Barrier controls are worn to prevent blood and body fluids from splashing, spraying or
otherwise contacting the eyes, mouth and skin. Skin defects such as exudative lesions,
dermatitis, cuts or abrasions provide a direct portal of entry of pathogens into the body.
They should be covered with a water-impermeable, occlusive bandage or otherwise shielded.
This includes the arms, face, and neck. Contact DCEMS Safety Officer at
441-1551x223 to discuss measures which should be taken for specific circumstances.
Protective garments such as gloves are not
intended to provide protection from puncture wounds. However, they may "wipe
off" some of the fluid as the needle passes through the glove, thereby diminishing
the amount of blood or other body fluids transmitted to the puncture wound. Certain glove
liners are available which provide some level of protection against percutaneous injuries.
Universal Precautions
Guidelines for Gloving, Gowning, Masking and other protective Barriers
All health care workers should
routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure
during contact with any patient's blood or body fluids that require universal precautions.
Recommendations for the use of
gloves are presented in detail in the Morbidity
and Mortality Weekly Report dated June, 1997, which is available by calling the
National AIDS Information Hotline at 1-800-342-2437 or the National AIDS Information
Clearinghouse at 1-800-458-5231.
Gloves should be worn:
- for touching blood and body
fluids requiring universal precautions, mucous membranes, or nonintact skin of all
patients, and for handling items or surfaces soiled with blood or body fluids to which
universal precautions apply.
- Gloves should be changed after
contact with each patient. Hands and other skin surfaces should be washed immediately, or
as soon as patient safety permits, if contaminated with blood or body fluids requiring
universal precautions. Hands should be washed immediately after gloves are removed.
Skin irritation, allergic contact dermatitis,
and latex allergy from glove materials
Skin irritation - is the most common skin
problem among persons who wear gloves for long time periods. Symptoms are dry, crackling
skin, skin sores or bumps and/or itching or rash under the glove area. These symptoms are
often aggravated by glove powder which causes mechanical abrasion of the skin.
Allergic Contact Dermatitis - Many medical
gloves contain additives (mercaptobenzothiazine or MBT), carbamates, thiurams, and
thioureas which are associated with a type IV contact dermatitis in some wearers. Symptoms
include dry, cracking skin, skin sores or bumps and/or itching or rash under the glove and
up the arm. The symptoms do not appear until hours after the exposure occurs.
Latex Allergy, a type 1 allergic reaction,
is caused by water soluble latex protein antigens which are present in latex gloves and
other latex products. Powdered latex gloves are a major cause of latex allergy because the
antigens are absorbed into glove powder which becomes airborne. Inhalation of the
contaminated glove powder is a major cause of sensitization and allergic reactions. People
who are atopic have elevated risk of developing latex sensitization. High quality,
non-powdered latex gloves which have undergone a process to "leach" out latex
proteins are available. Gloves with latex protein concentration less than 50 ug/gram (50
parts per million) of water-soluble latex proteins will prevent sensitization in most
individuals. However, sensitive individuals could react if exposed to latex proteins as
low as 1 part per billion.
Any DCEMS employee who has a question or
concern about medical gloves should contact DCEMS Safety Officer
441-1551x223. DCEMS will find out the level
of latex protein antigens in the glove and will also obtain information on the presence of
additives in the glove which may produce a type IV reaction.
Employees who are experiencing skin irritation,
contact dermatitis or a systemic reaction should contact DCEMS Safety
Officer at 441-1551x223. Patch or disk tests are available for diagnosing type IV
allergies to glove materials. A latex-specific IgE Allergan test is now available for
diagnosing a type 1 allergy.
Latex sensitivity among patients has become an
important issue in hospitals.
Any DCEMS employee who has a question or
concern about medical gloves should contact DCEMS Safety Officer
441-1551x223. DCEMS will find out the level
of latex protein antigens in the glove and will also obtain information on the presence of
additives in the glove which may produce a type IV reaction.
Employees who are experiencing skin irritation,
contact dermatitis or a systemic reaction should contact DCEMS Safety
Officer at 441-1551x223. Patch or disk tests are available for diagnosing type IV
allergies to glove materials. A latex-specific IgE Allergan test is now available for
diagnosing a type 1 allergy.
Latex sensitivity among patients has become an
important issue in hospitals.
Verification of adequate Barrier Protection
for Bloodborne Pathogens
To prevent latex sensitization or reactions, the
use of powdered latex gloves are discouraged at DCEMS.
In the past, many articles have been printed
stating that only latex gloves were an effective barrier against bloodborne pathogens.
This is inaccurate. The bloodborne pathogens standard requires that all medical exam glove
materials which will be used for protection against bloodborne pathogens, must pass
American Society for Testing and Material’s ES 22 - 1992 standard entitled "Emergency
Standard Test Method for Resistance of Protective Clothing Materials to Penetration by
Blood-borne Pathogens Using Viral Penetration as a Test System." This test
involves exposing protective clothing material to a liquid containing bacteriophage
Phi-X174. This microbe is used as a surrogate for bloodborne pathogens. It approximates
Hepatitis C in size and is used because of its small size, spherical morphology,
environmental stability and non-human infectivity. In three samples, the "clean"
side of the glove material must be free of bacteriophage for the material to pass the
test.
