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Natural rubber latex: glove use, sensitization, and airborne and latent dust concentrations at a Denver hospital.

Exposure to natural rubber latex may cause immediate hypersensitivity reactions. Published latex sensitization prevalence rates range from 2.9% to 22% among health care workers, and from 0.12% to about 20% of occupationally unexposed populations. In this study, self-administered questionnaires addressed job and personal characteristics, glove use, and symptoms in two groups of hospital workers: those who regularly used latex gloves and those who did not. Serum was tested for latex-specific immunoglobulin E. Air, surface, and air-filter dust samples for natural rubber latex were collected. The prevalence of latex sensitization was 6.3% in the non-users and 6.1% in the latex glove users (P = 0.9); 81.3% of sensitized workers were atopic compared with 59.5% of non-sensitized workers (P < 0.05). Reporting of work-related hand dermatitis was more common in the latex glove users (23.4%) than in the non-users (4.9%), as were rhino-conjunctivitis (16.3% and 7.9%, respectively, [P < 0.01]), and hand urticaria (9.9% and 2.1%, respectively, [P < 0.01]). There was no significant difference in work-related symptoms between the sensitized and non-sensitized workers. Environmental concentrations of latex were higher in the work areas of the non-sensitized workers, but higher in the clinical than in the non-clinical areas. Occupational latex glove use was not a risk factor for sensitization.

Adult↗

Occupational allergic contact dermatitis from bisphenol A in vinyl gloves.

Allergic contact dermatitis caused by polyvinyl chloride gloves is rarely reported, and in only 2 cases was bisphenol A considered to be the responsible sensitizer. We report a patient with occupational hand dermatitis after the use of a new type of high-density vinyl (HDV) gloves. Patch tests showed positive (++) reactions to both used and new HDV gloves and to bisphenol A. Chemical analysis by gas chromatography-mass spectrometry demonstrated the presence of bisphenol A in the HDV gloves. Replacement by nitrile rubber gloves resulted in complete clearance of the hand dermatitis.

Adult↗

Immediate allergy to rubber gloves: a questionnaire study of hospital personnel.

We conducted a questionnaire study of immediate allergy to natural rubber gloves among 2,408 medical workers who had used rubber gloves at Kumamoto University Hospital and allied hospitals. The response rate was 64.5% (1,321 workers). Among them, 8.5% (7.0-10.0% at 95% confidence limit) replied that they had experienced immediate allergy to rubber gloves. There were significant correlations among the frequency of rubber glove use, a history of atopic dermatitis or contact dermatitis, and the presence of skin lesions due to allergic reactions to rubber gloves. In 27 workers, skin lesions were associated with general symptoms. Of 59 workers who experienced immediate allergy and were tested for latex-specific IgE, 4 persons were positive. We conclude that the frequency of contact allergy to natural rubber products is substantially prevalent among Japanese hospital personnel and that education and awareness of this allergy are important.

Dermatitis, Allergic Contact↗

A novel digital tourniquet using a sterile glove and hemostat.

BACKGROUND: Surgery of the digit is facilitated with adequate hemostasis for visualization of the operative field. Several types of tourniquets have been used for this purpose, including glove fingers, Penrose drains, Marmed digital tourniquets, and standard pneumatic tourniquets. OBJECTIVE: To present a novel method to achieve hemostasis during surgery of the digit. MATERIALS: A slightly oversized sterile glove, a hemostat, and a pair of scissors. CONCLUSION: We present a novel method to achieve hemostasis using a sterile glove and a hemostat, that allows the surgeon to methodically titrate the amount of compression necessary to attain a bloodless field while minimizing the risks of excessive pressures. Surgery of the digit is facilitated with adequate hemostasis for visualization of the operative field. Several types of tourniquets have been used for this purpose, including glove fingers, Penrose drains, Marmed digital tourniquets, and standard pneumatic tourniquets. We present a novel method to achieve hemostasis using a sterile glove and a hemostat that allows the surgeon to methodically titrate the amount of compression necessary to attain a bloodless field while minimizing the risks of excessive pressures.

Fingers↗

Sterile versus nonsterile gloves during Mohs micrographic surgery: infection rate is not affected.

BACKGROUND: Mohs micrographic surgery (MMS) is an outpatient procedure that has become the treatment of choice for certain cutaneous malignancies. Although the major steps in this procedure are relatively standardized, one difference involves the use of sterile or nonsterile, clean gloves during the tumor removal phase. OBJECTIVE: This retrospective chart review study was performed to evaluate whether infection rates are affected by the use of sterile versus nonsterile gloves in the tumor extirpation phase of MMS. METHODS: This study evaluated the surgical records of 1,810 consecutive Mohs patients, of which 1,239 Mohs patients (1,400 Mohs procedures) met inclusion criteria. Age, sex, tumor diagnosis, anatomic location, number of Mohs stages, area of the defect, closure type, cartilage exposure, and sterile versus nonsterile glove use were recorded and evaluated. RESULTS: Twenty-five infections were identified. Statistically significant infection rates were discovered for patients with cartilage fenestration with secondary healing and malignant melanoma diagnosis only. There was no statistical difference in infection rates with all other measured variables to include the use of sterile or clean, nonsterile gloves. CONCLUSION: Our study lends support to the contention that clean, nonsterile gloves are safe and effective for use in the tumor extirpation phase of MMS, at a significant cost savings.

