Introduction
Allergic reactions to natural rubber latex (NRL) cause various consequences, ranging from mild irritation to anaphylaxis. NRL allergy’s effects extend to numerous determinants of healthcare organizations’ success, including patient safety, staff satisfaction, employee sick leave costs, and the facility’s reputation. This paper analyzes three courses of action, including mandatory allergy testing/employee health surveillance, procurement policies to limit exposure to latex-containing supplies, and no changes to current practices.
Background of Problem
NRL allergy has profound financial and workforce-related effects on dental clinics. Due to prolonged exposure to latex at work, dental hygienists face increased risks of type I and II NRL hypersensitivity, resulting in constant hand irritation (Lajolo et al., 2019). Sometimes, dermatological symptoms even contribute to these professionals’ intention to leave jobs that involve direct patient contact (Lajolo et al., 2019). Financially, this can result in extra expenses related to searching for new employees, organizing induction training, or paying sick leave benefits to employees that suddenly develop severe NRL hypersensitivity.
Adverse reactions to NRL are not always immediate and easily predictable, and the presence of incomplete medical history data can hinder the accuracy of risk assessments in patients. Any incident of care quality complaints can be devastating for the facility’s reputation and financial performance. It is because punitive damages in medical malpractice cases often exceed hundreds of thousands of U.S. dollars (Liberatore & Kelly, 2018). Thus, there are threats of complaints and even legal claims from patients that are exposed to NRL-containing dental supplies and disposables and fail to report their risk factors for allergies.
Possible Solution One
Solution one focuses on NRL allergy tests for every new employee and regular health surveillance measures for all staff members that are exposed to NRL-containing supplies in the workplace. Also, a brief 3-hour teaching program for the staff will improve their NRL allergy awareness by explaining warning signs and risk factors for healthcare workers. Bakiri et al. (2017a) and Bakiri et al. (2017b) argue that diagnostic strategies for the dental staff, including self-assessment risk evaluation questionnaires, health surveillance, and skin prick tests, support a culture of allergy prevention. Thus, option one would also involve monthly health checks for employees (ENT and dermatological assessments) and policies to test all new clinical staff for NRL hypersensitivity.
When it comes to effects, the solution will promote the early detection of staff members with high risks of allergy, thus supporting the dental facility in individualizing product use instructions for the staff. The costs will be comprised of teaching program development/implementation expenses and payments to an invited ENT doctor and a dermatologist for staff assessment activities. Patch tests for latex allergy will be another item or expenditure, and the costs will depend on the selected test type. As for the timeline, the project will take between 10 and 15 weeks. Around 2-3 months will be spent on developing the employee education program and amendments to the company’s policy. Documentation preparation and schedule rearrangement to fit in staff assessments will take 2-3 additional weeks.
Possible Solution Two
The second solution prioritizes changing the facility’s procurement strategy and limiting both service providers’ and clients’ exposure to supplies that are not NRL-free. This course of action will include forming the process improvement team led by the dental office manager and conducting a review of all purchased dental and medical supplies. NRL-containing items to be excluded will be identified, and the team will explore new offers if necessary. Then, it will alter the procurement plan to maximize the presence of non-latex dental dams, nitrile medical gloves, and other safe and hypoallergic disposables. As for the timeline, the implementation will take at least five weeks, including one week for procurement list analysis and four weeks for the remaining steps, including procurement list improvement or contracts with new suppliers. The organizational and financial effects of this option will include less frequent skin irritation cases in the staff and patients, slightly increased supply-related expenses, and the clinic’s reputation as a facility that prioritizes safety. Finally, no need for patient latex allergy risk assessments will speed up service delivery.
Latex-free environments are a viable allergy prevention option despite associated costs. Tabary et al. (2021) argue for hypoallergic non-latex gloves as the first line anti-allergy measure that outperforms the use of antihistamines (H1, H2 blockers). Critchley and Pemberton (2020) regard UK dental facilities’ practice of stopping the use of NRL-containing gloves as the most obvious risk reduction measure. Raulf (2020) regards ubiquitous allergen exposure minimization to be critical to success. Predicting the solution’s costs might be challenging due to the geographic and demand-related variation in the prices of NRL-containing and NRL-free medical products. However, latex-containing items are generally known to be more affordable (Raulf, 2020). Finally, supply agreement renewal expenses and the operation of the process improvement team will be other expenditure items in the project.
