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The role of gloves as part of the overall control of cross-infection in dental practice is examined. The case for the wearing of gloves is made, and the paper also deals with glove material, single or multiple use, hand protection, adverse reactions, and advice on glove use.
Selection of chemical protective gloves for use against industrial liquids in the controlled workplace is accomplished by risk analysis, in which the appropriate physical and chemical glove properties needed by the worker to perform the job are determined. Candidate protective gloves are then subjected to chemical permeation testing. Three representative case studies illustrate risk analysis and glove selection.
Contamination of surgical wounds by starch glove powders has produced peritoneal inflammation and adhesions in many patients. Some have required surgical operation because of possible infection, others because of obstruction of the intestine. Resolving granulomas and fibrosis have been observed as incidental asymptomatic lesions in some patients during reoperation for other conditions. Starch granules are probably capable of producing inflammation in any patient, and the degree is believed to be related to the amount of starch present. Care in removing glove powder from gloves before they are worn in an operation will diminish or eliminate the problem. Removal can be accomplished by rubbing the gloves with a moist sterile towel or laparotomy tape.
The first commercially available powderless glove was compared to other popular ophthalmic gloves. They were compared with scanning electron microscopy (SEM), the ease of donning, and tactile sensitivity. SEM revealed the new gloves to, in fact, be entirely powderfree. Customary washing procedures of the presently available commercial gloves revealed the inability to remove powder from the surfaces.
Repeated controlled tests have shown that impressions from laboratory gloves will print onto optical components in 20 to 40 min and, in some cases, sooner. Careful testing demonstrated that palmar sweat passed through the glove material; the problem was not that gloves conform to the friction ridges of the fingers and then transfer some contaminant. The problem can be alleviated to a great extent by wearing thin cotton gloves like those commonly used in the film industry.
The selection of gloves for the workplace can be accomplished using a seven step process including consideration of alternatives to protective clothing, evaluating the nature and extent of the hazard, determining material and human performance requirements for the gloves, and cost. The primary determinant is protection of the worker. Gloves selected for protection against chemical hazards should be chosen based on permeation resistance. No single glove is available that can provide all desirable chemical and physical properties, hence, compromise is usually necessary.
The value of protective gloves in the health care environment is well known. However, these gloves are not perfect. Some are permeable to microorganisms and various chemicals, and/or result in side effects for health care professionals. Gloves that offer the greatest protection and least side effects are highly desirable. Field of application rules and regulations, materials and manufacturing, and test methods of protective gloves are described in Part I of this three part series.
A case of a 7-year-old boy with myelodysplasia who developed a local acute hypersensitivity reaction after exposure to latex gloves during electromyography is presented. Anaphylaxis from latex gloves has been recently reported, especially in patients with myelodysplasia. Allergens from rubber gloves can be introduced under the skin during EMG and could cause local or systemic acute hypersensitivity reactions. Electromyographers should elicit a history to rule out rubber allergy and use vinyl gloves if suspicion of allergy exists.
The objective of the present study was to determine whether intraperitoneal exposure to glove powders modulates the inflammatory and immune responses by altering the influx of inflammatory and immune cells and peritoneal fluid cytokines and thus the outcome of surgically induced peritoneal wound healing. Peritoneal wall injuries were made by scraping the tissue until bleeding occurred in 360 mice. One of the following fluids was then introduced into the peritoneal cavity: phosphate-buffered saline solution, phosphate-buffered saline solution containing glove powders (Biosorb and Keoflo, 100 microg/ml), Hydrocote (Hydrogel film, Biogel 100 microg/ml), latex proteins (1 mg/ml), or lipopolysaccharides (12.5 microg/ml). At intervals of 1 to 28 days after injury, 10 mice per treatment per day and 10 uninjured mice were killed, peritoneal fluids were collected to determine the cytokine levels, the rate of fibrous adhesions formed at the site of injuries was graded, and peritoneal walls with attached fibrous adhesions were removed to determine the degree of inflammatory and immune cell infiltration into the wound. The results indicated that, with the exception of interferon-gamma, the peritoneal fluid levels of transforming growth factor-beta1, tumor necrosis factor-alpha, interleukin-1beta, and granulocyte-macrophage-colony stimulating factor in the phosphate-buffered saline solution-treated injured group significantly increased, reaching maximum between days 4 and 7 (p < 0.05) compared with the uninjured group and returned to uninjured values by day 14 after injury. The level of transforming growth factor-beta1 was higher in glove powders and Hydrocote-treated groups than in latex, lipo-saccharides, or phosphate-buffered saline solution-treated groups until day 14 after surgery (p < 0.05). The levels of tumor necrosis factor-alpha and interleukin-1beta increased in all treatment groups during the first week after injury compared with uninjured controls, with the exception of Hydrocote. The number of T helper/inducers (CD4), total leukocytes (CD11a), B lymphocytes (CD45R), granulocytes (Gr-1), and mononuclear phagocytes (Mac-3) in the wound increased during the first week after peritoneal wounding with no significant difference between treated and untreated groups. The rate of adhesion formation was not significantly altered in treated compared with untreated groups. These data suggest that a mechanism which mediates glove powder-induced peritoneal inflammatory and immune reactions in the postsurgical setting involves augmentation of cytokine production without influencing the influx of inflammatory and immune cells or adhesion formation.
