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Glove thermal insulation: local heat transfer measures and relevance.

When exposed to cold, the hands need to be protected against heat loss not only in order to reduce thermal discomfort, but also to keep their efficiency. Although gloves are usually the most common protection, their thermal insulation is generally unknown. The aim of this study was to measure the heat losses from a gloved hand with a special interest in local variations. Using a calorimetric hand placed in a cold box, several types of gloves were tested. The results indicated that depending on the glove and on the area covered the heat loss reduction may vary from almost 60% to 90%. When the least efficient pair of gloves was excluded, heat exchange coefficients varied from 1.8 to 4.8 W/m2 per degrees C for the palm and from 4.2 to 6.2 W/m2 per degrees C for the back of the hand. The three medium fingers seemed to be equally treated, with a heat exchange coefficient variation of 6.3-9.0 W/m2 per degrees C. The thumb and the little finger, which require better insulation, exhibited higher local heat transfer coefficients of 8.3-12.7 W/m2 per degrees C. Some practical aspects are evoked.

Calorimetry↗

Glove punctures in an orthopaedic trauma unit.

A series of 421 operations in an orthopaedic trauma unit have been studied for glove punctures; 37.5 per cent of operations had a puncture demonstrated in the surgeon's gloves. The procedures at a high risk of glove punctures were hip operations (57 per cent) and internal fixation (54 per cent). The use of double gloving reduced the contamination of the surgeon's hand in these operation groups to 17 per cent (P less than 0.05). The potential risk of the surgeon being infected by his patients has become increasingly important with the increase in the number of people infected with HIV. The trauma surgeon is at a high risk due to frequent spillage of body fluids in trauma and the difficulty in identifying patients who may be at risk. Reducing the risk to the surgeon is difficult but awareness of the areas of potential contamination such as glove puncture may help.

Cross Infection↗

Characterization of latex antigens and allergens in surgical gloves and natural rubber by immunoelectrophoretic methods.

Allergy to natural rubber (latex) products is increasingly frequent among both medical personnel and lay subjects. Although individual antigens and allergens in latex products have not been fully characterized, they are believed to derive from the sap of the rubber tree. Rabbit IgG and human IgE antibodies against rubber proteins were used to characterize antigens and allergens in surgical latex gloves and natural rubber by crossed immunoelectrophoresis and its modifications. The results from crossed-line immunoelectrophoresis demonstrated that the surgical latex gloves had at least 10 antigens in common with natural rubber sap and ammoniated latex. In crossed radioimmunoelectrophoresis, at least six of the 10 protein antigens in the surgical glove extract and natural rubber were allergens since they bound IgE antibodies from the latex-allergic patients' sera. The surgical glove extract also demonstrated one allergen not found in natural rubber, suggesting that rubber proteins may be altered during glove manufacture.

Animals↗

What is in the surgeon's glove?

Three aspects of surgical hand hygiene have been studied: the attitude of the surgeon, the microbiology of glove changing during an operation, and the use of antiseptic-coated gloves together with different handwash routines. The survey revealed that the predominant factor in choice of agent for surgical hand hygiene was skin tolerance. The microbiological studies showed that 'closed' glove changing was to be preferred to 'open' changing, and that antiseptic-coated gloves further suppressed the skin flora, even after prolonged operations, compared to standard gloves.

Anti-Infective Agents, Local↗

Quantitative determination of endotoxins on surgical gloves.

The amount of endotoxin on surgical gloves was investigated by the limulus chromogenic substrate method. Heavy endotoxin contamination was observed on the outside of certain surgical gloves sold in Sweden. Given an endotoxin absorption of 10% to the patients, one of the types of gloves studied would cause fever, chills, headache and muscle pain. The amount of endotoxin on the gloves could be minimized by rinsing in endotoxin-free water. We conclude that the manufacturing process of latex gloves should be checked microbiologically for Gram-negative bacteria before sterilization. Alternatively, the amount of endotoxin should be checked on the product by the limulus ameobocyte lysate test before release.

Endotoxins↗

A survey of glove preferences of general and orthopaedic surgeons in North West Thames Regional Health Authority.

The glove preferences of all the consultant surgeons and consultant orthopaedic surgeons in North West Thames were surveyed by questionnaire. Responses were received from 59 of 78 general surgeons and 47 of 55 orthopaedic surgeons. Twenty-two percent of general surgeons never double gloved compared with 4% of orthopaedic surgeons (P < 0.01). Seventy-three percent of general surgeons double gloved for 'high risk' patients compared with 17% of orthopaedic surgeons (P < 0.001). When double gloving the majority of surgeons (67%) used their normal sized glove inside and half a size larger on the outside.

