Assessing the impact of the COVID-19 pandemic on latex glove usage and latex allergy complaints among nurses: A descriptive study

Abstract

BACKGROUND:

The coronavirus 2019 (COVID-19) pandemic has led to a significant increase in the use of latex gloves among nurses. However, concerns about the rise in latex allergies and related complaints due to this increase remain uncertain.

OBJECTİVE:

This study aims to assess the rates of latex glove usage and allergy-related complaints among nurses working in hospitals during the COVID-19 pandemic.

METHODS:

Between May 15 and June 15, 2021, ethical approvals were obtained for a cross-sectional study involving 448 volunteer nurses. Descriptive statistics were used to represent categorical values as counts (n) and percentages (%), while continuous values were represented as mean±standard deviation. The normal distribution of the data was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Comparative analyses were conducted using paired sample t-test, Pearson’s chi-squared (x²) test, McNemar’s chi-squared (x²) test, and Spearman correlation analysis.

RESULTS:

Before the pandemic, the average number of invasive procedures was 45.13±26.48, whereas during the pandemic, this rate increased to 50.23±29.14. The average glove usage duration went from 7.69±3.13 hours to 14.73±3.68 hours during the pandemic. Among nurses, the rate of allergic symptoms, which was previously at 31.5%, rose to 33.3% during the pandemic.

CONCLUSİON:

This study revealed a significant increase in daily invasive procedures and the use of latex gloves among nurses during the pandemic period. Simultaneously, the frequency of allergic symptoms also rose. These findings underscore the importance of awareness and preventive measures, particularly regarding latex allergies, in the healthcare field.

Keywords

Allergy latex latex gloves rubber latex allergies coronavirus nursing

1 Introduction

Coronavirus 2019 (COVID-19) is a highly contagious disease primarily spread through droplets and physical contact [1 –3]. Despite significant strides in vaccine development, a definitive treatment remains elusive [4, 5]. Current recommendations for its management are primarily isolation and supportive care practices [1]. Given its high transmissibility, global guidelines underscore the importance of personal protective equipment, including gloves [1, 3]. This has consequently led to an uptick in the usage of latex gloves among healthcare professionals, especially nurses [2].

Latex, a natural substance extracted from the rubber tree (Hevea brasiliensis), finds frequent application in healthcare products, especially gloves [6 –8]. It has been identified that out of over 250 proteins present in latex, around 60 can bind to human IgE, instigating allergic reactions [9]. Latex Allergy (LA) can present various health complications, ranging from itching, hives, contact dermatitis, and conjunctivitis to life-threatening anaphylaxis [6 , 10]. While genetic factors have a role, environmental factors are heavily implicated in the development of LA [11]. The prolonged exposure to latex-containing products in the healthcare setting enhances the risk for nurses [7]. The International Labor Organization (ILO) even classifies LA under the chemical risks that nurses are exposed to, considering it an occupational risk [12].

Studies indicate that a significant number of operating room nurses and technicians manifest dermatological symptoms attributed to glove usage, with many being diagnosed with LA [13 –15]. This relationship between glove usage and LA has become increasingly prominent during the COVID-19 pandemic. Efforts to reduce LA include the promotion of powder-free, low-protein latex gloves, and latex-free gloves. However, completely prohibiting latex gloves in healthcare is debatable due to their superior barrier properties against bacteria and viruses compared to non-latex alternatives [8, 16]. Latex gloves continue to be used in healthcare and specifically for COVID-19 patient care [2 , 17]. In light of the COVID-19 pandemic, nurses have had to rely even more on latex gloves, even for non-sterile tasks, due to concerns regarding the virus’s longevity on surfaces [17, 18]. This increase in latex glove usage could escalate skin reactions and LA rates among nurses. Yet, literature on this topic remains scant. One study reported the most common skin reactions among health professionals using latex gloves for COVID-19 protection as dryness (55.7%), itching (31.2%), and rash (23.0%) [2].

