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Gloves and safety culture in hospitals

Gloves and safety culture in hospitals

Esah Yip

Dear Editor,

I read with interest your article entitled “Culture of safety keeps hospital workers from becoming patients” in the above-mentioned publication. You have correctly pointed out the concerns healthcare workers have about safety, such as contracting diseases like HIV or hepatitis from needlestick injuries. However, some clarifications are needed regarding the use of medical gloves, which all healthcare personnel rely on for protection against viral transmission and infectious diseases.

First, there is no doubt that in the past, latex gloves with uncontrolled levels of protein and powder had caused allergic reactions to a number of protein-sensitive individuals, and created public concerns and leafs about using latex gloves. In recent years, result of intensive research undertaken and advancements achieved in manufacturing technology have led to creation of a new generation of low protein, low powder or powder-free latex gloves that significantly lowers the risk of allergic reactions. A number of recent hospital studies undertaken in the U.S., Canada, Finland and Germany have in fact shown that the use of these improved latex gloves not only vastly reduces the incidence of allergy hilt also allows many latex sensitive individuals donning synthetic gloves to work alongside their coworkers wearing latex gloves without suffering ill effects. (References (1) through (7))

Although synthetic alternatives are now available in the market place, many of them do not have the superior glove properties of latex, such as effective barrier protection, comfort, fit, high resistance to tear and puncture, and tactile sensitivity. For example, widely used vinyl (PVC) gloves have been shown consistently by many studies to have inferior barrier performance; leakage rates as high as 63% for vinyl have been reported compared to 7% for latex gloves during use (References (8) through (16)). Other synthetic gloves may be better than vinyl, but they are more costly. Furthermore, the ability of latex to reseat after very small needle punctures enhances the barrier effectiveness of latex gloves. Such property is not found in synthetic gloves like vinyl and nitrile (References (17) through (18)).

Therefore, good safety culture calls for the use of low-protein latex gloves in hospitals and other healthcare facilities for majority of the workers; latex allergic individuals should be provided with high quality synthetic gloves with adequate barrier protection.

Second, it is incorrect to say that the recent appearance of colored latex gloves (dental variety) in the market place has hindered the differentiation between latex gloves, which are mostly in their native beige color, and brightly colored synthetic gloves, and led to confusion among latex allergic individuals. This might be so if all synthetic gloves were brightly colored. In fact, a large proportion of synthetic gloves (particularly vinyl) have a beige color similar to latex. Clearly, this issue needs to be resolved if a color strategy were to be adopted. Alternatively, easy distinction between latex and synthetic gloves could be made possible by simply labeling the synthetic gloves, which constitute only about 1/5 of the total medical gloves used.

With the adoption of a proper safety culture, hospitals can be safe places for healthcare personnel to work in. It is hoped that the Food and Drug Administration would be able to come out, without further delay, with its New Rule on medical gloves which requires, inter alia, latex gloves not to exceed upper limits set for protein and powder. The New Rule should also identify the type of synthetic material, as there are wide variations in the properties, performance and health risks associated with synthetic gloves made of different materials.

If there is any additional information or clarification you need, please feel free to contact me.

Dr. Esah Yip, Director

Malaysian Rubber Export

Promotion Council

Washington DC 20008

References

(1) Tarlo S.M., Easty A., Dubanks K., Min F., and Liss G. Outcomes of a Natural Rubber Latex Control Program in an Ontario Teaching Hospital Journal of Allergy, Clinical Immunology, 2001; Vol. 108: 628-633

(2) Rueff F., Schopf P. and Przybilla B. Parameters of Natural Rubber Latex Sensitization Decrease in Health Care Workers (HOW) Following Reduction of NRL Exposure. Klinik und Poliklinik fur Dermatologie und Allergologie, LudwigMaximilians-Universitat, Munich, Germany Presented at the 56th annual meeting of the American Academy of Asthma, Allergy and Immunology (AAAAI) in 2000.

