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Nine-hundred and eleven pairs of surgical gloves used by Ear, Nose and Throat surgeons and their scrub nurses were tested for perforations over a 6-week period. We studied the perforation rate for different surgical procedures and found the average rate to be 4.8%. The rates varied from endoscopy with a perforation rate of zero to major head and neck resections with a rate of 28.5%.
Many studies have documented nurses' attitudes and concerns regarding AIDS/HIV, but little is known about Taiwanese nurses. We documented attitudes, concerns, gloving practices and practical AIDS/HIV knowledge of 1090 nurses from one metropolitan hospital in Changhua City, Taiwan. The response rate was 80.9%. Both HIV and hepatitis contraction in the workplace was nurses' main concern. Two hundred and ten nurses (19.3%) were seriously considering leaving nursing because of fear of contracting AIDS/HIV. Virtually all nurses considered it their right to be informed of the presence of HIV-positive patients in their direct work area and many believed that HIV testing of patients should be mandatory. Practical AIDS/HIV knowledge was deficient. These Taiwanese nurses have concerns and fears that might be related to deficiencies in practical AIDS/HIV knowledge. Continuous educational programmes are recommended to alleviate these nurses' attitudes and concerns regarding AIDS/HIV.
Following interviews on glove-related skin symptoms, 202 subjects, 56 hospital workers at an operating theatre and 146 workers at dental care centres, were skin prick tested with different latex extracts. Also, in 193 cases, blood samples were RAST-analysed, using the CAP system. Sensitization to latex diagnosed by positive skin prick test and/or by demonstration of specific antibodies in serum analyses was found in 3.5% of the subjects investigated. 4 cases (2%) showed 1 or more positive skin tests, and 4 cases (2%) had positive RAST to latex antigens. Further work on the diagnostic tools is still needed, as are prognostic studies.
The histopathologic features characteristic of the inflammatory response associated with starch powder used as a lubricant for surgical gloves were investigated by implanting starch granules into 3 separate sites on the right side of 8 male Wistar rats. On the opposite side, a sham-operated site and sites implanted with talc were used as controls. Two rats were killed at 1, 2, 3 & 4-week intervals and tissue from the implanted sites was assessed for distinctive features. It was found that a consistent feature of the starch-implanted sites was the presence of large histiocytes containing prominent PAS-positive, diastase-resistant inclusions. These cells were not found in the control sites and, thus, were considered characteristic of starch contamination in tissue, even in the absence of identifiable starch granules. A possible clinical case of reaction to starch, identified retrospectively, using these results is discussed.
A single application of about 10 ml of 95% alcoholic chlorhexidine (0.5%) or tetrabrom-o-methyl phenol (0.1%) rubbed on to the hands until they were dry led to mean reduction in viable bacterial counts from standard handwashings of 97.9 +/- 1.09% and 91.8 +/- 4.63% respectively. After six of such treatments, three on each of two successive days, the mean reductions in relation to viable counts before the first treatment were 99.7 +/- 0.09% for alcoholic chlorhexidine and 99.5 +/- 0.17% for tetrabrom-o-methyl phenol. These reductions were greater than those obtained with 4% chlorhexidine detergent solution- 87.1 +/- 3.5% and 98.2 +/- 1.6%, and with 95% or 70% ethyl alcohol and with aqueous 0.5% chlorhexidine. Preoperative washing of the surgeon's hands with alcoholic chlorhexidine used without addition of water is more effective and less expensive than handwashing with antiseptic detergent preparations and running water.The viable counts of washings from hands treated with various antiseptics, including ethyl alcohol, were lower in relation to the pretreatment levels when gloves had been worn for three hours than when samples for counts were taken immediately after the antiseptic treatment. No such difference was found in samplings from hands washed with unmedicated soap.Tests for residual action of antiseptics on the skin showed a greater effect with alcoholic chlorhexidine than with tetrabrom-o-methyl phenol, though both showed greater residual activity than an Irgasan DP 300 detergent preparation. No residual action was shown after 70% ethyl alcohol.
A short cut review was carried out to establish whether the use of sterile gloves during the treatment of simple wounds reduces infections. Altogether 48 papers were found using the reported search, but none presented any evidence to answer the clinical question. More research is needed in this area and, in the mean time, local advice should be followed.
