Glove Selection Occupational Hazards To Health Care Workers August 1, 2002 Susan Wilburn
Why Wear Medical Gloves? History of Medical Glove Use • 1900s Halstead in surgery for nurses • 1987 CDC Universal Precautions • 1991 OSHA Bloodborne Pathogens Standard
Hierarchy of Controls • Elimination – Substitution • Engineering Controls • Administrative and Work Practice Controls • Personal Protective Equipment
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.
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
Types of Glove-Associated Reactions • Irritant Contact Dermatitis • Allergic Contact Dermatitis (Type IV Delayed Hypersensitivity) • Latex Allergy IgE-mediated response (Type I Immediate Hypersensitivity)
Chemical Barrier Viral Barrier Glove Needs
Glove Selection • Meeting existing standards and guidelines • Prevents illness and exacerbation of existing problems
Standards and Guidelines • OSHA • CDC • NIOSH • ASTM • FDA
CDC Guidelines “adequate barrier protection”
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
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
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
NIOSH Alert
Criteria for Glove Selection • In Use issues • User Preferences • Match glove to user criteria through in-use performance evaluation
Criteria for Glove – In Use • Exposure to infectious organisms • Physical stress/durability (orthopoedic surgery) • Chemical resistance (drugs, disinfectants)
Glove Standards • American Society for Testing & Materials (ASTM) • FDA
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
ASTM Glove Standards • ASTM F 1671 – 97a viral penetration • ASTM F 739-96 Chemical permeation
Chemical Sensitizers • Low Thiuram, Carbamates, Thiazole • Negative Modified Draize-95 • Negative patch test
Glove Materials • Vinyl (poly vinyl chloride) • Polyurethane • Natural Rubber Latex (powdered or non) • Neoprene (chlorinated) • Nitrile • Elastryn • Polyisoprene
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
Glove Selection Best Practices • Oregon Health Division partnership • Kaiser-Permanente • Emery University • Postal Worker and Airport Personnel
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
Kaiser-Permanente Eliminated latex and vinyl exam gloves; substitute with Nitrile Emery University Eliminated latex and saved $ on workers’ compensation Hospital Best Practices
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
Resources • www.nursingworld.org/dlrwa/osh • www.sustainablehospitals.org • www.cdc.gov/niosh • www.OSHA.gov
