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PubMedDate not supplied

The use of powdered gloves in dental practice: a cause for concern?

OBJECTIVES: To critically review the potential hazards associated with the use of powdered, natural rubber latex (NRL) gloves in dental practice and to report some practical difficulties which may be encountered when handling dental materials with powdered NRL gloves. DATA SOURCES: Articles published in the international literature over the last 10 years. STUDY SELECTION: A number of recent studies in the medical and surgical literature have confirmed that NRL proteins leach out of latex gloves and bind to surgical glove powders. The most serious, potential hazard associated with the continued use of powdered NRL gloves in dental practice is that of latex sensitization by exposure to aerosolized NRL proteins. Hand dermatitis is now recognized as an occupational hazard in dentistry and has been associated with the continuous wearing of protective gloves. Studies, in the dermatological literature, have suggested that glove powders may exacerbate an irritant dermatitis and enhance the potential for adverse reactions to other components of NRL gloves. The surgical literature has already highlighted the risks of post-operative granuloma formation, due to glove powder contamination of the surgical wound. The possible effects of powder contamination of dental implant sites, on the outcome and success of implants has yet to be established. Recent in vitro studies have investigated the effect of latex glove contamination on the shear-bond strength of porcelain laminate veneers: one study demonstrated that starch powder significantly affected the bond strength, whereas the other showed that latex glove contamination of the porcelain surface did not have any significant effect. Long-term, in vivo studies are now required. CONCLUSIONS: Dental practitioners should consider the potential health risks which are associated with the use of powdered NRL in dental practice. Powder contamination may affect the long-term results and success of clinical procedures in dentistry.

Dental Bonding↗
PubMed2003

Permeability of different types of medical protective gloves to acrylic monomers.

Dental personnel and orthopedic surgeons are at risk when manually handling products containing methyl methacrylate (MMA). Dental products may also contain cross-linking agents such as ethylene glycol dimethacrylate (EGDMA) or 1,4-butanediol dimethacrylate (1,4-BDMA). Skin contact with monomers can cause hand eczema, and the protection given by gloves manufactured from different types of material is not well known. The aim of this study was to determine the breakthrough time (BTT, min) as a measure of protection (according to the EU standard EN-374-3) for a mixture consisting of MMA, EGDMA and 1,4-BDMA. Fifteen different gloves representing natural rubber latex material, synthetic rubber material (e.g. nitrile rubbers), and synthetic polymer material were tested. The smallest monomer MMA permeated within 3 min through all glove materials. A polyethylene examination glove provided the longest protection period to EGDMA and 1, 4-BDMA (> 120 min and 25.0 min), followed by the surgical glove Tactylon (6.0 min and 8.7 min) and the nitrile glove Nitra Touch (5.0 min and 8.7 min). This study showed that the breakthrough time (based on permeation rate) cannot be regarded as a 'safe limit'. When the permeation rate is low, monomers may have permeated before BTT can be determined. Using double gloves with a synthetic rubber inner glove and a natural rubber outer glove provided longer protection when the inner glove was rinsed in water before placing the outer glove on top.

Acrylic Resins↗
PubMed1990

The incidence of undiagnosed punctures in non-sterile gloves.

This study investigates the incidence of undiagnosed punctures in five types of single and multiple patient use gloves worn by a group of practitioners (n = 6) in general and hospital practice, and provides data on the incidence of undiagnosed punctures in gloves worn on operative and passive hands. Gloves considered to be intact when discarded (n = 510, 85%) were examined for undiagnosed punctures by water inflation. The incidence of undiagnosed punctures varied considerably with glove type (range 3-49%) and among the practitioners (range 9-29%), and some gloves, notably the vinyl type investigated, appeared to be more prone to puncture than the other types of glove. More than 60% of the undiagnosed punctures were in the thumbs and second fingers of the gloves. The incidence of undiagnosed punctures in gloves from operative hands was only slightly greater than that for gloves from passive hands. The gloves intended for multiple patient use were found to have the lowest incidence of undiagnosed punctures. However, the single patient use gloves were typically misused, in that they were worn during the treatment of more than one patient.

