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Source To Surgery - February 1995, Vol. 3 Issue I
Barrier Integrity of Gloves Used in Clinical Practice
Denise M. Korniewicz, Associate Professor and Associate Dean for Academic Affairs, School of Nursing, Georgetown University, Washington, DC, USA
The use of gloves as a barrier to prevent transmission of microorganisms
between patients and health care professionals has become a predominant
issue in today's high-risk clinical settings. In the early 1900s,
Halstead1 introduced gloves into the
operating theatre to protect his nurses' hands from harmful chemicals
used during surgery. Subsequently, it became common practice to wear
gloves to reduce transmission of microorganisms between the health care
professional and the patient. Today, health care professionals have
redefined the use of gloves in clinical practice and demand two-way
protection from the transmission of microorganisms.
Glove Standards
Current standards for glove manufacture include:
- specific physical characteristics (e.g., width, length, thickness);
- strength and ability to withstand pressure or to pass the
watertight/leak test.
In the USA, failure rates are calculated on lot sizes of 2.5% for
sterile surgical gloves and 4% for non-sterile examination gloves.2 In the UK, BSI failure rates are 1.5% for
both surgical and examination gloves.
Glove Barrier Characteristics
Glove barrier integrity is defined as the ability of the glove material
to withstand rigorous physical testing and basic penetration tests. This
integrity is causing increasing concern. Gloves must provide an
effective two-way barrier between the patient and the health care
professional. When gloves are used for clinical procedures, the efficiency
of the barrier may be compromised by the task being carried out and the
length of time the gloves are worn.3-6
Barrier Materials
Currently there are several synthetic materials which have been used as
a substitute for latex in the manufacturing of gloves. Mmyl gloves have
been commonly used as an alternate choice among health care providers;
however, they have been found to be an ineffective barrier for clinical
procedures that expose health care providers to large amounts of blood
and body fluids. (Korniewicz et al, 1989 and 1990, Kotilian et al,
1989.) Other alternate synthetic gloves that are available have not been
shown to provide superior barrier qualities as good as latex. Therefore,
latex gloves remain the most cost-effective and safest barrier.
Leaks And Punctures
The author and her colleagues7 demonstrated
that gloves stressed during clinical procedures performed in the ICU
leaked 16% of the time when tested by the watertight/leak test.
Other authorities8-10 demonstrated that
gloves that had been worn for longer than three hours had more punctures
than gloves worn for shorter periods during surgical procedures.
Guidelines that reflect safe barrier protection could be considered for
manufacturers and health care professionals. For example, one
manufacturer electronically inspects gloves during manufacturing to
ensure barrier integrity.
However, stringent manufacturing procedures are worthwhile only if
health care professionals use the appropriate glove for the clinical
procedure (e.g., surgical, non-surgical) and discard the glove as soon
as the barrier has been breached.
Practice Implications
Health care professionals must change the way they use gloves in
clinical practice. For example, government standards for surgical gloves
differ from those for non-surgical gloves, and health care professionals
who practice in high-risk clinical settings may need to be advised about
the different barrier qualities of gloves and the fact that they may
require different gloves for various tasks in their unit.
Criteria For Selecting Quality Gloves
General quality control guidelines to help health care professionals
select appropriate gloves include:
- quality of product
- cost
- barrier integrity
- personal comfort and fit
The ideal glove would be:
- puncture-resistant
- resistant to viruses (e.g., hepatitis B and HIV)
- anabacterial
- hypoallergenic
- powder-free
- comfortable to wear and allow optimum senslavlty
The Future
Latex remains the material of choice among manufacturers, but it does
not meet the "ideal" required by health care professionals. Perhaps it
will be necessary for manufacturers to develop alternative devices that
alert the health care professional when the glove is no longer a safe
barrier, for example:
- electronic monitors that "sense" a breach in the glove integrity;
- gloves that "warn" the user when the barrier is no longer intact.
References
1 Halstead W. Ligature and suture material. JAMA 1913; 15: 119-25.
2 Department of Health and Human Services. Federal Register 1990; 55 239: 51254-7.
3 Komiewicz D, Laughon B. Butz A, Larson E. Integrity of vinyl and latex procedure gloves. Nurs Res 1989; 38: 1444.
4 Komiewicz D, Laughon B. Cyr H. Lytle D, Larson E. Leakage of virus through used vinyl and latex examination gloves. J Clin Microbiol 1990; 28: 787-8.
5 Komiewicz D, Kirwin M, Cresci K, Larson E. Leakage of latex and vinyl exam gloves in high and low risk clinical sethngs. Am Ind Hyg Assoc 1993; 541: 22-5.
6 Kotilian H. Brinker J. Avato J. Gantz N. Latex and vinyl examination gloves: quality control procedures and implications for health care workers. Arch Intem Med 1989; 149: 2749-53.
7 Korniewicz D, KinNin M, Cresd K, Markut C, Larson E. In-use comparison of latex gloves in two high-risk units: surgical intensive care and acquired immunodefidency syndrome. Heart Lung 1992; 21 1: 81-4.
8 Pate J. Risks of blood exposure to the cardiac surgical team. Soc Thoracic Surgeons 1990; 50: 248-50.
9 Gerberding J. Littrell C, Tarnington A, Brown A, Schecter W. Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990; 322 25: 1788-93.
10 Fell M, HopperW, Williams J etal Surgical glove failure rate. Ann Coll Surg 1988; 71: 1-10.
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