Colloidal Oatmeal and Its Use in Gloves

Oat grains that are ground, crushed or rolled are called oatmeal. Oats are known to be a good source of fiber and protein, and help to lower cholesterol. Furthermore, the benefits of oatmeal extend far beyond simply the food and diet realm. In fact, oatmeal has a number of biologically active properties that can be beneficial in skin care.¹

Colloidal oatmeal is a finely ground form of oatmeal that readily absorbs water. When added in lukewarm water; these grains do not settle at the bottom but instead form a filmy layer on the water surface. This is because of the presence of polysaccharides and beta-glucan which binds with water to form a colloidal dispersion. This colloidal dispersion can be mixed into creams, lotions and water to form different skin care products.¹

Properties of colloidal oatmeal¹:
Many studies have demonstrated the ability of colloidal oatmeal to bind to human skin and act as a protective barrier against irritants. Colloidal oatmeal contains hydrocolloids and water-binding polysaccharides that act to retain moisture in the skin, lending colloidal oatmeal emollient properties. Colloidal oatmeal also contains fats that support this emollient action, reducing the itchiness of dry skin. Additionally, colloidal oatmeal acts as a buffering agent to maintain the normal pH of skin.^1,2

A snapshot of colloidal oatmeal’s chemical compounds and their properties are as follows³ –

Benefits of colloidal oatmeal:
Due to its emollient and buffering action, colloidal oatmeal offers a relieving effect in the treatment of skin conditions, including dry skin patches, acne and psoriasis. It is also effective in treating sunburns, giving relief to skin suffering from bug bites, soothing the itch and irritation associated with chicken pox and plants such as ivy, oak and sumac. Itching, scratching, rash or any minor skin ailments can be relieved by applying colloidal oatmeal on the affected area.^1,3

Availability of colloidal oatmea¹:
Due to the various benefits of colloidal oatmeal on the skin; it is widely used in different forms of skin care. The powdered form of colloidal oatmeal can be found inside gloves, while it can also be found in the form of gel, creams and lotions. Cosmetically, colloidal oatmeal can be found in soaps, shaving gels, body washes and shampoos¹.

Use of colloidal oatmeal in gloves:
The inclusion of colloidal oatmeal in gloves provides manifold benefits for the skin, thus offering a better management of skin conditions, especially those related to continuous glove usage.

When included in the glove, colloidal oatmeal forms a protective skin barrier between the glove and the skin. Thus, it prevents direct contact between the skin and the glove, negating potential irritation from the glove film. The colloidal oatmeal coating also absorbs water, urea and salt secretions commonly found in sweat, which often cause skin irritation, redness and itching. This also helps to maintain the natural pH balance of the skin. Colloidal oatmeal in gloves is particularly beneficial to those with sensitive skin.

Thus, gloves with colloidal oatmeal help to protect and moisturize the hands, making it comfortable for the wearer to wear gloves for a longer duration, while performing their professional duties.⁴

References:
1. Lim D. Oatmeal – Skin facts. Available at https://dermnetnz.org/treatments/oatmeal.html accessed July 17th 2015
2. Food and Drug Administration. Skin protectant drug products for over-the-counter human use; final monograph. Fed Reg 2003; 68: 33362-81.
3. Kurtz ES, Wallo W. Colloidal oatmeal: history, chemistry and clinical properties. J Drugs Dermatol 2007; 6: 167-70
4. Neuser JH, Olson LM, Olson DW. Elastomeric gloves and methods of making. US Patent. Patent no. 7691436 B2 dated April 2010

Ancient Secrets of Colloidal Oatmeal

History
As early as 2000BC, oat grains were being grown and used in Ancient Egypt. However it was not until the Bronze Age (2000BC – 700BC) that mass cultivation of oats began. There is also evidence for the use of oats in Roman times, as literature from that period mentions its use for medical ailments. It was not until the beginning of the 17th century that oats began to be grown in North American, with initial plantations on Elizabeth Island, off the coast of Massachusetts. Today, oats are cultivated globally, including across Asia, Australasia, Europe, Russia and North and South America².

The journey of oats usage
Oats have been recognized since ancient times as a nutritious food source, with high levels of protein and fiber, and the ability to help lower body cholesterol. Oats are also used as a healthy food source for domestic animals². Due to their antioxidant properties, oats have also been used to preserve foods that are prone to fat oxidation¹.

The use of oats in skin treatments has been recognized since the early Roman period. However, it was not until the 1930s that literature was published on the role of oats as a skin protectant, cleanser, anti-irritant and the aesthetic benefits of oats in face masks and bath oil formulations. In the 1940s and 1950s, colloidal oatmeal, the product of fine milling of the oat husk, was developed. Colloidal oatmeal demonstrated further benefits for the skin, particularly relief of the irritation and itch associated with many skin conditions. During this time, the cosmetic use of oatmeal and colloidal oatmeal was widely accepted due to its numerous beneficial properties. By the 1970s, several topical skin products were using colloidal oatmeal as a key ingredient.

Finally, in 1989, the FDA identified colloidal oatmeal as a safe and efficacious over-the-counter (OTC) skin protectant, and recommended it as a Category I ingredient. In the year 2003, it was further regulated by FDA as a Skin Protectant Drug Product through an OTC monograph. The U.S. Pharmacopoeia currently standardizes the preparation of colloidal oatmeal¹.

Oatmeal today
The long history of oatmeal use, and its approval by contemporary authorities (FDA) as a skin protectant has strengthened the belief in the extensive applications of oatmeal for dermatological purposes. The benefits of oatmeal in normal applications include moisturizing, soothing and cleansing properties. For individuals with pruritic skin disorders such as atopic dermatitis, oatmeal possesses anti-inflammatory properties and while also acting to protect the skin barrier, and performing buffering activity. In addition, oatmeal’s sun-damage protective and antioxidant properties make it a popular inclusion in dermatological products, including skin, body, hair, sun-care, decorative and personal hygiene products^2,3.

The evidence for the safe, effective and powerful uses of colloidal oatmeal has encouraged its use in protective equipment such as gloves. The inclusion of colloidal oatmeal provides relief to glove wearers from the discomfort of dry, itching, irritated and allergy-prone skin that is often associated with chronic glove use. The skin protectant properties of oatmeal help to retain skin hydration and act as a shield from skin irritants⁴.

Thus, oats – the anciently preserved secret of skin care, has now progressed to widespread application in contemporary skin care and skin protective equipment (gloves). Oats provides numerous end-user benefits to professionals and consumers alike.

References:
1. Kurtz ES, Wallo W. Colloidal oatmeal: history, chemistry and clinical properties. J Drugs Dermatol. Feb 2007;6(2):167-70.
2. Lim D. Oatmeal – Skin facts. Available at:https://dermnetnz.org/treatments/oatmeal.html Accessed on Jul 29th 2015.
3. Pazyar N, Yaghoobi R et al. Oatmeal in dermatology: A brief review. Indian J Dermatol Venereol Leprol. 2012 Mar-Apr; 78(2): 142-5.
4. Neuser JH, Olson LM, Olson DW. Elastomeric gloves and methods of making. US Patent Publication no. 7691436 B2 dated April 2010

Should Disposable Gloves be Re-Used?

Gloves are personal protective equipment that provide barrier protection for hands against various hazards.¹ However, wearing gloves does not assure complete safety against contamination of hands. This is because any damage to gloves prior to or during usage will impair the basic barrier protective function of gloves.²

Disposable gloves are manufactured with the assurance of effective barrier protection intended for single use only. Disposable gloves are not meant to be washed or reused.³ Safe usage of disposable gloves is essential to assure their integrity and to shield hands against potential biological and incidental hazards.³

Critical factors for safe usage:
Disposable gloves can help prevent contamination of hands when the following factors are taken into consideration:
1. Hand hygiene: Practice hand hygiene with the help of hand wash or hand rub after removal of gloves.
2. Appropriate usage: Use of correct procedure for donning, removal, and disposal of gloves.⁴
3. No reuse: Disposable gloves are single use items, so reuse of gloves after washing or cleansing them to remove contaminants is not acceptable.^4,5,6

Reasons for avoiding re-use:
Since disposable gloves are single use items, glove decontamination and reprocessing are not recommended.⁴ Reasons to avoid reuse of disposable gloves include:

1. Absence of standardized procedures: There are no standardized, validated or affordable procedures available for safe glove reprocessing.⁴
2. Impairs protection: Reuse of disposable gloves by washing can destroy the protection factor of gloves against hazards
3. Contamination: Reusing disposable gloves may lead to personal contamination, contamination of work surfaces or contamination of personnel touching these surfaces, eventually leads to complications procedures.⁶
4. Risk of cross transmission: The inappropriate practice of reuse is accompanied with chances of cross transmission of various pathogens.⁴

Taking into consideration these crucial points, necessary efforts should be taken to prevent re-use of gloves.

Efforts taken against glove reuse:
The World Health Organisation has made a special mention in their “Glove Use Information Leaflet” that the practice of glove reuse after decontamination or reprocessing is not recommended. It has also stated that glove reuse in health-care settings should be prevented with every possible effort. Appropriate efforts should be taken to:

1. Reduce inappropriate usage of gloves
2. Purchase good quality disposable gloves
3. Replenish stock in timely manner⁴

Reuse of disposable gloves is also strongly opposed by the Environment, Health and Safety Departments of various renowned universities.^5,6

Reuse of disposable gloves is unfit, unhygienic and a threat to the wearer, people in contact with the wearer, as well as on the environment. Additionally, the cost of buying more gloves will far outweigh the costs of health and legal consequences one would need to face. Thus, reuse of disposable gloves should be strongly discouraged.

References:
1. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Setting. Available at: https://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf Accessed on: Aug 10th 2015
2. ADA Guidelines for Infection Control. Australian Dental Association. Guidelines for Infection Control. Available at: https://www.ada.org.au/app_cmslib/media/lib/1011/m274408_v1_infection%20control%20guidelines.pdf Accessed on: Oct 6th 2015
3. Glove Selection Guidance. Imperial College London. Available at: https://www3.imperial.ac.uk/OCCHEALTH/guidanceandadvice/gloveinformationandguidance/gloveselectionguidance Accessed on: Aug 11th 2015
4. Glove Use Information Leaflet. World Health Organisation. Available at: https://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf Accessed on: Aug 11th 2015
5. Glove Selection Guidance. Office of Environment, Health & Safety. University of California, Berkeley. Available at: http://www.ehs.berkeley.edu/workplace-safety/glove-selection-guide Accessed on: Oct 6th 2015
6. Re-use of disposable gloves. Environmental Health & Safety. Carnegie Mellon University. Available at: https://www.cmu.edu/ehs/newsletters/lab-safety/Re-use-of-disposable-gloves.html Accessed on: Aug 11th 2015

Nitrile Gloves and Its Benefits

Nitrile is a synthetic rubber – chemically termed as nitrile-butadiene rubber (NBR) – and formed from a blend of organic compounds known as acrylonitrile and butadiene. It is an unsaturated thermoset elastomer, which upon addition of suitable ingredients, has various applications in different fields such as automotive, aeronautical and other industries¹. It is widely used in applications where ordinary rubber cannot be used. Due to its high resilience, nitrile rubber is also used in chemical and biological industries, in the form of personal protective equipment (PPE) such as gloves.

Application of nitrile gloves:
Nitrile gloves are excellent for generalized protective purposes, as they provide a sufficient barrier against chemical and biological hazards². In most cases, they are the preferred form of glove to deliver the best protection against incidental contact from chemical hazards³. They also provide good shielding against oils and grease, as well as from certain solvents, acid and base splashes².

Additionally, nitrile gloves are widely used as non-sterile, disposable medical gloves in routine patient care.⁴ They minimize the risk of transmission of pathogens between the patients, the health-care providers and the surroundings.⁵ Plus, they also serve as a safe barrier in biochemical studies³.

Types of nitrile gloves:
Nitrile gloves come in different types according to the purpose they serve. Thicker, reusable gloves are typically used for extended contact, while disposable gloves are typically used for brief contact or procedures².

There are three types of nitrile gloves, all developed for different purposes⁶:
1. Non-medical gloves: Puncture and chemical resistant general purpose gloves. Useful in handling chemicals and contaminated sharps, as well as for cleaning and disinfection purposes.
2. Patient examination gloves: Sterile or non-sterile, single-use, disposable medical gloves. Used for performing examinations, nonsurgical and laboratory procedures.
3. Surgeons gloves: Sterile and single use medical gloves. Used for performing surgical procedures under aseptic conditions.

Properties of nitrile gloves:
The outstanding properties of nitrile gloves makes them an excellent choice of personal protective equipment (PPE), with wide applications.

1. Latex-free: Nitrile is composed of non-latex material, thus present a good alternative in latex allergy cases⁵
2. Temperature resistance: The nitrile material has a wide temperature range from –40°C to +125°C, thus gloves are able to remain intact in various temperature conditions¹
3. Chemical resistance: Nitrile gloves have good resistance to chemicals, including most solvents and certain acids and bases²
4. Durable: Nitrile gloves are puncture and abrasion resistant, thus have high durability^3,7
5. Visible rip: Nitrile gloves tear visibly when punctured, giving a clear indication of the need for disposal^2,3
6. Great fit: Nitrile gloves are elastic in nature, providing a perfect fit^3,4
7. Manual dexterity: Nitrile gloves are composed of flexible material, and thus make sensitive movements possible^3,4
8. Biological barrier: Nitrile gloves provide an adequate and effective protective barrier against pathogenic microorganisms⁷

Benefits of nitrile gloves:

Nitrile gloves are stronger as they are made of abrasion and puncture resistant material^3,7. They act as a functional screen over the hands, against deleterious chemicals and infectious pathogens.
The comfort provided by nitrile gloves such as great fit, grip and ability to perform fine finger movements, helps in performing repetitive tasks such as pipetting, and also means they can be used in examination or surgical tasks with ease^3,4.

While nitrile gloves render a comparable performance to the extensively used latex gloves, they offer an advantageous latex-free alternative to users who suffer from latex allergies^5.7. Due to the stringent manufacturing standards, and certified manufacturing facility and monitoring systems implemented to meet the requirements of PPE, the quality of nitrile gloves can be assured⁸.

Nitrile gloves provide many advantages over commonly used latex gloves and are the preferred choice of professionals in specific industries. The best quality nitrile gloves come from producers that have a certified manufacturing facility along with monitoring systems implemented to meet the requirements of PPE.⁸

References:
1. IIRSP. Acrylonitrile-butadiene rubber (NBR). Available at: https://www.iisrp.com/webpolymers/07nbr-18feb2002.pdf Accessed on Jul 27th 2015.
2. Glove Selection Guide. Office of Environment, Health & Safety. University of California. Available at: http://www.ehs.berkeley.edu/workplace-safety/glove-selection-guide accessed on Jul 28th 2015.
3. Glove Selection Guidance. Occupational Health. Imperial College of London. Available at: https://www3.imperial.ac.uk/OCCHEALTH/guidanceandadvice/gloveinformationandguidance/gloveselectionguidance accessed on Jul 28th 2015.
4. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Healthcare Infection Control Practices Advisory Committee (HICPAC). Available at: https://www.cdc.gov/hicpac/pdf/isolation/Pages41_65_Isolation2007.pdf accessed on Jul 27th 2015.
5. Standard principles for the use of personal protective equipment. Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care: Partial Update of NICE Clinical Guideline 2. Available at: https://www.ncbi.nlm.nih.gov/books/NBK115274/ accessed on Jul 27th 2015.
6. Frequently Asked Questions – Personal Protective Equipment. Infection Control. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/faq/protective_equipment.htm accessed on Jul 27th 2015.
7. Sawyer J, Bennett A. Comparing the level of dexterity offered by latex and nitrile safe skin gloves. Ann Occup Hyg. Apr 2006;50(3):289-96.
8. The Development of Nitrile Gloves. Health and Safety International – 2011. Available at: https://www.hsimagazine.com/article.php?article_id=144 accessed on Jul 27th 2015.

Choose Powder Free Over Powdered Gloves

The use of dusting powders during glove manufacturing is a common practice undertaken for the purpose of glove lubrication. Dry lubricants like cornstarch, silicone, etc. facilitate easy donning of gloves and prevent gloves from sticking together.¹ However, several health risks have been associated with the usage of glove powder.

