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At least 487 records · Page 27Linked to original sources

The permeability of surgical gloves to seven chemicals commonly used in hospitals.

Disinfectants may cause adverse effects directly on the skin or systemically by permeating through the skin. In this study breakthrough times were measured for surgical gloves with chemicals which are commonly used in healthcare. Classical methods of analytical chemistry were tailored for the permeation tests, which were carried out according to the European standard EN 374 and the American standard ASTM F739. An exception to the EN 374 standard was made by using a 4 h testing time instead of 8 h. The gloves did not exhibit permeation of potassium hydroxide (45%), sodium hypochlorite (13%) or hydrogen peroxide (30%). Furthermore, neither glutaraldehyde (2%) nor chlorhexidine digluconate (4%) in the commercial disinfectant solutions studied exhibited permeation. Slight permeation of peracetic acid (0.35%) and acetic acid (4%) from a disinfectant agent was observed through single layered natural rubber materials. Clear evidence of formaldehyde permeation was detected through single layered natural rubber gloves, where the ASTM breakthrough times were 17-67 min, but the permeation rates were not high enough for breakthrough to have occurred according to the EN standard. The gloves in this study which offered most protection from chemical permeation were the chloroprene gloves and the thick double layered natural rubber gloves.

Disinfectants↗

Starch, gloves and extradural catheters.

We have investigated contamination of extradural catheters during normal handling with starch powdered gloves. In the laboratory, extradural catheters were handled in sterile fields with both powdered and non-powdered gloves, simulating preparation for patient insertion. The catheters together with glove samples were then examined using a Zeiss 940 scanning electron microscope. Microscopy of samples revealed starch contamination of the catheters handled with powdered gloves, especially in the side hole areas. We conclude that extradural catheters may be contaminated easily by starch powder from surgical gloves. This powder may then be deposited into the extradural space. The effect of starch in the extradural space is not known but starch is known to cause inflammatory and granulomatous reactions in other parts of the body as well as being directly allergenic. Powder contamination of catheters may be avoided easily by the use of powder-free gloves and we feel that these should be used whenever possible.

Analgesia, Epidural↗

Glove use by orthodontists in England and Wales: changes since 1989 and comparisons with general dental practitioners.

Glove wearing during patient treatment has been considered to be an integral part of dental surgery cross-infection control routines. The degree of compliance with this recommendation was tested by distribution of a questionnaire to 1950 dentists known to be practising under the National Health Service (NHS) regulations in England and Wales. Of the dentists who replied, 40 were specialist orthodontists. Results indicated that 60 per cent of these orthodontic respondents used gloves routinely for all patients and procedures, while 25 per cent wore gloves for either selected patients or selected procedures. Fifteen per cent never wore gloves. Comparison with results from a similar survey carried out in 1989 indicated increasing compliance by the orthodontic respondents to glove-wearing recommendations. However, the levels of glove use by orthodontists was found to be lower than that of their general dental practitioner colleagues.

England↗

The routine wearing of gloves: impact on the frequency of needlestick and percutaneous injury and on surface contamination in the operating room.

The impact of wearing gloves on surface contamination and on the incidence of percutaneous injury were prospectively compared for two 4-mo periods in a single anesthesia department. Period I was immediately prior to the institution of mandatory glove wearing, and Period II followed a 1-mo adjustment period of mandatory glove use. Recording of all needlestick and other percutaneous injuries was performed on an ongoing basis, and incident reporting was actively and regularly solicited. During the final week of each period, 12 specific sites at each of nine anesthetizing locations were tested for occult blood. The incidence of needlestick injury was 0.28% for Period I versus 0.10% for Period II (P = 0.10) and the incidence for all percutaneous injuries was 0.60% for Period I and 0.27% for Period II (P = 0.06). If the one needlestick that occurred during noncompliance with gloving during Period II is eliminated, then there was a significant reduction in both needlestick and overall percutaneous injury (P < 0.05). Of 109 operating room sites, 42.2% were contaminated after Period I versus 31.2% after Period II (P = 0.07). The implementation of a mandatory glove use policy was associated with nonsignificant trends toward reduction in the incidence of needlestick and other percutaneous injury and in the level of surface contamination in the anesthesia workplace. Compliance with glove use resulted in a significant reduction in needlestick injury and overall percutaneous injuries.

Accidents, Occupational↗

Prevalence of latex sensitization among hospital physicians occupationally exposed to latex gloves.