Joint angles are measured using goniometers according to the neutral-zero method. These measurements are dependent on the examiner and are thus subject to great variation. With a newly developed sensor glove, the grip patterns of the hand can be captured with a computer-assisted technique. In a comparative study involving five subjects, the joint angles during power grip around a cylindrical body and while clenching a fist were determined by nine examiners at three different times, using the conventional technique according to the neutral-zero method. In the same experimental design, the joint angles were measured with the sensor glove. As a criterion for the reproducibility of the measurements, the intraclass correlation coefficient (ICC) was calculated by means of an analysis of variance. The ICC is a value which approximates 1 if the reliability of the measurements is high. At 0.94, the ICC of the data determined with the sensor glove was markedly higher than the mean ICC for all examiners of 0.50 using the conventional method. Besides the measurement of the finger joint angles, the sensor glove allows the dynamic recording of joint movements of all finger joints during different grip patterns of the hand.
BACKGROUND: A high rate of sensitization and clinical allergy to natural rubber latex (NRL) gloves has been reported in dental students and staff members. OBJECTIVE: The purpose of this study was to determine whether a change in glove use from high-protein/powdered to low-protein/powder-free latex gloves at a previously surveyed dental school reduced the prevalence of NRL sensitivity among students and staff members. METHODS: A cross-sectional study was performed through use of a questionnaire and skin prick testing to low ammoniated NRL extract; the method was similar to that used in a study conducted in 1995. Analyses were performed on the entire groups as well as on a subset of senior students. RESULTS: A total of 97 subjects (61 students and 36 staff members) completed the questionnaire and underwent skin prick testing; this compared with 131 subjects in 1995. Percentages of subjects reporting asthma symptoms, rhinitis or conjunctivitis, urticaria, or pruritus within minutes of NRL exposure were 4%, 7%, 6%, and 8%, respectively; the corresponding percentages in the 1995 survey were 7% (P = not significant), 13% (P = not significant), 20% (P =.004), and 22% (P =.005). Results were similar for the subset of senior students, but in addition there were also significantly fewer complaints of rhinoconjunctivitis in 2000 than in 1995 (0% and 12%, respectively; P =.007). Of 97 subjects who underwent skin prick testing, 3 (3%) had positive skin prick test responses of 2+ or greater to NRL; this compared with 13 (10%) of 131 subjects in 1995 (P =.03). There were 3 positive skin test responses among staff members in 2000; there were none among students. CONCLUSIONS: Our results suggest a preventive effect on NRL allergy in dental students from the change to low-protein/powder-free NRL gloves in the dental school.
The influence of a baseball glove on the positioning and grasping components of one-hand catching was studied under both vision impaired and unimpaired conditions. Skilled softball and baseball players (N = 20) caught tennis balls barehand and softballs with a fielder's glove. In half of the trials, a screen positioned alongside the subject's head blocked vision of the catching hand. All trials were videotaped and errors were categorized by type (position or grasp). Results indicated that with the glove performance was essentially perfect, regardless of the screen condition. Barehand grasping performance, however, was affected by the subject's inability to see his hand to a much greater extent than barehand positioning. We argue that the baseball glove functions to reduce both the positioning accuracy requirements and the grasp timing requirements in simple catching. Peripheral vision of the limb, however, is necessary for controlling the barehand grasp phase.
This study explored chemical permeation of latex neoprene gloves by acetone. Twenty-three specific glove sites were monitored to determine the breakthrough time and the challenge liquid concentration at steady-state. In summation, the thinnest parts of the gloves, which are the backs, the palms, and the interstices between the fingers, exhibited the shortest breakthrough times and largest steady-state concentrations. The thickest parts of the gloves, the fingertips, exhibited the longest breakthrough times and least steady-state concentrations. The backs or palms are appropriate specimens to use for chemical permeation testing.