Hazards of powdered gloves:

The use of powdered gloves has potential for dermatological, allergic and other toxic health hazards, which are as follows:
1. Wound infection: Significantly higher bacterial concentration is found in wounds contaminated by contact with glove powder. Glove powder has also shown to enhance a wound’s inflammatory response.²
2. Hypersensitivity: Glove powder is associated with negative biological responses to foreign bodies. Cornstarch powder may also be a contributing factor in development of irritation and Type IV allergies.¹ It has been reported that there is increased risk of latex allergy among powdered glove wearers, as latex antigens remain bound to cornstarch powder.²
3. Peritoneal tissue adhesion: Being a foreign body, glove powder has the potential to cause adhesions of peritoneal tissue after surgery.¹ Cornstarch glove powder has adverse effects on the healing of incision wounds due to formation of adhesions.²
4. Respiratory allergic reactions: Cornstarch powder from gloves binds to natural latex proteins which are allergenic and can thus cause respiratory allergic reactions. The tissue’s resistance to infection could be damaged by glove powder, leading to a risk for occupational asthma.¹
5. Bacterial environmental contamination: Circumstantial evidence has shown that bacterial environmental contamination may increase due to examination and surgical glove powders.²

Need for gloves without powder:
As adverse health effects have resulted from particulate matter release (release of particles such as glove powder) from glove surfaces, the need to manufacture and use “low powder” or “powder-free” gloves has been recognized. The Food and Drug Administration (FDA) and other agencies have received several requests to ban use of glove powder. The National Institute of Occupational Safety and Health (NIOSH) has issued safety alerts which recommend the use of powder-free gloves.¹

Powder-free gloves:
Gloves with low amounts of residual particles are referred as “powder-free” or “powderless”.¹ Powder-free gloves transmit less protein on to the skin and on to the respiratory tract.³ The FDA recognises gloves as “powder-free” based on the ASTM test standard D 6124-97, which states that glove powder less than or equal to 2 mg particulate weight is permissible. The Office of Device Evaluation (ODE) accepts gloves as “powder-free” based on a negative iodine test.

Supporting studies:
A study conducted in a hospital in Finland demonstrated that use of powder-free gloves for an extended duration of time was associated with a lower prevalence of respiratory allergic reactions.⁴ One study demonstrated that lesser allergen levels were observed in laboratories where powder-free gloves were used (< 0.02 ng/m3), compared to laboratories using powdered gloves (39 to 311 ng/m3).⁵

Manufacturing techniques:
Using powder-free manufacturing processes, several powder-free examination and surgical gloves can be developed.¹ Powder-free gloves may be manufactured either by polymer coating or by chlorination.
1. Chlorination: Chlorination is the most common process employed for the majority of powder-free glove production. It is a permanent method for reduction of surface drag in natural rubber latex (NRL) products. In this process, chlorine reacts with the glove surface to reduce its natural tackiness and eliminates the need for the addition of dusting powder.¹
2. Synthetic polymer coating: Coating with a synthetic polymer on the internal surface of the glove is another alternative for manufacturing powder-free gloves. Polymers used for coating on the inner side of gloves are hydrogel, silicone or other suitable polymers. The polymer coat is physically bound to the internal surface of the glove in contact with the skin. It has low coefficient of friction, which enables easy donning on dry as well as wet hands.^1,6,7

Thus, there has been exhaustive documentation of the toxic hazards of glove powder as well as the availability of suitable techniques of manufacturing powder-free gloves. This certainly justifies the use of powder-free gloves as an alternative to eliminate the hazards of glove powder usage. Users and purchasers of gloves should thus consider switching to powder-free gloves, in order to minimize the toxic and allergic effects attributed to the use of dusting powders in gloves.

References:
1. Medical Glove Powder Report. U.S. Food and Drug Administration. 2015 Aug. Available at: https://www.fda.gov/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm113316.htm Accessed on: Aug 12th 2015
2. Edlich RF, Long WB et al. Dangers of Cornstarch Powder on Medical Gloves Seeking a Solution. Annals of Plastic Surgery. 2009 Jul; 63: 822-6.
3. Glove Selection. University of Colorado Springs. Available at: https://www.uccs.edu/Documents/pusafety/EHS/Lab%20Safety%20Manual/UCCS.LS%20Appendix%20H%20Glove%20Selection.pdf Accessed on: Aug 12th 2015
4. Kujala VM, Reijula KE. Glove-related rhinopathy among hospital personnel. Am J Ind Med. 1996 Aug;30(2):164-70.
5. Tarlo SM, Sussman G et al. Control of airborne latex by use of powder-free latex gloves. J Allergy Clin Immunol. 1994 Jun;93(6):985-9.
6. Fisher MD, Neal JG et al. Ease of donning commercially available powder-free surgical

Natural Rubber Latex and Its Use in Gloves

Natural rubber latex (NRL) is a milky, fluid, plant product used in the manufacturing of several latex products.¹ It is a widely used and cost effective material which does not pose health risks for the majority of the population.²

Latex products are used for various applications ranging from simple household use, to use in performing specialized operations. Latex gloves are considered to be the best in terms of fit, and ease in surgical use.

Source and processing of NRL:
NRL is obtained from the commercially grown rubber tree, Hevea brasiliensis. Fresh latex can be transformed into different rubber forms such as sheets, crepes or blocks using various processes. Commercial latex is obtained by processing this fresh latex through blending, coagulation, drying or finishing.^1,3 Coagulation is obtained by adding coagulants such as formic or acetic acid. Regulation of viscosity and color is facilitated by addition of various chemicals.⁴ Rubber latex can also be converted into latex concentrate. This is used for making dipped products – where glass or porcelain formers in the shape of the item to be made are dipped into liquid latex.²

Properties of NRL:^2,5
1. Durability: The material is strong enough to withstand pressure and damage.^2,5 It displays resistance to tear.⁶
2. Flexibility and elasticity: NRL conforms to a number of different shapes and surfaces. Its thickness delivers greater flexibility, allowing its use as a comfortable shield without hampering free movement.^2,5
3. Reseals on puncture: NRL has the unique property of resealing on rupture, remaining as a protective seal.^2,6
4. Chemical resistance: NRL provides resistance against many inorganic chemicals.⁷
5. Barrier protective: NRL forms an effective barrier against microorganisms, protects against fluid penetration, and thus against biological hazards.^5,6

Applications:^1,8

1. About 90% of the processed NRL is used in the manufacture of rubber products such as tyres. The remaining 10% is used in the production of dipped products such as gloves, balloons, etc.¹
2. Industrial use: NRL is used in the manufacture of rubber tubings, linings for storage tanks and pneumatic tyres used in bicycle and motor vehicles.
3. Personal protective equipment (PPE): NRL is used in making rubber gloves for general purpose and industry use. It is also used in protective equipment for surgical procedures such as surgical gloves, face masks.
4. Hospital equipment: NRL is used in the fabrication of equipment such as catheters, oxygen masks, stethoscope tubing, etc.
5. Birth control methods: NRL is used in manufacture of birth control equipment such as condoms and diaphragms.
6. Household applications: NRL is used for home use articles such as pillows, mattresses, bathmats.
7. Children’s products: NRL is used in the teats of baby bottles, toothbrush, toys, diapers.
8. Other: NRL is used in general purpose items such balloons, swimming caps, rubber bands, storage bags.

Benefits in glove use:
Gloves made from natural rubber latex are the most extensively used single-use devices made from the material for professional use.² These gloves offer secure protection against infections, preventing transmission of pathogens arising from contact with infected body fluids.^2,6 They are a preferred choice in clinical procedures where manual dexterity and tactility is necessary. Usually chosen in brief patient contact tasks, they are easy to wear, provide good grip and comfort to hands.^5,2,,9 NRL gloves also provide sensitivity, comfort, flexibility and good conformance to the hand.⁵

Though latex gloves have many benefits, their use may be accompanied with mild to severe allergic reactions such as eczema, asthma and hay fever.^1,3 In such cases, substitution with nitrile gloves can be advantageous as these provide comparable performance.^7,10 A study conducted on healthcare workers in the hospital of Cuneo, Italy, also concluded that switching from latex gloves to nitrile is safe and cost-effective.11 This will result in a reduction in latex allergies, and could be beneficial in improve the ease with which individual’s perform their tasks.

References:
1. Latex Allergy. Available at: https://www.slhd.nsw.gov.au/rpa/allergy/resources/allergy/latexallergy.pdf Accessed on: Sep 8th 2015.
2. About NRL (Natural Rubber Latex). Latex Allergy Support Group. Available at: https://www.lasg.org.uk/information/about-nrl-natural-rubber-latex Accessed on: Sep 8th 2015.
3. Preventing Allergic Reactions to Natural Rubber Latex in the Workplace. CDC – NIOSH Publications and Products. 2015. Available at: https://www.cdc.gov/niosh/docs/97-135/ Accessed on: Sep 8th 2015.
4. Natural rubber processing. United Nations Conference on Trade and Development. Available at: https://www.unctad.info/en/Infocomm/Agricultural_Products/Caoutchouc/74337/Research-and-Development/ Accessed on: Sep 8th 2015.
5. Mylon P, Lewis R et al. A study of clinicians’ views on medical gloves and their effect on manual performance. Am J Infect Control 2014; 42: 48-54
6. Patel HB, Fleming GJ, Burke FJ. Puncture resistance and stiffness of nitrile and latex dental examination gloves. Br Dent J. 2004 Jun 12;196(11):695-700; discussion 685; quiz 707.
7. Glove Selection Guidance. Occupational Health. Imperial College London. Available at: https://www3.imperial.ac.uk/OCCHEALTH/guidanceandadvice/gloveinformationandguidance/gloveselectionguidance Accessed on: Sep 7th 2015.
8. Latex items. Available at: https://www.pennstatehershey.org/c/document_library/get_file?folderId=1042150&name=DLFE-11454.pdf Accessed on: Sep 8th 2015.
9. Fundamental elements needed to prevent transmission of infectious agents in healthcare settings. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Available at: https://www.cdc.gov/hicpac/2007IP/2007ip_part2.html Accessed on: Sep 8th 2015.
10. Standard principles for the use of personal protective equipment. Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care: Partial Update of NICE Clinical Guideline 2. [Internet] [cited on 2015 Jul 27] Available at: https://www.ncbi.nlm.nih.gov/books/NBK115274/
11. Gerbaudo L, Violante S et al. Collateral effects of a project of latex rubber removal in a hospital institution. G Ital Med Lav Ergon. 2007 Oct-Dec;29(4):883-9.

Nitrile Gloves – Best Against Industrial Oils & Fats

Protection from contact with hazardous materials is essential for safeguarding the health of personnel, and environmental safety. Glove use is a simple but important aspect of personal protective equipment to safeguard hands against occupational hazards. There are various types of gloves, each with properties suitable for materials to be handled and the task undertaken.¹ Amongst the various types of gloves available, nitrile gloves are best for handling sticky and slippery substances like industrial oils, greases and fats – which otherwise may lead to discomfort on skin.

Nitrile gloves are manufactured from acrylonitrile-butadiene rubber (NBR), commonly known as nitrile rubber.² Nitrile rubber offers resistance to a variety of chemicals and hazardous materials.³ The proportion of acrylonitrile content used in the manufacturing process is responsible for greater oil and solvent resistance.² This is the basis for nitrile gloves as good barriers against lubricating oils, fats and oil-based products.³

Properties of Nitrile gloves:
The properties of nitrile gloves responsible for protection against industrial oils and greases are:

1. Mechanical strength: They demonstrate abrasion and puncture resistance along with stiffness. Thus they possess good mechanical strength.⁴
2. Chemical resistance: They are highly resistant to many chemicals, oils and greases.⁵ They do not deteriorate upon exposure to such chemicals.
3. Temperature resistance: They are stable along a wide temperature range of –40°C to +125°C. This provides good protection when handling fats and oils at various temperatures.²
4. Durable: They have longer shelf life and can remain usable for a longer duration.⁶ Such durable equipment is useful in automotive industries.
5. Grip: They offer good grip, fit and thus are useful in performing tasks accurately, even in oily environments.¹
6. Flexibility and elasticity: They provide enough comfort to carry out skilled tasks without movement restriction¹ This property is very important when working with oily substances for adequate handling and prevention of spillage.

Advantages offered by Nitrile gloves:
Nitrile gloves are manufactured from synthetic rubber and thus form an ideal replacement for latex gloves in the cases of latex allergies.⁶ Repetitive movements can be performed freely because of the flexibility and elasticity offered.¹ The mechanical strength offered by the material, serves as a robust shield for hands against physical hazards.¹ With longer shelf life accompanied with material strength, they can be worn for longer periods with comfort.⁶

Nitrile gloves provide good barrier protection against many hazards.⁷ They demonstrate high resistance against many chemicals such as chlorinated solvents, corrosive compounds, acids and alkalis.⁵ They also provide good protection against sticky substances like oils, lubricating fats and oil-based products.³ They offer good grip and comfort while working on oily surfaces, including reduced chances of slip. Oily parts can be handled with greater ease and industrial tasks can be performed with less fatigue and greater accuracy.

Application in industries:
Nitrile gloves, due to their good resistance to industrial fats and oils, offer wide applications in the automotive industry. Their wide temperature resistance makes nitrile gloves ideal for performing tasks at extreme temperatures. In the automotive field, they are useful in manufacturing as well as maintenance processes. They also have applications in industrial processes for handling fuel and oil carrying seals, hoses and grommets. They render extensive applications in industries dealing with oil storage, processing and delivery.²

Nitrile gloves safeguard against incidental contact by offering protection against splashes or spills.¹ Such protection is of utmost importance when performing tasks in automotive and related industries.

Thus, nitrile gloves – due to their unique properties, have a very important protective role in industries where users have high exposure to irritants like industrial oils and animal fats.

References:
1. Glove Selection Guidance. Occupational Health. Imperial College London. Available at: https://www3.imperial.ac.uk/OCCHEALTH/guidanceandadvice/gloveinformationandguidance/gloveselectionguidance Accessed on: Sep 7th 2015
2. Acrylonitrile-butadiene rubber (NBR). [Internet] [cited on 2015 Jul 27] Available at: https://www.iisrp.com/webpolymers/07nbr-18feb2002.pdf Accessed on: Sep 7th 2015
3. .Chemically Resistant Gloves. Available at: https://chem.kuleuven.be/en/hse/info/proc2sub5d.htm#Nitrile%20gloves Accessed on: Sep 9th 2015
4. Patel HB, Fleming GJ, Burke FJ. Puncture resistance and stiffness of nitrile and latex dental examination gloves. Br Dent J. 2004 Jun 12;196(11):695-700; discussion 685; quiz 707.
5. Laboratory Safety Manual. UCLA Department of Chemistry and Biochemistry. Available at: https://www.chem.ucla.edu/labsafety Accessed on: Sep 7th 2015
6. Environmental Risks. Available at: https://www.sdaa.sk.ca/Workplace%20Issues/Handbook-pdf/CH7-EnvironmentalRisks-2015.pdf Accessed on: Aug 7th 2015
7. Korniewicz DM, El-Masri M et al. Performance of latex and nonlatex medical examination gloves during simulated use. Am J Infect Control. 2002 Apr;30(2):133-8.

Benefits of Lipids (Oat Oil) in Colloidal Oatmeal

Skin as a barrier and protectant

In normal skin conditions, the superficial epidermal layer of the skin behaves as a two-sided barrier. It prevents the penetration of harmful agents into the skin, and also prevents water evaporation in the reverse direction. The right blend of intercellular lipids and stratum corneum cells (the outermost skin layer) make up and maintain this essential barrier property. When this barrier function is compromised, it can cause several skin disorders such as atopic dermatitis, or lead to additional skin inflammation due to uninhibited penetration of irritants, allergens and microbes into the skin.¹ For this reason, emollients that repair and protect the stratum corneum are important for general skin health, as well as for the improvement of certain eczema-like conditions.¹

Lipids in colloidal oatmeal
Oats are a natural ingredient employed in a variety of skin products in the form of colloidal oatmeal. Colloidal oatmeal contains an array of vital chemical compounds such as lipids, avenanthramides, starches, hydrocolloids like β-D-glucan, phenolic esters, saponins and vitamins. The total lipid content in oats is comparatively high (about 6% to 12%). This includes a composition of 41% triglycerides and 5% free fatty acids, which is greater than other cereals. The oats are especially rich in unsaturated fatty acids such as linoleic acid and oleic acid, which account for about 40% and 36% of the total fatty acids present. Additionally, about 19% of palmitic acid and minute quantities of other fatty acids like stearic and myristic acids are also present.¹ This lipid content is extracted from the oat crop by a meticulous process, resulting in a product known as oat oil.^1,2,3

Lipids from oat oil: Role in skin care
Lipids from oat oil have demonstrated benefits for skin conditions that involve a compromised permeability barrier. Lipids are not only helpful in improving the protective skin barrier, but also provide vital moisturization for skin that is irritated¹. In particular, linoleic acid contributes to maintaining skin barrier properties and plays a vital role in soothing and maintaining healthy skin.¹

Oat oil as a whole retains all advantageous properties of the oatmeal, including anti-oxidant, anti-inflammatory, anti-irritant and anti-allergic features. It bestows excellent softening and hydrating action on the skin, which contributes to its use in a wide range of cosmetic products. It is also incorporated in many personal care products such as massage oils, anti-ageing creams and sun care products.^2,3

Lipids from colloidal oatmeal: shielding hands
The skin barrier properties of lipids complement the shielding role of colloidal oatmeal, thus leading to the wide application of colloidal oatmeal and oat oil in personal protective equipment, including gloves.

