team Brief the team must identify the NRL sensitive patient on the list 7.10 If the patient is placed on an operating table with contains NRL products, the trolley must be covered with a cotton bed sheet to prevent contact between the patient’s skin and the trolley mattress. 7.11 All known NRL-containing items should have been removed from the anaesthetic room. 7.12 There must be clear signs on the doors of the anaesthetic room which declare an NRL-sensitive procedure is taking place.

Induction of Anaesthesia: 7.13 Anaesthetic team members should wear only NRL-free gloves when attending an NRL-sensitive patient. 7.14 Use only NRL-free products for induction of anaesthesia. 7.15 It is recommended that drugs which are contained in glass ampoules with screw-off or snap-off tops are used. 7.16 If multi dose vials are used the entire stopper must be removed and under no circumstances should the stopper be pierced. 7.17 Only NRL-free cannulas and syringes should be used. 7.18 Only NRL-free intravenous infusion sets should be used. 7.19 Emergency Drug Box - beware of the minijet syringe system as some of these contain rubber stoppers and therefore should not be pierced. 7.20 Inform Pharmacy when latex allergy patients are scheduled on an operating list and Pharmacy will provide a current list of drugs/products which do and do not contain latex. 7.21 If an exsanguinator is to be used then the patient’s limb must either be elevated or enclosed in a plastic bag prior to applying the exsanguinator. 7.22 Only NRL-free blood pressure cuffs; tourniquets; breathing circuits; re-breathing bags; table attachments; supports and pulse oximetry finger probes must be used.

Intraoperatively 7.23 Perioperative staff must maintain an NRL-free environment throughout the operation. All items must be checked to ensure they are NRL free. 7.24 All members of the perioperative team must wear NRL-free gloves throughout the perioperative period.

Post anaesthetic care unit / Recovery: 7.25 Recovery staff must maintain an NRL-free environment; all items must be checked to ensure they are NRL free. Noble’s Hospital, Isle of Man Policy For The Management of Latex Allergy
Originator: Lynn Reid, Operating Department Manager Date of Issue: February 2003
Date of Review: November 2013 / November 2014 / June 2015 / May 2017 to be reviewed May 2020 Ratified by: Patient Safety and Quality Committee 7.26 Anaphylactic reactions occur up to 60 minutes after exposure (start of anaesthetic). It is therefore recommended that when dealing with short cases, the patient is kept for a longer recovery period, so that their duration of stay from start to finish meets these recommendations and for close monitoring to continue.

7.27 Keen eyes are necessary for the continuity of care, observing signs and symptoms of delayed Latex Sensitivity/Allergy, which may include skin reactions (dermatitis) respiratory problems, asthma attacks, and /or anaphylactic shock (Davis 2000).

7.28 If patient experiences anaphylactic shock arrange admission to ICU for 24 hours of monitoring, since symptoms may re-occur following successful treatment (LAIR, 2001). Principles to manage anaphylaxis are laid out in the Guidelines of the Treatment of Anaphylaxis (Resuscitation Council 2008)

7.29 Where possible patients should be recovered in an end bay recovery bed with all relevant measures taken. Where this is not possible, the patient should be recovered in the operating theatre until ready to return to the ward.

7.30 Remind ward staff of the need to continue latex safe environment post –operatively and to be alert for delayed signs of reaction as above.

Special Procedures – Employees

11.1 Limit exposure to latex gloves by not wearing them when there is no risk of contact with infectious materials (e.g. bed making-unless soiled) (H.S.A. Report). Note: While it is imperative that latex/nitrile gloves are worn for Universal Precautions, gloves should not be over used. Gloves are no substitute for hand washing (H&S Executive 2005).
11.2 When gloves are necessary (as per Regulations e.g. food safety) but not likely to involve contact with infectious materials (e.g. food preparation) non-latex gloves su