Given the implications and potential risks of increased latex glove usage, it is imperative to explore the prevalence and duration of skin reactions and allergic complaints among nurses during the COVID-19 pandemic. This study seeks to determine the frequency and duration of latex glove usage and the ensuing skin reactions and allergic complaints among hospital-employed nurses throughout the COVID-19 pandemic. In this context, this study seeks to answer the following research questions.

1.1 Research questions

Is there a difference in allergic symptoms due to latex glove use among nurses during the pandemic versus pre-pandemic?

What is the prevalence of allergic symptoms caused by latex glove use among nurses?

2 Materials and methods

2.1 Study type, location, and duration

This is a descriptive study conducted between May 15 and June 15, 2021, at an Education and Research Hospital in Turkey. All stages of the study were reported following the STROBE cross-sectional study guidelines from the EQUATOR network [20].

2.2 Location characteristics of the study

Approximately 600 nurses are working in the hospital where the study was conducted in Turkey. All personal protective equipment is provided free of charge to the nurses by the hospital. Latex and PVC (plastic bag) gloves are provided to nurses for use in tasks that require or do not require sterility, and non-latex gloves are also provided to nurses with a positive latex allergy test if they provide a medical report from a physician.

2.3 Population and sample of the study

The population of the study consisted of nurses working at the hospital, and the sample was made up of nurses who met the inclusion criteria and volunteered to participate in the study. The study reached 74.68% of the population. The sample size calculation for the study was performed using the G*Power 3.1.9.7 program, with prior calculation for the Mc Nemar Chi Square test from the Exact test family. Cohen’s d for medium effect size was used in the calculation [21]. When calculated with a two-sided hypothesis, an odds ratio of 1.5, α error of 0.05, β error of 0.20, power of 0.80, and effect size of 0.5, the number of nurses to be sampled was determined to be N = 398. Considering data loss, all nurses working at the hospital were invited to participate in the study. Data from 71 nurses with incomplete data collection forms, data from 49 nurses who were on leave during the study period, data from 30 nurses who did not want to participate in the study, and data from 2 nurses who wanted to withdraw from the study after volunteering were not included in the study. The sample of the study consisted of 448 nurses.

2.4 Criteria for participant selection in the study

2.4.1 Inclusion criteria

Being currently employed as a nurse at the Education and Research Hospital where the study is being conducted, and having worked continuously at the same hospital in this capacity in the last month preceding the commencement of the study. Being actively involved in direct patient care throughout the pandemic period. Expressing a willingness to participate in the study. Not having taken any leave or opted for remote work during the duration of the COVID-19 pandemic.

2.4.2 Exclusion criteria

Being on leave during the period in which the study is conducted, refusing to participate at the outset or withdrawing after initial enrollment, and displaying symptoms of COVID-19 or receiving a positive COVID-19 test result within the last 14 days are also among the exclusion criteria. Engaging solely in online training sessions or administrative tasks during the pandemic, possessing a previously identified severe latex allergy which prevents the use of latex gloves, also constitute the exclusion criteria. The data from participants who wish to withdraw at any stage of the research will not be included in the final analysis.

2.5 Pilot study

After making the necessary adjustments to the data collection form according to the recommendations of experts, a pilot study was conducted with 20 nurses. Since no corrections were needed in the data collection forms after the pilot study, the data obtained from the pilot study were included in the research.

2.6 Data collection tool

The data for the study was collected using two forms, the nurse identification form and the form for evaluating nurses’ skin reactions and allergic complaints, which were developed by the researchers based on a review of sources [2 , 15] To determine the content validity of the data collection forms, the opinions of two dermatology specialist physicians, one allergy specialist physician, and five experts, including two nurse instructors, were obtained. The experts were asked to evaluate the suitability and comprehensibility of each question in the data collection form by giving a score between 1–4 (1: not suitable, 2: somewhat suitable, 3: quite suitable but minor changes needed, 4: very suitable). According to the opinions of the experts, the Scope Validity Index (SVI) of the data collection forms was calculated as 0.96. As SVI: 0.96 > 0.80, it was considered suitable for this research [22]. To determine the reliability of the data collection forms, Cronbach’s alpha value was calculated, and it was found to be 0.93 for this study.

