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Particles of talc have been identified on the route surface of surgeons' rubber gloves and in sections of tissue classified as 'starch' or 'foreign body' granulomas. This analytical study indicates that under certain circumstances these granulomas could have been caused by talc contamination.
The prevalence of type I allergy against latex was investigated in dental students by questionnaire, prick tests and the determination of specific IgE antibodies. Positive prick tests against different latex fluids were found in 18 (8.7%) of 206 students, with clinical relevance in 11 cases. When the total number of students in each semester was taken into account an increase in the minimal prevalence of clinically relevant latex allergy from 2% in the second semester to 10.4% in the tenth semester was seen. A history of glove intolerance presenting as a wheal-and-flare reaction was associated with a type I allergy against latex in only 50% of the affected subjects. Atopic diseases and hand eczema of different causes proved to be risk factors in 16 and 5 of 18 students with latex allergy, respectively. A high-ammonia accelerator-free latex fluid proved to be a very reliable test medium compared to the less sensitive determination of specific IgE antibodies to latex.
Dressing post-operative hypospadias using a glove finger is technically easy to apply, inspect, and remove; gives uniform compression; is cheap and easily available; prevents contamination; and does not slip like ordinary dressings.
Seven gloves were studied worn by eight sedentary subjects (six men and two women) exposed to cold-dry, C D, (mean dry bulb temperature Tdb = -17.2 degrees C; mean dew point temperature Tdp = -25.1 degrees C), and cold-wet, C-W, (Tdh = 0 degrees C; Tdp = -8.4 degrees C) conditions. Mean endurance times were 75 min for the C-D and 162 min for the C W conditions. A three-phase response pattern of the temperature in the fingers was characterized. Phase I comprised an initial period during which finger temperature remained close to the pre-exposed level, due to delayed vasoconstriction in the finger. Phase II involved an exponential-like decrease of finger temperature indicative of the onset of vasoconstriction in the finger. Phase III manifested periodic finger temperature changes due to cold induced vasodilatation (CIVD). Mean wave patterns for phase III indicated approximately 3.5 waves x h(-1) in the C D but only about 2 waves x h(-1) in the C-W condition. Extension of endurance time, due to CIVD, was defined as the difference in time between the actual end of the experiment and the time the finger-tip would have reached the set temperature endurance limit as extrapolated by a continued exponential drop. Three overall response patterns of fingers in the cold were characterized: type A exhibiting all 3 phases; type B1 or B2 exhibiting either phases I+ II or phases II+ III; and type C showing only phase II. Considerable inter- and intra-subject variability was found. In both test conditions the final physiological thermal states of the subjects were between comfortable and slightly uncomfortable but acceptable and thus did not correlate with the responses in the fingers.
Pelvic abscesses may develop after retention of foreign bodies. A case is presented in which during drainage of a post cesarean section pelvic abscess a small piece of a latex glove was recovered. The formation of pelvic abscesses due to foreign bodies is discussed.
A variety of foreign bodies are capable of eliciting a granulomatous tissue response. Surgical glove lubricant powder is one source of foreign bodies. The consequences of talc and starch contamination of tissues are frequently reported for tissue sites outside the oral region. This article describes the clinical and histologic features of an intraoral starch granuloma.
A 33-year-old latex glove inspector was diagnosed as having occupational asthma on the basis of peak flow and methacholine-responsiveness changes related to workplace exposure. She had latex sensitivity by skin prick testing. This finding led to a survey of her workplace. Of the 81 workers, 84% completed a questionnaire to assess work-related respiratory symptoms, 79% underwent skin prick testing to latex and six other workplace chemicals, and 62% performed workshift spirometry. Seven workers had spirometric changes consistent with asthma, of whom five had greater than or equal to 15% fall in FEV1 during the workshift. Six of these workers underwent methacholine-challenge testing, and three were found to have a significant improvement in responsiveness to methacholine away from work, suggestive of occupational asthma. Two of these workers had positive skin test responses to latex. Including the index case, 6% of workers who had pulmonary function testing had findings of latex-related occupational asthma. Skin test responses to latex occurred in 11% of workers tested. Our findings suggest that latex should be considered among the causes of occupational asthma.