Corn starch particles are used as a surgical glove lubricant. At present there is no better alternative for this lubricant. Implantation of corn starch particles into the peritoneal cavity can induce foreign body reactions, starch peritonitis and starch granulomata, and may cause adhesions and intestinal obstruction. Starch peritonitis should be treated conservatively.
PURPOSE: Onycholysis and skin toxicity occur in approximately 30% of patients treated with docetaxel. We investigated the efficacy and safety of an Elasto-Gel (84400 APT Cedex, Akromed, France) frozen glove (FG) for the prevention of docetaxel-induced onycholysis and skin toxicity. PATIENTS AND METHODS: Patients receiving docetaxel 75 mg/m2 alone or in combination chemotherapy were eligible for this case-control study. Each patient wore an FG for a total of 90 minutes on the right hand. The left hand was not protected and acted as the control. Onycholysis and skin toxicity were assessed at each cycle by National Cancer Institute Common Toxicity Criteria and documented by photography. Wilcoxon matched-pairs rank test was used. RESULTS: Between August 2002 and September 2003, 45 patients were evaluated. Onycholysis and skin toxicity were significantly lower in the FG-protected hand compared with the control hand (P = .0001). Onycholysis was grade (G) 0 in 89% v 49% and G1 to 2 in 11% v 51% for the FG-protected hand and the control hand, respectively. Skin toxicity was G0 in 73% v 41% and G1 to 2 in 27% v 59% for the FG-protected and the control hand, respectively. Median time to nail and skin toxicity occurrence was not significantly different between the FG-protected and the control hand, respectively (106 v 58 days for nail toxicity; 57 v 58 days for skin toxicity). Five patients (11%) experienced discomfort due to cold intolerance. CONCLUSION: FG significantly reduces the nail and skin toxicity associated with docetaxel and provides a new tool in supportive care management to improve a patient's quality of life.
Healthcare workers' (HCWs') occupational risk of exposure to blood-borne pathogens has been well documented. Subsequent educational programmes, awareness campaigns and policy implementation made limited impact on HCWs' level of knowledge of these risks and compliance with universal precautions. Two hundred HCWs completed a questionnaire to evaluate their level of knowledge. Results demonstrated that despite a comprehensive educational programme for nurses and training for medical staff, knowledge of inoculation injuries and associated issues remained inadequate. Indeed, policies and procedures were not followed. Furthermore, gloves were not routinely worn in the clinical setting. Educational programmes ware essential to inform HCWs of occupational risk of exposure to blood-borne pathogens and guide practice following an inoculation injury. However, efficacy of such programmes must be reviewed, alternative strategies evaluated, and the cause of HCWs' limited knowledge determined.
CASE REPORT: An accidental exposure due to reuse of containers of toluene diisocyanate to transport nontoxic substances and subsequent occupational toxic exposure caused illness among forty workers in a glove manufacturing plant. Examination and investigation of the patients and factory site inspection were carried out. Toluene diisocyanate-contaminated latex was examined by the infrared spectroscopy. Thirty-two of forty patients had muscle pain and seven had elevated creatine phosphokinase activity. These features have not been reported previously as components of toluene diisocyanate toxicity and their underlying causation remains speculative.
Ten samples of retail packed lunches purchased from convenience stores were determined for 11 phthalates and di(2-ethylhexyl) adipate (DEHA) in August 2000, 2 months after the prohibition of DEHP-containing PVC gloves in Japan. Each homogenized sample was extracted with acetonitrile, partitioned with n-hexane, and cleaned up using Florisil and PSA columns. Phthalates in the extract were determined by GC/MS (SIM). The limits of detection were 14.9 ng/g for di(2-ethylhexyl) phthalate (DEHP) and 18.6 ng/g for dibutyl phthalate (DBP). Levels of phthalates in packed lunch samples were 45 to 517 ng DEHP/g (198 ng/g, average), ND to 90 ng DEHA/g, and ND to 10.0 ng BBP/g. Diisononyl phthalate (DINP) was detected in one sample at 76 ng/g. Average DEHP level in ten samples was 4% of that in 1999. The contents of other phthalates were also reduced. DBP was not detected in any sample. Recovery of deuterated isomers added as surrogates was 27.9% for DNP-d4, and 40.6 to 101.5% for the other phthalates.
