摘要：Objectives. This study explored whether the prevalence of latex-related health conditions has increased among individuals employed in medical occupations relative to those employed in nonmedical occupations since the issuance of universal precautions in 1987. Methods. Data derived from the 1983 to 1994 versions of the National Health Interview Survey were used to obtain odds ratios comparing prevalence rates of latex-related symptoms over time. Results. No statistical evidence was found that the universal precautions resulted in increased prevalence rates of latex-related health conditions among medical workers relative to those employed in nonmedical occupations. Conclusions. Increased use of latex gloves among health care personnel subsequent to the implementation of universal precautions appears to have had no effect on latex allergic reactions experienced by these workers. Use of natural rubber latex (NRL) gloves significantly increased after the Centers for Disease Control and Prevention (CDC) introduced universal precautions in 1987. Between 1987 and 1996, the use of NRL gloves among medical professionals rose by more than 1000%. 1, 2 Some investigators have speculated, on the basis of limited findings, that health care workers are at higher risk of becoming sensitized than individuals in the general population because of their use of NRL gloves. 3– 6 Although this assumption is appealing at an intuitive level, research conducted among health care workers to date has produced inconsistent results, and in many instances the findings vary little in comparison with measurements involving the general population. Estimates of NRL sensitization among health care workers gained through the use of different methodologies, such as skin prick and patch tests, in vitro tests, and questionnaires, vary greatly between studies. For example, Kim et al. found a sensitization rate of 1.5%, whereas Yassin et al. reported a rate of 17%. 7, 8 Other studies involving health care workers have reported rates varying widely between these 2 extremes. 9– 12 In contrast, studies aimed at obtaining NRL sensitivity estimates for the general population have consistently reported sensitization rates between 5% and 7%. 13– 16 In many cases, point estimates of health care worker sensitization rates fall within the confidence intervals of general population rates. 17– 20 It is difficult, on the basis of these findings, to draw conclusions regarding sensitization prevalence rates among health care workers relative to those employed in other occupations. A study conducted by the National Institute for Occupational Safety and Health that specifically attempted to determine whether NRL gloves were a source of sensitization by comparing health care workers with varying levels of exposure to gloves revealed no significant differences in sensitization rates between those who used gloves frequently and those who did not. 21 Another hypothesis that has emerged from research on reactions to NRL is that cornstarch powder, frequently used as a donning agent, binds to the gloves’ NRL allergens and may act as an aeroallergen transmitter in health care environments. Similar to the hypotheses offered by other researchers focusing on glove use and sensitization, this hypothesis has received mixed support. Several studies, for example, have produced evidence that workers who are exposed to NRL glove powder have a higher risk of becoming sensitized than do those who are not exposed. 22, 23 However, several large studies have recently presented a challenge to the earlier findings on the glove powder hypothesis. 21, 24 As with research on health care worker sensitization rates, there is currently no conclusive evidence regarding the hypothesis that NRL glove powder contributes to increased sensitization among health care employees relative to workers in other occupations who are less exposed to airborne NRL allergens. Although studies have explored sensitization rates at varying exposure levels, there has been little comparative research on reported reactions to NRL. In the research project described here, we used self-report data on conditions commonly associated with NRL reactions to estimate relative risks among health care workers and workers in other occupations. Using symptoms as a means of assessing reactivity is a viable method for estimating occupational disease rates over time, and it has been successfully employed to analyze workers’ compensation claims potentially stemming from NRL reactions. 25– 27 The data included in the present study covered the periods both before and after adoption of universal precautions; thus, we were able to assess over time the effect of increased glove use on the relative risks of potential NRL-related conditions for health care workers as compared with those involved in other occupations. If reactions from occupational exposures to NRL are widespread, then our results should show not only significantly greater overall prevalence rates of symptoms commonly associated with NRL reactions among health care workers than among other workers but also a rise over time in ailments commonly associated with NRL among health care workers after the implementation of universal precautions.
