UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: LATEX SCREENING
Effective Date: June, 2004 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed June, 2005 May, 2008 April 2012
PURPOSE: To provide guidelines for the screening of latex allergies at UWMF Clinics.
POLICY: The clinical staff will utilize the following guidelines to screen UWMF
patients for latex allergies prior to all surgeries and invasive clinic procedures.
Latex Screenings (if found negative) should be re-evaluated with each surgery, invasive
clinic procedure, or every six months (which ever is greater).
If indicted by the Primary Care Provider or Allergist, Latex Specific IgE testing should
be completed 7 working days prior to the surgery or invasive clinic procedure.
DEFINITION: The latex of concern (involving allergy) is a raw material from the
rubber tree used in making rubber products. Examples of natural latex rubber products
include latex gloves, pacifier, balloons, bandages, adhesive tape, condoms, and catheters.
SUPPLIES: Latex Screening Questionnaire form (P-2202 Badger Graphics number)
Patient’s electronic medical record, Pen
1. Wash hands and gather paperwork.
2. Introduce yourself and identify the patient, verifying patient’s full name and date
3. Explain the need for the Latex Screening Questionnaire to the patient.
4. Assist patient in filling out the questionnaire.
5. Staff should review the completed form and complete the bottom portion of the
form – below the heading ‘For Clinic Use Only’
NOTE: if patient answers yes to 1- 4, 7 or 8, the surgical procedure
should be done with latex precautions and patient should be referred to the
patient’s primary provider or to the Allergy clinic for further evaluation.
6. If patient is seen by the Primary Provider or the Allergy clinic prior to the surgical
procedure and a Latex Specific IgE testing is completed, the location where the
patient is to have surgery (MSC and Meriter) will be notified of the patient’s latex
allergy testing results and/or the need to implement latex precautions even if the
Latex IgE is negative.
7. Documentation of the following into HealthLink:
Education regarding the need to complete the latex screening
questionnaire prior to surgery
Any patient questions or concerns
If the patient had Latex Specific IgE testing
Add latex allergy to the allergy section (if found to have positive IgE test
or positive latex history)
Completed form faxed to appropriate surgery center
Completed form sent to HIS Scanning – 414
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVISED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator
REVIEWED BY: Dr. Thomas Puchner, Clinical Assistant Professor Medicine-Allergy
Dr. Robert Kriz, Clinical Assistant Professor Medicine-Allergy
Dr. Marcus Cohen, Clinical Assistant Professor Medicine-Allergy
Dr. Michael Ritter, Clinical Assistant Professor Medicine-Allergy
Melinda Kloppedal, Registered Nurse-Team Leader Ob/Gyn
Ellen Johnson, Clinic Operations Managers Family Medicine
Deb Brausen, Director, Clinic Operations Surgery Center
Sandy Schumacher, RHIT, Director of Health Information Services
Kathy Werla, Ambulatory Clinical System Mgr Info Services
1. Latex Screening Questionnaire for Employees (UWMF)
Medical Director Date