Gloves that contain colloidal oatmeal form a safeguarding layer on the hand surface, protecting the skin from water loss from the skin surface. A colloidal oatmeal layer also prevents skin exposure to the potentially irritating glove material, as well as other irritants. The finely textured oatmeal can also aid in absorbing sweat, and act as a buffer to maintain skin pH.⁴

Thus, colloidal oatmeal, when used in gloves, increases the comfort of users through the lipid rich oat oil layer that protects the skin barrier.

References:
1. Oat Oil Improves the Skin Barrier. The dermatologist. Available at: https://www.the-dermatologist.com/sites/default/files/supplements/Aveeno_SeptInsert_2012_0%20(1).pdf Accessed on Aug 4th 2015.
2. Oat Oil. Natural Sourcing. Available at: https://www.naturalsourcing.com/product-literature/NS_info_oat_oil.pdf Accessed on Aug 4th 2015.
3. Oat oil. CEAPRO. Available at: https://ceapro.com/wp-content/uploads/2012/09/OatOil-906-3003-HIGHRES-Sept.13.pdf Accessed on Aug 4th 2015.
4. Lim D. Oatmeal – Skin facts. Available at https://dermnetnz.org/treatments/oatmeal.html accessed July 17th 2015

Why Dermatologists Trust Colloidal Oatmeal

Colloidal oatmeal has a long history of beneficial use in dermatology. As a natural product that has an excellent safety record, it has demonstrated efficacy for the treatment of atopic dermatitis, psoriasis, drug-induced rash and other conditions. The benefits of colloidal oatmeal are further enhanced by the endorsement of the product by the US-FDA, and standardization by the US Pharmacopoeia.¹

Studies conducted by dermatologists over the globe, have demonstrated the role of colloidal oatmeal in improving skin conditions, along with raising quality of life in 80% of patients.² These results, along with literature on its ancient usage in skin conditions, has further strengthened the trust of dermatologists in colloidal oatmeal.

Bioactive constituents of oatmeal:^{1,2, 3}
The chemical polymorphism of colloidal oatmeal offers various dermatological benefits. Colloidal oatmeal consists of about 70 to 80% starch and beta-glucans that are responsible for its moisturizing properties – a prerequisite in skin care. Flavonoids in colloidal oatmeal strongly absorb ultraviolet UVA radiation, offering photo-protection to the skin, while Vitamin E helps in preventing photo damage. These properties are valued by dermatologists for individuals with vulnerable skin conditions. The mild cleansing action contributed by saponins and antioxidant, plus the anti-inflammatory and anti-pruritic actions due to presence of avenanthramides further increase a dermatologist’s armamentarium.

Beneficial effects of oatmeal:^1,3
Colloidal oatmeal provides proven clinical benefits in generalized dermatological care with several favourable effects on the skin:

1. Anti-inflammatory activity: Attributed to the inhibition of biosynthesis of prostaglandin E2 (an inflammatory mediator), helpful in the management of skin disorders.
2. Anti-itch and soothing action: Aids to reduce itching associated with various forms of xerotic dermatoses.
3. Moisturization: Upholds water conserving emollients and the natural protective barrier properties of the skin’s surface.
4. Cleansing agent: Can be safely used in baths to thoroughly cleanse abraded skin associated with several debilitating skin diseases.
5. Buffering properties: Assists to prevent itching associated with dermatitis by maintaining normal skin pH.

Application of Colloidal oatmeal in various clinical conditions:^1-3
The long history of safe usage of colloidal oatmeal, along with its several admirable benefits in skin care has encouraged its wide use in dermatological practice and as a complementary therapy in numerous pruritic conditions.

1. Atopic dermatitis: Colloidal oatmeal is widely used as an adjunct in the treatment of atopic dermatitis. It restores the cutaneous skin barrier by alleviating distressing symptoms and is shown to be useful in management of sensitive skin, even in children below 2 years of age.
2. Psoriasis: The anti-inflammatory properties of colloidal oatmeal are beneficial as a remedy for this debilitating skin disorder that takes its toll on the psychosocial wellbeing of affected individuals.
3. Antiviral: Colloidal oatmeal provides effective relief by inhibiting inflammation causing components at a cellular level, in viral skin diseases.
4. Skin protection: Absorption of ultraviolet radiation by colloidal oatmeal serves as a protectant against skin damage, an action further endorsed by US FDA and US Pharmacopoeia.
5. Antifungal activity: Colloidal oatmeal’s role as an antifungal has also been proved successfully in vitro and can be safely used as an add-on therapy in fungal infections.
6. Acne-like eruptions: Colloidal oatmeal is advantageous in improving patient compliance to anti-cancer treatments that may be responsible for acne-like eruptions on facial skin.
7. Other uses: Colloidal oatmeal is widely accepted as a mild ingredient in cosmetics such as cleanser, moisturizer, shampoos and shaving gels which can be safely used in pruritic skin disorders.

Colloidal oatmeal for dermatologists’ use:

For usage in clinical practice, as per a multicenter study conducted in Greece, dermatologists self-scored the properties of a colloidal oatmeal emollient and rated improvements in clinical dryness, scaling, itching and erythema in patients with eczema.² This confirms the usage and benefits of topical colloidal oatmeal formulations for skin care.

Dermatologists, by the very nature of their profession have a high skin contact exposure, prompting a higher need to wear gloves for patient examination and procedures. Chronic glove usage often leads to drying, irritation and allergic conditions for dermatologist’s themselves.^4,5

Anecdotal reports also support the role of colloidal oatmeal as a dusting powder for use in gloves.3 Availability of gloves with added colloidal oatmeal prevents sticking to the skin and forms a protective coat on the hands, thereby protecting the wearer from irritation and allergy.

Thus, colloidal oatmeal is well accepted by dermatology practitioners, and is a regular part of their usage in prescription products and personal protective equipment.

References:
1. Kurtz ES, Wallo W. Colloidal oatmeal: history, chemistry and clinical properties. J Drugs Dermatol 2007; 6: 167-70
2. Nebus J, Nollent V, Wallo W. New Learnings on the Clinical Benefits of Colloidal Oatmeal in Atopic Dermatitis. The Dermatologist. 2012 Oct; Available at: https://www.the-dermatologist.com/sites/default/files/supplements/Aveeno_Insert_Oct2012_0.pdf Accessed on Jul 30th 2015.
3. Pazyar N, Yaghoobi R et al. Oatmeal in dermatology: A brief review. Indian J Dermatol Venereol Leprol. 2012 Mar-Apr; 78(2): 142-5.
4. Lim D. Oatmeal – Skin facts. Available at: https://dermnetnz.org/treatments/oatmeal.html Accessed on Jul 29th 2015.
5. Neuser JH, Olson LM, Olson DW. Elastomeric gloves and methods of making. US Patent Publication no. 7691436 B2 dated April 2010

Winner of the GloveOn Contest Announced

We are pleased to announce the winner of our GloveOn website contest is Brianna Coulter! Congratulations, Brianna! Brianna has won a brand new iPad Air 2 for telling us why she thinks GloveOn is the better choice:

“GloveOn is a better choice because it makes me want to leave my GlovesOn!”

Brianna is a research assistant at the Hunter Medical Research Institute (HMRI) in the Newcastle-Hunter area. Established in 1998, HMRI aims to deliver research outcomes closely aligned with technology, to meet and exceed community health needs. By facilitating collaboration between researchers, scientific advances can be translated into better clinical care and improved health care guidelines. The HMRI research teams have published a number of important findings over the years, most recently addressing asthma in the elderly and fertility solutions. Under the team led by Professor Andrew Boyle, Brianna is currently assisting in research focusing on cellular signalling in cardiac fibrosis and remodelling following heart attacks. MUN has had an ongoing relationship with the HMRI teams for a number of years and we are glad their choice to use GloveOn gloves has resulted in a win! We hope you enjoy your new iPad, Brianna!

MUN team member Gary presenting Brianna with her new iPad

7 Active Ingredients in COATS

COATS is an acronym for the term “Colloidal Oatmeal Active Therapeutic System”.¹ The patented process formulates colloidal oatmeal as virtually water soluble powder, making it easily usable in powder-free gloves.² Colloidal Oatmeal is a starch protein concentrated complex produced from finely powdered de-hulled oats.¹ It is a U.S. FDA recognized skin protectant, with numerous benefits for the skin.³

7 Active ingredients in COATS:
Each of the ingredients present in colloidal oatmeal has a specific role in skincare. The contribution of each constituent and their specific properties are as follows:

1. Avenanthramides: A group of polyphenolic compounds possessing high antioxidant activity.
Skin care properties –

• Antioxidant activity: They have 10 to 30 times greater antioxidant activity than other oat phenolics. The antioxidant activity confers improved outcomes in various skin diseases.
• Anti-inflammatory activity: Avenanthramides inhibit prostaglandin biosynthesis and release of pro-inflammatory mediators. This contributes to anti-inflammatory activity, useful in management of various skin conditions such as allergies.
• Anti-irritant and skin protectant: Avenanthramides can be used to provide relief to sensitive and sun-exposed skin⁴.
• Anti-pruritic activity: Avenanthramides sooth and reduce itch-induced scratching.

Avenanthramides are therefore suggested as potential natural ingredients in improving the signs of atopic dermatitis skin.^4,5

2. Avenacins: Phenolic esters structurally similar to saponins, possessing a large lipophilic region and a short chain of sugar residues interacting with non-lipid components.
Skin care properties –

• Cleansing activity: Avenacins demonstrate soap-like action and therefore serve as a cleanser, buffer and a soothing agent. This mild cleansing action is beneficial in irritating skin conditions like atopic dermatitis.
• Anti-fungal: Moreover, avenacins also possess anti-fungal activity. They are used as an adjunct in curing fungal infections^3,6

3. Phenolics and Flavonoids:

Phenolics: A natural source of many antioxidant compounds, providing protection against oxidative stress.
Skin care properties –

• Anti-aging: Phenolics prevent lipid peroxidation and oxidative degradation. This property helps in protecting skin cells against oxidative stress damage.^7,8

Flavonoids: are also phenolic structures and thus they are also potent antioxidants.
Skin care property –

• UV-protectant: They strongly absorb ultraviolet A (UVA) radiation in the 320-370 nm range. This protects skin from photodamage.³

4. ßeta-Glucan: Important polysaccharides, hydrocolloidal in nature. Exhibit viscous nature when in solution form, which imparts emollient property.
Skin care properties –

• Moisturizing activity: Beta-glucan can lead to formation of an occlusive and water-holding colloidal film, thus retaining moisture. This helps in providing relief from dry, itchy skin.

5. Lipids/Oils: The lipid content in colloidal oatmeal is high (about 6-16%). It is rich in triglycerides and free fatty acids.
Skin care properties –

• Skin barrier activity: Lipids act as a skin barrier, repairing and protecting the stratum corneum (the outermost layer of skin). Lipids are beneficial in compromised skin permeability conditions like atopic dermatitis. Lipids also protects skin from external irritants.
• Moisturization: Lipids form a layer on the skin surface, to aid in moisturizing, soothing and maintaining a healthy skin.⁹

6. Starch: An important polysaccharide present (65% to 85%) in colloidal oatmeal.
Skin care properties –

• Emollient activity: Starch has protective and water-retaining properties. It helps in hydration of the skin, which is necessary for dry and sensitive skin types.⁶
• Physical barrier: Starch forms viscous solutions, creating a barrier on the skin surface. This prevents water evaporation from the skin surface, thus allowing the skin to remain hydrated. Useful in xerotic skin conditions.³
• Absorptive and adsorptive action: Starch helps in adsorbing harmful substances like urea and salt excretions from the skin surface. This prevents skin itch and irritation.¹⁰

Starch confers smoothness and anti-irritant properties and can be used as dusting powder in gloves.¹¹

7. Oat Peptides: Extracted from oat kernels.
Skin care properties –

• Protective film: Oat peptides have the capacity to form a protective film, thus imparting skin protection.
• Water binding activity: Oat peptides Impart moisturization to the skin and therefore prevent dryness of the skin.¹²
• Buffering action: Soluble over a wide pH range and help to maintain normal skin pH.
• Skin repair: Promotes collagen and elastin formation to help in skin repair.¹⁰

These active ingredients present in colloidal oatmeal thus have a wide array of benefits for skin care. Usage of colloidal oatmeal in COATS glove technology thus helps in protecting skin from drying, irritation and allergic conditions arising due to contact allergy. This patented technology helps in improving compliance and ease of patient handling for professionals, along with providing protection to hands.

References
1. What is COATS? Available at: https://www.hartalega.com.my/pdf/coats-brochure.pdf Accessed on: Aug 14th 2015
2. Elastomeric gloves and methods of making. US 7691436 B2
3. Kurtz ES, Wallo W. Colloidal oatmeal: history, chemistry and clinical properties. J Drugs Dermatol. 2007 Feb;6(2):167-70.
4. Avenanthramides: oat compounds with a growing role in dermatology. Available at: https://www.aveenomd.com/sites/aveenomd/files/documents/Avenanthramide%20White%20Paper%201%2010.pdf Accessed on: Aug 17th 2015
5. Nebus J, Nollent V, Wallo W. New Learnings on the Clinical Benefits of Colloidal Oatmeal in Atopic Dermatitis. The Dermatologist. 2012 Oct; Available at: https://www.the-dermatologist.com/sites/default/files/supplements/Aveeno_Insert_Oct2012_0.pdf Accessed on Jul 30th 2015.
6. Pazyar N, Yaghoobi R et al. Oatmeal in dermatology: A brief review. Indian J Dermatol Venereol Leprol. 2012 Mar-Apr; 78(2): 142-5.
7. Serafini M, Laranjinha JA et al. Inhibition of human LDL lipid peroxidation by phenol-rich beverages and their impact on plasma total antioxidant capacity in humans. J Nutr Biochem. 2000 Nov;11(11-12):585-590.
8. Brouda I, Edison B et al. Lactobionic Acid Anti-Aging Mechanisms: Antioxidant Activity, MMP Inhibition, and Reduction of Melanogenesis. Poster Exhibit at the Summer Academy Meeting of the American Academy of Dermatology, Chicago, IL, August 4-8, 2010. Available at: https://www.neostratapro.com/images/neostratapro/en_us/local/landing/lactobionic_acid_antiaging_mech.pdf Accessed on: Aug 17th 2015
9. Oat Oil Improves the Skin Barrier. The dermatologist. Available at: https://www.the-dermatologist.com/sites/default/files/supplements/Aveeno_SeptInsert_2012_0%20(1).pdf Accessed on Aug 4th 2015.
10. Oat Cosmetics: Oat COM Extruded Colloidal Oatmeal. Oat Cosmetics. Available at: https://www.oatcosmetics.com/ingredients-formulations/colloidal-oatmeal/ Accessed on: Aug 17th 2015
11. Non-Food Uses for Oat Fractionation Products. Available at: https://www.oat.co.uk/wp-content/uploads/2013/11/2.-oatec-Non-Food-Uses-for-Oat-Fractionation-Products.pdf Accessed on: Aug 17th 2015
12. Ingredients – the humble oat comes of age. Available at: https://www.cosmeticsbusiness.com/technical/article_page/Ingredients__the_humble_oat_comes_of_age/57401 Accessed on: Aug 17th 2015

Gloves as Part of PPE

Occupational Safety and Health Administration, OSHA defines personal protective equipment (PPE) as “specialized clothing or equipment, worn by an employee for protection against infectious materials.”¹

Importance of PPE:

PPE is designed to minimize exposure to different types of hazards. It is necessary to establish and maintain a healthy and a safe work environment. Co-operation from employers as well as employees is essential to ensure maximum protection in the workplace. PPE includes items such as gloves, hard hats, goggles, boots, full body suits and respirators.²

Gloves as part of PPE:
Gloves are a part of personal protective equipment, which protect the hands of wearers from various hazards.¹ They are most commonly used in healthcare settings to safeguard against infectious materials. Single use, non-sterile gloves of latex, nitrile or vinyl material are most commonly used in patient care procedures.²

Types of protective gloves:
Different types of gloves offer wide protections against hazards. Glove selection depends on the nature of the gloves and work to be performed. Specific type of gloves will give protection against certain hazards only. Factors influencing selection of gloves are type of chemicals handled, grip requirements, comfort, abrasion or puncture resistance, etc. The following are some different types of gloves:

1. Leather, canvas or metal mesh gloves: provides protection against heat, burns or cuts.
2. Fabric or coated fabric gloves: offers protection for use in carrying heavy, sharp and slippery objects.
3. Chemical resistant gloves: provides resistance against various chemicals.