(3) Hunt, L.W., Kalker P., Reed, C.E. and Yunginger J.W. Management of Occupational Allergy to Natural Rubber Latex in a Medical Center: The Importance of Quantitative Latex Allergen Measurement and Objective Follow-Up. J. Allergy Clin. Immunol, 2002; 110: S94-106.

(4) Turjanmaa K., Kanto M., Kautiainen H., Reunala T. and Palosuo T. Long-term Outcome of 160 Adult Patients with Natural rubber Latex Allergy J. Allergy Clin, Immunol, 2002; 110:S70-74.

(5) Allmers H., Schmengler J. and Skudlik C. Primary prevention of natural rubber latex allergy in the German healthcare system through education and intervention. J. Allergy and Clinical Immunology (United States), 2002, 110(2): 318-323.

(6) Kelly K.J., Klancnik M, Kurup V., Barrios-Jankol C., Fink J.N. and Petsonk E.L. A Four-Year Prospective Study to Evaluate the Efficacy of Glove Interventions in Preventing Natural Latex Sensitization in Healthcare Workers at Two Hospitals. J. Allergy Clin. Immunology, 2003; Vol. 111, Part 2, #2, No. 426.

(7) Allmers H, Brehler R., Chen Z., Raulf-Heimsoth M., Fels H., and Baur X. Reduction of Latex Aeroallergens and Latex-specific IgE Antibodies in Sensitized Workers After Removal of Powdered Natural Rubber Latex Gloves in a Hospital J. Allergy Clin. Immunol. 1998; 102:841-846.

(8) Korniewicz, D.M., Laughon, B.E., Butz, A. and Larson, E Integrity of Vinyl and Latex Procedure Gloves. Nur. Res. 1989: 38:144-6.

(9) Korniewicz, D.M., Laugho,n B.E., Cyr, W.H., Lytl,e C.D., and Larsen, E. Leakage of Virus through Used Vinyl and Latex Examination Gloves Journal of Clinical Microbiology, 1990,28:787-8

(10) Klein, R.C., Party, E. and Gershey, E.L. Virus Penetration of Examination Gloves. Biotechniques, 1990;9: 196-9.

(11) Olson, R.J, Lynch, P,. Coyle, M.B., Cummings, J., Bokete, T. and Stamm, W.E. Examination Gloves as Barriers to Hand Contamination in Clinical Practice. JAMA 1993;270:350-3

(12) Korniewicz, D.M., Kirwin, M., Cresci, K., Tian Seng and Tay, E.C., Wool, M., and Larson, E. Barrier Protection with Examination Gloves: Double versus Single. American Journal of Infection Control, 1994;22(1):12-5.

(13) Douglas, A., Simon, T and Goddard, M Barrier Durability of Latex and Vinyl Medical Gloves in Clinical Settings. Am. Ind. Hyg. Assoc. J. 1997; 58:672-6.

(14) Rego, A. and Roley, L. In-use Barrier Integrity of Gloves: Latex and Nitrile Superior to Vinyl American Journal of Infection Control. \ 1999; 27(5): 405-10.

(15) Baumann, M.A., Rath, B., Fischer, JH and Iffland, R. The permeability of dental procedure and examination gloves by an alcohol based disinfectant. Dent. Mater. 2000; 16(2): 139-44.

(16) Korniewicz D.M., El-Masri M., Broyles J.M., Marin C.D. and O’connell K. P. Performance of latex and non latex medical examination gloves during simulated use. Am. J. Infect. Control, 2002; 30: 133-138.

(17) Hasma, H. and Othman, A.B. Barrier Performance of NR, Vinyl and Nitrile Gloves on Puncture Paper presented at the “Latex 2001” Conference, RAPRA, 4-5 December 2001, Munich, Germany Reprinted to MARGMA Newsletter, April 2001.

(18) Broyles J.M., O’Connell K.P. and Korniewicz D.M. A PCR based method for detecting viral penetration of medical exam. groves. J. Clin. Microbiol. 2002; 52: 965-999.

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