Dentistry, Operative↗
PubMed2002

Type I allergy to natural rubber latex and type IV allergy to rubber chemicals in health care workers with glove-related skin symptoms.

BACKGROUND: It has been established that there are type I and type IV allergens in latex gloves. OBJECTIVE: The purpose of the study was to establish the prevalence of rubber glove-induced skin symptoms among health care workers in one Italian hospital. METHODS: Health care workers (n = 1584) were evaluated using a written questionnaire and 295 respondents with glove-induced skin symptoms were tested. We performed: skin prick test with latex glove extract and commercial latex, and environmental and food allergens; glove use test; patch tests with a rubber additive series; and RASTs. RESULTS: Hospital employees who used or had used latex gloves at work were 1294. Three hundred and sixteen (24.4%) reported glove-induced symptoms, namely, cutaneous symptoms in all the cases and non-cutaneous symptoms in 105 subjects (8.1%). Twenty-seven of the 295 symptomatic employees tested (9.1%) were latex sensitive. Thirty-one patients (10.5%) exhibited positive patch test to rubber-related allergens. The most positive readings were obtained from the Thiuram mix and the Carba mix, with 12 and 9 positivities, respectively. The risk factors for latex skin sensitization were: a previous history of atopy and asthma; history of surgery; pre-existing hand dermatitis; work-related symptoms; and positive skin tests to common inhalant and certain foods (P < 0.05). Subjects who exhibited positive patch test were significantly more likely to have a prior hand dermatitis (P < 0.001). Of the 295 cases, 275 (93.2%) were contact dermatitis (CD), 13 (4.4%) contact urticaria (CU) (including protein CD) and 7 (2.4%) CD associated with CU. CONCLUSIONS: Our results show a high prevalence of rubber glove-induced dermatoses among the employees in one Italian hospital. The majority of skin complaints of latex gloves are related to skin irritation rather than to allergy. The immediate allergy to latex and the delayed allergy to rubber chemicals suggest that all the health care workers with glove-related dermatitis should undergo both skin prick test and glove use test to detect type I hypersensitivity to latex, and patch test to detect type IV hypersensitivity to rubber chemicals.

Adult↗
PubMed2002

Latex glove disorders: a management strategy for reducing skin sensitivity.

The use of latex gloves by health care workers has increased over recent years. Proteins within the latex gloves and chemical additives during the manufacturing process have been linked to allergic skin and systemic disorders. Evidence suggests that latex-related skin disorders are increasing. Unless more stringent measures to control prolonged contact with latex gloves are implemented, skin disorders will continue to increase. While employees have a professional responsibility to reduce longer contact with latex gloves and use other safer alternatives, employers may also contribute through better education provisions, more strict monitoring and control of glove usage and purchasing gloves that are safer. An Infection Control Nurse can support both employees and management by developing and supporting better education and guidance for glove usage and an Employee Health Nurse could provide better care and support to affected workers. Glove manufacturers should identify the level of each protein in their gloves, the health risks involved and undertake new research to produce more hypoallergenic gloves. Collaborative efforts among employees, employers, researchers and glove manufacturers are needed to prevent the spiraling latex health risks to health care workers getting worse.

Allied Health Personnel↗
PubMed2000

Permeability of protective gloves by HEMA and TEGDMA in the presence of solvents.

The breakthrough times and permeation rates of two commonly used allergenic components in dentin bonding agents or resins, HEMA and TEGDMA, were measured for 5 types of latex gloves and 5 types of nitrile gloves. In addition, the breakthrough times and permeation rates for the gloves were measured for HEMA and TEGDMA when diluted with either ethanol or acetone-solvents often appearing in dentin bonding agents. The mean breakthrough times for the 5 latex gloves for HEMA and TEGDMA, concentrated, diluted in ethanol, or diluted in acetone, were 4.9, 4.8, and 2.8 min, respectively. For the 5 nitrile gloves the equivalent breakthrough times were 15.7, 9.9, and 2.8 min, respectively. There were great variations between the various gloves, and 1 nitrile glove showed a breakthrough time of 28-30 min when tested with concentrated HEMA and TEGDMA. Compared to latex gloves, nitrile gloves have a longer-lasting protection against skin contamination with methacrylates in the absence of solvents. The longer protection was reduced or not present for methacrylates diluted in organic solvents, especially acetone. In addition, the nitrile gloves showed fairly high permeation rates in the presence of this solvent. The results indicate that latex and nitrile gloves only give a limited protection against allergenic methacrylates in dentin bonding agents when they contain acetone.

