Training On Glove Usage

Introduction

With increased demands from the general public for healthcare professionals to be accountable for their actions, many are becoming familiar with clinical governance and other initiatives to improve clinical practice. Good infection control is central to nursing practice. To achieve higher standards of clinical practice, especially when thinking about how to reduce the risk of cross-infection, it is necessary to not only do the right thing, but also do the thing right. Safe practice should be uppermost in the minds of healthcare professionals when caring for patients. This articles attempts to look at the practical aspects in the selection of medical gloves that are available for use. It also shares some latest findings on latest problem of allergies to latex.

General Selection

The selection of the proper glove begins with an evaluation of the job application. Factors in this selection include :

• Type of procedure to be executed
• Frequency and duration of use
• Risk of cross contamination/infection
• Risk of exposure to blood and body fluid
• Puncture, and tear resistance requirements
• Size and comfort requirements

The key factor for choosing what material the glove is made of is the type of chemical to be handled. The more common materials are :

Rubber

Highly flexible and conforming produced by rubber plants.

Merits

• Excellent barrier properties against viral transmission
• High resistance to tears and punctures during use
• High tensile strength and elasticity
• Excellent finger dexterity to reduce hand fatigue
• Excellent tactile sensitivity for better feel
• Highly durable
• Biodegradable and environmentally friendly

Demerits

• Resistance to oil and grease is not as good as synthetic substitutes
• Low resistance to ozone, oxygen and ultraviolet rays.
• Contains proteins (Significantly reduced now)
• Contains residual chemicals

Nitrile

A copolymer available in a wide rang of acrylonitrile content; higher acrylonitrile content equates to greater chemical resistance and increase stiffness.

Merits

• Protein free
• Good resistance to oil and grease
• Good elasticity but lower than latex
• Good strength and durability

Demerits

• Low resistance to tears
• Not as flexible nor elastic as latex
• Less comfort, fit and feel
• Contains residual chemicals (similar to natural rubber latex)
• Release cyanide during incineration or disposal
• Not biodegradable nor environmental friendly
• Poor resistance against benzene, methylene chloride and many ketones.

Polyvinyl Chloride

A stiff polymer made softer for protective applications.

Merits

• Protein free
• Good resistance to light and ozone

Demerits

• Inferior barrier properties against viral transmission
• Low resistance against tears and punctures during use.
• Most susceptible to sharp object, e.g. needle sticks
• Poor elasticity and strength
• Less comfort and fit
• Poor tactile sensitivity or feel
• Releases dioxin during incineration or disposal
• High content of plasticizers e.g. DEHP
• Not biodegradable nor environmental friendly

The greater the thickness of the material selected, the greater protection to chemical exposure is offered. However, with the increased thickness, loss of dexterity, grip and handling safety can be expected.

Gloves that are too small will increase hand fatigue. Gloves that are too large are uncomfortable, hard to work with and can pose a danger if working around moving machinery.

Selection of gloves for safe use

The main function of wearing gloves is to protect the wearer against contamination of infectious materials particularly viruses, bacteria, infected blood and body fluids. Thus, the single most important criterion in glove selection is barrier protection, as defined by all users, including physicians, dentists, medical and non-medical workers and researchers. The next most important criterion is strength, fit and comfort, that is , the ability for the glove to stretch, remain soft, and conform to the hand. Other important requirements include tactile sensitivity, the ability to grip thing well, and the ease of donning. It is widely acknowledged that NR latex gloves are unsurpassed in their range of properties. Hence, selection of glove for safe use should be one with the following properties:

• Good barrier performance
• Strength
• Fit and comfort
• Tactile sensitivity
• Good grip
• Easy donning
• Low extractable protein content
• Minimum level of chemical residues

When Natural Rubber Latex Gloves are used, it is recommended to use gloves of low level of water soluble protein content. The RRIM (Rubber Research Institute of Malaysia), in collaboration with Dr. K. Turjanmaa of the Department of Dermatology, Tampere University in Finland, has shown that when latex hypersensitive subjects were skin tested with latex gloves of varying protein content, about 60% of them indicated no allergic response at levels less than 400 µg/g. Up to hundred percent of negative responses were observed at EPRRIM lower than about 100 µg/g in this study.

The Powder Free gloves produced by N.S .Uni-Gloves Sdn Bhd is consistently below 50 µg/g

Use and Care

Always inspect your gloves before using them. Principal concern are cuts, tears and punctures. Discoloration or stiffness may indicate compromise due to chemical.

One method to detect pinholes or other defects is to conduct a leak test. One can first stretch the beaded portion of the glove and inspect for tear and holes at the cuff area. Gloves that show no hole(s) shall be filled with air by swinging the piece of glove toward the other hand so that the cuff opening is closed quickly by the grapping hand. Inspect the lightly air inflated glove for leak(s). Dispose of the glove if it leaks.

Pin holes may develop when the gloves are in use. Such phenomena is prominent among gloves made of synthetic materials. Prolonged usage with the same pair of glove is therefore not recommended. there is a need to change gloves at regular intervals to prevent accumulation of fluids in the gloves. For challenging surgical procedures which could sometimes result in holes and cuts, the use of double gloving is recommended to provide maximum protection. The contact with oil-based antiseptics, phenols and their derivatives, petroleum-based grease, kerosene and other related organic compounds, should be avoided.

Hands should first be washed and dried before donning the gloves. It is a good practice to do so to minimize cross contamination and to avoid discoloration of gloves when they are in use.

An open box of glove should not be exposed to direct sunlight, UV lights, moist environment and excessive heat to minimize deterioration in its physical properties. It is recommended that opened boxes of gloves are kept away from light and free moving air by placing them an enclosed container that should be stored in a cool dry place. Storage for an unnecessarily long period is not recommended. As soon as signs of deterioration appear (e.g. tackiness, brittleness, acrid odour), the gloves should not be used.