Below are some rubber glove types and the protection they offer against particular chemicals:²

Properties of ideal gloves:
No single glove can possess properties to serve every wearer’s requirement. Some of the desirable properties for glove use are:

1. Comfortable fitting: Should comfortably fit the user’s hands. They should not be very loose or tight.²
2. Tear/abrasion resistance: Should not get torn or damaged easily, to offer good protection while handling sharp or rough surfaces.²
3. Durability: Should be strong enough to perform tasks for long durations.²
4. Tactility: Should give good grip while handling objects and performing skilled operations.³
5. Flexibility and elasticity: Should be stretchable enough to maintain dexterity and tactility of hands. It should enable smooth movement and reduce hand fatigue.³
6. Barrier protection: Should protect against physical, chemical and biological hazards by forming a protective shield on hands.⁴

Glove usage:
Gloves are used by various professionals for personal protection at workplace. Surgeons and other healthcare professionals use sterile surgical gloves while performing invasive procedures. Industrial personnel often use heavy duty gloves to offer them protection against physical hazards.

Thus, the appropriate use of gloves as PPE can minimize hazards in the workplace in a simple manner. The safety and health of all professionals in various occupations can thus be ensured by wearing PPE.

References:
1. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Setting. Available at: https://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf Accessed on: Aug 10th 2015
2. Personal Protective Equipment. Occupational safety and health administration. Available at: https://www.osha.gov/Publications/osha3151.html Accessed on: Aug 10th 2015
3. Mylon P, Lewis R et al. A study of clinicians’ views on medical gloves and their effect on manual performance. Am J Infect Control 2014; 42: 48-54
4. Glove Selection Guidance. Occupational Health. Imperial College London. Available at: https://www3.imperial.ac.uk/OCCHEALTH/guidanceandadvice/gloveinformationandguidance/gloveselectionguidance Accessed on: Sep 7th 2015.

Glove Usage Fundamentals

Gloves are equipment that protect the hands of wearer from various hazards, depending on the glove type selected.¹

Depending on the profession, glove usage differs from handling infectious hazardous materials of biological origin to handling corrosive, toxic chemicals, or for protection against physical hazards such as sharp objects or very hot and cold materials.²

Glove usage in different fields: Gloves are used in different fields with the purpose of providing protection against several hazards such as:

1. Engineering: Protection against metal working fluids, oils, greases, solvents, adhesives, cement, etc.
2. Maintenance: Resistance against paints, solvents, epoxy resins, tar, cement, degreasers, oils, etc
3. Printing: Prevent permeation of inks, solvents, processing chemicals, adhesives, etc.
4. Catering: For handling ovens, dishwasher liquids, surface cleaning agents, etc.
5. Agriculture: Safeguard against harmful pesticides, weed killers, solvents, etc.
6. Cleaning: Prevent exposure to bleaches, detergents, cleaning agents, etc.²
7. Healthcare: Extensively used at the time of surgery, patient contact or to prevent exposure to hazardous microorganisms as well as chemicals.³

Glove use in health care settings: In health care, it is necessary to consider when to use or remove gloves. Adhering to proper glove usage policies helps in ensuring appropriate glove use and preventing risks due to over-use.3 Indications for glove use as per WHO guidelines, 2009 are as follows:⁴

1. When to use gloves:

i. Before performing an aseptic procedure.
ii. When contact with body fluids such as blood is anticipated.
iii. During contact precautions such as before patient contact.
iv. When contact with chemical hazards such as disinfectants is anticipated.

2. When to remove gloves:

i. When there is damage or suspicion of non-integrity.
ii. After contact with body fluids, non-intact mucous membrane and skin.
iii. After patient contact, contact with their surroundings or any contaminated body site.
iv. When there is a requirement for hand hygiene.
v. After contact with chemicals.

Donning and removal of gloves in healthcare:
Special care has to be taken in donning and removal of gloves in healthcare facilities, as there are chances of infection outbreaks. The method for donning and removal of gloves is as follows:⁵

1. Donning:
Gloves are to be donned last among the other personal protective equipment (PPE) such as gowns, face masks, goggles, etc. The steps for glove donning are:

i. Insert hand into the respective glove and adjust for desired dexterity and comfort.
ii. If gown is worn, tuck the gown cuffs beneath each glove to obtain complete barrier protection.

2. Removal:
Glove removal comes first in the sequence for PPE removal. Following are the steps for removal and disposal of single use, contaminated gloves:

i. With one hand gloved, grasp the opposite glove from the outside, starting from the wrist.
ii. Pull and take off the glove inside-out, keeping the contaminated side on the inside.
iii. Hold the removed glove in the opposite hand
iv. Put two fingers under wrist of the second glove.
v. Peel off glove from inside, forming a bag for both the gloves.
vi. Discard in the waste container.

By paying close attention to these basic fundamentals of glove usage, safety and efficacy in the workplace can be achieved. Thus, occupational hazards will be prevented and personnel safety will be assured.

References:
1. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Setting. Available at: https://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf Accessed on: Aug 10th 2015
2. Glove Selection Guidance. Imperial College London. Available at: https://www3.imperial.ac.uk/OCCHEALTH/guidanceandadvice/gloveinformationandguidance/gloveselectionguidance Accessed on: Sep 14th 2015
3. Tools of the trade. Royal College of Nursing. Available at: https://www.rcn.org.uk/__data/assets/pdf_file/0003/450507/RCNguidance_glovesdermatitis_WEB2.pdf Accessed on: Sep 14th 2015
4. Glove Use Information Leaflet. World Health Organisation. Available at: https://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf Accessed on: Sep 15th 2015
5. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Setting. Available at: https://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf Accessed on: Aug 10th 2015

Basics of Hand Hygiene in Healthcare

Hand hygiene is one of the most important factors in preventing the spread of infection.
In order to disrupt the transmission of microorganisms to patients, healthcare providers should practice hand hygiene at key junctures. These junctures include: after contact with blood, bodily fluids or contaminated surfaces (even if gloves are worn), before invasive procedures and after removing gloves (wearing gloves is not enough to prevent the transmission of pathogens in healthcare settings).

Transmission of Pathogens
Transmission of pathogens may take place through direct or indirect contact, water or fluid droplets, air or through some other common vehicle. In many healthcare settings, the most common vehicle is transmission through the contaminated hands of healthcare workers

Merely touching a patient, or contaminated surroundings in a patient’s room, can result in hand contamination. This leads to the growth of microorganisms, and progressive colonization of hands with commensal flora and pathogens, which can survive on hands for up to 60 minutes. Microorganisms that are commonly found on health care worker’s hands are methicillin resistant S. aureus (MRSA), vancomycin resistant Enterococcus (VRE), MDR-Gram Negative bacteria (GNBs), Candida spp., and Clostridium difficile, which can survive for as long as 150 hours.

Further, it is estimated that 105 skin epithelial cells containing viable microorganisms are shed daily from the hands. This carries a huge risk of contamination to gowns, bed linen, bedside furniture and other objects in the patient’s environment. In the absence of hand hygiene action, continued treatment of patients can lead to the transmission of infection; the longer the duration of care, the higher chance of transmission.

The Importance of Hand Hygiene
Proper hand hygiene is the single most important, simplest, and least expensive means of reducing the prevalence of infections in hospitals and other healthcare settings. Effective hand hygiene can also assist in putting a stop to the increasing issue of antimicrobial resistance. There is ample evidence which demonstrates that hand washing virtually eradicates the carriage of MRSA, a pathogen that is invariably present on the hands of healthcare workers working in ICUs. Further, evidence suggests that adherence to hand hygiene practices significantly reduces the rates of pathogen acquisition on hands, and ultimately reduces the rates of hospital-acquired infections.

World Health Organization recommendations for Hand Hygiene
The World Health Organisation recommends washing hands with soap and water when:

1. Hands are visibly dirty or contaminated with proteinaceous material, blood, or other bodily fluids
2. If exposure to Bacillus anthracis is suspected or proven (washing and rinsing hands in such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores);
3. After using a restroom
4. Before and after eating

The World Health Organisation recommends use of an alcohol-based hand rub when

1. Moving from a contaminated body site to a clean body site during patient care.
2. Before direct contact with patients or with any other objects near the patient
3. Before donning and after removal of sterile gloves when inserting a central intravascular catheter
4. xBefore inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure.
5. After contact with a patient’s intact skin, body fluids or excretions, mucous membranes, wounded skin, or wound dressings.

Method of hand washing
To begin, remove any hand jewelry and rinse hands under running water (preferably warm). Lather with soap and using friction, cover all surfaces of hands and fingers. Wash thoroughly under running water. Turn off faucet with wrist/elbow. Dry hands with a single use towel or by using forced air drying. Pat skin rather than rubbing to avoid cracking. If disposable towels are being used; throw in trash immediately.

This method is designed to eliminate skin excoriation, which may lead to bacteria colonizing the skin and the possible spread of blood borne viruses or other microorganisms. Skin excoriation that leads to sore hands may also result in decreased compliance with hand washing protocols. If using antiseptic rub, take an adequate amount and rub on all surfaces for the recommended time. Let the antiseptic dry on its own.

Selecting hand hygiene products for healthcare institutionns
Hand hygiene products at minimum must possess bactericidal and fungicidal (yeasts), properties to counteract the wide range of microorganisms with which healthcare workers may come into contact. It is also essential that hand hygiene possess virudical (coated virus) properties, as healthcare workers frequently come into contact with blood or other bodily fluids during routine patient care. Additional activity against fungi (including molds), mycobacteria, and bacterial spores may be relevant in high risk wards or during outbreaks. Hospital administrators should also take into account the physical features of the product (smell, feel, skin irritation), to ensure the avoidance of allergies and ensure the satisfaction of all users.

Adapted from:

1. Mathur P1.Hand hygiene: back to the basics of infection control.Indian J Med Res. 2011 Nov;134(5):611-20.
2. WHO Guidelines on Hand Hygiene in Health Care: a Summary. Available from https://whqlibdoc.who.int/hq/2009/WHO_IER_PSP_2009.07_eng.pdf?ua=1
3. Hand wash picture sourced from www.flickr.com/photos/usdagov/7008312299/

Risks of Using Powdered Gloves

Surgical gloves were introduced in the year 1889 for use in the operating theater. At this time, the primary purpose of using gloves in an operating theater was to protect the operator from powerful antiseptic agents. However, it was soon adopted as a two-way barrier to also protect the patients.

In order to facilitate glove donning, a powder-talcum or lycopodium (spores of the moss family) was used, however since they induced foreign-body granulomas, starch powder was introduced in 1947. Initially starch powder was thought to be inert, but reports of granulomas began to appear a few years later, followed by cases of starch-induced inflammation (peritonitis) and starch-powder granulomas mimicking cancerous tumours (peritoneal carcinomatosis).¹

Need for powder in gloves
The main reason for the use of powder in gloves is to facilitate donning and to prevent the gloves from sticking together. The latex and polymer used in glove manufacturing tends to be tacky, which enables the material to stick to the mold or to the former. Thus, the dusting powder in the gloves helps in absorbing moisture during manufacturing².

What is the “powder” that is used for gloves?
Initially, lubricating materials such as dusting powder mixtures consisting of talcum powder, calcium carbonate or a combination of Lycopodium spores and talc were used. However, Lycopodium introduced toxicity, and talcum powder had clinical complications during the post-operative treatment due to adhesion formation and granuloma. Consequently, corn-starch was introduced as dusting powder, as it is easily absorbed and possesses non-irritating properties. A combination of corn starch and calcium carbonate or corn starch and silicone is the current powder used in gloves².

Hazards of powder in surgical and examination gloves
A number of hazards associated with the use of powdered gloves have been cited and well documented. First and foremost, the cornstarch used in gloves has documented detrimental effects on wound closure techniques. Secondly, this powder is known to elevate wound infection. Thirdly, cornstarch is known to induce peritoneal adhesion formation and granulomatous peritonitis. Finally, these powders serve as carriers of latex allergen and may precipitate a life-threatening allergic reaction in sensitized patients.

It has been observed that powder on the examination and surgical gloves leads to contamination of the surgical wounds and peritoneal adhesions. Nearly 60-80% of intestinal obstructions and wound inflammation have been caused by peritoneal adhesion post-surgery. Some of the major adhesions and reactions in post-surgery is due to peritoneal granulomas and suture granulomas in the wound area^2,3

Hazards of glove powder with reference to infection control
Donning of gloves with dusting powder has a strong potential to cause dryness of skin, leading to cracking and itching. The symptoms may be severe in presentation due to the tendency for latex proteins to penetrate damaged skin, leading to allergies and irritant reactions. Irritant dermatitis has a severe effect on the skin and prolonged exposure may lead to augmentation of the condition, thus causing failure to respond to treatment^2,4.

Hazards of inhaled cornstarch powder from gloves
When cornstarch is blended with the glove material, it produces natural latex protein allergens which can cause respiratory allergic reactions and asthma attacks. Other problems such as rhinitis, bronchitis, bronchospasm and dyspnea (breathing problems), are common hazards from inhaling cornstarch powder⁵.

Consequences of glove powder in the hospital environment
Physicians and nurses, the most common users of gloves in the hospital, are frequently exposed to cornstarch glove powder. Cornstarch or dusting powder that is exposed to natural latex produces allergenic proteins which cannot be detached by washing. Exposure to glove powder can also lead to asthma attacks, dermatitis or other skin irritations, peritoneal adhesion, hypersensitivity, allergic reactions, urticaria, conjunctivitis, anaphylaxis and other such ailments⁵.

References:
1. Poole. Hazards of powdered surgical gloves.Lancet. Volume 350, No. 9083, p973–974, 4 October 1997
2. Medical glove powder report [internet], 1997 September. Available from: https:// https://www.fda.gov/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm113316.htm
3. Edlich RF, Woodard CR, Pine SA, Lin KY, Hazards of powder on surgical and examination gloves: a collective review [internet], 2001;11(1-2):15-27. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11495102
4. Woods JA, Morgan RF, Watkins FH, et al; Surgical glove lubricant: from toxicity to opportunity [internet], 1997 Mar-Apr; 15(2):209-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9144064
5. Toraason M, Sussman G, Biagini R, et al; Latex allergy in the workplace [internet], 2000 Nov; 58(1):5-1. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11053535
6. Picture taken from https://www.hsmemagazine.com/article.php?article_id=274

Clinicians called to improve hygiene standards

Infection experts* are warning clinicians that hygiene standards in hospitals need to improve, in order to reduce the incidence of golden staph infections. Golden staph is a common bacterium that lives on the skin or nose, but can cause severe infections, even death, if it enters the bloodstream. While incidences of golden staph in Australia have declined in the past year, patients are up to three times more likely to contract the disease while in hospital. Moreover, golden staph is becoming increasingly resistant to traditional forms of antibacterial treatment, earning it the title of “superbug”.

Experts affirm* that most golden staph infections in hospitals are avoidable if appropriate hygiene standards are enforced and maintained. The simplest strategy is thorough hand washing, which can reduce the chance of infections and transference by up to 50%. However, as most infections occur as a result of skin-to-skin contact, or contact with infected surfaces, it is vital that an appropriate protection barrier is employed. Donning a fresh pair of gloves before treating each patient can help to reduce infection rates of not only golden staph, but many other bacterium. This practice ensures that transferences between patients does not occur, and that potentially infected skin is not exposed. Effective use of gloves, and thorough hand washing practices can help to combat and reduce Australia’s golden staph infection rates. To find out what kind of gloves you should wear, visit our Gloveon website.