The Food and Drug Administration (FDA) is revising the patient examination glove classification regulation, set forth in 21 CFR 880.6250, by revoking exemptions from the premarket notification procedures and certain current god manufacturing practice (CGMP) requirements identified in the regulation. The revocations are necessary because of the importance of this device in helping to prevent the transmission between patients and health-care workers of the HIV (human immunodeficiency virus) virus that causes AIDS (acquired immunodeficiency syndrome).
Six Hevea brasiliensis latex protein allergens, Hevb 1, Hev b 2, Hev b 3, Hev b 4, and two variants of Hev b 7 (7b and 7c), were purified from Hevea latex, while a seventh protein, Hev b 5, was prepared in recombinant form. The presence of these proteins in glove extracts was indicated by their respective antibodies in the serum of rabbits immunized against the extracts. The relative propensities of IgE binding to the individual latex allergens were compared using sera from latex-allergic patients. IgE recognition of Hev b 4, Hev b 7b, Hev b 5 and Hev b 2 was most frequently encountered, with 75, 61, 31 and 28%, respectively, of the patient sera reacting. Sensitivity to multiple latex proteins was common, and out of the 31 seropositive patients, 23 (74%/ ) had IgE against at least two latex allergens, while 12 (39%) had IgE specific for at least three allergens. Statistical analysis of the data suggested that many patients might have acquired sensitivity to Hev b 2, Hev b 4 and Hev b 7b from a common source. (e.g., from latex products). On the other hand, sensitivity to Hev b 5 and to Hev b 7c were interrelated. It is plausible that sensitivity to these two proteins might have been acquired from sources other than latex products (e.g., from certain foods).
The paper describes the different stages of microsurgical training which should be followed in an experimental laboratory; it also stresses the main characteristics to which microsurgical trainees must pay attention without neglecting any steps, even the most banal ones, because microsurgery is a sequence of exercises and not a single one (microsuture). The rigorous and increasingly difficult step-by-step progress of the different phases allows the trainee to face the different passages with greater ability and mastery without losing that enthusiasm which is the motivating force. Obstacles and failures can be evaluated with a more critical and reflective eye. Microsurgical training foresees the gradual passage from synthetic materials, such as surgical gloves, to non-living biological structures, such as chicken legs, finishing with experimental animals such as the rat. These biological models are almost identical to human structures making the experimental stage very similar to direct clinical application. Microsurgery, nowadays, is an integral part of all surgical disciplines. A correct approach to surgery using a microscope, according to this teaching scheme, is surely of great help not only for young surgeons but for the veterans of surgery too.
1. The prevalence of latex allergy in health care workers is estimated to be between 10% and 17%. 2. Reactions from wearing latex gloves can include irritant contact dermatitis, allergic contact dermatitis, and contact urticaria from latex proteins. 3. Individuals with a history of atopy, multiple surgeries early in life (particularly with bladder catheterization), or allergies to certain foods are considered at risk of latex allergy. 4. An early intervention protocol and documentation forms are offered for occupational health nurses faced with assessing potentially latex allergic employees.
The paper presents the proposal for a method for testing the resistance of materials used for the production of protective clothing and gloves to penetration by concentrated chemical preparations of pesticides. It has been based to a large extent on the recommendations of European standards, with certain modifications resulting from the specific properties of non-volatile and non-water-soluble biologically-active components of pesticides. These modifications primarily involved the use of a solid sorption medium and adjustment of research apparatus to the research conditions consistent with the proposed method. The results of preliminary studies on penetration of the selected biologically-active components of pesticides (dichlorvos, 2,4-D, cypermethrin, carbofuran) through the selected protective materials (fabric coated with viton and butyl on both sides, rubberised fabric, butyl rubber) are presented. The study confirmed the usefulness of the proposed method for testing the resistance of materials protecting against the effect of pesticides.
A method of washing the outside of surgeons' gloves with cetrimide is described. Experiments on animals showed that the method resulted in a considerable reduction in the amount of intraperitoneal contamination by starch powder.
Supplies that are purchased for facility-wide use can have a sizeable impact on a hospital's bottom line as well as patient and employee safety. Here, review how to maximize your purchasing power when selecting medical gloves.