Acetone↗
PubMed1994

A quantitative evaluation of gloves used with non-powered hand tools in routine maintenance tasks.

Non-powered hand tools are a major means of carrying out routine maintenance and repair activities. The use of gloves in such situations is essential in order to protect the hands from potential injuries. Together, the gloves and hand tools accomplish the task by transmitting the muscle force on to the workpiece. Several studies have reported that the capability of hands to exert force/torque is severely influenced by the use of gloves. The use of gloves could also lead to a cumulative trauma disorder, rapid onset of muscular fatigue, etc. Most previous studies have focused on determining the influence of gloves on grip strength or push/pull forces one would exert while using devices such as knives. The purpose of this study was to determine the influence of a variety of commercially available gloves on the force/torque exertion capability of workers with wrenches and screwdrivers that are commonly used in performing routine maintenance and repairs. Nineteen males participated in the study and, using seven different hand tools and nine varieties of commercial gloves, exerted peak volitional torques on a simulated workpiece. The peak torque and electromyogram of flexor and extensor muscles were recorded. The results indicated that muscle activity did not differ significantly between the glove and no-glove conditions and the peak torque exertion capability of individuals generally increased with gloves. The magnitude of torque exerted on the workpiece was different for different gloves. The results also contradict some of the previously reported findings.

Adult↗
PubMed2004

Determination of the attenuation properties of laboratory gloves exposed to an ultraviolet transilluminator.

The transmission of ultraviolet radiation (UVR) from an ultraviolet transilluminator through three types of laboratory gloves (latex, nitrile, vinyl) was determined using two independent methods. First, transmittance was measured with a radiometer equipped with UVA and actinic UV detectors. Second, a spectrophotometer was used to determine the UVR transmittance vs. wavelength (250-440 nm); this data was then used to compute the effective attenuation of the glove material. The average UVA percent transmittance using the radiometer method with an unstretched glove was 73.4%, 0.18%, and 1.10% for vinyl, nitrile, and latex, respectively. The average actinic percent transmittance for an unstretched glove was 13.3%, 0.015%, and 0.024% for vinyl, nitrile, and latex, respectively. Slight increases in UVR transmittance resulted from stretching the gloves by 30% or wetting them with saline. Six hours of UVR exposure decreased transmittance of vinyl gloves and increased transmittance by latex gloves. Results from the spectrophotometer method and radiometer methods of determining UVR transmittance agreed that vinyl gloves had the highest transmittance; however, the spectrophotometer method greatly overestimated UV glove attenuation due to the effect of light scattering by the glove material. The study suggests that in some circumstances, vinyl gloves will provide inadequate protection against workplace ultraviolet radiation.

Equipment Failure↗
PubMed2004

Gloves and dermal exposure to chemicals: proposals for evaluating workplace effectiveness.

There are standardized laboratory tests for chemical protective gloves that provide estimates of breakthrough time and steady-state permeation flux. However, there is evidence to suggest that these tests may not be completely relevant to glove usage in the workplace. There is no consensus about how glove workplace effectiveness should be assessed, although a few studies have attempted to measure the effectiveness of chemical protective gloves. We have used a conceptual model of dermal exposure to help analyse how workers' skin may become exposed while wearing gloves, and propose a new glove workplace protection factor (PFgloves), which is based on the ratio of the estimated uptake of chemicals through the hands without gloves to the uptake through the hands while wearing protective gloves. Mathematical simulations demonstrate that glove protection factor is unlikely to be constant for a glove type, but will be strongly influenced by the work situation and the duration of the exposure. This has important consequences for the selection of protective gloves.

