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NEWS & INFORMATION
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Source To Surgery - October 1993, Vol. 1 Issue III
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Barrier Integrity of Gloves Used in Clinical Practice
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Denise Korniewicz, Associate Professor and Associate Dean for Academic Affairs, School of Nursing, Georgetown University, Washington DC, USA
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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 water-tight/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 efficacy
of the barrier may be compromised by the task being carried out and
the length of time the gloves are worn.3-6
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 water-tight/leak test.
Other authorities8-10 demonstrated that gloves that had been worn for
longer than 3 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 manufacture 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
- barrier integrity
- cost
- personal comfort and fit.
The ideal glove would be:
- puncture-resistant
- resistant to viruses (e.g., hepatitis B and HIV)
- antibacterial
- hypoallergenic
- powder-free
- comfortable to wear and allow optimum sensitivity.
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
- Halstead W. Ligature and suture material. JAMA 1913;15: 119-25.
- Department of Health and Human Services. Federal Register 1990;
55 239: 51254-7.
- Korniewicz D, Laughon B, Butz A, Larson E. Integrity of vinyl and latex pro-
cedure gloves. Nurs Res 1989; 38:144-6.
- Korniewicz 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.
- Komiewicz D, Kirwin M, Cresci K, Larson E. Leakage of latex and vinyl exam
gloves in high and low nsk clinical seKings. Am Ind Hyg Assoc 1993; 54 1: 22-5.
- Kotilian H, Brinker J, Avato J, Gantz N. Latex and vinyl examination gloves:
quality control procedures and implications for health care workers. Arch Intern
Med 1989; 149: 2749-53.
- Korniewicz D, Kirwin M, Cresci K, Markut C, Larson E. In-use comparison of
latex gloves in two high-risk units: surgical intensive care and acquired immun-
odeficiency syndrome. Heart Lung 1992; 21 1: 81-4.
- Pate J. Risks of blood exposure to the cardiac surgical team. Soc Thoracic Surgeons 1990; 50: 248-50.
- Gerberding J, LiKrell C, Tarnington A, Brown A, Schecter W. Risk of expo-
sure of surgical personnel to patients' blood during surgery at San Francisco
General Hospital. N Engl J Med 1990; 322 25: 1788-93.
- Fell M, Hopper W, Williams J et al Surgical glove failure rate. Ann CoD Surg
1988; 71: 1 -10.
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