Patients undergoing surgery who have a history of occupational exposure to latex gloves may be predisposed to intraoperative anaphylaxis caused by latex allergy. Thus, medical personnel who routinely wear latex gloves may be at higher risk than the general population. The prevalence of latex sensitization has not been reported previously among physicians using latex gloves in a North American hospital setting. Using a latex skin prick test (SPT), we determined the prevalence of latex sensitization among 101 staff anesthesiologists, radiologists, and surgeons who regularly use latex gloves and among 100 atopic controls who were not occupationally exposed to latex gloves. Latex SPT was positive in 10 of 101 physicians (rho = 0.099; 95% confidence interval [CI] 0.041, 0.157) and 3 of 100 controls. Subgroup analysis showed that 9 of 38 atopic physicians were SPT-positive (rho = 0.237; 95% CI 0.102, 0.372). Atopic physicians were more likely to be latex SPT-positive than either nonatopic physicians or atopic controls (atopic vs. nonatopic physicians: P = 0.0006, odds ratio = 19.2, 95% CI 15.4, 23.1; atopic physicians vs. atopic controls: P = 0.0005, odds ratio = 9.1, 95% CI 7.5, 11.6). We conclude that compared to nonatopic physicians exposed to latex, or nonexposed atopic controls, atopic physicians who wear latex gloves are at increased risk of latex allergy.

Adult↗

Glove perforation in pediatric orthopedic practice.

A prospective study was conducted to assess the glove perforation rate during 100 consecutive pediatric orthopedic operations. Eight hundred fifty-four gloves were tested for perforations. The overall glove perforation rate was 8.43%. Assistant surgeons had a rate of 45.8%, surgeons 33.4%, and scrub nurses 20.8%. More perforations were noticed on the left glove; the thumb and index finger were the most common sites of perforation. The duration of surgery was significantly related to the perforation rate. Two patients had postoperative wound infections and the gloves of surgeons and assistant surgeons were found to be perforated. Every attempt needs to be made to reduce the risk of glove perforation.

Equipment Failure↗

Comparison of positive pressure gloves on hand use in uninjured persons.

The purpose of this study was to examine functional hand use in uninjured adults when wearing a standard, custom-made pressure glove (SPG) as compared with a glove with select placement of suede, The New York-Presbyterian Dexterity Glove (NYPDG) (patent pending). Thirty-four participants received a custom SPG and NYPDG in a randomized order. Gloves were worn for one day during all activities of daily living (ADL). Hand function, difficulty of fine and gross motor ADL, and participant glove preference were assessed. The process was repeated approximately 1 week later with the remaining glove incorporating a quasi-experimental, repeated measure design. Data were analyzed using a crossover design. Results were significant in favor of the NYPDG in all of the four outcome categories: time to complete the Jebsen, the Jebsen Likert scale, fine motor ADL, and gross motor ADL. In conclusion, this study demonstrated that functional tasks were faster and easier to perform when using the NYPDG.

Adult↗

Survey of sulfur-containing rubber accelerator levels in latex and nitrile exam gloves.

2-Mercaptobenzothiazole and zinc dialkyldithiocarbamates are commonly used sulfur-containing rubber vulcanization accelerators known to cause allergic contact dermatitis. Exposure to these agents occurs through clothing such as undergarments and shoes, latex medical devices and latex and nitrile gloves. A simple, inexpensive screening method for total sulfur accelerator and a high performance liquid chromatographic speciation method were developed in the present study. These methods were applied to screen and quantify the sulfur accelerator content from 38 brands of 'off-the-shelf' latex and nitrile gloves obtained from commercial vendors. It was found that accelerator levels ranged from not detectable to 7.35 mg/g in the gloves analysed. Brands were found to contain single and multiple accelerator species within the glove. Powdered gloves had significantly higher accelerator levels than powder-free gloves from the same manufacturer; however, these chemical accelerators do not preferentially partition to the powder. The present analytical methodology is suitable for both manufacturing quality validation purposes, as well as for accelerator allergy research.

Allergens↗

The hevein domain of the major latex-glove allergen Hev b 6.01 contains dominant T cell reactive sites.