The aim of this study was to define from a morpho-structural point of view, using scanning electron microscopy, the features of various types of disposable latex gloves commonly used in Italian dental practice (Biogel D, Trend, Pagni, J&J, Latechnics, Pehasoft, Bantex). None of the brands examined was free from morphological flaws; however, while in some of these only slight depressions were found (Biogel D, Trend), in others (Latechnics, Bantex) there was a marked lack of homogeneity in the latex structure or real holes (Pehasoft). This study emphasizes the current difficulties faced by dentists in the search for safe working conditions.
The frequency of unused surgeons' gloves with perforations was investigated by using a watertightness test. Lot-to-lot variations and inter-lot variation were found. It is the responsibility of the manufacturer to ensure that the quality of the lot is in accordance with the stated Acceptable Quality Level.
The choice of the silver impregnated Acticoat dressing (Smith & Nephew, UK) for burns is well documented due to its recognised sustained bactericidal activity, reduction of inflammation and ability to promote healing. Its use in the burnt hand, however, is a compromise between adequate dressing cover of this injury and the ability to splint and perform hand therapy on the injured limb. Trying to wrap individual fingers, maintaining web spaces and keep a relatively light dressing for the hand therapists is often difficult and time consuming. We introduce a simple, effective method of creating a custom made Acticoat glove which provides a thin, light dressing covering the hands allowing full mobilisation of the wrist and finger joints.
A method is presented which simplifies the use of the electric pulp tester for the dentist who routinely wears gloves in practice. Advantages of this method include a reduction in patient apprehension as well as a possible decrease in discomfort for the patient.
During the past decade, there has been an increasing problem with acrylate allergy and natural rubber latex (NRL) allergy among dental personnel. The aim of the present study was to evaluate the prevalence of these problems among dentists, dental nurses and dental hygienists in Uppsala county, Sweden. The study was based on a self-administered questionnaire sent to 690 persons with 527 responders (76%). The most common skin problem was dry skin, fissures and/or itching on the hands. Of the 72 persons (13.6%) reporting to have suffered from hand eczema during the past 12 months, 41 were patch tested with the TRUE Test standard series and the Swedish dental screening series. In the patch tested group, 9.8% reacted to 1 or more of the acrylates. In addition, 389 persons were tested for NRL allergy with the Pharmacia Upjohn CAP-RAST test, and of these, we found 7.2% to be positive. The prevalence of self-reported hand eczema and the number of positive CAP-RAST tests differed between the 3 occupations, with higher figures for the dentists. There was also a correlation between atopic eczema and hand eczema. Of those reporting skin symptoms, 67.7% connected them to the place of work and 28.8% related them to the use of gloves.
We describe two cases of malaria occurring in a malaria-free zone in two in-patients, two weeks after a case of Plasmodium falciparum malaria, acquired in Burkina Faso, had been admitted to the same ward. After reviewing the techniques used by nursing staff, we conclude that transmission probably occurred via gloves contaminated following manipulation of venous cannulae and drip lines of the patient with Burkina Faso-acquired malaria and which had not been discarded before manipulating the intravenous lines of the other two patients. Nosocomial transmission of unusual and potentially life-threatening infections should be taken into consideration in those settings where compliance with universal precautions is not rigorous.