2.6.1 Identifying information form

The identifying information form consists of questions aimed at determining the age, gender, education status, department of work, nursing experience, experience in the last working department, glove selection, family history of atopy, personal history of atopy, cross-food allergies, latex glove usage, duration of glove use in a day, number of invasive procedures, presence of diagnosed latex allergy, measures taken to prevent latex allergy, awareness of non-latex gloves, and complaints after contact with latex-containing products.

2.6.2 Allergic symptoms evaluation form

The form consists of questions aimed at determining skin reactions and allergic symptoms such as itching, redness, swelling, hives, lesions, rash, contact dermatitis, swelling around the mouth and throat, nasal discharge, itching, sneezing, itching, redness, watering of the eyes, shortness of breath, coughing, wheezing, fainting, feeling of faintness, loss of consciousness, thinking that existing symptoms are related to work, etc.

2.6.3 Data collection for the research

The data for the research were collected through an online survey method. After electronically agreeing to participate in the study online, the participants answered the questions in the identifying information form and the allergic symptoms evaluation form in the data collection form.

2.6.4 Statistical analysis of data

The data was analyzed using SPSS 21.0 software (IBM Corp., Armonk, NY, USA). In descriptive statistics, discrete values were represented by number (n) and percentage (%), and continuous numerical values were represented by mean±standard deviation. The data distribution’s normalcy was determined using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Their skewness and kurtosis values also confirmed the normal distribution of the data. The paired samples t-test was utilized for continuous variable comparisons. For discrete variables, the Pearson Chi-square and McNemar Chi-square tests were used. To evaluate the correlation between the data, Spearman correlation analysis was employed. Importantly, for interpreting the correlation coefficients, the following guidelines were adhered to 0.00≤|r|< 0.100.00≤|r|< 0.10: Negligible correlation, 0.10≤| r |< 0.300.10≤|r|< 0.30: Weak correlation, 0.30≤| r |< 0.500.30≤|r|< 0.50: Medium correlation,| r |≥0.50|r|≥0.50: Strong correlation; A p-value of P < 0.05 was taken as statistically significant.

2.6.5 Ethical aspects of the research

Before initiating the research, necessary permissions were obtained from the Ministry of Health of the Republic of Turkey. The ethics committee granted approval under reference number 2021/64. Permissions were also procured from a Provincial Health Directorate in southern Turkey with reference number E-91971397-000-8667 and from a hospital administration in the same region with reference number E-61909346-604.02. The study was registered on ClinicalTrials.gov under NCT05515276. All nurses involved in the study were informed about its aims and methodologies. Their participation was entirely voluntary, and written consents were collected from those willing to participate. Those who chose not to engage with the survey were allowed to withdraw. Data was collected through an online survey, which took participants approximately 10–15 minutes to complete. The research adhered strictly to the guidelines of the World Medical Association’s Helsinki Declaration [23].

3 Results

The mean age of the nurses who participated in the study was 30.03±5.73 years, with the youngest being 22 and the oldest being 49 years old. 69.6% of the nurses were female, and 88.8% had a bachelor’s or postgraduate degree. The average experience of the nurses was 7.12±5.54 years, and Years of work experience at the last clinic/unit was 3.45±3.58. It was determined that 14.5% of the nurses had personal atopy and 5.4% had a history of cross-food allergies. 8.7% of the nurses were examined for latex allergy complaints, 4.02% had IgE testing, and 6.9% used medication for latex allergy complaints. 19.6% of the nurses waited for their symptoms to resolve spontaneously (Table 1).