Result if No Change is Made
This option includes continuing to purchase both NRL-free and lower-protein latex gloves and instructing the staff to decide based on clients’ explicit concerns and medical anamnesis. Also, reliance on staff members’ professional expertise and risk evaluation skills is emphasized. Lajolo et al. (2019) argue that the presentation of natural latex as the key occupational irritant for dental hygienists and other dental professions is overstated. Japundžić et al. (2018) demonstrate that the incidence of NRL allergy in clinical settings might be overestimated, so anti-allergy measures aside from exposure avoidance if the known risk factors are present can be excessive. Particularly, the authors claim that almost two-thirds of cases attributed to hypersensitivity to NRL turns out to be linked with non-allergy conditions (Japundžić et al., 2018). However, as for the actual effects of no change for the facility, the risks of staff members’ insufficient allergy detection competence cannot be excluded. Particularly, it creates the threat of unforeseen expenses related to worker compensation claims or complaints from patients that did not know they were allergic.
Best Option to the Resolve the Problem
The second solution could be recommended due to three reasons. Firstly, as opposed to new policy/health surveillance and current anti-allergy safety measures, option two involves a simpler process. Particularly, the process for this option requires no specific education for the staff or extra activities that would need to be included in the schedule. Secondly, from the financial perspective, option two is more budget-friendly since its realization would not involve hiring temporary specialists, such as narrow-focus medical professionals, to conduct health evaluations. Instead, current team members, including the dental office manager and dentists, will be able to introduce innovative procurement strategies without external assistance. In particular, the cost of its implementation would be limited to the committee members’ extra hours of work, contract renewal fees, and possible slight increases in overall expenses on medical disposables. Thirdly, the medical supplies market is full of diverse offers, including affordable hypoallergic disposables. Thus, aside from eliminating both staff members’ and patients’ exposure to NRL, the selected option offers more financial flexibility and opportunities for the minimization of extra expenses.
Challenges to Implementing the Solution
The two potential challenges are the need to find new and trustworthy suppliers and employees’ unwillingness to switch to NRL-free supplies. The first barrier will be overcome by relying on ratings and other signs of quality. For instance, the list of manufacturers holding membership of the Health Industry Distributors Association could be used to ensure potential suppliers’ professional reputation. For the second challenge, the staff can be educated on the risks of allergic reactions in patients due to incomplete or incorrect health information. For instance, a person with allergies associated with increased risks of reactions to NRL (bananas, chestnut, etc.) may be unaware of these allergies (Vandenplas & Raulf, 2017). Their failure to report these risk factors might result in issues for the staff.
Risks and Dependencies
The chosen option is linked with external and financial risks and project dependencies or activities that can only be started once the implementation is initiated. The external risk of collaborating with disreputable suppliers could be mitigated by following other facilities’ recommendations and ensuring new suppliers’ membership in professional associations. Financial risks, such as NRL-free products’ expensiveness compared to the currently purchased items, could be addressed by educating staff on reducing medical waste or joining a hospital group purchasing organization. The dependencies are the gradual removal of latex-containing disposables from clinical use and searching for new suppliers, both of which should be preceded by procurement list evaluation. Strictly following the predetermined committee creation and supply evaluation plan will reduce the dependencies’ negative impact on overall progress.
Conclusion
Based on the analysis, altering procurement practices to create a latex-free facility can be regarded as a cost-effective allergy prevention option. Apart from reducing exposure to NRL in both patients and dental service providers, the strategy would minimize the need for latex allergy education and would not require staff expansion and associated expenses. The option’s flexibility and the presence of resources to overcome related challenges also support the recommendation.
References
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Bakiri, A., Skenderaj, S., Kraja, D., Petrela, E., Mingomataj, C. E., & Mingomataj, D. (2017b). Questionnaire’s and diagnostic tests’ reliability on natural rubber latex allergy among Albanian dental students. The Open Access Journal of Science and Technology, 5(3), 1-8. Web.
Critchley, E., & Pemberton, M. N. (2020). Latex and synthetic rubber glove usage in UK general dental practice: Changing trends. Heliyon, 6(5), e03889. Web.
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