The toxicities of many agricultural pesticides require that hand protection be used by persons who mix, load, and apply these products, as specified on the label and material safety data sheet. Selection of gloves for formulations that contain organic solvents is particularly problematic because a solvent that permeates the glove can carry with it the active ingredient of the pesticide formulation. With a test method that measures the simultaneous permeation of the carrier solvent(s) and active ingredient(s), in particular those active ingredients that have low solubility in water and low volatility, over 100 permeation tests (in triplicate) with approximately 20 pesticide formulations were conducted with 13 different glove materials. These results are summarized and generalizations are presented within the perspective of the large base of permeation data for neat chemicals and another large permeation study with pesticides. Key among the findings is that the carrier solvent generally permeates first and at a much higher rate than the active ingredient. Furthermore, the permeation behavior of formulations containing solvents generally mirrored that of neat carrier solvents alone. Thus, insight into the selection of the most appropriate glove material for a given pesticide formulation can be gained from permeation data for neat chemicals. For the types of solvents that may be present in pesticide formulations, preferred materials include nitrile rubber, butyl rubber, and plastic film laminates. Natural rubber and polyvinyl chloride materials generally are not recommended.
Measurements have been made of the rate at which tritiated water and 125I-labelled sodium iodide solution penetrate various types of protective gloves, both isotopes being in common use in this form in universities and similar establishments. Diffusion coefficients relating to the glove materials are also determined. The health physics aspects are discussed and it is concluded that intakes by workers through intact gloves are not likely to be of major significance and can easily be minimised by the correct use and choice of glove.
Virtual reality (VR) technology is increasingly recognized as a useful tool for the assessment and rehabilitation of neurologic and psychiatric disorders. The hope that VR can accurately mimic real-life events is also of great interest in basic neuroscience, to identify the brain activity that underlies complex behavior by combining VR with techniques such as functional magnetic resonance imaging (fMRI). Toward these applications, in this study we designed and validated an fMRI-compatible data glove with a built-in vibratory stimulus device for tactile feedback during VR experiments. A simple VR-fMRI experiment was performed at 3.0 Tesla on four young healthy adults involving touching a virtual object with and without tactile feedback. The usefulness of the data glove was subsequently assessed using a series of questionnaires, behavioral performance, and the resulting activation images. Questionnaire scores indicated positive opinions with respect to the data glove, the tactile feedback, and the experimental paradigm. All subjects felt comfortable in the scanner during the VR experiment and were able to perform all aspects of the tasks successfully and with reasonable accuracy. In addition, activation maps showed the anticipated modulations in motor, somatosensory, and parietal cortex. These results support that tactile feedback enhances the realism of virtual hand-object interactions, and that the tactile data glove is suitable for use in other VR-fMRI research applications (e.g., VR physical therapy for stroke recovery).
Intravenous phenytoin, available for use since 1956, has several well known adverse effects, such as hypotension, arrhythmias and toxicity. Purple glove syndrome is a less common complication that can have serious consequences. Fasciotomies, amputations and permanent disuse of the hand and forearm have been reported. The etiology of purple glove syndrome is still unknown, but possible etiologies and risk factors have been suggested. Three stages of purple glove syndrome have been identified: appearance, progression and resolution. During the second stage, progression, purple glove syndrome can be identified as either mild or severe. Mild cases may heal uneventfully when nursing measures such as elevation, application of dry, gentle heat and measures to prevent secondary injury are instituted. Severe cases may require emergency surgical intervention such as fasciotomy to relieve pressure and restore blood flow. Therapeutic nursing interventions aimed at maximizing healing and promoting comfort are essential.
Most current data on the protective effect of gloves against chemicals are obtained in vitro, using permeation cells. In vivo testing would give additional information on efficiency but is both expensive and time-consuming. It would therefore be valuable to know whether any definitive relationship exists between results obtained in vivo and in vitro. Gloves of natural rubber, butyl rubber and polyvinyl chloride (vinyl) were tested against 3 organic solvents, toluene, 1,1,1-trichloroethane and butanol, in vivo in guinea pigs and in vitro in permeation cells. Breakthrough times, absorption rates and steady state permeation rates were determined and compared on a relative basis. Some of the gloves that had a low degree of resistance to the test solvent in vitro nevertheless showed a rather good reducing capacity on the percutaneous absorption in vivo. However, for 2 gloves where no breakthrough was noted for butanol in vitro, permeation occurred at a degree lower than the minimum detection level. At this low concentration, the solvent was not absorbed through intact skin but through damaged skin. The breakthrough times for the 3 solvents corresponded well for the 2 test systems. The relative absorption rates and relative steady-state permeation rates varied considerably and no definitive relationship between the 2 sets of test results could be seen.