Table 1
Distribution of nurses’ descriptive characteristics (N = 448)

N %

Age (mean±SD* = 30.03±5.7, youngest- oldest = 22- 49)

≤30 297 66.3

≥31 151 33.7

Gender

Female 312 69.6

Male 136 30.4

Education level

Vocational school & associate degree 50 11.2

Bachelor’s degree & graduate degree 398 88.8

Years of professional experience (mean±SD* = 7.12±5.54, min-max = 2–30)

≤5 229 51.2

6–15 174 39.5

≥16 42 9.3

Years of work experience at the last clinic/unit (years) (mean±SD* = 3.45±3.58, min-max = 0.5–24)

≤5 377 84.2

6–15 63 14.0

≥16 8 1.8

Last clinic/unit worked

General ward 404 92.20

COVID ward & COVID intensive care clinic/unit 42 7.8

Personal atopy history

Yes 65 14.50

No 383 85.5

Family history of atopy

Yes 65 14.50

No 383 85.5

Cross-reactive food allergy (allergic to bananas, strawberries, kiwi, and avocado)

Yes 24 5.40

No 424 94.6

the condition of testing positive for ıge antibodies

Yes 18 4.02

No 430 95.98

Getting examined for latex allergy symptoms

Yes 39 8.70

No 409 91.30

Using medication for latex allergy symptoms

Yes 31 6.90

No 417 93.10

The condition of waiting for latex allergy symptoms to resolve on their own

Yes 88 19.68

No 360 80.32

	N	%
Age (mean±SD* = 30.03±5.7, youngest- oldest = 22- 49)
≤30	297	66.3
≥31	151	33.7
Gender
Female	312	69.6
Male	136	30.4
Education level
Vocational school & associate degree	50	11.2
Bachelor’s degree & graduate degree	398	88.8
Years of professional experience (mean±SD* = 7.12±5.54, min-max = 2–30)
≤5	229	51.2
6–15	174	39.5
≥16	42	9.3
Years of work experience at the last clinic/unit (years) (mean±SD* = 3.45±3.58, min-max = 0.5–24)
≤5	377	84.2
6–15	63	14.0
≥16	8	1.8
Last clinic/unit worked
General ward	404	92.20
COVID ward & COVID intensive care clinic/unit	42	7.8
Personal atopy history
Yes	65	14.50
No	383	85.5
Family history of atopy
Yes	65	14.50
No	383	85.5
Cross-reactive food allergy (allergic to bananas, strawberries, kiwi, and avocado)
Yes	24	5.40
No	424	94.6
the condition of testing positive for ıge antibodies
Yes	18	4.02
No	430	95.98
Getting examined for latex allergy symptoms
Yes	39	8.70
No	409	91.30
Using medication for latex allergy symptoms
Yes	31	6.90
No	417	93.10
The condition of waiting for latex allergy symptoms to resolve on their own
Yes	88	19.68
No	360	80.32

Mean±SD = Mean±Standard Deviation.

The nurses’ working hours per day before the pandemic were 22.57±3.77 hours, while during the pandemic, it was 22.82±3.55 hours. When the working hours before and during the pandemic were compared, the difference was not statistically significant (t = 1.609, p = 0.108). The nurses’ glove use time per day before the pandemic was 7.85±3.32 hours, while during the pandemic, it was 12.91±3.40 hours. When the glove use times before and during the pandemic were compared, the difference was statistically significant (t = 30.480, p = 0.001). The number of invasive procedures performed by the nurses per day before the pandemic was 45.13±26.48, while during the pandemic, it was 50.23±29.14. When the number of invasive procedures before and during the pandemic was compared, the difference was statistically significant (t = 7.405, p = 0.000) (Table 2).

Table 2

Descriptive characteristics of nurses’ working conditions and latex glove use before and during the pandemic (N = 448)