BACKGROUND: Without protective practices such as Universal Precautions, health care workers are at substantial risk for bloodborne infection, especially in areas such as Thailand with high prevalence of HIV infection. The purpose of this study was to evaluate the effectiveness of a peer feedback program (PFP) on handwashing and glove wearing (HW/GW) among Thai health care workers. METHODS: Subjects (N = 91) were randomly assigned to receive PFP versus no treatment. By using a checklist, peer observers rated HW/GW compliance in their coworkers during patient care. For 1 month, the investigator posted a report of compliance behaviors from each 3 days of observations. HW/GW was also assessed by the investigator by direct observation at 1 month before the intervention, during the intervention period, and 1 month after the intervention. RESULTS: Baseline HW/GW rates for the PFP and control groups were 49.2% and 61.5%, respectively. The PFP group had a significantly higher adjusted compliance rate than the control group during the intervention period (P =.0001). However, there was no significant difference in the compliance scores obtained 1 month after the intervention. CONCLUSIONS: The PFP was effective during the intervention period, but there was no retention of effect. Therefore, adjunct methods should be sought to promote retention of effect.
Many factors should be considered in the selection of chemical protective clothing, but the majority of selections are based on manufacturers' permeation data composed of average results for three replicates; usually no information about variability is provided. It was hypothesized that variability across batch lots might be considerable, and that variability may be due to cure factors that may vary from one site to another within the same company. Glass transition temperature (Tg) has been demonstrated to be an indicator of cure, and so its relationship to permeation parameters was examined. Steady state permeation rate, breakthrough detection time (BDT), cumulative permeation at 125 minutes (ASTM F1407), and Tg (ASTM E1356) were measured for two makes of nitrile gloves presumably in four batches. Tg was not related to any of the permeation parameters even though batch-to-batch variability was statistically significant for all parameters except BDT. A comparison with recent ASTM round-robin results indicates that some of the variability may be due to the method; however, manufacturer quality control must be suspected as the major source of variability based on the results of this study.
OBJECTIVE: To investigate the persistence of colonization of premature babies by Klebsiella oxytoca, with special emphasis on the mode of transmission of the bacterium and evaluation of Standard Precautions to stop the epidemic. DESIGN: Retrospective analysis of cases and prospective study of systematic bacteriological samples (stools and throat) from babies, healthcare workers (HCWs), and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction. SETTING: A premature baby unit (PBU) and a neonatal intensive care unit in the university hospital of Saint-Etienne, France. RESULTS: An outbreak of K oxytoca was suspected in two pediatric wards after the occurrence of a fatal bacteremia in a newborn hospitalized in the PBU and the colonization of other babies 2 months later. Retrospective analysis showed that 24 babies' digestive tract had been colonized. No environmental reservoir was recovered in the units nor in enteral feeding. No K oxytoca was isolated from HCW samples. Genotyping confirmed the presence of epidemic strains, although independent clones were responsible for infections or colonizations in each of the two units. The chronology and the site of babies' colonization (isolation of K oxytoca in stools before throat) were determined during a prospective study and suggested that enteral feeding procedures could be the source of contamination. Therefore, use of gloves during this practice by HCWs was recommended and, after readjustment of Standard Precautions, stopped the outbreak. CONCLUSION: To prevent cross-contamination among high-risk babies, careful attention must be paid to Standard Precautions. Bacteriological surveillance of the digestive tract of neonates could help to check compliance with these guidelines
Medical surveillance was used in the workplace to determine and monitor the level of hand-arm vibration syndrome (HAVS) and carpal tunnel syndrome (CTS) present in workers exposed to upper extremity vibration. Ergonomic intervention in the form of new tools with lower vibration levels and the use of International Standards Organizaiton (ISO) 10819 antivibration gloves were associated with a decrease in the pathologic findings and symptoms in these workers. Workers without such intervention were more likely to show progression of symptoms and findings. These findings suggest that ergonomic intervention can be effective in controlling the workplace hazard of tool vibration.
Hand-assisted laparoscopic surgery (HALS) has widened the range of laparoscopic surgery. An appropriate port allowing the passage of the hand while maintaining pneumoperitoneum is mandatory for HALS to be performed. Commercially available ports are expensive and may not be universally available. An inexpensive 2-component port using the flange of a stoma appliance and a glove, which could be readily assembled at short notice, is described.