Glove Selection
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Transcript of Glove Selection
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Glove Selection
Occupational Hazards
To Health Care Workers August 1, 2002
Susan Wilburn
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Why Wear Medical Gloves?
History of Medical Glove Use
• 1900s Halstead in surgery for nurses
• 1987 CDC Universal Precautions
• 1991 OSHA Bloodborne Pathogens Standard
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Hierarchy of Controls
• Elimination – Substitution
• Engineering Controls
• Administrative and Work Practice Controls
• Personal Protective Equipment
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NIOSH Latex Allergy Alert
June 1997
WARNING! Workers exposed to rubber gloves and other latex-containing products may develop allergic reactions such as skin rashes, nasal or sinus symptoms, asthma and in rare instances shock.
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Latex Allergy: Type I Immediate Hypersensivity• 1979: First reports in literature
• 1988-1992: Latex glove use and reactions– 11.8 billion exam and 1.8 billion surgical
gloves use in US– FDA reports > 1,000 systemic reactions to latex– FDA reports 15 deaths
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Types of Glove-Associated Reactions
• Irritant Contact Dermatitis
• Allergic Contact Dermatitis (Type IV Delayed Hypersensitivity)
• Latex Allergy IgE-mediated response (Type I Immediate Hypersensitivity)
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Glove Needs
• Chemical Barrier • Viral Barrier
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Glove Selection
• Meeting existing standards and guidelines
• Prevents illness and exacerbation of existing problems
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Standards and Guidelines
• OSHA
• CDC
• NIOSH
• ASTM
• FDA
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CDC Guidelines
“adequate barrier protection”
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OSHA Bloodborne Pathogens Standard, 1991
• 29 CFR 1910.1030• Gloves shall be worn . . hand contact with blood,
other potentially infectious materials, mucous membranes and non-intact skin
• Appropriate PPE in appropriate sizes• Hypoallergenic gloves, glove liners, powderless
gloves or similar alternatives shall be readily available to those employees who are allergic to the gloves normally provided
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OSHA PPE Standard
• 29 CFR 1910.132 and 1910.138
• Select the most appropriate glove for a particular application and determine how long it can be worn
• Know the performance characteristics of the gloves relative to the specific hazard anticipated
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OSHA Technical Information Bulletin
Potential for Allergy to Natural Rubber Latex Gloves, 1998
• Reduce unnecessary exposure to natural rubber latex protein for all workers
• Choose latex gloves with lower protein• Selecting powder-free gloves offer additional
benefit of reducing systemic allergic responses• Provide suitable alternatives to latex gloves
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NIOSH Alert
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Criteria for Glove Selection
• In Use issues
• User Preferences
• Match glove to user criteria through in-use performance evaluation
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Criteria for Glove – In Use
• Exposure to infectious organisms
• Physical stress/durability (orthopoedic surgery)
• Chemical resistance (drugs, disinfectants)
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Glove Standards
• American Society for Testing & Materials (ASTM)
• FDA
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FDA
Safety Medical Devices Act
• No Viral or Chemical barrier testing required• AQL Water Leak
– Surgeon’s gloves = 2.5%
– Exam gloves = 4 %
• Proposed Powder and Protein Labeling – Powder non > 120 mg per glove
– Protein maximum 1,200 mcg per glove
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ASTM Glove Standards
• ASTM F 1671 – 97a viral penetration
• ASTM F 739-96 Chemical permeation
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Chemical Sensitizers
• Low Thiuram, Carbamates, Thiazole– Negative Modified Draize-95– Negative patch test
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Glove Materials
• Vinyl (poly vinyl chloride)
• Polyurethane
• Natural Rubber Latex (powdered or non)
• Neoprene (chlorinated)
• Nitrile
• Elastryn
• Polyisoprene
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Glove Performance
• Permeation tests with Latex, PVC, Latex/neoprene and nitrile to Cyclophosphamide, Ara-C, vincritine, methotrexate, daunomycin– All drugs permeated all glove materials:
highest permeation with PVC, lowest with Nitrile
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Glove Selection Best Practices
• Oregon Health Division partnership
• Kaiser-Permanente
• Emery University
• Postal Worker and Airport Personnel
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Oregon Strategic Plan for Reducing Occupational Dermatitis• Joint labor-management, public-private,
intergovernmental partnership to eliminate latex use in food service based on occupational dermatitis worker’s comp claims
• Oregon Health Division Occ & Enviro• Liberty Northwest Insurance • Oregon Restaurant Association• UFCW, Local 555• County health departments environmental services
in 5 counties
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Hospital Best Practices
Kaiser-Permanente
• Eliminated latex and vinyl exam gloves; substitute with Nitrile
Emery University
• Eliminated latex and saved $ on workers’ compensation
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Purchasing Products for Safety
• Management commitment
• Worker involvement
• Health and safety committee involved in surveillance & glove selection decision; work with purchasing to set criteria for RFP to include independent testing of viral and chemical barrier
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Resources
• www.nursingworld.org/dlrwa/osh
• www.sustainablehospitals.org
• www.cdc.gov/niosh
• www.OSHA.gov