*Source: Channel Ten News (https://tenplay.com.au/news/national/2015/4/9/staph-infections-rise)

Factors to Consider When Choosing Gloves

Gloves are an important tool in protecting individuals from harmful substances, and ensuring their safety when working in risky environments. Skin can be damaged easily by toxic chemicals, friction or extreme heat, while skin contamination can lead to severe infection in the absence of any protective material. Even while wearing gloves, it is essential to understand the parameters which affect glove usage, and strategies to prevent avoidable injury.

When Should Gloves be Worn?
Gloves should be worn when handling corrosive material, hazardous/toxic chemicals, sharp/rough edged materials and hot/cold objects. For maximum protection, gloves should be worn for as long as the wearer is in the workplace. However, individuals must be aware that, while gloves do protect the wearer while they are worn, they do not remove any contamination that may have pre-existed prior to glove donning. Thus, to avoid contamination, gloves must be worn in the correct manner.

Selecting the Right Glove
A number of factors should be jointly considered when determining the suitability of a glove. Gloves should be selected based on: the type of work taken up by the individual, the task at hand, any pre-existing health conditions, the size and fit of the glove and workplace conditions such as temperature, dust, moisture density etc.

Factors to Consider When Using Gloves:

1. When working with chemicals, it is essential to identify the chemical properly, as some chemicals can cause degradation or permeation. If the appropriate gloves are not used, glove material may degrade in the form of swelling, tackiness and loss of flexibility. Chemicals may also possess permeability properties, meaning they can seep through gloves by diffusion without actually damaging the gloves. Hence, when working with chemicals under the class of toxic, harmful or hazardous chemicals, refer to the chemical resistance chart to select the appropriate glove.
2. In general, gloves are designed to provide adequate protection against bacteria and viruses. However, tasks such as manipulating cultures or micro-surgery require a glove with a higher degree of sensitivity and dexterity, to facilitate fine movements. Thus, it is essential to consider the differing designs of gloves when choosing gloves for specific purposes.
3. Glove thickness should be considered in relation to the task to be performed. While thicker gloves provide better resistance to chemicals and mechanical damage, they cannot be used for all tasks, as they impair grip and dexterity. Hence, unless high degree of protection is not required thinner gloves are preferred.
4. For minor tasks, gloves with a standard cuff length to the wrist usually provide suitable protection. However, highly hazardous work, such as working with highly irritant chemicals, handling high grade pathogens or using large volumes of liquids (where there is a chance liquid may enter the glove), require a higher grade of protection. In these circumstances, a glove with a longer cuff is essential to protect the lower arm.
5. Gloves are available in both smooth and textured surfaces for a variety of tasks. While smooth gloves may be used for many everyday tasks, they do not provide as much grip as a textured glove. Hence, when working in wet or oily conditions, textured gloves are recommended.
6. In tasks where repetitive movements are required, the flexibility and elasticity of the glove needs to be considered. It is recommended that nitrile gloves be used in these circumstances, as they provide a thinner, more flexible barrier than glove of other materials, facilitating ease of movement and avoiding hand fatigue.
7. The reusability of gloves is a further factor to consider when choosing the right glove. Disposable gloves are prone to abrasions, punctures, snags, tears and cuts, thus cannot be re-used after they are worn. However, thicker, cut-resistant gloves may be re-used, as they provide a higher degree of protection against physical hazards.
8. Wearing the proper glove size is essential to maintaining high barrier protection. Gloves that are too small can cause undue fatigue and rashes on the hands, while gloves that are too large tend to be uncomfortable, and may snag or interfere with grip precision. To ensure proper grip and avoid fatigue and rashes, a glove that offers a range of sizes should be chosen, including small, small, medium, large and extra large.
9. While latex gloves are the most common choice in many industries, allergies to latex are widespread, and interfere with an individual’s ability to work. Latex allergies can cause asthma attacks, anaphylactic reactions or widespread urticarial. Individuals can also spread latex fibers from gloves to shared equipment such as door handles. Therefore, while individuals with latex allergies in particular should avoid latex gloves, it is recommended that an alternative to latex should also be sought by others around them.
10. Gloves should not be directly donned onto hands where the skin is irritated or broken. Any cuts on the hands should be covered with a water-proof bandage before donning, to prevent irritation and possible infection. If the skin is irritated, or an individual suffers from skin problems such as eczema, cotton glove liners should be used to cover the hands before glove donning, to avoid irritation from sweat. While disposable gloves themselves are not re-usable, cotton liners may be re-used if they are washed regularly and rinsed well to avoid soap residue.
11. Gloves should not be worn for long periods of time. Extended use of gloves leads to excess sweat, which can lead to rashes or dermatitis. To avoid this, gloves should be changed frequently and a new pair only donned when hands are fully dry. Wearing a cotton glove liner inside the gloves also helps to absorb excess sweat.

References:
1. Glove use information leaflet [internet], 2009 August. Available from: https://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf
2. How to prevent latex allergies [internet], 2012 February. Available from: https://www.cdc.gov/niosh/docs/2012-119/pdfs/2012-119.pdf

Acceptance Quality Level – An Overview

Gloves form an inherent component of a health care workers’ preventive, precautionary measures. As a vital protective barrier, it is crucial that users choose gloves that offer adequate protection and subsequent user confidence for performance of risky tasks1.

As gloves today are mass-manufactured in large quantities, testing the quality of each glove individually would be impractical. Thus, to ensure quality standards and to keep defects to a minimum, manufacturers follow a statistical measure of quality, known as the ‘Acceptable Quality Level’ or AQL. Through this process, rigorous sample inspection is undertaken before the product(s) are ready for sale2.

Defining Acceptance Quality Level
Acceptable Quality Level or AQL is a criteria assigned to the characteristics measured by a Quality Control inspection for any given set of manufactured materials. AQL is a standard fixed by the U.S. Food & Drug Administration (US-FDA) and the testing methods for AQL are from the American Society for Testing & Materials (ASTM), a firm that makes standards for various industries across the globe.3 The AQL is the highest percentage of a production run that the manufacture will accept as “rejects” when the samples are tested.

AQL, as a method applied to glove manufacturing, is determined as the percentage of defects allowed. That is, in a batch of 100 gloves with an AQL of 4.0, only four gloves in the batch can fail the test. If more than four gloves fail, the complete batch fails to meet the standard. In such cases, manufacturers will have to review the manufacturing process to determine what adjustments or process modifications need to be incorporated.

AQL for Gloves
As the risks involved in the medical field are higher (contamination from pathogens and chances of deadly infections), AQL for gloves that are to be used for medical uses is 1.5 % (for surgical gloves) and 2.5 % (for examination gloves), as per the FDA regulations.3

Of course, the AQL only defines the poorest number of defects that a manufacturer could allow in their processes before taking appropriate quality control action. Reputed manufacturers therefore ensure that they regularly have a production that exceeds the AQL levels.

AQL Testing Methods for Gloves
The quality testing for gloves involve multiple tests. A ‘pin-hole leak test’ is used to determine the integrity of the glove barrier, as even a small discontinuity in the material will expose the wearer to pathogens. In this test, the gloves are filled with a litre of water, bound or sealed at the cuff and hung topside down to test for water leaks. Observance for leakage is conducted straight away, and again after 2 minutes, during which the glove fingers are manipulated. Gloves that do not show leakage during the testing period are acceptable for medical usage3. This test is also referred to as the “watertight” or “water leak” test, and is referred to in the FDA regulations as the ‘ASTM D5151’ test4. It is the standard method for detection of holes in medical gloves.

Another test applied is the ‘Visual defects examination’. For this test, each of the gloves are examined for visual defects. Gloves that are found defective in this test do not require further scrutiny, and are covered in the total number of defective gloves counted for the sample.

Importance of AQL
For gloves that are manufactured and registered for protection against chemicals and micro-organisms, AQL is mandatory to ensure quality control. A benefit provided by AQL is that, in spite of large production lines, entire batches of gloves can be tested through random sampling techniques. By conducting quality control tests on each manufactured batch, and checking the underlying drift, manufacturers can promptly identify products that fail to meet AQL, and move to correct their processes. AQL is a valid and reliable system to ensure lasting quality of the product over time.

What Does AQL Mean to the End User?
When using gloves, a user always expects that the basic properties of security and impermeability will be offered by the particular product. Depending on the level of AQL, a user can evaluate how stringently a given pair of gloves have been evaluated during production, and whether they are confident in the protection that the glove can offer. The AQL can also assist a user in choosing a product that significantly enhances their protection from occupational hazards.

References:
1. Fay MF et al. Gloves: New selection criteria. Quint Int. Jan 1995; Vol. 26(1): 25-29.
2. Spashett J. AQL – What is an Acceptable Quality level? Available at https://www.camlab.co.uk/originalimages/sitefiles/AQL_-%20_What_is_an_Acceptable_Quality_Level.pdf accessed July 13th 2015
3. USFDA. CFR – Code of Federal Regulations Title 21. Available at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=800.20 accessed July 13th 2015
4. ASTM D5151 – 06(2011). Standard Test Method for Detection of Holes in Medical Gloves. Active Standard ASTM D5151. Available at https://www.astm.org/Standards/D5151.htm accessed on July 13th 2015

Understanding Latex Allergy

Latex allergy has been categorized as a serious concern among the health care workers. The biggest risk for developing and aggravating a latex allergy comes from powdered rubber latex gloves, used often in the medical setting. As latex allergy can be fatal, it is a major concern for healthcare professionals.

Environmental sampling studies confirm that the frequent use of latex powdered gloves is a strong determinant of airborne latex allergen levels in hospitals. Powdered gloves are known to have a higher latex allergen content than powder-free gloves, and there is ample evidence that the use of powdered gloves is associated with a substantially higher prevalence and rate of latex sensitization. This is due to the cornstarch particles added to powdered gloves as a donning agent. When airborne, these cornstarch particles carry latex particles, thus greatly increasing aeroallergen exposure. Exposure to airborne allergens is closely correlated with frequency of latex allergic symptoms.

Latex – Another Name for Natural Rubber
Natural rubber is a milky sap produced by rubber trees (Hevea brasiliensis), extracted by making cuts in the tree bark. During processing, several chemicals including stabilizers and preservatives are added to the sap to prevent it from coagulating, which is then blended to give the desired latex characteristics. The latex is then processed to lower the protein content of the rubber, and vulcanized to denaturalize the remaining proteins. This type of latex is used to manufacture health care products such as stoppers for tubes, pistons, masks, and cannulas. It is also often used to manufacture gloves used in the medical setting.

Brief History of Latex AllergyThe first case of latex allergy (through type I hypersensitivity) was described in Germany in 1927. During the 1980s, the number of cases reported increased considerably, and the first documented case was published in Spain in 1986. The increase in latex allergies in the 1980s can be attributed to three main factors:

• Widespread use of latex gloves.
• Simplification of the manufacturing process.
• Substitution of talcum powder with starch to prevent the formation of granulomas (starch is an extremely efficient vehicle for the diffusion of allergens).

Types of Latex Allergy & Reactions
Latex allergy occurs when people are allergic to either the proteins found naturally in latex (type I allergy) or the array of chemicals added during the manufacturing process (type IV allergy). Latex allergy may result in relatively simple allergic reactions such as skin irritation, but can also result in potentially life threatening reactions like anaphylaxis.

There are three types of reactions that can occur when using latex products:

• Irritant Contact Dermatitis
  This is the most common negative reaction to latex and manifests as itchiness of skin when using products made from natural rubber latex. Common symptoms include dry, itchy, irritated skin—most often on the hands.
• Allergic Contact Dermatitis (delayed hypersensitivity)
  This reaction has a delated onset of approximately 24-96 hours after contact. The skin breaks out in a rash, similar to that experienced after contact with poison ivy.
• Latex Allergy (immediate hypersensitivity)
  This type of reaction usually happens within minutes of exposure, but symptoms can also occur a few hours later. Symptoms of a mild reaction include skin redness, hives, or itching. Symptoms of a more serious reaction might include a runny nose, sneezing, itchy eyes, scratchy throat, wheezing, coughing, or difficulty in breathing. Though uncommon, anaphylactic shock may also occur within minutes of exposure. Anaphylaxis can be fatal and must be promptly treated with an adrenaline injection.

Recommendations for prevention of Latex allergies
If a health care worker is known to have a latex allergy, the following strategies are recommended:

• Ask for reduced-protein, powder-free gloves.
• Avoid oil-based creams or lotions when using latex gloves. They may cause the gloves to break down
• Wash hands with a mild soap and dry hands completely after using gloves
• Recognize symptoms of latex allergy (rash; hives; flushing; itching; nasal, eye, and sinus irritation; asthma; and shock).
• Avoid direct contact with latex gloves and other latex-containing products if the user has symptoms of latex allergy.
• Use latex alternative gloves, such as Nitrile gloves. Nitrile glove is a synthetic rubber which does not consist of any protein content. GloveOn has a wide selection of Nitrile Gloves. Visit us at gloveonglobal.com to view our products.

Adpated from:
1. https://www.aaaai.org/conditions-and-treatments/allergies/latex-allergy.aspx
2. https://www.hse.gov.uk/healthservices/latex/allergyguide.pdf
3. https://www.jiaci.org/issues/vol22issue5/1.pdf
4. https://www.anaphylaxis.org.uk/userfiles/files/Latex%20Allergy%20Factsheet.pdf
5. https://www.health.ny.gov/publications/1454.pdf
6. https://www.sswahs.nsw.gov.au/rpa/allergy/resources/allergy/latexallergy.pdf
7. https://www.research.northwestern.edu/ors/safety/general/ppe/documents/allergic-reactions-to-gloves.pdf
8. Picture taken from https://www.iacdworld.org/skin/latex.htm

World Health Organization Rapid Advice Guideline

Below are glove guidelines extracted from World Health Organization Personal Protective Equipment (PPE) in the context of Filovirus Disease Outbreak Reaponse dated October 2014

5b. Gloves

Recommendation 5

All health workers should wear double gloves while providing clinical care for patients with filovirus disease in order to prevent virus exposure. Strong recommendation, moderate quality evidence for double gloving as compared to single glove use.

Rationale and remarks

Double gloves are recommended compared to single gloves to decrease the potential risk of virus transmission to the health worker due to glove holes and damage to gloves from disinfectants such as chlorine; double gloving may also reduce the risk from needle-stick injuries and contamination of hands when removing PPE. The confidence in effectiveness was assessed as moderate based on accumulated evidence for transmission of other blood-borne pathogens such as HIV and hepatitis viruses. Although there is some degree of decreased tactile sensation, impaired dexterity, and discomfort related to double gloving, studies demonstrate that in most cases the feeling of impaired tactile sensation is overcome within a few days, even when performing delicate surgery.

Preferably, the outer glove should have a long cuff, reaching well above the wrist, ideally to the midforearm. In order to protect the wrist area from contamination, the inner glove should be worn under the cuff of the gown/coverall (and under any thumb/finger loop) whereas the outer glove should be worn over the cuff of the gown/coverall.

Use of tape to attach gloves to gowns/coveralls should be avoided, as this may interfere with safe gown/coverall and glove removal because of the need for additional manipulation and the risk of tearing of the gown/coverall, potentially resulting in contamination. There is no evidence that more than two gloves on each hand provide further protection; this has the potential to interfere with dexterity and add complexity to glove removal, and is not considered safe.

Best IPC practice dictates that gloves should be changed between patients. However, feasibility issues (i.e. provision of clean gloves and waste disposal within the patient treatment and isolation area) were of concern. Because of this, the GDG did not reach consensus on the recommendation for changing gloves between patients inside the clinical area. Nine members were in favour of changing gloves between patients, two were against, and two members abstained. The following 2- step procedure could help facilitate changing gloves safely while providing clinical care for patients with filovirus disease: 1) disinfect the outer gloves before removing them safely and 2) keep the inner gloves on and disinfect them before putting on a fresh outer pair. Alcohol-based hand rubs are preferred when disinfecting hands and gloved hands. If a glove becomes compromised, it should be changed using the procedure described above.

Sterile gloves are not required except when performing a sterile procedure as per standard IPC recommendations. Adaptations of the gloving procedures described above may be required for specific surgical and obstetric procedures.

Recommendation 6

Nitrile gloves are preferred over latex gloves for health workers providing clinical care for patients with filovirus disease in order to prevent virus exposure.