BACKGROUND: Sensitization to natural rubber latex (Hevea brasiliensis) is a major cause of occupational asthma and rhinitis affecting frequent latex-glove users. Hev b 6.01, a known major latex allergen, is cleaved naturally into hevein (4.7 kDa) and a C-terminal fragment (14 kDa). Hevein is an abundant protein in latex-glove extracts. As the immune response to allergens is initiated by activation of allergen-specific CD4(+) T cells, identification of dominant T cell epitopes is crucial for the development of specific immunotherapy. OBJECTIVE: To identify dominant T cell epitopes of Hev b 6.01 in latex-allergic glove users. METHODS: Ten latex-allergic frequent glove users and six non-latex-allergic atopic control subjects were selected, based on clinical symptoms and positive latex-specific serum IgE. Serum IgE reactivity to glove extract and recombinant Hev b 6.01 (rHev b 6.01) were analysed by ELISA. Latex-specific short-term oligoclonal T cell lines were generated from peripheral blood of latex-allergic subjects. These lines were tested for proliferative responses to overlapping 20-mer peptides of the Hev b 6.01 molecule. CD4(+) T cell intracellular cytokines, IL-4 and IFN-gamma were assessed following stimulation with immobilized anti-CD3 in the presence of IL-2. RESULTS: All ten of the latex-allergic patients showed serum IgE binding to glove extract while eight of these also showed IgE binding to rHev b 6.01 by ELISA. Western blotting confirmed reactivity with rHev b 6.01 at around 20 kDa. T cell proliferation assays showed that latex-specific T cell lines from all subjects responded to one or more peptides, with greatest frequency of reactivity to peptides Hev b 6.01 p(10-29) and Hev b 6.01 p(19-38) in the hevein domain. An allergic-type cytokine profile with considerable IL-4 in addition to IFN-gamma was evident from intracellular cytokine staining. CONCLUSION: Hevein is an important T cell as well as B cell immunogen and contains dominant T cell reactive sites.

Adult↗

Latex allergens in glove-powdering slurries.

Exposure to airborne glove powder contaminated with latex allergens is known to provoke respiratory symptoms in latex-sensitized individuals. In the commonly used wet-powdering process in glove manufacturing, powder is applied by dipping gloves in a cornstarch suspension, a slurry. The slurry is a potential source of allergen contamination of the powder. The protein and latex allergen contents in five different slurries and in extracts from the corresponding latex gloves were measured using the BCA assay and the IgE antibody inhibition assay (EAI assay). Latex allergens were found in all slurries and gloves. No correlation between the values of protein contents and allergen contents was found. Wet powdering of gloves induces a risk of latex protein contamination of the cornstarch.

Adult↗

What is "powder free"? Characterisation of powder aerosol produced during simulated use of powdered and powder free latex gloves.

OBJECTIVES: To characterise the distribution of particle size and mass of glove powder aerosol released from powdered and powder free non-sterile latex gloves under controlled conditions. METHODS: Gravimetric sampling and aerodynamic particle size analysis were performed during simulated use of gloves on a prosthetic hand in a chamber designed to minimise background particle concentrations. RESULTS: Aerosol was detectable for both powdered and powder free gloves under both aggressive and non-aggressive handling conditions. Most of the particles detected had aerodynamic diameter less than 10 microm. CONCLUSION: Powder free gloves were not entirely free of powder aerosol. Particles from both powdered and powder free gloves are sufficiently fine to penetrate into the thoracic region of the respiratory tract.

Air Pollutants, Occupational↗

Radiation-attenuating surgical gloves: effects of scatter and secondary electron production.

PURPOSE: To evaluate the effects of scatter and secondary electron production on the protection provided by flexible radiation-attenuating gloves. MATERIALS AND METHODS: Four sets of radiation-attenuating flexible gloves and one set of standard surgical gloves were tested for scattering characteristics and secondary electron production caused by the interactions of x rays inside the gloves. A thin-window ion chamber was used to measure the penetration of secondary electrons in polyethylene. A diagnostic-type chamber was used to measure forward-scattered and backscattered x rays produced by the gloves. RESULTS: Forward-scattered and backscattered x rays added an average of about 13% to the exposure of the hands. Secondary electrons increased the signal in the thin-window chamber by large factors but were weakly penetrating, and only a small fraction produced by x rays of 90 kVp and higher energies contributed to dose to basal cells. CONCLUSION: Forward-scattered and backscattered x rays reduce the effectiveness of radiation-attenuating gloves, and secondary electron dose to basal cells in the back of the hand can further reduce effectiveness.

Absorption↗

Permeability testing of glove materials for use with cancer chemotherapy drugs.

The present study evaluated the effectiveness of several types of hospital gloves that are recommended by the manufacturers for handling chemotherapy drugs. Gloves were examined for permeability against five cancer chemotherapy drugs (doxorubicin, cyclophosphamide, 5-fluorouracil, carmustine, and cisplatin) at several time points up to 2 h using a bacterial mutation assay as the measure of permeation. Of the 5 types of gloves tested at a single thickness, 4 were completely impermeable to all drugs and the remaining 1 demonstrated only limited permeability. A latex examination glove used for comparison was permeable to carmustine. One glove material that was tested as a double thickness was impermeable to the 5 drugs. Results indicate that various types of gloves may offer protection against exposure to chemotherapy drugs for healthcare workers.

