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Inhaled cornstarch glove powder increases latex-induced airway hyper-sensitivity in guinea-pigs.

BACKGROUND: Breathing is one of the most important modes of sensitization to natural rubber latex (NRL) for health-care workers, a group most at risk. Cornstarch powder (CSp) from medical powdered NRL gloves is known to be an allergen carrier, and sensitization to NRL can occur by inhaling airborne particles from such gloves. OBJECTIVE: The aim of this study was to demonstrate, using an experimental model, which CSp may act as an adjuvant in NRL-induced airway hyper-responsiveness. METHODS: Guinea-pigs were exposed to aerosolized NRL-contaminated CSp or to NRL in saline solution for 1 h every day for 2 weeks. The control groups were exposed either to CSp or to saline alone. An additional group of guinea-pigs was exposed to aerosolized ovalbumin (OVA) in saline. Three weeks after the last exposure, specific bronchial challenges were performed. In addition, Specific IgG and IgG1 in sera and thromboxane (Tx) B(2) levels in bronchoalveolar lavage fluid (BALF) were measured. RESULTS: The NRL challenge caused significant bronchospasm in the animals that had been exposed to NRL compared with those in the control groups (P<0.02). Guinea-pigs exposed to OVA also demonstrated a significant bronchospasm after OVA challenge (P<0.001). The guinea-pigs that had inhaled NRL-contaminated CSp had a significantly higher bronchoconstriction level than those that had inhaled NRL alone (P<0.02). Specific IgG and IgG1 were undetectable in sera from all groups, whereas significant amounts of TxB(2) (P<0.001) were found in the lungs of the guinea-pigs exposed to NRL or OVA. CONCLUSION: Inhaling CSp increases the airway response to NRL. The fact that specific IgG and IgG1 were not detected might be the result of an immune response limited to the airways. This finding is supported by a significant increase of TxB(2) level in the BALF of sensitized guinea-pigs.

Aerosols↗

Latex allergy from glove powder--an unintended risk with the switch from talc to cornstarch?

The present study aimed to investigate to what extent glove powders of different origins and brands bind and release latex allergens. One mineral talc and five cornstarch powders were used. The allergenic material was sap of Hevea brasiliensis. The powders were incubated together with the natural rubber latex sap, and four series of experiments were performed. The talc showed the highest tendency to bind isotope-labeled proteins. When incubated with a latex allergen solution, it reduced free allergen from 100 to 2 units/ml compared to a reduction to 70-98 units/ml for the cornstarch powders. In contrast to the nonstable binding of allergen to cornstarch, the binding to talc was irreversible. The allergen bound to talc was allergenically intact and, when incubated with serum, reduced the concentration of free IgE antibody to latex to 10% of the initial level. Mineral talc had a high capacity to bind latex allergens firmly. In contrast, cornstarch captured the latex allergen, but the binding seemed less pronounced and was unstable. The replacement of talc by cornstarch as glove-donning powder has coincided with the rapid increase in latex allergy. Mineral talc is heavy and only transiently airborne. Could this difference between talc and cornstarch in latex-allergen-binding pattern and the tendency of the latter to be airborne play an important role in the bioavailability of latex allergen and thus in the epidemic of latex sensitization.

Allergens↗

Detection of glove puncture and skin contamination during caesarean section.

Measures that can be taken to reduce exposure to potentially infected body fluids are of particular relevance in obstetric and gynaecological surgery due to high rates of glove puncture and relatively higher prevalence of human immunodeficiency virus seropositivity in the obstetric age group. We describe the use of a simple electronic device that alarms following puncture of surgical gloves or the creation of a fluid bridge between surgeon and patient. Further exposure to potentially infected body fluids is thus prevented. This present study was performed in the context of caesarean section, but the application of the technique to gynaecological procedures is appropriate.

Cesarean Section↗

Contact urticaria to rubber gloves is IgE-mediated.

Serological studies were performed in 3 patients with typical contact urticaria to latex surgical gloves. Specific IgE antibodies to natural latex as well as to vulcanized glove material have been detected by radioimmunoassay. Contact urticaria to latex is considered to be of the immunologic type.

Adult↗

Allergy to gloves. Case report.

The risk of contracting infectious diseases from patients with either serious or even fatal consequences has led to considerable changes in dental practice in the last few years. A key step in infection control is to prevent contact between the dentist's skin and the patient's blood and saliva by wearing gloves. The practice initially requires some patients and tolerance but then has few disadvantages. This paper reports a case where there were adverse effects to the patient from the dentist wearing gloves.

Aged↗

Influence of the sterilization method and of magnesium oxide on the tissue responses in the rat to modified starch glove powders.