Gloves, Protective↗
PubMed1991

Allergenicity suppression in natural latex surgical gloves.

By a revised manufacturing process we aimed to obtain latex surgical gloves without immediate allergenicity, and also to determine a simple physical technique by which to estimate this allergenicity. Five glove samples were evaluated for allergenicity by physical and biochemical methods and by skin tests at the University Allergy Centre. Three groups of allergic patients with documented anaphylaxis to surgical gloves, positive skin tests to latex extract and specific IgE to latex (RAST Pharmacia greater than or equal to class II), volunteered for the study. The protein content, the in vitro allergenic potency of glove supernatants (RAST inhibition) and the skin test results with glove supernatants were lower in washed gloves than in non-washed samples (P less than 0.02 to P less than 0.009). The supplementary effect of glove sterilization at 120 degrees C (for 1 h in saturated steam) was obvious. The protein content became undetectable in four of the five glove supernatants, and skin tests results with sample supernatants were decreased (M +/- SEM = 0.68 +/- 0.29 mm vs 3.06 +/- 0.61 mm with non-sterilized gloves), P less than 0.009 by Wilcoxon test. With the Spearman test there was a significant correlation (P = 0.029) between the mean wheal size, obtained with supernatants (Groups 1 and 2) and electrical conductivity. Skin tests through pieces of gloves randomly distributed and coded were decreased by sterilization: 0.66 +/- 0.25 mm vs 2.86 +/- 0.45 mm, P less than 0.0001. Thus, it is possible to decrease glove allergenicity by washing them after mould forming and then sterilizing with steam. Electrical conductivity may be a simple parameter for revealing allergenicity.

Adult↗
PubMed1997

The effect of the use of dental gloves on mixing vinyl polysiloxane putties.

PURPOSE: The purpose of this study was to determine the delay in setting times that occurs with selected brands of gloves or residual powder from those gloves on eight popular brands of vinyl polysiloxane putties. MATERIALS AND METHODS: The putties were mixed and rolled into a round 3-inch-long cylinder without gloves on hand, with gloves on hand, and with powder residue on hands, immediately after degloving. The end of a cement spatula was drawn over the putty at various intervals with a force of 3 ounces. The setting time was recorded to be when no permanent indentation of the putty occurred. RESULTS: All materials set within 5 minutes without gloved hands. Eighty-eight percent of the putties set within 5 minutes when mixed with Friction Grip Powder Free and Medical Gloves on hands. When mixed with Pharmaseal gloves on hands, 50% of the putties set in 5 minutes. When mixed with Micro-Touch Latex Medical Gloves, 38% of the putties set in 5 minutes. When the putties were mixed with the residual powders left on ungloved hands, the same results occurred with the above-mentioned gloves. With residual powder on hands from Natraflex and Medical Exam Tex, 25% of the putties set in 5 minutes. CONCLUSIONS: Gloved hands interfered with the setting of more brands of putties than did residual powder on hands immediately after degloving. There are gloves available that do not interfere with the setting of most of the vinyl polysiloxane putties.

Analysis of Variance↗
PubMed1992

Permeation and destructive effects of disinfectants on protective gloves.

In working situations where there is a possibility of acquiring blood-borne infections, the use of disinfectants is important. It is also important to use protective gloves, both to protect the skin against disinfectants and to protect against infections. Changes in the structure of the glove material may, however, interfere with the protective capability of the gloves. The influence of 4 disinfectants on the material structure and protective effect of 6 different brands of protective gloves was studied. The proposed International Organization for Standardization (ISO) standard method for determining the liquid chemical resistance of air-impermeable materials was used for permeation testing. Pieces of latex and vinyl glove were also exposed to isopropanol and ethanol for 10, 30 and 60 min and then viewed in a scanning electron microscope. Isopropanol permeated through latex and vinyl gloves in less than 10 min. The polyethylene (PE) gloves were of quite variable quality, and the breakthrough time ranged from 4 to greater than 240 min. The latex and vinyl gloves were also permeated by ethanol, but at a much lower rate. The disinfectants Blifacid, based on p-chloro-m-cresol, and Cidex, based on glutaraldehyde, did not permeate any of the gloves tested within 60 min. Isopropanol had a destructive effect on the material, which became opaque, stiff and brittle. This change in structure was verified with the scanning electron microscope. The tested gloves of latex, vinyl and PE, gave acceptable protection from contact with Blifacid and Cidex for at least 60 min. The same gloves do not give any total protection from contact with isopropanol and ethanol.

