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Bioterrorism Agents And Barrier Protection
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Personal Protective Equipment
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DEFINITION
Informed use of Personal Protective Equipment (PPE) is a very critical component
of a hospital’s infection control and bioterrorism response program. Where there
is likelihood of contact with potentially infectious material, appropriate PPE includes
gloves, gowns, laboratory coats, face shields, masks, eye protection, and ventilation
devices.
MEDICAL GLOVES
When selecting a medical glove, an important consideration should be the barrier
requirement related to the procedure or task at hand. Be aware of the level of exposure
risk that the patient-care activities will require. Procedures that involve exposure
to blood, bodily fluids, and other potentially infectious material require a glove
material that provides appropriate barrier protection.
LATEX MEDICAL GLOVES
Latex remains the gold standard for hand barrier protection due to its strength,
proven barrier protection, elasticity, fit, feel, comfort, and relatively low cost.
With the availability of low-protein, powder-free gloves, many clinicians are confidently
continuing to wear gloves made of natural rubber latex. Latex gloves are recommended
as the first choice for barrier protection in the healthcare environment, except
for wearers who are allergic to latex proteins. In the event of bioterrorist activity,
clinical personnel can have confidence in the barrier properties of the latex glove
to protect them. Double-gloving in a bioterrorist event is also recommended. Natural
rubber latex is available in both surgical and examination gloves.
LATEX-FREE MEDICAL GLOVES
For healthcare workers allergic to natural rubber latex, the preferred recommendation
as an alternative for medical examination gloves would be a latex-free material
of nitrile or neoprene and a latex free material of neoprene, or polyisoprene for
surgical gloves. In independent testing for barrier properties, studies showed that
nitrile, neoprene, and latex gloves are comparable in barrier properties during
in-use performance testing.9
Nitrile
Nitrile is a petroleum-based, cross-linked film. It is extremely strong with puncture
resistance superior to all glove films. Nitrile’s elasticity is very good and the
gloves tend to conform to the shape of the wearer’s hands, providing good comfort
and fit. There are no natural rubber latex proteins in nitrile; therefore, there
is no chance of latex allergy with use. Nitrile exhibits excellent resistance to
most chemicals. Nitrile is recommended as a preferred alternative to natural rubber
latex for a bioterrorist event. Nitrile is available in examination gloves.
Neoprene (Polychloroprene)
Neoprene is a petroleum-based crosslinked film and provides barrier protection similar
to latex. Neoprene contains no latex proteins, and is available without chemical
accelerators, making it a great choice for those with allergies. It is a strong
material, with good resistance to many chemicals, and provides great comfort. Neoprene’s
elasticity is close to that of latex and memory is very high, enabling the film
to retain its original shape. It is somewhat puncture-resistant and is recommended
as a preferred alternative to natural rubber latex for a bioterrorist event. Neoprene
is available in both surgical and examination gloves.
Polyisoprene
Polyisoprene is a petroleum-based, cross-linked film. Polyisoprene provides high
strength, elasticity, and comfort. It contains no natural rubber latex proteins,
but contains some curing agents that can cause allergic reactions. Polyisoprene
is durable and is somewhat punctureresistant. Polyisoprene provides good barrier
protection but is more permeable than latex, and is recommended as a preferred alternative
to latex in a bioterrorist event if nitrile or neoprene is not available. Polyisoprene
is available in surgical gloves.
Polyvinyl Chloride (PVC)
Many hospitals provide a latex-free material called Polyvinyl chloride (PVC), commonly
known as “vinyl,” as a choice for exam gloves. PVC is a petroleum-based film, but
it is not molecularly cross-linked. Because it lacks cross-linking, the individual
molecules of vinyl tend to separate when the film is stretched or flexed. This causes
small holes and breaches to form during glove donning and normal use. Studies have
shown that 63% of vinyl examination gloves permitted leakage of a test virus after
normal use, compared with 7% of latex examination gloves.9 Vinyl is the
weakest of the glove films, with poor elasticity, memory, and fit. Because of these
poor physical properties, vinyl would not be an acceptable choice of glove to use
when handling the diseases caused by biological agents. Polyvinyl chloride is only
available in examination gloves.
SELECTING A GLOVE THAT’S RIGHT FOR YOU
In closing, glove selection is a serious business. The two primary considerations
should be barrier protection and allergen content. If a glove does not provide an
intact barrier, it is not doing its job. To maximize barrier effectiveness, you
may wish to choose a glove manufacturer that is reliable and experienced, to ensure
that your gloves will be of consistent quality and regularly available.
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