Attitude of Health Personnel↗

Effects of a protective foam on scrubbing and gloving.

OBJECTIVE: To test the effects of a skin protectant on surgical scrub and glove integrity. DESIGN: Forty-nine healthy adult volunteers were assigned (12 subjects per group) to apply a protective foam (DermaMed; Benchmark Enterprises, Salt Lake City, Utah) in conjunction with surgical scrub in one of the following formulations: 70% isopropyl alcohol, a liquid detergent base containing 4% chlorhexidine gluconate, a liquid detergent base containing 7.5% povidone-iodine, or a nonantimicrobial liquid soap (control). According to a standard protocol, subjects performed a surgical scrub on 3 days (every other day). Foam was applied after surgical scrub on day 1 and before surgical scrub on day 3. No foam was applied on day 2. Subjects were gloved for 2 hours after surgical scrub. SETTING: Laboratory setting. RESULTS: On all test days, there were significant differences in bacterial reduction by products (chlorhexidine gluconate or alcohol > povidone-iodine > control). When controlling for baseline counts and products used, there were no significant differences in colony-forming unit counts on hands with or without foam immediately after scrubbing or at 2 hours after scrub on gloved or ungloved hands, nor were there differences in glove leakage rates when foam was on hands. CONCLUSIONS: Such protectants can be used without detrimental effects to scrub effectiveness or glove integrity.

1-Propanol↗

Permeation of Telone EC through protective gloves.

Telone is a potent fumigant that is based on the chlorinated unsaturated hydrocarbon, 1,3-dichloropropene (1,3-DCP). It is often applied without dilution and so poses severe inhalation and air pollution threats. Urinary metabolites of 1,3-DCP have been detected after Telone skin exposure, so that preventing dermal exposure is also important. The objective of the study was to assess if nitrile and multi-layer ("laminated") gloves provide adequate protection against Telone EC formulation. To accomplish this, disposable (Safeskin) and chemically resistant (Sol-Vex) nitrile and laminated (Barrier mark and Silver Shield) glove materials were challenged by Telone EC with hexane liquid collection in an ASTM-type I-PTC-600 permeation cell. Analyses of cis- and trans-1,3-DCP in the collection fluid at specified times were performed on a moderately polar capillary column by gas chromatography-electron capture detection. Telone EC caused microholes in both nitrile materials, though the chemically protective material was degraded slower than the disposable nitrile. The laminated gloves offered limited protection. Silver Shield protected best because 1.5-2.3 mg 1,3-DCP permeated by 8 h relative to 2.5-7.6 mg for Barrier, implying about 2.5 times more protection for 8 h. Even for Silver Shield, the extent of protection was inadequate as illustrated by a risk assessment of the skin exposure situation. The normalized breakthrough times for both types of laminated gloves varied between 27 and 60 min. It is recommended that Viton gloves still be worn for protection.

Allyl Compounds↗

Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission?

Improvement in hand hygiene compliance is important for reducing cross-infection by micro-organisms. The objective of this prospective observational study was to measure how the improper use of gloves limits compliance to hand hygiene and exposes patient's to infection. The study was conducted in five wards (three intensive care units and two medical wards) in a French university hospital. Staff-patient and staff-environment contacts were observed in 120 healthcare workers caring for patients colonized or infected with pathogenic bacteria. Hand hygiene was not undertaken due to improper gloving in 64.4% (95%CI, 64.1% to 65.1%) of instances. Possible microbial transmission might have occurred in 18.3% (95%CI, 17.8% to 18.8%) of all contacts because used gloves were not removed before performing care activities that necessitated strict aseptic precautions. Failure to change or remove contaminated gloves was a major component in the poor compliance with hand hygiene and carried a high-risk of microbial transmission. Improving hand hygiene compliance will require changing healthcare workers behaviour towards glove use.

Anti-Infective Agents, Local↗

Prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among obstetrics and gynaecology workers in rural China.