Antineoplastic Agents↗

Surgical gloves. How do you change yours?

Surgical gloves are frequently changed intraoperatively, and different techniques exist. We surveyed surgeons and scrub staff in our hospital and prospectively compared contamination between two glove changing techniques. We questioned 25 surgeons and 25 scrub staff regarding their intra-operative glove changing technique. Twenty scrub staff performed a standard 'surgical scrub', following which aliquots of fluorescent powder were applied symmetrically to each forearm prior to donning gown and gloves. Subjects were randomised to group 1-open technique (OT) followed by closed technique (CT), or group 2-CT followed by OT. Following unassisted glove change, glove and hand contamination was assessed.

Attitude of Health Personnel↗

Bronchial provocation testing in the diagnosis of occupational asthma due to latex surgical gloves.

In sensitized subjects, provocation tests to latex may induce severe systemic reactions and even anaphylactic shock. It is probable that part of the risk is due to the difficulty in grading the stimulating dose and in starting from very low levels of exposure. To identify the aetiological agent of work-related asthma in four nurses with previous allergic contact urticaria to latex surgical gloves dusted with cornstarch powder, we performed a specific bronchial provocation test study, based on exposure on three different days to nonpowdered latex surgical glove extract, powdered latex surgical glove extract and cornstarch powder extract, respectively. Extracts were nebulized in increasing concentrations in a 7 m3 challenge room, in the absence of the patients. The initial extract concentration was a tenfold dilution of the predetermined skin test end-point in the individual undergoing challenge, and the highest concentration was the undiluted extract. After exposure, the patients' forced expiratory volume in one second (FEV1) was monitored for 2 h. If FEV1 decreased by at least 15%, the next scheduled exposure was not carried out and FEV1 was monitored over a period of 24 h. Whereas nebulization of cornstarch powder extract caused no bronchial reaction in the patients, nebulization of nonpowdered latex surgical glove extract induced immediate bronchoconstriction in two subjects as an undiluted solution, and nebulization of powdered latex surgical glove extract induced immediate bronchoconstriction in all subjects at the 1:10 dilution. No systemic reaction was elicited by the bronchial provocation challenges. Our results demonstrate that airborne powder from latex gloves can be an inhalative occupational hazard.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Rationalizing the purchase and use of gloves in health care.

The last two decades have seen a substantial increase in the use of protective gloves in healthcare establishments. This is attributed to the widespread publicity regarding the risks of transmission of human immunodeficiency virus and hepatitis B and C from blood and body fluid contact. Further, directives from official agencies stressing the need to protect staff from blood-borne viruses in the workplace led to the introduction of a variety of disposable gloves, each claiming total or adequate protective ability. The resulting sensitization to latex in some users has caused concern. This article reports on the process used within one NHS trust to explore glove use and determine the level of latex sensitization among staff. The audit identified an irrational approach to glove purchasing as well as inappropriate use of different types of gloves. The audit was followed by a trial aimed at rationalizing both the purchase and use of gloves.

Cross Infection↗

Patients' attitudes towards the use of gloves by healthcare staff.

There is a concern among healthcare providers regarding the use of gloves in non-mandated clinical situations and its impact on patient sensitivities. A convenience sample of 76 Israeli hospital inpatients were surveyed to measure patients' attitudes towards the use of gloves by healthcare providers. The Patient Sensitivity Questionnaire (PSQ) was developed and used to collect the data. Overall, patients were found to have a positive attitude towards the use of gloves in most patient care situations. Significant differences in patient attitudes towards glove use were found based on country of origin and number of hospital admissions in the previous year. The study concluded that hospitalized patients, in general, support healthcare providers' use of gloves. In addition, subjects agreed with the (American) Occupational Safety and Health Administration regulations regarding glove use.

Attitude to Health↗

Prevalence of perforations in disposable latex gloves during routine dental treatment.

Durability of gloves with respect to reducing cross-contamination and decreasing the risk of occupationally acquired infections was studied. In this study, pinholes were found in 1.8% of unused surgical latex gloves and 2.0% of latex examination gloves. The incidence of pinhole defects in gloves emphasizes the importance of operative techniques that minimize stress to the glove and the need to change gloves, especially for procedures lasting more than 2 hours.

Acrylic Resins↗