The tissue response to samples of a surgical glove powder was assessed from counts of the adhesions and granulomas found 7 and 14 days after introduction into the peritoneal cavity of rats, and by a histological study of affected tissues. Negative control groups treated with no powder and positive controls treated with talc were included. Various sample treatments were implemented to examine the effect of the sterilization method on the tissue response and the influence of magnesium oxide, normally added as a dispersing agent. The glove powder produced less reaction when steam-sterilized than when gamma-irradiated and the presence of magnesium oxide at 2% concentration made no detectable difference.

Animals↗

Application of a gloved-hand model for multiparameter measurements of skin-degerming activity.

The application of an established gloved-hand model to multiparameter measurements of skin-degerming activity is described. In particular, appropriate experimental designs are illustrated which allow characterization of performance of topical skin-cleansing preparations in terms of rapid, sustained, cummulative, and persistent skin-degerming effects on the hand. Single-contact studies were used to define the degerming activity profiles of selected commercial surgical scrub preparations, and to establish the optimal post-treatment sampling interval for individual preparations. Rapid and sustained skin-degerming effects were measured and contrasted. Rapid skin-degerming activity, iodophor preparation. Sustained skin-degerming activity, namely, that occurring on the gloved hand during a postcontact interval, was shown and characterized for two hexachlorophene preparations. Multiple-contact studies with a 3% hexachlorophene preparations were used to illustrate cummulative and persistent skin-degerming effects. Cummulative skin-degerming activity was demonstrated in terms of progressive bacterial reductions after repeated contacts within a single day. Presistent skin-degerming activity was shown in terms of the profile of daily pretreatment bacterial counts after multiple contacts over successive days. Uniformity of treatment response was established for a broad range of pretreatment bacterial counts extending from approximatley log 4 to log 7 per hand. The importance of pretreatment bacterial count measurement and of adequate neutralization of hand extract samples is stressed. A randomized-hand experimental design is discussed relative to its versatility and amenability to statistical analysis.

Bacteria↗

Method for determining bioburden of surgical gloves.

A washing procedure that removed maximum numbers of contaminating microorganisms from whole surgical gloves was developed. Washing, coupled with membrane filtration, proved to be a simple and effective method for bioburden determinations on whole gloves.

Bacteriological Techniques↗

Combined use of alcohol hand rub and gloves reduces the incidence of late onset infection in very low birthweight infants.

OBJECTIVE: To assess the incidence of late onset (> 72 hours) infection and necrotising enterocolitis (NEC) in very low birthweight (VLBW) infants in two 36 month periods using two hand hygiene protocols: conventional handwashing (HW; first 36 month period); an alcohol hand rub and gloves technique (HR; second 36 month period). METHOD: VLBW infants admitted to the neonatal intensive care unit during the period December 1993-November 1999 were eligible. A new hand hygiene protocol using alcohol handrub and gloves was introduced in December 1996. Each patient's case record was reviewed retrospectively by two independent investigators using a standard data collection form. The incidence of NEC and systemic infections, including bacterial or fungal septicaemia, meningitis, and peritonitis, in the two periods were compared. RESULTS: The HW and HR groups contained 161 and 176 VLBW infants respectively. The incidence of late onset systemic infection decreased from 13.5 to 4.8 episodes (including NEC)/1000 patient days after introduction of the HR regimen, representing a 2.8-fold reduction. Similarly, the incidence of Gram positive, Gram negative, and fungal infections decreased 2.5-fold, 2.6-fold, and 7-fold respectively. There was also a significant reduction in the incidence of NEC in the HR group (p < 0.0001). Subgroup analysis revealed that the incidence of methicillin resistant Staphylococcus aureus (MRSA) septicaemia was significantly decreased in the second 36 month period (p = 0.048). The clinical data suggest that infants in the HW group had significantly earlier onset of sepsis (p < 0.05) and required oxygen supplementation for longer (p < 0.05) than those in the HR group. Significantly more VLBW infants were discharged from the neonatal intensive care unit without ever being infected (p < 0.0001), and also significantly fewer infants had more than one episode of infection in the HR group (p < 0.0001). CONCLUSION: The introduction of the HR protocol was associated with a 2.8-fold reduction in the incidence of late onset systemic infection, and also a significant decrease in the incidence of MRSA septicaemia and NEC in VLBW infants. This decrease in infection rate was maintained throughout the second 36 month period.

2-Propanol↗

Severe allergy in a pregnant woman after vaginal examination with a latex glove.