This study identified the prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among rural obstetrics and gynaecology workers in two poor counties in Anhui, China. A cross-sectional survey was conducted using a self-administered anonymous semi-structured questionnaire. The study population included all health workers in the departments of obstetrics and gynaecology in township hospitals and county health facilities. Among the 137 participants, the rate of non-compliance with glove utilization was 61%, the rate of non-compliance with hand hygiene was 40%, and the rate of non-compliance with both was 67%. 'Unnecessary and inconvenient' accounted for 66% of the reasons for not always using gloves and 71% for not always washing hands. 'Short of gloves or water' accounted for 15% and 22% of reasons, respectively. Two variables were associated with non-compliance: county [odds ratio (OR)=11.56, P<0.001] and knowledge (OR=0.10, P=0.033). After removing county from the regression model, institutional level (OR=2.34, P=0.059), institutional support (OR=3.85, P=0.009) and knowledge (OR=0.05, P=0.007) were associated with non-compliance. The prevalence of non-compliance with glove utilization and hand hygiene was high. The risk factors for non-compliance were institutional level, institutional support and knowledge. These variables incorporated both subjective and objective reasons for non-compliance.

Adult↗

Indirect latex glove contamination and its inhibitory effect on vinyl polysiloxane polymerization.

STATEMENT OF PROBLEM: The inhibitory effect of indirect latex contamination on the polymerization of vinyl polysiloxane (VPS) impression material has been previously reported. However, the transfer of specific elements that cause inhibition has not been confirmed, nor has the removal of such contaminants been reported. PURPOSE: This study examined the surfaces of materials commonly used in restorative procedures that were contaminated by indirect latex glove contact and then evaluated for inhibition of polymerization of VPS. The effect of selected cleansing procedures was then studied. MATERIAL AND METHODS: Four experimental groups (n = 8) were prepared: (1) clean vinyl gloves (control), (2) clean gingival retraction cords (control), (3) contaminated vinyl gloves, and (4) contaminated gingival retraction cord. Microscopic evaluation of the appearance and the characterization of surface particulate contamination were performed for each. Three cleansing protocols were then evaluated for efficacy in cleaning vinyl glove surfaces contaminated by latex contact (n = 10): (1) brushing with water, (2) brushing with soap/rinsing with water, (3) cleansing with rubbing alcohol. The subsequent degree of VPS polymerization inhibition was evaluated subjectively. A chi-square test was used for data analysis (alpha=.05). RESULTS: Particulate sulfur elements and sulfur-chloride compounds were present on the contaminated substrates. None of the 3 cleansing procedures eliminated polymerization inhibition (P =.33). Residual elemental sulfur remained on all tested surfaces. CONCLUSION: Particulate sulfur and sulfur-chloride compounds were identified as the particulate contamination that resulted in polymerization inhibition of the tested VPS dental impression material. Removal of these contaminants from the tested vinyl gloves and gingival retraction cord was not possible with the 3 cleansing protocols tested in this study.

2-Propanol↗

Health effects associated with medical glove use.

Adverse reactions to medical gloves represent an important public health issue. Accordingly, there is increasing interest in understanding the information reported to the US Food and Drug Administration (FDA) describing health effects associated with the use of medical gloves. This article provides a retrospective analysis and summary of health effects associated with medical glove use reported to the FDA. The FDA's medical device adverse event databases were searched via computer using keywords to identify reports of reactions associated with any type of medical glove. Demographic and clinical information abstracted from these reports was used to perform frequency and trend analyses. The reported medical glove-related events, including the noted trends in reporting, suggest the need for further study and continued monitoring of such reports.

Adult↗

Barrier protection and latex allergy associated with surgical gloves.

Latex continues to be the material of choice for surgical gloves because it is resealable and flexible, and it maintains the wearer's tactile sensitivity. The use of latex gloves for barrier protection may need to be reevaluated in light of the increasing number of individuals who are sensitive to latex. Hospital personnel can use low-allergen gloves or nonlatex gloves when caring for patients with known sensitivity to latex; however, only nonlatex gloves may be effectives at reducing or preventing anaphylactic reaction. Health care facilities must develop policies and procedures for dealing with latex-sensitive patients and health care workers.

Gloves, Surgical↗

[The advent of surgical gloves].

The advent of surgical gloves had a double evolution. Evolution of the material: cecum of a sheep, cotton, silk, leather, rubber. Originally introduced to protect theatre staff's hands from corrosive solutions, subsequent use was to protect the patient from contamination by theatre staff. Many surgeons contributed to the evolution of the surgical gloves. The use of gloves was truly part of an evolutionary process than a discovery. The turning of surgical gloves is now incontestable, and their use more and more important. Surgical gloves must secure a crossing protections between surgeon and patient.