Disinfectants↗
PubMed2002

Integrity of powdered and powder-free latex examination gloves.

OBJECTIVES: The difference in permeability between one brand of powdered and another of powder-free latex examination gloves was evaluated to determine leak rates. METHODS: Thirty-one of each type of glove were tested for each of three different conditions: usage by dental personnel (1) for 15 minutes or longer, (2) for less than 15 minutes, and (3) directly from the manufacturer's packaging (zero usage time). Each glove was evaluated in the fingers and the palm. The phiX-174 viral solution in the glove was allowed to penetrate for 15 minutes. Powder (cornstarch) was subsequently added to 20 powder-free gloves, and 15 of these were pierced with a 30-gauge needle. RESULTS: Powdered gloves showed no leakage rates. Because of this, 30-, 27-, and 25-gauge needles were used to pierce five gloves each. One glove with 27- and 25-gauge needle holes showed leakage. Leakage rates for powder-free gloves: 45.1 percent for more than 15 minutes of use, 25.8 percent for less than 15 minutes of use, and 16.1 percent for zero minutes of use. Two of the 20 pierced and one of the five unpierced powder-free gloves with added cornstarch leaked. CONCLUSION: Significant differences in leak results between powdered and powder-free gloves suggest further study is needed.

Bacteriophage phi X 174↗
PubMedDate not supplied

Avoiding problems: evidence-based selection of medical gloves.

Allergenic contact reaction to glove proteins and residual chemicals increased from 1980 onwards; circumstantial and technical evidence indicates that change from reusable to disposable latex gloves was a causative factor. Several protein fractions are potentially allergenic; if low protein gloves contain a dominant protein fraction, people with sensitivity may still have an adverse reaction. Use of chlorinated powder-free gloves reduces risk of allergenic reaction; other powder-free gloves may still pose a contact risk to patients. Adverse comparative tests of vinyl vs latex medical gloves may, in some cases, have used non-medical gloves without assessment of initial quality or involved an unrealistic test method; these have discouraged use of a non-allergenic alternative to latex gloves. Vinyl medical glove properties are reviewed. Nitrile examination gloves offer better protection than latex types when handling lipid-soluble substances and chemicals. Properties of medical gloves made from other materials are described.

Evidence-Based Medicine↗
PubMed1999

Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU.

STUDY OBJECTIVE: To evaluate the effectiveness of warning labels permanently attached to mechanical ventilators in improving the practice of hand washing and use of gloves by respiratory care practitioners (RCPs) in the ICU. DESIGN: The study consisted of two 4-week periods. Daily observations of hand washing and use of gloves by RCPs were made over four 1-h observation periods. Prior to the first 4-week period, the importance of hand washing and use of gloves was presented to all staff. At the end of the first period, "Wash Hands Use Gloves" labels were permanently placed on all ventilators in the ICU. The RCPs were not aware they were being observed for hand washing and use of gloves in either period. MEASUREMENTS AND RESULTS: The total number of encounters between the RCPs and patients as well as the rates of hand washing and use of gloves were obtained during the study. The rates of hand washing and use of gloves were significantly higher during the second period when labels were attached to the ventilators, as compared to the rates during the first period: hand washing, 92% vs 46% (p < 0.05); use of gloves, 92% vs 43% (p < 0.05), respectively. During the first period, the rates of pre-encounter hand washing (78%, 48%, 27%, and 29% in weeks 1 through 4, respectively) and the use of gloves (56%, 37%, 32%, and 45% in weeks 1 through 4, respectively) were primarily declining. This was not observed during the second period of the study (94%, 88%, 95%, and 92% in weeks 1 through 4, respectively) for the rates of pre-encounter hand washing and the use of gloves. CONCLUSIONS: Simple measures such as the placement of warning labels on mechanical ventilators can significantly improve hand washing and use of gloves by RCPs in the ICU.