Adult↗

Discomfort from rubber gloves indicating contact urticaria.

Rubber glove intolerance is a common dermatological problem and hypersensitivity of both delayed and immediate types occur. In order to study immediate skin reactions induced by rubber gloves, 15 patients with discomfort and itch produced by rubber gloves were examined. The patients were provoked by wearing rubber gloves, scratch tested with gloves, rubber chemicals and powders. RAST-tests were performed using an extract from the rubber tree (Hevea brasiliensis). In 6/15 patients, contact urticaria was confirmed, in 3 of whom IgE antibodies to latex were demonstrated.

Adult↗

Incidence of immediate allergy to latex gloves in hospital personnel.

Latex surgical gloves may cause contact urticaria and serious allergic reactions in sensitized persons, but the frequency of this allergy is not known. In the present study, 512 hospital employees were screened with a latex-glove scratch-chamber test; 23 (4.5%) were suspected and 15 (2.9%) were proven allergic with latex prick and use tests. All of them were doctors and nurses, and 12 had had contact urticaria but no serious symptoms. They could continue their routine work using cotton or vinyl undergloves or special latex surgical gloves. Atopy, hand eczema and surgical work seemed to be predisposing factors. In operating units, 7.4% of the doctors and 5.6% of the nurses were allergic; the frequency was lower in non-operating units and among laboratory personnel. The high frequency of latex glove allergy, especially in operating units, focuses attention on the quality of surgical latex gloves.

Adolescent↗

The effects of protective occlusive gloves on stratum corneum barrier properties.

Data suggests that protection from gloves is paradoxically reduced because of effects of occlusion on the skin. The aim of this study was to characterize these effects on physical and functional properties of stratum corneum. Volunteer trials were conducted using patches of polyvinyl chloride (PVC) glove material on the skin. Impairment of barrier function was assessed by measuring transepidermal water loss (TEWL). Hydration and water sorption-desorption was assessed using skin conductance. The major finding was a short-term impairment of barrier function, measured as an increase in TEWL of 1.7 gn-2h-1 (95% C.I. 0.4 to 2.6 gn-2h-1,p < 0.01). Temporary increases in hydration and water sorption were also observed. On this basis, the effects of wearing PVC gloves over 2 days on stratum corneum barrier properties on the dorsum of the hand were studied. TEWL measurements remained elevated by 1.5 gn-2h-1 the day after occlusive glove removal (95% C.I. 0.2 to 2.8 gn-2h-1, p < 0.01), indicating a possible cumulative effect. In conclusion, our studies demonstrate a potential hazard resulting from the repeated use of protective gloves.

Adult↗

Atopy and other risk factors for UK dentists reporting an adverse reaction to latex gloves.

A study was conducted to assess the significance of a personal history of atopy and other risk factors for UK dentists reporting an adverse reaction to natural rubber latex (NRL) gloves. 2535 dentists completed a self-administered questionnaire and, of these, 1034 (group 1) reported an adverse reaction to NRL gloves and 1501 (group 2) did not. Risk factors investigated were: sex, years in clinical practice, exposure to gloves and a history of atopy or food allergy. The signs and symptoms reported by group 1 dentists were recorded. Logistic regression analysis was used to identify a set of risk factors that produced the most discrete model for a dentist reporting an adverse reaction to NRL gloves. A personal history of atopy was a significant risk factor. Dentists with a history of eczema and hand eczema in childhood were most likely to report an adverse reaction to NRL gloves.

Adult↗

Pyrogens from surgeons' sterile latex gloves.

Pyrogens have been detected in water extracts from surgeons' sterile latex gloves, using both the Limulus Amebocyte Lysate (LAL) test and the rabbit test. After the gloves were rinsed with pyrogen-free water, the amount of pyrogens in extracts was markedly reduced. Pyrogens could also be detected in extracts from an angiographic catheter after it had been handled with latex gloves, whereas an unused catheter was free from pyrogens. The incidence of febrile reactions in our catheterization laboratory has been markedly reduced from 11.6% to 0.6% when rinsing the latex gloves prior to the catheterization was included in our routine procedure. So far the absence of pyrogens in surgeons' sterile gloves has not been demanded. Our observations indicate that such a requirement may be justified.

Animals↗

Study of how frequently surgeons' gloves are perforated during operations.