	Before the pandemic mean±SD = min - max n (%)	During the pandemic mean±SD = min - max n (%)	Test** /p
Working hours in one day (hours)	22,57±3.77 (8–24)	22,82±3,55 (8–24)	t = 1.60 p = 0.108
Working hours in one month (hours)	201,71±11.02 (176–248)	211.35±21.17 (176–272)	t = 10.94 p = 0.001
Number of invasive procedures in one day	45.13±26.48 (4–200)	50.23±29.14 (4–200)	t = 7.40 p = 0.001
Glove usage time in one day (hours)	7,85±3.32 (1–20)	12.91±3.40 (3–20)	t = 30.48 p = 0.001
Time of using the same gloves (minutes)	23.77±27.33 (3–240)	24.02±35.45 (5–240)	t = 0.27 p = 0.783
	n(%)	n(%)
Wearing latex gloves during invasive procedures
Always	244 (54.5)	267 (59.6)	X² = 11.78
Only if needed	195 (43.5)	177 (39.5)	p = 0.008
Never	9 (2)	4 (0.9)
Wearing double latex gloves
Always	85(19.0)	112(25.0)	X² = 43.75
during invasive procedures	318(71.0)	301(67.2)	p = 0.001
Never	45(10.0)	35(7.8)
Changing the upper glove when double gloves are used and become contaminated
Yes	149(33.3)	189(42.2)	X² = 15.84
No	299(66.7)	259(57.8)	p = 0.001
Changing both gloves when double gloves are used and become contaminated
Yes	209(46.7)	223(49.8)	X² = 2.81
No	239(53.3)	225(50.2)	p = 0.093

Mean±SD = Mean Standard Deviation, t = Paired t-test.

It was determined that the incidence of allergic symptoms among nurses was 31.5% before the pandemic and 33.3% during the pandemic; the difference between the incidence of allergic symptoms before and during the pandemic was statistically significant (x² = 412.899, p = 0.001). The incidence of contact dermatitis among nurses was 28.8% before the pandemic and 32.4% during the pandemic; the difference between the incidence of contact dermatitis before and during the pandemic was statistically significant (x² = 412.394, p = 0.001). The incidence of urticaria among nurses was 26.1% before the pandemic and 29.0% during the pandemic; the difference between the incidence of urticaria before and during the pandemic was statistically significant (x² = 387.364, p = 0.001). The incidence of conjunctivitis among nurses was 5.4% before the pandemic and 5.8% during the pandemic; the difference between the incidence of conjunctivitis before and during the pandemic was also statistically significant (x² = 411.588, p = 0.001) (Table 3).

Table 3

Comparison of allergic symptoms related to latex glove use among nurses before and during the pandemic (N = 448)

	Before the pandemic n (%)	During the pandemic n (%)	Test/p
Presence of allergic symptoms
Yes	141 (31.5)	149 (33.3)	X² = 412.89
No	306 (68.5)	299(66.7)	p = 0.001
Presence of allergic symptoms outside of work
Yes	141 (31.5)	149 (33.3)	X² = 412.89
No	306 (68.5)	299(66.7)	p = 0.001
Pain, redness, and itching on hands (contact dermatitis)
Yes	129 (28.8)	145 (32.4)	x² = 412.39
No	319 (71.2)	303 (67.6)	p = 0.001
Redness, swelling, rash on hands (urticaria)
Yes	117(26.1)	130 (29.0)	X² = 387.36
No	331(73.9)	318 (71.0)	p = 0.001
Itching, tearing in eyes (conjunctivitis)
Yes	24(5.4)	26 (5.8)	X² = 411.58
No	424(94.6)	422 (94.2)	p = 0.001
Runny nose, sneezing (allergic rhinitis)
Yes	24(54)	24 (5.4)
No	424(94.6)	424 (94.6)
Swelling around the mouth, throat
Yes	6(1.3)	7(1.6)
No	442(98.7)	441(98.4)
Shortness of breath, cough, wheezing
Yes	8(1.8)	8(1.8)
No	440(98.2)	440(98.2)
Fainting, feeling faint, loss of consciousness (anaphylaxis)
Yes	0(0)	0(0)
No	448(100)	448(100)

X² = ** Mc Nemar Chi-square.