Surgical (sterile) gloves are available in latex,
neoprene and thermoplastic elastomers. Patient examination gloves are available in latex,
vinyl, polyethylene, thermoplastic elastomers, nitrile or polyurethane. Various brands of
medical gloves made of each of these materials have passed the ES-22 test. The acceptable
quality limit is the amount of defects which are permitted in gloves. The AQL of gloves
varies widely among manufacturers, materials and different lots of the same
manufacturer/material. Surgical gloves are required to have a lower defect rate compared
to exam gloves.
Although publications from the CDC 1
and OSHA have stated that there are no reported differences in barrier effectiveness
between intact latex and intact vinyl gloves there are many studies which indicate that
latex is superior barrier when compared to vinyl. Although all gloves must meet the
FDA’s acceptable quality limits for all defects such as physical defects and leaks,
many of reports have cited that there were problems with vinyl glove materials tearing
easily or developing more defects per unit time compared to latex gloves. However, there
is a wide spectrum in the quality of both latex and non-latex products and sturdy vinyl
gloves which provide tactile sensitivity and fit similar to latex are available.
Other glove considerations
Oil-based hand lotions which contain mineral oil
or petroleum-based products such as Vaseline can weaken latex, allowing the glove to tear.
Only water-based hand lotion should be used. Also, the longer the same pair of gloves are
worn, the less effective they become as a barrier. For this reason gloves should be
changed on a regular basis during lengthy procedures. Research on the effectiveness of
double gloving is underway. Some researchers strongly recommend double gloving to reduce
the risk of contact with blood or body fluids if the outer glove punctures or tears. Use
aseptic technique for removing contaminated gloves to prevent skin contamination.
Latex gloves are rapidly permeated and degraded
by solvents such as 70% ethanol. DCEMS Safety Officer should be contacted to determine which gloves are
least likely to be degraded if they are to be used while working with solvents.
Other Personal Protective Equipment
Masks and protective
eyewear or face shields should be worn by health care workers to prevent exposure of
mucous membranes of the mouth, nose, and eyes during procedures that are likely to
generate droplets of blood or body fluids requiring universal precautions. Gowns or aprons
should be worn during procedures that are likely to generate splashes of blood or body
fluids requiring universal precautions as follows:
- Potential for soiling clothes - wear gowns,
lab coats, apron
- Potential for splashing or spraying - wear fluid
resistant gown or lab coat
- Potential for soaking - wear fluid-proof gown or
lab coat
Hygiene Practices
Health care workers have inquired about flushing
skin with a dilute solution of bleach following a bloodborne pathogen exposure. Currently
there appears to have been no studies performed to determine whether this practice should
be recommended or discouraged. The CDC currently recommends that the site should be washed
with mild soap following an exposure. Harsh or abrasive soaps which may open fragile scabs
or other sores should be avoided.
Handwashing practices, required by the
DCEMS Exposure Control Plan are summarized below:
- Readily accessible hand washing facilities must be
readily provided.
- Employees should wash hand immediately or as soon
as feasible after removal of gloves.
- At non-fixed sites (i.e., emergency scenes, mobile
blood collection sites) which lack hand washing facilities, DCEMS will provide interim hand
washing measures, such as antiseptic towelettes, antiseptic gel and paper towels. Employees can later wash
their hands with soap and water as soon as feasible.
- Employees should wash body parts as soon as
possible after skin contact with blood or other potentially infectious materials occur.
Sources:
1. Centers for Disease Control. 1988.
Universal precautions for prevention of transmission of human immunodeficiency virus,
hepatitis B virus and other bloodborne pathogens in health care settings.
MMWR. 373:377
382, 387-388
Dalgleish and AG and M. Malkovsky 1988.
Surgical gloves as a mechanical barrier against Human immunodeficiency virus. Br J. Surg
75: 171-172 Zbitnew, AK Greer. J Heise-Qualtiere and J Contly. 1989. Vinyl versus latex
gloves as barriers to transmission of viruses in the healthcare setting. J. Acquired
Immune Deficiency Syndromes 2:301-304.
Korniewicz DM, et al. Integrity of vinyl and
latex procedure gloves. Nursing Research 1989; 38(3):144-146.
Korniewicz DM, et al. Leakage of virus through
used vinyl and latex examination gloves. J Clinical Microbiology 1990; 28(2):787-788.
Korniewicz DM, et al. In-use comparison of
latex gloves in two high risk units: Surgical intensive care and acquired immunodeficiency
syndrome Heart Lung 1992; 21:81-4)
Brown JW, and Blackwell H. Putting on gloves
in the fight against Aids Medical Laboratory Observer. November 1990
Hamman MD, Nelson JR, "Permeability of
latex and thermoplastic elastomer gloves to the bacteriophage phi x174 (Am J. Infect
Control 1993; 21:289-96
Degroot-Kesoleharden J, Jones J. Permeability
of latex and vinyl gloves to water and blood. Am J Infect Control 1989; 17: 196-201.
Klein RC, Party E, Gershey E. Virus
Penetration of Examination Gloves. Biotechniques Vol 9 No 2, 1990
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