Caustics↗

Factors influencing murine embryo bioassay: effects of proteins, aging of medium, and surgical glove coatings.

The 2-cell murine embryo bioassay as quality control for human in vitro fertilization (IVF) was used to evaluate the effects of protein supplements, medium aging, and surgical glove coatings. Ham's F-10 medium (GIBCO, Grand Island, NY) without protein supplementation supported growth of the 2-cell embryos to blastocysts. Addition of bovine serum albumin (BSA), fetal cord serum (FCS), or maternal serum (MS) did not enhance or reduce the blastulation rates (medium alone, 89.4%; BSA, 86.4%; FCS, 90%; MS, 74.7%). Unsupplemented Ham's F-10 medium was found to contain three major peaks of approximately 50,000 daltons and several minor peaks, analyzed on high-performance liquid chromatography (HPLC) and sodium sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), suggesting the presence of protein(s) in the medium itself. The storing of medium up to 425 days at 4 degrees C affected neither the HPLC profile nor its ability to support embryo growth (blastulation rates: fresh, 84%; stored 150 to 425 days, 77.7%). The coating of surgical gloves affected embryo growth. Both talc-coated (TC) and "talc-free," starch-coated (SC) surgical gloves were found to be progressively embryotoxic when they touched the medium for increasing lengths of time, compared with uncoated latex (UL) gloves and untouched control medium. Quality control of medium preparation and handling in murine embryo bioassay is reemphasized, with requirements for protein supplementation, use of fresh medium, and possible contamination with even talc-free, SC surgical gloves reevaluated.

Animals↗

Assessment of the efficacy of Proguard RR-2 radio-protective gloves during forearm manipulation.

The hazards of ionising radiation are well known and precautions, such as lead aprons and thyroid shields are routinely used. Orthopaedic surgeon's hands are at particular risk from direct and scatter radiation, when manipulating forearm fractures, due to the proximity of the image intensifier. The use of lead gloves has been recommended in the literature but are seldom employed. Proguard RR-2 gloves provide similar tactile sensitivity to double gloves and are claimed by the manufacturer to provide up to 55% protection in vitro at a direct beam energy level of 60 kV. This claim was tested in a clinical setting. The gloves were worn during forearm manipulations and the radiation dose measured using thermoluminescent dosimeters (TLDs). The results demonstrated a radiation attenuation of 60-64%. These gloves appear to achieve a good compromise between protection and sensitivity and should be included in routine protection against ionising radiation during MUA.

Equipment Design↗

Risk factors for the development of encapsulated filtering blebs. The role of surgical glove powder and 5-fluorouracil.

PURPOSE: To study risk factors for the development of encapsulated filtering bleb, especially the effect of surgical glove powder and 5-fluorouracil on the development of encapsulated blebs. METHODS: One hundred forty-eight patients who underwent trabeculectomy were prospectively studied. After patient of each surgeon were divided into two subgroups of 5-fluorouracil versus no 5-fluorouracil, each subgroup was then randomized for powder versus powder-free surgical gloves. All patients were followed for at least 2 months (mean, 3.5 months; range, 2-10 months). RESULTS: The overall incidence of encapsulated bleb was 11.2% when an encapsulated bleb was defined by clinical characteristics with a peak intraocular pressure of 26 mmHg or higher. The group that received 5-fluorouracil had a lower incidence of encapsulated blebs despite a higher rate of previous surgeries, whereas the group with powdered gloves had increased incidence. The subgroup in which powder-free gloves were used in conjunction with postoperative injections of 5-fluorouracil had the lowest incidence of encapsulated blebs (2.6%) compared with the other subgroups (12.0%-17.9%) (P = 0.01). CONCLUSION: Combined use of powder-free surgical gloves and 5-fluorouracil may reduce the incidence of encapsulated bleb.

Adult↗

Use of gloves among dermatologists.

Despite evidence that rubber or latex surgeon's gloves appear to prevent or reduce the transmission of hepatitis B virus, physicians continue to perform surgical procedures without wearing gloves. Surveys regarding glove usage among members of the American Academy of Dermatology revealed that a majority of those responding do not regularly wear gloves while performing basic dermatologic procedures, such as shave and punch biopsies and curettage and desiccation. Others are still not wearing gloves regularly while performing excisional surgery, hair transplants, and dermabrasion procedures.

Dermatologic Surgical Procedures↗