The relationship between the age of the participants and the presence of allergic reactions related to latex gloves was not found to be significant before the pandemic (r = –0.059, p = 0.210) and during the pandemic (r = –0.058, p = 0.222). There was no significant relationship between the participants’ work experience and the presence of allergic reactions related to latex gloves before and during the pandemic. When the working period of the nurses in the last department where they worked was examined in relation to the presence of allergic reactions related to latex gloves, a weak but significant relationship was found both before the pandemic (r = 0.095, p = 0.044) and during the pandemic (r = 0.107, p = 0.023). While there was no significant relationship between the daily working hours and the presence of allergic reactions related to latex gloves before the pandemic (r = 0.042, p = 0.380), there was a statistically significant relationship during the pandemic (r = 0.104, p = 0.028). When the monthly working hours of the participants were examined in relation to the presence of allergic reactions, a significant relationship was found both before the pandemic (r = 0.307, p = 0.001) and during the pandemic (r = 0.397, p = 0.001). While there was no significant relationship between the duration of glove use per day and the presence of allergic reactions before the pandemic (r = –0.010, p = 0.826), there was a significant relationship during the pandemic (r = 0.197, p = 0.001). When the relationship between daily invasive procedures and allergic reactions was examined, there was no significant relationship before the pandemic (r = 0.030, p = 0.514), but there was a significant relationship during the pandemic (r = 0.155, p = 0.001). Similarly, while there was no relationship between using the same gloves multiple times and the presence of allergic reactions before the pandemic (r = –0.010, p = 0.826), there was a significant relationship during the pandemic (r = 0.159, p = 0.001) (Table 4).

Table 4

Association between the presence of latex glove-related allergic symptoms and some continuous variables in nurses before and during the pandemic (N = 448)

	Pandemic prevalence of allergic symptoms Test /p	Pandemic period prevalence of allergic symptoms test /p
Age	r = –0.059 p = 0.210	r = –0.058 p = 0.222
Duration of professional experience (years)	r = –0.840 p = 0.074	r = –0.071 p = 0.133
Duration of experience in the last clinic/unit worked (years)	r = 0.095 p = 0.044	r = 0.107 p = 0.023
Working hours per day (hours)	r = 0.042 p = 0.380	r = 0.104 p = 0.028
Working hours per month (hours)	r = 0.307 p = 0.001	r = 0.397 p = 0.001
Duration of glove use per day (hours)	r = –0.010 p = 0.826	r = 0.197 p = 0.001
Average number of invasive procedures per day	r = 0.030 p = 0.514	r = 0.155 p = 0.001
Duration of using the same gloves (minutes)	r = –0.010 p = 0.826	r = 0.159 p = 0.001

r: Spearman correlation analysis was used.

4 Discussion

The COVID-19 pandemic has brought about both medical and societal challenges worldwide [1, 2]. During this unprecedented period, nurses stepped forward, adopting strict personal protective measures in the face of the virus’s contagious nature, risking their own health to protect the community. However, these protective measures, especially the use of latex gloves, can increase the risk of latex allergies among nurses and other healthcare professionals. This study aimed to understand the magnitude and effects of this risk, we observed skin reactions like contact dermatitis and urticaria in nurses due to the intensive use of latex gloves. This has resulted in both physical and psychological strain on nurses and other healthcare professionals [1]. These findings provide insight into the potential dangers of latex allergy and its impact on healthcare workers [10].

The increased duration and frequency of latex glove use by nurses during the COVID-19 pandemic have led to allergic reactions and skin complaints linked to latex. Contact dermatitis and urticaria are allergic reactions and irritant dermatitis that can be associated with wearing latex gloves [24, 30]. Allergic symptoms like contact dermatitis, urticaria, and irritation from the gloves can be triggered by the combination of latex and powder in the gloves. Mechanical irritation caused by the glove arises from the combination of latex and powder within it.

In our study, we observed a significant increase in allergic symptoms, contact dermatitis, and urticaria incidence during the pandemic compared to the pre-pandemic period. The daily glove use duration for nurses averaged 7.85 hours before the pandemic and increased to 12.91 hours during the pandemic. We believe that this increase in duration is directly related to the statistically significant rise in allergic symptoms. Furthermore, we cannot overlook the possibility that the increased handwashing and antiseptic use may also contribute to skin complaints.

