A variety of medical gloves are now offered to hospitals. Because medical gloves are an important protective barrier for workers and patients alike, it is essential that one make an educated choice to ensure that the glove provides the necessary protection. Here are some points worth thinking about when you consider medical gloves:
1. The starting point for selection of medical gloves
The most important point for selecting medical gloves is to define: Who is being protected? What is being protected against?
Medical gloves are typically used to protect health care workers from a range of hazards encountered in the workplace, including:
During the glove selection process, one must recognize what protection the gloves need to provide and make sure that any gloves selected provide that type of protection. (Not all gloves protect against chemotherapy drugs, for example).
- Biological exposures (bacterial and viral)
- Chemotherapy drugs
2. Consider known health effects associated with gloves
Medical gloves themselves have the potential for adversely affecting both health care workers and patients. Therefore, it is important to consider the following concerns and make sure that gloves will provide the protection needed without introducing risk to health care workers or patients.
3. Important points for selecting gloves
- Latex allergy can affect both health care workers and patients.
- Use of powdered gloves can lead to granulomas and adhesions in surgical patients, requiring surgical attention.
- Airborne powder may have high bacterial and latex protein levels, introducing risk of infection or allergic reaction for both patients and hospital staff.
- Allergy to rubber accelerators (used in the manufacture of gloves) can affect the health care worker. In addition, cracked skin (associated with the allergic reaction) compromises the skin's inherent protective barrier against infection.
- Use of vinyl gloves is unfavorable because incineration of vinyl (as waste) can result in the formation of dioxin, a human carcinogen, which is released into the air.
- Glove fit is important to prevent chafing of the skin. If a glove's sizing is not well matched to the wearer, a glove selected for good finger fit may be tight across the hand and cause chafing of the skin across the back of the hand. (This may be mistaken for an allergic reaction). In addition, gloves that fit poorly sometimes make it difficult to perform manual tasks, such as grasping or manipulating medical devices. In some cases, workers compensate by gripping more tightly, which over time can cause hand trauma or accidents.
Selection of gloves must be a systematic process, rather than a one-step operation. At minimum the process must include:
4. Make the Manufacturer a "VIP"
- Verification that a glove is powder-free.
- Verification that a glove provides barrier protection against penetration of blood-borne pathogens, per ASTM F 1671. (This information is provided by the vendor).
Note: Although viral barrier protection is the primary purpose for use of medical gloves, the FDA does not require manufacturers to test the efficacy of gloves against viral penetration. Some manufacturers voluntarily test their gloves for viral barrier resistance, typically using a standard test procedure, ASTM F1671-97a. This ASTM test method is designed for modeling viral penetration of Hepatitis B, Hepatitis C, and HIV transmitted in blood and other potentially infectious body fluids. Only gloves which pass this test should be considered for situations where contact with blood borne pathogens is possible.
- Verification that a glove provides barrier protection against permeation of chemicals, chemotherapy drugs, and sterilants that are encountered in the workplace. Verification should reflect testing per ASTM F 739-96. (Information provided by the vendor)
Note: In practice, medical gloves are sometimes used as a protective barrier against chemicals, chemotherapy drugs, and sterilants. Testing the permeation resistance of a glove to these agents is not an FDA requirement, but some manufacturers voluntarily perform the testing. ASTM F 739-96 is a standard protocol for evaluating the resistance of gloves to permeation by fluids under conditions of continuous contact. This ASTM protocol is the method most often used by manufacturers who test their gloves with various chemicals.
- Validation of glove performance in the hospital setting to ensure that work can be safely performed using the glove. Feedback from glove wearers should include the following: fit, comfort, integrity (resistance to leaking, tearing), skin irritation, tactile sensitivity, friction (ability to hold objects without dropping), ability to perform job tasks.
The manufacturer should be made a key part of the glove evaluation and selection process. Feedback to manufacturers provides the driving force for development of better products. (Interestingly enough, many manufacturers choose not to refine existing products -- even for the better -- for fear of jeopardizing relationships with customers).
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