Strong recommendation, moderate quality evidence on effectiveness and safety of nitrile gloves over other alternatives

Rationale and remarks

Nitrile gloves are recommended because they resist chemicals, including certain disinfectants such as chlorine, and nitrile is more environmentally friendly than latex. There is a high rate of allergies to latex and contact allergic dermatitis among health workers. However, if nitrile gloves are not available, latex gloves can be used. Non-powdered gloves are preferred to powdered gloves.

Source: https://apps.who.int/iris/bitstream/10665/137410/1/WHO_EVD_Guidance_PPE_14.1_eng.pdf?ua=1&ua=1

MUN Supports Safe Child Birth with BFKA Sponsorship

SYDNEY, November 8, 2014 – In support of promoting clean and safe birthing environments for women, MUN Australia, the distribution arm of Hartalega Holdings Berhad, the world’s largest synthetic glove manufacturer, recently became a major sponsor of the Birthing Kit Foundation (Australia) (BKFA).

The charitable organisation strives to ensure that disadvantaged women in developing and under developed countries have access to sanitary birthing practices, which helps reduce incidences of infant and maternal mortality rates.

As part of the two-year sponsorship, MUN contributions consists of both monetary and product assistance towards the production of 140,000 birthing kits on an annual basis.

Mr David Teng, Director of MUN Australia, said, “Our passion for care is at the heart of our company, and we are glad to be able to support this worthy cause. Maternal and infant health is a critical priority the world over. Quality healthcare is a basic human right and it is our sincere hope that this sponsorship will go a long way towards helping underprivileged mothers and babies. Every baby is entitled to be born with dignity and in a safe environment.”

“This effort is part of our ongoing corporate social responsibility programme, through which we aim to make a positive impact on the community with our various initiatives.

Along with our contributions, we will also educate MUN staff to become goodwill ambassadors to further promote BKFA’s laudable objectives. With these efforts, we aim to enhance awareness of this important issue,” concluded Mr Teng.

BKFA is firmly founded on the philosophy that every woman has the right to a clean and safe childbirth. Working towards the vision of creating a world in which all women have access to clean and safe birthing practices, BKFA works together with various organisations and communities to provide essential support to improve outcomes for birthing mothers and their babies.

Malaysia sends medical gloves to five African nations affected by Ebola

The Malaysian Government will send 20.9 million medical rubber gloves to five African nations that are affected by the deadly Ebola virus outbreak.

Malaysia will send 11 containers, each holding 1.9 million medical rubber gloves.

Liberia, Sierra Leone and Guinea will each receive three containers; Nigeria and the Democratic Republic of Congo will each receive one container.

Earlier, Prime Minister Datuk Seri Najib Razak had attended a symbolic handing-over ceremony of contribution from the Malaysian Government to the ambassadors of Ebola affected countries.

Also present was Deputy Foreign Affairs Minister Datuk Seri Hamzah Zainuddin and advisor in the Prime Minister’s Department Tan Sri Dr Jamaludin Jarjis.

Others include representatives from Sime Darby, Felda, Kuala Lumpur Kepong and IOI Group plantations as well as those from Top Glove and other Malaysia Rubber Gloves Manufacturing Association (MARGMA).

In a statement issued Monday, the Prime Minister’s office said some of the affected countries have appealed for help in their battle against the deadly virus, which has killed more than 2,000 people in West Africa.

It added that medical experts have cited the shortage of medical rubber gloves as a key problem in combating the outbreak.

News Source

A New Generation of Latex Gloves

More than 40,000 types of commercial products are made from natural rubber latex (NRL), an extract of the Pará rubber tree. Valued for its desirable properties, NRL is used in numerous products in the medical industry and elsewhere, including latex gloves. However, out of more than 200 proteins contained within NRL, 13 are known to be allergens. The American Latex Allergy Association estimates that up to 1 percent of the general population and 17 percent of health care workers exhibit some form of latex allergy, thus hindering their use of gloves made from this material.

Fortunately, a solution to the protein content of NRL exists. It involves the patent-protected addition of aluminum hydroxide, Al(OH)3, a well-known protein binding chemical, to latex while still in liquid form. This compound acts as a binding agent to the latex and produces protein complexes that can be removed using existing industry practices. The result is an ultra low-protein variant of NRL that retains the advantages of latex with most of the antigenic proteins removed. How is this patented aluminum hydroxide-modified NRL made, what advantages does it offer health care workers and others who wear latex gloves, and what makes it superior to standard NRL?

The treatment process for this type of modified NRL removes specific non-rubber impurities from NRL through the directed application of aluminum hydroxide. A commonly used absorbent, emulsifier, ion-exchanger, and antacid, aluminum hydroxide is commonly used in the process of water purification. It forms a jelly-like structure suspending unwanted materials in water, including bacteria.

Using traditional latex processing methods, a slurry of aluminum hydroxide can be strategically added to the harvested latex. The effective binding of protein and other non-rubber impurities from this latex emulsion to insoluble aluminum hydroxide occurs, with some of the non-rubber impurities adsorbed to the reactive surface of the aluminum hydroxide crystals.

With this patented processing step integrated into the manufacturing stage, there is no added expense of capital equipment. Reacted aluminum hydroxide complexes are removed by standard filtration and centrifugation. The remaining rubber particles retain the surrounding lipid layer, which, during subsequent maturation, improves the mechanical stability of the latex. Scientists have observed that this process yields products that exhibit greater clarity and significantly reduced odor, in addition to the removal of most of the antigenic proteins, without sacrificing the properties that give NRL advantages over synthetic alternatives. Prior industry efforts have produced reduced protein-source latex through the treatment of raw latex with enzymes, with little commercial success.

A New Latex Glove
The rise of the AIDS epidemic in the 1980s highlighted the widespread use of latex gloves to protect against infection. But for many health care professionals, the increased exposure to latex led to allergic reactions. Symptoms ranged from watery and itchy eyes to red and irritated skin, to breathing trouble and even life-threatening anaphylaxis. Some health care professionals developed dangerous latex allergies that, in some cases, limited or ended their care-providing careers. Latex gloves were also negatively perceived because of the powder associated with the gloves that left residue on users’ hands and caused skin irritation.

It must be stressed that NRL gloves are known for their superior barrier properties and cost effectiveness. As such, they have been, and still are, widely used, particularly in health care settings where effective barrier protection is of great importance against viral transmission and infectious diseases. With the exception of vinyl or PVC gloves, which have been shown to provide lesser barrier protection, latex gloves are generally less expensive than many synthetic alternatives, such as polyisoprene, neoprene, and often nitrile.

There is thus an obvious market for this aluminum hydroxide-modified NRL in the surgical, examination, and industrial glove markets. Both surgical and examination gloves in manufacturer trials contained significantly fewer antigenic proteins than untreated control gloves. This indicates that glove manufacturers using the aluminum hydroxide-modified NRL as their raw material can adhere to ASTM glove protein compliance levels with only “pre-leaching” to remove residual compounding chemicals, thus conserving water and energy. While reducing the antigenic protein content, such gloves preserve the durability, comfort, fit, tactile sensitivity, and high resistance to puncture and tear for which NRL is known.

In August 2010, latex glove manufacturer Brightway Holdings SDN BHD Malaysia announced the successful culmination of material use evaluation trials of this aluminum hydroxide-modified NRL. Conducted at Biopro, one of Brightway’s facilities in Malaysia, the results paved the way for the manufacture and market introduction of the first exam and cleanroom gloves made from this material.

The aluminum hydroxide-modified NRL not only contains significantly fewer antigenic and total proteins, but also results in a more stable, cleaner latex that requires fewer compounding additives during production. The reduction in certain non-rubber constituents that can break down over time contributes to its greater stability compared to standard NRL. Customer observations reflect the “clean” appearance and lack of odor in the expansive list of products made from this aluminum hydroxide-modified NRL.

Unlike most synthetic alternatives, aluminum hydroxide-modified NRL uses green chemistry to modify natural latex. The aluminum hydroxide-modified NRL derived from the rubber tree remains 100 percent natural. As proof, note that bacteria and fungi are capable of degrading NRL; one elegant experiment has demonstrated that latex balloons degrade equally, if not faster than, oak leaves. In contrast, many synthetic alternatives to latex, such as PVC vinyl, nitrile, neoprene, and polyurethane, which are made from petrochemical derivatives, are neither biodegradable nor compostable. The incineration of these synthetic products can lead to the liberation of toxins and carcinogens, such as dioxin, cyanide, vinyl chlorides, and hydrogen chloride. Unlike such synthetic alternatives, the aluminum hydroxide-modified NRL has minimal impact on the environment.

Another advantage to the use of this aluminum hydroxide-modified NRL is the decreased amount of water required for end-product manufacture. Within the latex-dipped goods industry, manufacturers have demonstrated increased efficiency by reducing processes such as excessive washing and leaching, typically used to reduce protein levels. This reduction can significantly lower water and energy consumption and simultaneously reduce the presence of harmful chemicals used in the manufacturing process, such as zinc in wastewater. The overall environmental impact is minimized, resulting in increased production cost savings. This aluminum hydroxide-modified NRL is slightly more expensive than traditional NRL but is priced comparably to nitrile and neoprene, other commodity-priced, albeit synthetic alternatives.

Raw, natural latex is a liquid. When dried and cured, the film dries semi-transparent yellow. Manufacturers can add whitening agents, such as titanium dioxide or calcium carbonate, to the latex to express whiteness in the finished product or to provide a white background for which color pigments can be used. A common alternative, the use of titanium dioxide, can be more expensive. Because the aluminum hydroxide-modified NRL is characteristically whiter in appearance, its use reduces the amount and cost of the whitening agents.

Collectively, these results suggest that manufacturers can achieve savings in energy and material costs when using aluminum hydroxide-modified NRL. Natural products that minimize environmental impact while maximizing economic, health, and safety benefits are critical to the sustainability of the latex industry. This need is addressed by commercializing the process of modifying NRL with aluminum hydroxide while enhancing its attributes and performance. The process of using aluminum hydroxide eliminates a significant portion of proteins and other non-rubber composition in latex, providing a cleaner, more stable raw material. In fact, the aluminum hydroxide-modified latex is the only NRL on the market today that meets the new ASTM D1076-10 Category 5 standard for a natural latex containing less than 0.5 percent non-rubber content.

The use of this aluminum hydroxide-modified latex is an option for manufacturers that are currently using standard latex across a broad scope of industries, including medical manufacturing. The performance benefits and attributes of this aluminum hydroxide-modified latex offer a unique value proposition to these manufacturers, allowing them to continue to capitalize on the green advantages of natural rubber latex. Production cost-saving opportunities using aluminum hydroxide-modified latex makes this a sensible material of choice for future generations. Balancing material acquisition and production costs, manufacturers can quantify the true cost savings of aluminum hydroxide-modified NRL.

It is clear that the development of aluminum hydroxide-modified NRL has the potential to pave the way for a new era in the use of latex gloves, both within and outside the health care arena. Caregivers prone to latex allergies may find a new class of products at their disposal. As production of aluminum hydroxide-modified NRL products ramps up in coming years, it is reasonable to expect that users and their organizations will find it a welcome alternative to standard NRL and petroleum-based synthetics.

This article originally appeared in the April 2011 issue of Occupational Health & Safety.

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Nine Myths About Disposable Safety Gloves

Disposable nitrile, natural latex, and vinyl gloves, often referred to as thin-mil gloves, are used in a variety of distinct applications. Understanding the truths about glove performance is important in selecting the right glove for each application.

Myth #1: More Texture Means Better Grip

One of the most common misconceptions about disposable gloves is that more texture results in better grip. In fact, texture has very little effect on grip. It is possible to make an extremely textured glove with low grip and a smooth-surfaced glove with high grip.

Surface treatment is the most significant factor in the grip level of a glove. Natural latex is inherently sticky, or tacky, much like glue. Without proper processing, natural latex sticks together like a large ball of adhesive. To reduce this tack, the surface must be treated. The most common surface treatments are surface chlorination and coating. Chlorination changes the surface properties and creates a hard, lower-tack shell around the glove. Coating technology adds a new, lower-tack layer to the glove.

Reality: Surface tack, or grip, can be controlled by the level of chlorination or the characteristics of the coating.

Myth #2: Gloves Remain Safe Throughout Use

Throughout use, gloves can develop holes due to degradation and wear. According to one study, after only 12 minutes of simulated clinical use, natural latex and vinyl glove defect rates increased to 9 percent and 35 percent, respectively. Without proper curing and cross-linking, nitrile can swell and develop holes or defects over time. Failure is commonly observed in the crotch between the thumb and forefinger.

In addition to formulation and process, use factors, such as average wear time and application, affect the inuse defect rate. Buyers should consider the potential defect rate increase and the risk imposed. They should ask their glove suppliers for supporting studies on in-use testing. Buyers and users can perform a representative test themselves by wearing a pair of new, tight-fitting gloves for the prescribed use time and then removing and filling the gloves with water to see whether a hole developed.

Reality: Gloves degrade during use.

Myth #3: Gloves Can Be ‘100%’ Nitrile, Natural Latex, or Vinyl

Glove suppliers frequently claim glove composition of “100%” of the respective materials. Without additives, it is practically impossible to produce a usable glove of any of these materials. Adding curatives, cross-link agents, and accelerators to nitrile and natural latex is essential to making a strong, durable glove. Vinyl requires plasticizers and activation agents. Surfactants, which help with film formulation, are another additive found in most gloves. Formulations typically require 4-10 percent of additives to make a good glove.

Reality: Claims of “100%” nitrile, natural latex, or vinyl are not accurate.

Myth #4: Fillers Always Diminish Glove Performance

Fillers are used broadly in gloves. Most manufacturers use or have the ability to use fillers to help reduce the cost of making a glove. Fillers are often difficult, but possible, to detect through advanced technologies such as Thermal Gravimetric Analysis.

Fillers help to reduce the cost of a glove and, up to certain amounts, actually can improve specific performance characteristics. For example, tear strength is significantly improved in natural latex gloves when a moderate amount of calcium carbonate is added. The key word is “moderate.” Fillers up to about 15 percent are tolerable; anything above that can become detrimental to the performance and quality of the glove in use. Some manufacturers have experimented with up to 50 percent filler, with limited success.

Reality: When used in moderation, fillers can improve certain disposable glove performance characteristics.

Myth #5: All Allergy Issues Can Be Addressed by Using Nitrile or Vinyl Instead of Natural Latex

Glove-related allergies are a primary concern to many glove users. The belief that glove-related allergies are caused only by natural latex is a common one. Latex allergies are the most serious glove allergies because they can be systemic and cause anaphylactic shock. Latex allergies are also the most common type of glove allergies.

Some users confuse chemical allergies with latex allergies. There are often components in both nitrile and vinyl gloves that can elicit a chemical allergy. For example, nitrile gloves, like natural latex gloves, often use carbamates or thiazoles, which can cause a skin allergy. Certain vinyl gloves use activation agents that can also cause skin allergies. In all cases, the less a glove is washed, the more chemical residue is available for potential contact to the user. Users should consult their physician if they suspect an allergy to gloves.

Reality: Natural latex is not the only glove material that can cause allergies.

Myth #6: ‘Powder-free’ Means ‘Clean’

Surface treatment is the most common way to remove powder from a glove. Two types of surface treatment are chlorination and the addition of a wax or polymer coating. Chlorination is the traditional process and requires gloves to be washed prior to packing. The washing process is designed to rid the gloves of residual chemicals.

Wax and polymer coatings allow a glove manufacturer to “strip and pack,” avoiding the chlorination and washing process. Wax and polymer coatings can leave residual chemicals that have not been properly washed. Though not always harmful, the residual chemicals can contribute to skin sensitivity or process contamination.

Reality: The process of making a glove “powder-free” can leave residual chemicals on the glove.

Myth #7: Chemical Resistance of Powder-free Natural Latex is Similar from Glove to Glove

As discussed in myth #6, powder is removed from gloves by chlorination or coating treatment. The treatment type, or lack thereof, can affect the chemical resistance properties of the glove. For example, natural latex gloves achieve better overall chemical resistance when chlorinated. Chlorination changes the surface properties and creates a hard shell around the glove. This “plasticized” shell has proper ties slightly different from natural rubber and provides additional chemical resistance that would otherwise not be available. On the downside, over-chlorination can damage gloves, making them brittle and unusable.

Reality: Latex gloves varies from glove to glove.