Comparing our study with others, the prevalence of contact dermatitis in the study by Yusoff and colleagues was lower than ours. However, Liu and colleagues’ study with nurses indicated a much higher prevalence of contact dermatitis and urticaria than what we observed. Discrepancies in the prevalence of skin complaints among healthcare workers across various global regions in other studies depend on the recent clinical adjustments, daily work hours, monthly work hours, years of experience, daily glove usage duration, number of daily invasive procedures, duration of using the same pair of gloves, weather conditions, quality of gloves used, and lifestyles in their personal lives. The influence of these factors on study participants’ latex allergies and allergic symptoms is under investigation in our further analysis. Especially when assessing potential side effects of personal protective measures brought by the pandemic on healthcare workers, we must highlight that this situation is a serious concern [16].

The majority of participants are educated young women. This demographic composition may suggest that young health professionals might exhibit an adaptive response to the challenges they face and perhaps show more resilience against job stress. However, our research findings emphasize that even this educated and young group cannot be overlooked concerning the potential allergic effects of increased latex glove usage. Before the pandemic, nurses were already working at an intensive pace. During the pandemic, there was only a minimal increase in total working hours. Still, the most significant change was observed in glove usage duration. Daily glove usage durations before the pandemic soared even higher during the pandemic. This pronounced increase in glove usage duration during this period directly correlates with the allergic reactions and skin issues we identified in nurses. Beyond these durations, the relationship with allergic reactions has become even more critical given the additional burdens added by the pandemic on top of the already extended working hours and daily glove usage durations. Additionally, increased hand hygiene practices during the pandemic, frequent handwashing, antiseptic product usage, and extended periods spent in gloves have amplified the magnitude of this problem, as observed in our study [31].

The global prevalence of latex allergy varies depending on the geographical region. The rate of 4.02% that we determined in our study is consistent with the study by Köse and colleagues in Turkey. However, while Liu’s studies in China, Boonchai’s in Thailand, and Yusoff’s in Malaysia indicate higher rates than in Turkey, studies by Galindo in Spain and Wang in the USA are similar to our results. Understanding the reasons for geographical differences is complex. Latex glove production methods and materials may vary regionally; it is possible that more allergenic components are used in some regions. Protective equipment standards adopted in the health sector of countries can also affect prevalence. Genetic predisposition in certain populations can also play a role in allergic reactions. Therefore, comprehensive research is required to understand regional differences in latex allergy prevalence.

This study clearly demonstrates how the use of latex gloves during the pandemic is directly linked to the significant increase observed in allergic reactions. The rise in specific health issues such as dermatitis, urticaria, and conjunctivitis cannot be denied. The course of such allergic reactions not only constitutes a physical challenge for healthcare workers but also a psychological burden. In parallel with the studies conducted by Yusoff, Lui, and other colleagues, these observations indicate the presence of a global trend. However, observed variations in prevalence can differ depending on geographical regions and even between hospitals. Such variations can depend on numerous factors, from the health infrastructure of each country or region, environmental conditions, to even the quality, type, or brand of the glove used. Especially the production processes and material quality of latex gloves play a critical role in allergic reactions. In light of this information, a review of protection methods and strategies against allergic reactions associated with the use of latex gloves stands as an urgent need.

According to this study, there was no significant relationship found between the ages of participants before and during the pandemic and allergic reactions related to latex gloves. Similarly, no significant connection was identified between the participants’ work experience and allergic reactions. However, a weak but statistically significant relationship has been identified between the duration nurses have worked in their most recent unit and allergic reactions related to latex gloves. This might indicate that nurses who have worked for a longer period in a particular unit could potentially be more susceptible to such reactions. During the pandemic, significant relationships were found between daily working hours, monthly working hours, daily glove usage duration, daily invasive procedures, and reusing the same gloves multiple times with allergic reactions. This demonstrates the additional burden and protective measures the pandemic has imposed, leading to adverse effects on nurses. Especially, the connection of glove usage duration and reusing the same gloves multiple times during the pandemic with allergic reactions reveals that nurses were under significant risk during this period. This data provides an in-depth understanding of how the pandemic has affected the working conditions and health of nurses, and this information should be considered in the management of similar crises in the future.