Allied Health Personnel↗
PubMedDate not supplied

Postoperative integrity of veterinary surgical gloves.

A multicenter, prospective study was performed to document the incidence of defective gloves postoperatively in veterinary surgery and to correlate defects with a variety of influencing factors. Gloves were collected after surgical procedures performed by the small animal clinical services at two veterinary teaching hospitals and one institution's student surgery laboratories. Gloves were evaluated for defects using electrical resistance testing. The overall incidence of glove defects was 23.3%. Significantly more defects occurred in gloves used for nonsoft-tissue procedures and in gloves worn on the nondominant hand. Eighty-four percent of all defects occurred in procedures lasting >60 minutes. No differences were detected in the brands of gloves used nor among surgeons of different experience levels. The individuals performing the surgery were not able to accurately predict the presence of a defect in their gloves. Surgeons should remain alert for possible glove defects and consider measures such as changing gloves every 60 minutes or double-gloving to minimize potential complications.

Animals↗
PubMed1999

[The efficacy of repeated disinfection of disposable gloves during usage].

The efficacy of disinfecting medical gloves with isopropanol 60% (v/v) while they are worn was assessed for 4 different brands of latex gloves (Biogel Diagnistic (A), Safeskin Satin Plus (B), Safeskin LPE (C) and Baxter Non-Sterile Latex Exam Gloves (D)) and one latex-free nitrile glove (100% Nitrile N-Dex (E)). Even in the presence of coagulated blood disinfection of the gloves was more efficient than disinfection of the bare hand. The efficacy of the disinfection of glove C, D and E decreased if 10 disinfections were carried out successively. An increase of perforations detected with the water inflation test according to EN 455-1 was found for brand E. As gloves of brand C and D became tacky after 10 disinfections, they were inappropriate for manual work. As a result, disinfection with isopropanol 60% (v/v) can be recommended for gloves of brand A and B only. Disinfection of these gloves is admissible e.g. after indirect patient contact, taking blood samples or laboratory work if no visible contamination or perforation has occurred. However, after contact with patients suffering from an infectious disease or carrying multiresistant organisms the gloves have to be changed. The same holds true if the gloves might be contaminated with naked viruses (e.g. Poliomyelitis virus), since virucidal alcoholic hand disinfectants require high concentration thus leading to materials incompatibility.

2-Propanol↗
PubMed2004

The en 455-3 modified lowry assay does not yield a reliable estimate of the allergenicity level of latex gloves with low total protein content.

BACKGROUND: Estimation of the allergenicity of latex gloves by measurement of total extractable protein content with the modified Lowry method is not satisfactory. Therefore, complementary methods that are accurate, sensitive, and clinically relevant are needed. The Competitive Immunoassay for Antigenic Latex Proteins (CIALP) method described in a previous study could be a reliable complementary method for estimating the allergenicity of latex gloves. MATERIAL/METHODS: Extracts from 62 powdered or powder-free gloves (16 surgical and 46 examination) were tested by the EN 455-3 modified Lowry assay, IgE-inhibition, and CIALP. The results were compared with those from 36 glove extracts reported in a previous study. RESULTS: Significant correlations were observed between CIALP, IgE-inhibition, and the Lowry assay for the 62 glove extracts (r between 0.79 and 0.87; p<0.001), mostly rich in proteins. After inclusion of results from the previous study, significant correlations between the three methods were again observed (r between 0.76 and 0.90; p<0.001). However, there was no correlation between CIALP or IgE-inhibition and results of the Lowry assay for gloves that had a total protein content <50 micro g/g of glove. Furthermore, 15/16 extracts with undetectable total proteins were positive in both the CIALP and IgE-inhibition methods. CONCLUSIONS: The modified Lowry assay alone is useful for estimating the allergenicity of latex gloves when the total protein content is >/=50 micro g/g of glove. For gloves with a total protein content <50 micro g/g of glove, complementary methods such as CIALP are necessary.

Allergens↗