Myth #8: All Disposable Gloves are Basically the Same

Disposable gloves come in several different material types. The most common types are made from nitrile, natural latex, and vinyl. Each of these types is based on commodity raw materials with price fluctuations that depend on specific market factors. In general, nitrile is often considered premium to latex, which in turn is often considered premium to vinyl. The fact is that materials are not equal in performance in all applications. Nitrile has better puncture resistance of the three and resists more chemicals overall, including oils and solvents. Latex has better tear resistance, often fits better, and provides better dexterity. Vinyl has the best electrostatic dissipation properties and resists sulfuric acid better than nitrile or latex.

Even within the same material, there are significant differences from manufacturer to manufacturer. Other factors influencing glove performance are raw materials, formulation, process, and washing. These vary significantly from glove to glove and can result in performance differences in most applications. Typically, standards for the different materials also are not harmonized. ASTM exam glove standards have different tensile strength requirements for latex, nitrile, and vinyl. Vinyl has the most relaxed strength requirement, followed by nitrile, while latex has the highest tensile strength requirement of the three.

Reality: Multiple factors affect the performance of a disposable glove.

Myth #9: Lower Priced Gloves Always Result in Cost Savings

One of the biggest mistakes made by disposable glove buyers is buying based solely on price. The overall value of a glove is much more complicated than just the price of a box. In addition to price, buyers should consider durability in the application, safety risks, and productivity.

Many gloves are not properly formulated or processed. They are often under-cured and do not last long in application. Medical exam applications consume the majority of the disposable gloves produced globally and nurses, the largest users, typically wear a single pair of gloves for only a few minutes before discarding and replacing for each patient. On the other hand, many industrial applications require 2-4 hours of continuous use of a single pair of gloves. This extended length of time stresses the glove longer and can lead to failures in a glove that would not normally happen during a short, routine medical exam. For longer use times, it is important to choose a glove that is properly formulated and processed to withstand the application. A 10 percent savings can quickly be negated by a glove that lasts only half the time.

Productivity is another very important factor when considering the savings of one glove over another. Often, workers will be more productive with gloves that fit well, have good grip, and lower hand stress. In addition, beware of lower-quality gloves that fail, causing injury and the resulting cost associated with workplace accidents. Productivity and prevention are important factors when considering the economics of glove use.

Reality: Many factors determine the “value” of a disposable glove.

Conclusion Choosing the right glove type or source is not as simple as reviewing a specification or buying at the lowest price. A number of critical factors should be considered. Understanding the truths about glove performance is important in selecting the right glove for each application.

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Are There Hidden Dangers in Food Prepared with Latex Gloves?

If you have a latex allergy, you could be in danger of having an allergic reaction at your local family restaurant. Recent studies have found that latex gloves worn during food preparation can shed latex proteins into the food in amounts large enough to cause reactions.

The studies were a result of multiple reports from latex-allergic individuals who claimed that they had experienced allergic reactions from eating food at restaurants that used latex gloves. One study done at the Guthrie Research Institute found that fingerprints of latex proteins were detectable on cheese and lettuce that were handled with latex gloves. No latex proteins were found on lettuce handled with vinyl gloves. You can read the abstract from this study here:https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11061040&dopt=Abstract

Awareness of this problem is increasing, thanks to state legislation and education by food industry associations. The following is a list of recent developments.

• Oregon has banned the use of latex gloves in food service facilities. (https://www.dhs.state.or.us/publichealth/foodsafety/latex.cfm)
• The Arizona Department of Health Services has updated the requirements for food safety in restaurants and other food establishments, and has included the rule that “people…handling foods that are ready to eat without additional cooking must use utensils or non-latex gloves…” (https://www.azdhs.gov/phs/oeh/pdf/fy02_activity_summary.pdf)
• Rhode Island has banned the use of latex gloves in food service establishments and stores licensed by the Office of Food Protection. (https://www.health.ri.gov/environment/food/foodallergy.php)
• The State Assembly of New York passed a bill that requires any food service establishment that uses latex gloves to provide written notice to consumers as follows: “Latex gloves are used by staff in the preparation and conveyance of food in this establishment. If you are allergic to latex products, please take appropriate precautions.” (https://assembly.state.ny.us/leg/?bn=A08545)
• The State Senate and House of Massachusetts amended the General Laws by adding a section stating that latex gloves are banned from every food service business and that any establishment not in compliance can be assessed a fine up to $100. (https://www.latexallergylinks.org/)

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Frequently asked questions on Ebola virus disease

1. What is Ebola virus disease?
Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a severe, often fatal illness, with a death rate of up to 90%. The illness affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees).

Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan.

The origin of the virus is unknown but fruit bats (Pteropodidae) are considered the likely host of the Ebola virus, based on available evidence.

2. How do people become infected with the virus?
Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has occurred through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. It is important to reduce contact with high-risk animals (i.e. fruit bats, monkeys or apes) including not picking up dead animals found lying in the forest or handling their raw meat.

Once a person comes into contact with an animal that has Ebola, it can spread within the community from human to human. Infection occurs from direct contact (through broken skin or mucous membranes) with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people. Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments that have become contaminated with an Ebola patient’s infectious fluids such as soiled clothing, bed linen, or used needles.

Health workers have frequently been exposed to the virus when caring for Ebola patients. This happens because they are not wearing personal protection equipment, such as gloves, when caring for the patients. Health care providers at all levels of the health system – hospitals, clinics and health posts – should be briefed on the nature of the disease and how it is transmitted, and strictly follow recommended infection control precautions.

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Persons who have died of Ebola must be handled using strong protective clothing and gloves, and be buried immediately.

People are infectious as long as their blood and secretions contain the virus. For this reason, infected patients receive close monitoring from medical professionals and receive laboratory tests to ensure the virus is no longer circulating in their systems before they return home. When the medical professionals determine it is okay for the patient to return home, they are no longer infectious and cannot infect anyone else in their communities. Men who have recovered from the illness can still spread the virus to their partner through their semen for up to 7 weeks after recovery. For this reason, it is important for men to avoid sexual intercourse for at least 7 weeks after recovery or to wear condoms if having sexual intercourse during 7 weeks after recovery.

3. Who is most at risk?

During an outbreak, those at higher risk of infection are:

• health workers;
• family members or others in close contact with infected people;
• mourners who have direct contact with the bodies of the deceased as part of burial ceremonies; and
• hunters in the rain forest who come into contact with dead animals found lying in the forest.

More research is needed to understand if some groups, such as immuno-compromised people or those with other underlying health conditions, are more susceptible than others to contracting the virus.

Exposure to the virus can be controlled through the use of protective measures in clinics and hospitals, at community gatherings, or at home.

4. What are typical signs and symptoms of infection?

Sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.

Laboratory findings include low white blood cell and platelet counts, and elevated liver enzymes.

The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. The patients become contagious once they begin to show symptoms. They are not contagious during the incubation period.

Ebola virus disease infections can only be confirmed through laboratory testing.

5. When should someone seek medical care?

If a person has been in an area known to have Ebola virus disease or in contact with a person known or suspected to have Ebola and they begin to have symptoms, they should seek medical care immediately.

Any cases of persons who are suspected to have the disease should be reported to the nearest health unit without delay. Prompt medical care is essential to improving the rate of survival from the disease. It is also important to control spread of the disease and infection control procedures need to be started immediately.

6. What is the treatment?

Severely ill patients require intensive supportive care. They are frequently dehydrated and need intravenous fluids or oral rehydration with solutions that contain electrolytes. There is currently no specific treatment to cure the disease.

Some patients will recover with the appropriate medical care.

To help control further spread of the virus, people that are suspected or confirmed to have the disease should be isolated from other patients and treated by health workers using strict infection control precautions.

7. What can I do? Can Ebola be prevented?
Currently there is no licensed vaccine for Ebola virus disease. Several vaccines are being tested, but none are available for clinical use right now.

Raising awareness of the risk factors and measures people can take to protect themselves are the only ways to reduce illness and deaths.

Ways to prevent infection and transmission

While initial cases of Ebola virus disease are contracted by handling infected animals or carcasses, secondary cases occur by direct contact with the bodily fluids of an ill person, either through unsafe case management or unsafe burial practices. During this outbreak, most of the disease has spread through human-to-human transmission. Several steps can be taken to help in preventing infection and limiting or stopping transmission.

• Understand the nature of the disease, how it is transmitted, and how to prevent it from spreading further. (For additional information, please see the previous questions about Ebola virus disease in this FAQ.)
• Listen to and follow directives issued by your country’s respective Ministry of Health.
• If you suspect someone close to you or in your community of having Ebola virus disease, encourage and support them in seeking appropriate medical treatment in a care facility.
• If you choose to care for an ill person in your home, notify public health officials of your intentions so they can train you and provide appropriate gloves and personal protective equipment (PPE), as well as instructions as a reminder on how to properly care for the patient, protect yourself and your family, and properly dispose of the PPE after use.
• When visiting patients in the hospital or caring for someone at home, hand washing with soap and water is recommended after touching a patient, being in contact with their bodily fluids, or touching his/her surroundings.
• People who have died from Ebola should only be handled using appropriate protective equipment and should be buried immediately.

Additionally, individuals should reduce contact with high-risk infected animals (i.e. fruit bats, monkeys or apes) in the affected rainforest areas. If you suspect an animal is infected, do not handle it. Animal products (blood and meat) should be thoroughly cooked before eating.

8. What about health workers? How do they protect themselves from the high risk of caring for sick patients?

Health workers treating patients with suspected or confirmed illness are at higher risk of infection than other groups.

• In addition to standard health care precautions, health workers should strictly apply recommended infection control measures to avoid exposure to infected blood, fluids, or contaminated environments or objects – such as a patient’s soiled linen or used needles.
• They should use personal protection equipment such as individual gowns, gloves, masks and goggles or face shields.
• They should not reuse protective equipment or clothing unless they have been properly disinfected.
• They should change gloves between caring for each patient suspected of having Ebola.
• Invasive procedures that can expose medical doctors, nurses and others to infection should be carried out under strict, safe conditions.
• Infected patients should be kept separate from other patients and healthy people, as much as possible.

9. What about rumours that some foods can prevent or treat the infection?

WHO strongly recommends that people seek credible health advice about Ebola virus disease from their public health authority.

While there is no specific drug against Ebola, the best treatment is intensive supportive treatment provided in the hospital by health workers using strict infection control procedures. The infection can be controlled through recommended protective measures.

10. How does WHO protect health during outbreaks?

WHO provides technical advice to countries and communities to prepare for and respond to Ebola outbreaks.

WHO actions include:

• disease surveillance and information-sharing across regions to watch for outbreaks;
• technical assistance to investigate and contain health threats when they occur – such as on-site help to identify sick people and track disease patterns;
• advice on prevention and treatment options;
• deployments of experts and the distribution of health supplies (such as personal protection gear for health workers) when they are requested by the country;
• communications to raise awareness of the nature of the disease and protective health measures to control transmission of the virus; and
• activation of regional and global networks of experts to provide assistance, if requested, and mitigate potential international health effects and disruptions of travel and trade.

11. During an outbreak, numbers of cases reported by health officials can go up and down? Why?

During an Ebola outbreak, the affected country’s public health authority reports its disease case numbers and deaths. Figures can change daily. Case numbers reflect both suspected cases and laboratory-confirmed cases of Ebola. Sometimes numbers of suspected and confirmed cases are reported together. Sometimes they are reported separately. Thus, numbers can shift between suspected and confirmed cases.

Analyzing case data trends, over time, and with additional information, is generally more helpful to assess the public health situation and determine the appropriate response.

12. Is it safe to travel during an outbreak? What is WHO’s travel advice?

During an outbreak, WHO reviews the public health situation regularly, and recommends any travel or trade restrictions if necessary.

The risk of infection for travelers is very low since person-to-person transmission results from direct contact with the body fluids or secretions of an infected patient.

WHO’s general travel advice

• Travelers should avoid all contact with infected patients.
• Health workers traveling to affected areas should strictly follow WHO-recommended infection control guidance.
• Anyone who has stayed in areas where cases were recently reported should be aware of the symptoms of infection and seek medical attention at the first sign of illness.
• Clinicians caring for travelers returning from affected areas with compatible symptoms are advised to consider the possibility of Ebola virus disease.

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How to Choose the Right Medical Gloves

Like any healthcare professional, those working in small medical offices know that protection against blood and other bodily fluids is essential for preventing disease and the transmission of illnesses. Medical gloves are one of the first lines of defense.

In general, medical gloves are made of polymers like latex, nitrile rubber, vinyl, neoprene and polyisoprene. Each material has its own strengths and benefits and is best suited for specific types of work. Before you place an order, it’s important to know which type of glove will best meet your needs.

Latex
For jobs that require extended wear times, latex exam gloves are a good choice. Latex offers great performance and the best comfort and fit of any glove type. However, some people have allergic reactions to latex, which is a major downside to choosing this material. And latex is weak against some chemicals used in medical and industrial settings. Also worth noting: Latex rubber is a natural product, so fluctuating raw material costs can cause pricing to change rapidly.

Nitrile Rubber
Advances in technology have allowed manufacturers to use nitrile rubber to re-create the feel of a latex glove while eliminating allergy concerns. Nitrile exam gloves have become a go-to alternative partly because they are more puncture- and abrasion-resistant than latex. And because nitrile gloves are also more resistant to chemicals, they are a good choice for tough medical and industrial jobs, or jobs where chemicals are involved.

Vinyl
Vinyl exam gloves are the most cost-effective choice for small medical offices. These gloves excel at short-term jobs where comfort is not a concern, frequent glove changes are required and a basic barrier will suffice. Vinyl gloves have the lowest puncture and chemical resistances.

Vinyl gloves are less elastic than latex and nitrile, so when you choose this type, you sacrifice comfort and fit. That said, manufacturers have made advancements to improve the fit and feel of vinyl gloves, which has allowed multiple generations of them to exist in the market. For example, 3G vinyl (a patented third-generation stretch vinyl) is the most advanced to date.

Neoprene
In the surgical field, you will often find neoprene gloves. This latex-free alternative provides protection from harsh chemicals, acids, solvents, oil, grease and much more, and is another economical choice.

Polyisoprene
Polyisoprene is a synthetic rubber formulation also found in some surgical gloves. These gloves have the benefit of being nearly identical to latex gloves in terms of fit and feel. When comfort, protection and tactile sensitivity are important, polyisoprene gloves offer an edge over neoprene surgical gloves.

Other Things to Consider When Purchasing Medical Gloves

Beyond the glove’s material, it’s important to consider whether you want the gloves to be powdered or nonpowdered. Powdered gloves have a powder-like substance, such as cornstarch, inserted into the glove to act as a lubricant, making it easier to put them on and take them off. Nonpowdered gloves typically use a polymer coating. The disposable glove industry has been trending away from powdered gloves due to concerns about residue contamination.

You can also find gloves that have a coating of organic aloe to moisturize hands during use. Hand washing and constant glove wearing can cause skin irritation, which sometimes leads healthcare professionals to stop following proper hand-washing procedures. Natural body heat activates the aloe so hands stay soft and smooth throughout the gloves’ use.

An Essential Part of the Uniform

Medical gloves are an essential part of the uniform for many workers in small healthcare offices. Getting the right gloves for the job is critical and can make all the difference in day-to-day work.

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Gloves Related Information

Gloves can protect both patients and healthcare workers from exposure to infectious agents that may be carried on hands (Duckro et al 2005). As part of standard precautions, they are used to prevent contamination of healthcare workers’ hands when (Siegel et al 2007):

• anticipating direct contact with blood or body substances, mucous membranes, non-intact skin and other potentially infectious material; and
• handling or touching visibly or potentially contaminated patient-care equipment and environmental surfaces (Boyce & Pittet 2002; Bhalla et al 2004; Duckro et al 2005).

The capacity of gloves to protect healthcare workers from transmission of bloodborne infectious agents following a needlestick or other puncture that penetrates the glove barrier has not been determined (Siegel et al 2007).

Gloves are an essential component of contact precautions (in particular for patients with MROs) (see Sections B2.2.3 and B3.1.2) and may also be used as part of droplet precautions (see Section B2.3.3).

When and how should gloves be worn?
As with all PPE, the need for gloves is based on careful assessment of the task to be carried out and the related risk of transmission of microorganisms to the patient and the risk of contamination of the healthcare worker’s clothing and skin by the patient’s blood and body substances (Pratt et al 2001; Clark et al 2002). Risk assessment includes consideration of:

• who is at risk (whether it is the patient or the healthcare worker);
• whether sterile or non-sterile gloves are required, based on contact with susceptible sites or clinical devices and the aspect of care or treatment to be undertaken;
• the potential for exposure to blood or body substances;
• whether there will be contact with non-intact skin or mucous membranes during general care and invasive procedures; and
• whether contaminated instruments will be handled.