Considering the potentially life-threatening severe effects of latex allergy, proactive management and reduction of risks are of vital importance. Correct and rapid recognition of early symptoms is crucial for interventions to be made as soon as an individual feels the initial signs of an allergic reaction. Combined with specific and sensitive diagnostic methods like the IgE test, this facilitates nurses’ access to early treatment and significantly reduces the risk of potential complications. Knowing that prolonged contact with latex can lead to adverse reactions underscores the necessity of being extra careful when using it. Ensuring that hands are fully dried can reduce the risk of reactions by preventing moisture from accumulating under the glove. Similarly, adopting the double gloving method emerges as an effective method in reducing direct latex contact. Strategies like these can assist nurses and other health professionals in minimizing the risk of allergic reactions while also ensuring maximum protection.

In conclusion, this study illuminates the multifaceted challenges healthcare professionals, especially nurses, faced during the COVID-19 pandemic. Latex gloves have served as a shield for nurses and played a crucial role in minimizing the risk of virus transmission. However, this protective measure has led to unforeseen health issues like allergic reactions. Considering this, within the continuously evolving and changing nature of the healthcare sector, it’s vitally important for us to strike a balance between protective measures and potential side effects we might encounter. Especially during global crises like a pandemic, protecting the health of frontline professionals aiming to safeguard community health should be regarded as equally critical.

5 Conclusions

Our study highlights an increased risk faced by nurses during the pandemic. The extended duration of glove usage and the surge in invasive procedures might be linked to the rise in allergic reactions, contact dermatitis, urticaria, and conjunctivitis cases. While no substantial correlation was identified between age, professional experience, and daily work hours with allergic reactions related to latex gloves, a slight association was observed with the working hours in the final segment. This underscores of enhancing protective measures for healthcare workers and improving their working conditions during the pandemic.

5.1 Recommendations

Nurses need to adopt a more proactive approach. It’s essential to remember that a proactive stance can mitigate long-term complications. Before putting on gloves, they must ensure their hands are completely dry, as moisture can exacerbate skin irritations. If they experience persistent symptoms or unusual discomfort, they should consider using double gloves to minimize direct latex contact. In cases of evident allergic reactions or symptoms, nurses should promptly seek consultation with a dermatologist.

Healthcare facilities must prioritize providing non-latex or hypoallergenic glove options. Having these alternatives readily available can significantly reduce the risk of exposure to latex. Management needs to schedule regular training sessions on best practices for glove use. These sessions will not only help minimize health risks but also promote the well-being of the staff, paving the way for a long-lasting career. It’s crucial to encourage nurses with a high risk of allergic reactions to consult dermatologists and to establish a referral system to support this process.

For researchers: The urgent need to research and develop latex alternatives has become evident. It is imperative to delve deeper into potential allergic reactions caused by the prolonged use of personal protective equipment. Understanding both immediate and long-term effects is crucial. An in-depth analysis of the clinical factors leading to allergic reactions will aid researchers in developing more targeted and effective solutions. The focal point of these studies should be strengthening the connection between clinical practices and materials science.

5.2 Limitations

This study is based on data collected through a survey method, which suggests that the results might be subjective. Moreover, the presence of latex allergies and related symptoms was not specifically verified during the study. We recommend comparing our findings with studies conducted in different geographical regions and varied hospital environments.

Ethical approval

Before initiating the research, necessary permissions were obtained from the Ministry of Health of the Republic of Turkey. The ethics committee of Hasan Kalyoncu University granted approval under reference number 2021/64. Permissions were also procured from a Provincial Health Directorate in southern Turkey with reference number E-91971397-000-8667 and from a hospital administration in the same region with reference number E-61909346-604.02

Author Contributions

Concept- İ.E., A.K., A.Y Design- İ.E., A.K., A.Y Data Collection or Processing-İ.E. Analysis or Interpretation- İ.E., A.K., Literature Search- İ.E., A.K., A.Y Writing- İ.E., A.K., A.Y

Conflict of interest

The authors have no conflict of interest to report.

Footnotes

Acknowledgments

The authors have no acknowledgments.

Funding

No funding was obtained from any source.

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