Surgical gloves were collected after 231 first opinion and referral surgical procedures performed at the University of Liverpool Small Animal Hospital. They were tested for defects by the water load test and the site of any defects was recorded; 10.2 per cent of the gloves had defects, and at least one glove became defective during 51 (22.1 per cent) of the surgical procedures. Significantly more defects occurred during orthopaedic procedures and the likelihood of a defect occurring increased with the duration of the surgical procedure. The majority (78 per cent) of the defects occurred in the gloves worn on the non-dominant hand and 64 per cent of them were in the index finger. The surgeon or assistant was aware of a glove being punctured in only 3.8 per cent of cases.

Animals↗

Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987-1998.

BACKGROUND: Occupational reaction to natural rubber latex (NRL) glove use by healthcare employees has been an area of increasing concern. Unfortunately, there is little data demonstrating the prevalence and severity of actual reactivity to NRL. METHOD: Occupational reaction to NRL was estimated using workers' compensation claims filed by healthcare employees in Oregon for the period of 1987-1998. For the first ten years, these claims were estimated by source and conditions consistent with NRL glove reactions, while in the last two years a specific code developed in 1997 for NRL glove reactions was also employed. RESULTS: The claim rate was on average 0.58 per 10,000 healthcare workers annually, which constituted 0.29% of all workers' compensation claims. The most common condition experienced was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions were minor in nature, although one fatality was reported. The average NRL claim cost was $8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per year. The occupational groups with the highest number of claims were nurses (30.8% of claimants) and nursing aides and orderlies (24.6% of claimants). CONCLUSIONS: In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or conjunctival reactions to NRL gloves are common.

Adult↗

Biogel Super-Sensitive and Biogel Indicator glove systems.

Surgical gloves have been in use since the late 19th century. Initially, gloves were introduced to protect clinical staff from the carbolic acid used to sterilize equipment and prepare skin before surgery. During the mid-20th century emphasis was more towards protecting the patient from the clinician's skin flora and now, at the beginning of the 21st century, the balance lies between protecting the patient from the clinician and the clinician from the patient. The three main types of glove are latex, vinyl and polythene and they can be used singly or as part of a double gloving system. This article discusses how one hospital evaluated the glove systems Biogel Super-Sensitive and Biogel indicator underglove from Regent Medical (a division of SSL International). The results indicate that both systems are acceptable to clinical staff in a variety of specialty areas.

Gloves, Surgical↗

The appropriate use of gloves to reduce allergies and infection.

Twenty years ago, the wearing of gloves for non-sterile procedures was viewed as insulting to the patient as it made him/her feel 'unclean'. Today, gloves are worn for all procedures and are often wastefully used. There must be a fine balance between inappropriate and appropriate use of gloves and between the use of latex gloves for comfort and fine movements vs the potential for latex allergies. This article will review the use of synthetic and latex gloves and examine some of the related issues.

Gloves, Protective↗

Operating gloves. The good and the bad.

The use of gloves in all types of dentistry has been a major benefit to both patients and dentists. However, operating gloves are not without challenges. Tight ambidextrous gloves can produce significant and debilitating hand pain; latex allergies are a problem for many dental personnel and patients; and the disagreeable taste; odor and powder of some brands of gloves has frustrated both professionals and patients. In spite of the challenges that glove use poses, it offers many advantages--foremost among them the protection of patient and dentist alike from infection.

Functional Laterality↗

The effect of glove contamination on the bond strength of resin to enamel.

Over the past twenty years infection control protocol has evolved and use of gloves is now mandatory. Practitioners have become aware of potential interactions between the latex gloves and many of the dental material used as well as the potential for contamination from the gloves. The purpose of this study was to evaluate the shear bond strength of bonded restorations to enamel of uncontaminated and contaminated resin adhesive with powder free and powdered latex gloves. The results of the study demonstrated that the resin bonding agent that was in contact with either powdered or non- powdered latex gloves did not have a significant effect on the shear bond strength of the bonded restoration.

Acid Etching, Dental↗

AIDS prevention: improving nurses' compliance with glove wearing through performance feedback.

A performance feedback procedure was used to increase glove wearing by nurses in a hospital emergency room in situations in which contact with body fluids was highly likely. Infection-control nurses provided biweekly performance feedback to staff nurses on an individual private basis to inform them of the percentage of contact opportunities in which they wore gloves. Observations made prior to (baseline) and during feedback in a multiple baseline design across 4 subjects indicated that substantial increases in glove wearing in target situations occurred after implementation of the feedback program and that increases occurred across most of the specific situations in which glove wearing was advised. Percentage increases in glove wearing ranged from 22% to 49% across subjects. The results are discussed in terms of prevention of acquired immune deficiency syndrome (AIDS) by use of universal precautions.

Acquired Immunodeficiency Syndrome↗