When gloves are worn in combination with other PPE, they are put on last (see Section B1.2.7).

When should gloves be changed?
International guidance suggests that changing of gloves is necessary:

• between episodes of care for different patients, to prevent transmission of infectious material (Pratt et al 2001; Siegel et al 2007);
• during the care of a single patient, to prevent cross-contamination of body sites (CDC 1995; Boyce & Pittet 2002); and
• if the patient interaction involves touching portable computer keyboards or other mobile equipment that is transported from room to room (Siegel et al 2007).

Prolonged and indiscriminate use of gloves should be avoided as it may cause adverse reactions and skin sensitivity (Pratt et al 2001; Clark et al 2002).

Hand hygiene should be performed before putting on gloves and after removal of gloves. Single-use gloves should not be washed, but discarded.

Recommendations

7 Wearing of gloves
Gloves must be worn as a single-use item for:

• each invasive procedure;
• contact with sterile sites and non-intact skin or mucous membranes; and
• activity that has been assessed as carrying a risk of exposure to blood, body substances, secretions and excretions

Gloves must be changed between patients and after every episode of individual patient care.

8 Sterile gloves
Sterile gloves must be used for aseptic procedures and contact with sterile sites.

What type of gloves should be worn?
Non-sterile single-use medical gloves are available in a variety of materials, the most common being natural rubber latex (NRL) and synthetic materials (e.g. nitrile). NRL remains the material of choice due to its efficacy in protecting against bloodborne viruses and properties that enable the wearer to maintain dexterity (Pratt et al 2001; Clark et al 2002). However, sensitivity to NRL in patients, carers and healthcare workers may occur (see below) and must be documented. A local policy is required on using alternative glove types when patients have latex allergies.

The selection of glove type for non-surgical use is based on a number of factors (Korniewicz et al 1994; Bolyard et al 1998; Korniewicz & McLeskey 1998; Ranta & Ownby 2004):

• the task to be performed (i.e. glove type should be fit for purpose and aim to avoid interference with dexterity, friction, excessive sweating or finger and hand muscle fatigue);
• anticipated contact with chemicals and chemotherapeutic agents; and
• personal factors, such as latex sensitivity and size.

Facility policies for creating a latex-free environment should also be taken into account.

Table B1.7: Selection of glove type

Sources: Derived from Kotilainen et al 1989; Korniewicz et al 1989; Korniewicz et al 1993; Rego & Roley 1999; Pratt et al 2001; Korniewicz et al 2002; Sehulster & Chinn 2003; Siegel et al 2007; Queensland Health 2010.

Latex allergy
Latex allergy is a reaction to certain proteins in latex rubber. The amount of latex exposure needed to produce sensitisation or an allergic reaction is unknown. However, current understanding of latex allergy is as follows (NIOSH 1998):

• increasing the exposure to latex proteins increases the risk of developing allergic symptoms — most people who are allergic to latex have had frequent exposure to latex over many years; the majority are nurses, doctors, dentists or patients who have had a number of operations;
• in sensitised people, symptoms usually begin within minutes of exposure; but they can occur hours later and can be quite varied — mild reactions involve skin redness, rash, hives, or itching; more severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat, and asthma (difficult breathing, coughing spells, and wheezing); and rarely, shock may occur although a life-threatening reaction is seldom the first sign of latex allergy; and
• the risk of latex allergy is influenced by the amount of protein/allergen and powder in the latex glove; not by powder alone (Hunt et al 2002).

Healthcare workers with latex allergies should inform their managers to ensure that their work areas can be latex free.

If latex gloves are used, they should be non-powdered due to the risks associated with aerosolisation and an increased risk of latex allergies.

Removing and disposing of gloves
Gloves (other than utility gloves) should be treated as single-use items. They should be put on immediately before a procedure and removed as soon as the procedure is completed.

When removing gloves, care should be taken not to contaminate the hands. After gloves have been removed, hand hygiene should be performed in case infectious agents have penetrated through unrecognised tears or have contaminated the hands during glove removal (Olsen et al 1993; Tenorio et al 2001; Boyce & Pittet 2002).

Gloves must not be washed for subsequent re-use — infectious agents cannot be removed reliably from glove surfaces and continued glove integrity cannot be ensured. Glove re-use has been associated with transmission of methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacilli (Doebbeling et al 1988; Maki et al 1990; Olsen et al 1993).

Gloves should be disposed of as soon as they are removed, with disposal complying with local policies and standards.

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Glove use

Q. Can staff wear gloves instead of cleaning their hands?
A. No. Gloves are not a substitute for handwashing or hand disinfection. Glove usage should be appropriate for the task in hand and removed at the end of the task for which they were worn.

The WHO Guidelines on Hand Hygiene in Health Care emphasise that the use of gloves does not replace the need for hand cleansing by either handrub or handwashing and that gloves should be removed after caring for a patient. It is also emphasised that the same pair of gloves should not be worn for the care of more than one patient. The advice goes even further, indicating that when wearing gloves they should be changed or removed during patient care if moving from a contaminated body site to a clean body site within the same patient.

Q. Do you need to clean your hands if you wear gloves?
A. Yes. Gloves used in healthcare may have holes in them allowing infectious agents to pass between the carer’s hands onto the patient, in either direction. Additionally, the hands of someone wearing rubber or latex gloves are well suited to bacterial growth, being warm and moist. Hands should be cleaned before and after every care activity and after any activity that may result in them being contaminated (ie, after exposure to body fluids), regardless of whether gloves are used.

Q. Should hands be cleaned with soap and water rather than cleansed with alcohol handrub after gloves are removed?
A. The Center for Disease Control (CDC) guidelines state that use of alcohol handrubs is ok after disposable gloves are used. The alcohol handrub supplier should advise whether their product will adversely impact on skin if used immediately after glove removal.

Q. Can alcohol be used on gloved hands?
A. No. Staff should not use the alcohol handrub whilst gloves are on their hands. This will not replace the need for gloves to be changed. Also the integrity of the glove may be breached, posing an infection risk (the product supplier can advise on this).

The WHO guidelines make it clear that the use of gloves does not replace the need for hand cleaning by either handrub or handwashing. If alcohol handrubs are used after glove removal, it is very important that staff allow the alcohol to dry properly before donning gloves again.

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THE FIRST GLOBAL PATIENT SAFETY CHALLENGE Clean Care is Safer Care

GLOVE USE (technical)

Evidence and different considerations on glove use

It is widely recommended that health-care workers (HCWs) wear gloves for two main reasons: (i) to prevent microorganisms which may be infecting, commensally carried, or transiently present on HCWs’ hands from being transmitted to patients and from one patient to another; (ii) to reduce the risk of HCWs themselves acquiring infections from patients.

The effectiveness of gloves in preventing contamination of HCWs’ hands and helping to reduce transmission of pathogens has been confirmed in several clinical studies.

Nevertheless HCWs should be informed that gloves do not provide complete protection against hand contamination. Bacterial flora colonizingpatients may be recovered from the hands of up to 30% of HCWs whowear gloves during patient contact. In such instances, pathogens presumably gain access to the caregivers’ hands via small defects in gloves or bycontamination of the hands during glove removal.

The impact of wearing gloves on adherence to hand hygiene policies has not been definitively established, since published studies have yielded contradictory results. Several studies found that HCWs who wore gloves were less likely to cleanse their hands upon leaving a patient’s room. In contrast, other studies proved the direct opposite. The recommendation to wear gloves during an entire episode of care of a patient undergoing isolation precautions could actually lead to HCWs missing opportunities for hand hygiene

Use of gloves
Gloves should be worn during all patient-care activities that may involve exposure to blood or body fluids contaminated with blood. In addition, gloves should be worn in activities that include contact with potentially infectious material other than blood, such as mucous membranes, and non-intact skin or during outbreak situations, as recommended by specific requirements for Personal Protective Equipment (PPE).

The unnecessary use of gloves in situations when their use is not recommended represents a waste of resources without necessarily leading to a reduction of cross-transmission and may also result in missed opportunities for hand hygiene.

It is important that HCWs are able to correctly select the most appropriate type of gloves to be worn and to differentiate between specific clinical situ ations when gloves should be worn and changed and those where their use is not recommended (see pyramid overleaf).

Glove reprocessing must be strongly discouraged and should be avoided, even if it is common practice in many health-care settings in developing countries where glove supply is limited. At present no standardized, validated and affordable procedure for safe glove reprocessing exists. Every possible effort should be made to prevent the occurrence of glove reuse in health-care settings. This includes educational activities to reinforce the need to reduce inappropriate glove use, purchasing good quality disposable gloves and replenishing stocks in time. Further research is needed to identify a standardized glove reprocessing procedure, to evaluate the integrity of different glove material when exposed to different products used for hand antisepsis or handwashing (e.g. alcohol, chlorhexidine, or iodine solutions) and to develop a valid evaluation process for settings practicing or planning the reprocessing of gloves, in order to minimize this practice.

Key messages for glove use:

• Gloves are effective in preventing contamination of HCWs’ hands and helping reduce transmission of pathogens.
• Gloves do not provide complete protection against hand contamination.
• HCWs should be reminded that failure to remove gloves may contribute to the transmission of organisms.
• If the integrity of a glove is compromised (e.g., punctured), it should be changed as soon as possible.
• HCWs should be trained in planning the sequence of procedures in a rational manner which limits the use of gloves and to use non-touch techniques as much as possible during care. The emphasis should be on minimizing the need for glove use and change.
• In some published studies, vinyl gloves more frequently had defects than did latex gloves, the difference being greatest after use.
• It is appropriate to have more than one type of glove available.
• Use of petroleum-based hand lotions or creams may adversely affect the integrity of latex gloves and some alcohol-based handrubs may interact with residual powder on HCWs’ hands.
• The unnecessary use of gloves in situations where their use is not appropriate should be avoided

Recommendations on glove use:

• The use of gloves does not replace the need for hand cleansing by either handrubbing or handwashing.
• Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, or nonintact skin will occur.
• Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient.
• When wearing gloves, change or remove gloves in the following situations: during patient care if moving from a contaminated body site to a clean body site within the same patient; after touching a patient; after touching a contaminated site and before touching a clean site or the environment.
• Avoid the reuse of gloves. If gloves are reused, an adequate and validated reprocessing method needs to be developed to ensure glove integrity and microbiological decontamination.
• Double gloving in countries with a high prevalence of HBV, HCV and HIV for long surgical procedures (>30 minutes), for procedures with contact with large amounts of blood or body fluids, for some high-risk orthopedic procedures, is considered an appropriate practice.

Gloves must be worn according to STANDARD and CONTACT PRECAUTIONS. The pyramid details some clinical examples in which gloves are not indicated, and others in which clean or sterile gloves are indicated. Hand hygiene should be performed when appropriate regardless of these indications for glove use.

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Torn Surgical Gloves Put Patients at Risk for Infection

TUESDAY, June 16 (HealthDay News) — Holes in surgical gloves increase the risk of surgical site infection among patients who aren’t given antibiotics before their surgery, Swiss researchers say.

In procedures lasting more than two hours, the rate of glove perforations ranges from 8 percent to 50 percent, according to a study published in the June issue of the Archives of Surgery.

Sterile gloves worn by surgical staff can be perforated by needles, bone fragments and sharp surgical instruments, and the resulting holes enable skin-borne pathogens to travel from the hands of surgical staff into patients.

In the study, Dr. Heidi Misteli and colleagues analyzed 4,417 surgical procedures performed at University Hospital Basel between 2000 and 2001, and found that sterile glove perforations occurred in 677 of the surgeries. Antibiotic therapy given before surgery to prevent infection was used in 3,233 of the surgeries, including 605 of the surgeries involving perforated gloves.

Overall, there were 188 surgical site infections (4.5 percent of surgeries), with 7.5 percent of infections occurring in procedures performed with perforated gloves and 3.9 percent occurring in procedures where gloves remained intact, the researchers found.

In surgeries where antibiotics were used, glove perforation wasn’t associated with surgical site infection. Among patients who didn’t receive antibiotics, surgical site infection rates were 12.7 percent when glove perforation occurred and 2.9 percent when there was no glove perforation.

“The present results support an extended indication of surgical antimicrobial prophylaxis [antibiotics] to all clean procedures in the absence of strict precautions taken to prevent glove perforation,” Misteli and colleagues concluded. “The advantages of this surgical site infection prevention strategy, however, must be balanced against the costs and adverse effects of the prophylactic antimicrobials, such as drug reactions or increased bacterial resistance.”

The study authors noted that procedures to reduce the risk of glove perforation — such as double gloving and replacing gloves more frequently –are effective and safe and should be encouraged.

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Glove Selection Guide

Summary: Use this checklist to choose the appropriate type of protective glove for your job. The Glove Selection Chart also provides advantages and disadvantages for specific glove types. This guidance was prepared for laboratory researchers but may also be helpful for other people working with hazardous materials.

Once selected, glove use requirements for your lab should be posted in your Chemical Hygiene Plan flipchart under the Standard Operating Procedures section.

Questions about glove selection?

Please contact the Office of Environment, Health and Safety at 642-3073 or ehs@berkeley.edu.

Glove material	Intended use	Advantages and disadvantages	Example Photos
Latex (natural rubber)	Incidental contact	Good for biological and water-based materials. Poor for organic solvents. Little chemical protection. Hard to detect puncture holes. Can cause or trigger latex allergies
Nitrile	Incidental contact (disposable exam glove) Extended contact (thicker reusable glove)	Excellent general use glove. Good for solvents, oils, greases, and some acids and bases. Clear indication of tears and breaks. Good alternative for those with latex allergies.
Butyl rubber	Extended contact	Good for ketones and esters. Poor for gasoline and aliphatic, aromatic, and halogenated hydrocarbons.
Neoprene	Extended contact	Good for acids, bases, alcohols, fuels, peroxides, hydrocarbons, and phenols. Poor for halogenated and aromatic hydrocarbons. Good for most hazardous chemicals.
Norfoil	Extended contact	Good for most hazardous chemicals. Poor fit (Note: Dexterity can be partially regained by using a heavier weight Nitrile glove over the Norfoil/Silver Shield glove.
Viton	Extended contact	Good for chlorinated and aromatic solvents. Good resistance to cuts and abrasions. Poor for ketones. Expensive.
Polyvinyl chloride (PVC)	Specific use	Good for acids, bases, oils, fats, peroxides, and amines. Good resistance to abrasions. Poor for most organic solvents.
Polyvinyl alcohol (PVA)	Specific use	Good for aromatic and chlorinated solvents. Poor for water-based solutions.
Stainless steel Kevlar Leather	Specific use	Cut-resistant gloves. Sleeves are also available to provide protection to wrists and forearms. (If potential for biological or chemical contamination: wear appropriate disposable gloves on top of your cut-resistant gloves and discard after use).
Cryogenic Resistant Material Leather	Specific use	For use with cryogenic materials. Designed to prevent frostbite. Note: Never dip gloves directly into liquid nitrogen.
Nomex	Specific use	For use with pyrophoric materials. Consider wearing a flame-resistant glove such as a Nomex ‘flight’ glove with a thin nitrile exam glove underneath.

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ADA Infection Control Guidelines

This second edition of the ADA Guidelines for Infection Control incorporates a number of changes that have arisen since the publication of the first edition in 2008, including the release in October 2010 of the National Health and Medical Research Council (NHMRC) Australian Guidelines for the Prevention and Control of Infection in Healthcare .It is the intention of the Australian Dental Association Inc. (ADA) that these infection control guidelines will be updated every three years to ensure that they remain aligned to the evidence base of infection control.

The current edition of the ADA Guidelines is the result of over 20 years of dedicated work by the members of the ADA’s Infection Control Committee. During that time the Committee has assisted external expert bodies such as the NHMRC and the Communicable Diseases Network of Australia (CDNA) help define safe practice. Quite fittingly, the ADA Guidelines are now recognised as a key source of information for the NHMRC Guidelines, and have been identified by the Dental Board of Australia as a major resource for dental practitioners.

The production of this document has required a considerable effort over a long period. Special thanks and acknowledgment are due to the current members of the ADA’s Infection Control Committee (chaired by Professor Laurence Walsh) for their generous donation of time and their technical advice and expertise in preparing this document.

The ADA declares that no conflict of interest existed in the development of these guidelines, and that they have been developed independently without any corporate interest or sponsorship.

F Shane Fryer

President

Australian Dental Association Inc.

To view the complete guidelines click here to download the document.

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