Recently case reports about latex allergy were increased. We have experienced severe latex allergy in a pregnant women after vaginal examination with a latex glove. A 33-year-old woman, 38 weeks pregenant, was hospitalized for management of fetal IUGR. She underwent a vaginal examination with a latex glove and soon developed severe anaphylactic reactions. Although two hours later her condition had remarkably improved, regular uterine contractions appeared, and fetal cardiotocogram showed late decelerations. So emergency cesarean section was performed under the situation without using any latex products. She delivered a male infant weighing 2,227 g (-2.21 SD) at 38 weeks gestation. His Apgar score was 5 points at 1 min and 8 points at 5 min. The latex-specific IgE of this patient was high and IgE for banana, avocado and kiwi were also positive. These foods showed cross-reactions with latex, but she had no history of allergic reactions against these foods. She had a history of atopic reactions and of atopic dermatitis while working as a nurse at the ICU. It is thought that this patient was in the high-risk group.

Adult↗

Safer surgical gloves: evaluation and implementation.

In 2003 the Scottish Health Service Central Legal Office was consulted on the requirement to supply an alternative to natural rubber latex gloves for healthcare professionals within NHS Lothian University Hospitals Trust. Counsel stated that as latex is now accepted as being hazardous to health, employers must prove the statutory defence in Regulation 7(1) of the Control ofSubstances Hazardous to Health Regulations (HSE 2002). Counsel also stated that, as there are now adequate alternatives to latex gloves, NHS employers would have an indefensible position if no attempt was made to supply alternatives.

Equipment Safety↗

Dermal in vitro penetration of methiocarb, paclobutrazol, and pirimicarb: effect of nonylphenolethoxylate and protective gloves.

Dermal exposure has become the major route of human occupational exposure to pesticides. Detergents are used as part of formulated pesticide products and are known to change the barrier properties of human skin in vitro. However, studies on the influence of detergents as well as protective glove materials on dermal penetration of pesticides are scarce. In an experiment using in vitro static diffusion cells mounted with human skin, we evaluated the effect of nonylphenol-ethoxylate on dermal penetration of three extensively used pesticides--methiocarb, paclobutrazol, and pirimicarb--and the protection against dermal penetration offered by protective gloves made of latex or nitrile. There was a general tendency, though not statistically significant for all pesticides, for nonylphenolethoxylate to decrease the percutaneous penetration of the three pesticides. The nitrile generally offered better protection against percutaneous penetration of pesticides than did latex, but the degree of protection decreased over time and depended on the pesticides used.

Aged↗

An allergic reaction to latex rubber gloves.

Most dental practitioners are gloving up to work. With this trend, reports on manual dexterity, barrier effectiveness, and more have been recorded. This case report describes a new consideration--an allergic reaction by a patient to the dentist's rubber-gloved hands.

Aged↗

Latex glove reactions found in a dental school.

When a survey was distributed to students, faculty and staff of a dental school to determine the incidence of latex glove reactions, 15 percent reported adverse reactions to glove use. The most frequently reported symptom was dermatitis, followed by urticaria, sweating, conjunctivitis and rhinitis.

Adult↗

Glove powder's carrying capacity for latex protein: analysis using the ASTM ELISA test.

Glove donning powders carry latex proteins and disperse them into the workplace environment. We have used the ASTM D6499 ELISA to quantify the amount of latex antigen bound to and carried by glove powders. We could differentiate between a small amount of protein actually bound to the powders and a larger amount carried by the powder. Enhanced binding of a major allergen, Hev b 5, to the starch powders was demonstrated by Western blot. The D6499 ELISA is able to measure total latex antigen, soluble and powder bound, simultaneously without the need to centrifuge the samples.

Enzyme-Linked Immunosorbent Assay↗

Glove perforation in elective orthopedic surgery.

A survey of glove perforation in 16 orthopedic surgeons during a 6-month period was carried out. During this time, the surgeons performed 304 elective operations. In 1,398 pairs of gloves tested, evidence of perforation was found in 26 percent.

Accidents, Occupational↗

Medical devices; patient examination and surgeons' gloves; adulteration--FDA. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to: (1) Define adulteration for patient examination and surgeons' gloves; and (2) establish the sample plans and test method the agency will use to determine if these gloves are adulterated as defined by the rule. With the prevalence of human immunodeficiency virus (HIV) infection and the risk of clinical transmission of other infections, the importance of the quality of an effective barrier to the transmission of infection in health care settings is crucial. The public health will benefit through improved quality control of these protective barriers.

Cross Infection↗

Latex gloves fingered in allergic reactions.

As more hospital workers don disposable latex examination gloves, reports of serious reactions and at least 16 deaths from latex allergies are being noted. Symptoms of latex allergy range from mild eczema to hives, welts and anaphylaxis. A rise in such incidents is of great concern for hospitals, which are expected to spend more than $500 million on latex examination gloves this year.

Gloves, Surgical↗