Testing for viral penetration of non-latex surgical and examination gloves: a comparison of three methods.

Currently, there are no international standards based on microbiological methodology for testing the ability of medical examination or surgical gloves to prevent the passage of viruses. Three protocols for the direct examination of the viral barrier properties of non-latex gloves were compared with 1080 gloves (270 gloves from each of two surgical brands and two medical examination brands). In two of the methods, gloves were filled with and suspended in a nutrient broth solution, and bacteriophage phiX174 was placed either inside or outside the glove, while the entire test vessel was agitated. Gloves tested using the third method were filled with a suspension of bacteriophage and allowed to rest in a vessel containing nutrient broth. Gloves were tested directly from the manufacturer's packaging, or after being punctured intentionally or subjected to a stress protocol. The passage of bacteriophage was detected with plaque assays. Significant differences in failure rates between glove brands were apparent only among gloves that had been subjected to the stress protocol. Overall, the two methods in which bacteriophage were placed inside the gloves provided more sensitivity than the method in which bacteriophage was spiked into broth outside the gloves. Thus the placement of bacteriophage inside test gloves (or the use of pressure across the glove barrier during testing), and the use of a standardised stress protocol, will improve significantly the ability of a glove test protocol to determine the relative quality of the barrier offered by medical examination and surgical gloves. Further research is needed to provide test methods that can incorporate reproducibly both the use of bacteriophage and simulated glove use in an industrial quality control setting.

Implementing a nonlatex surgical glove study in the OR.

Sterile surgical gloves are used to protect patients and health care workers (HCWs) from infection during surgery and to shield HCWs from exposure to bloodborne pathogens. Based on increased reports of latex allergy, many HCWs now use nonlatex surgical gloves as a substitute for natural rubber gloves. Little is known, however, about the performance of nonlatex gloves in surgery. This article describes a study that currently is being performed to test the barrier performance of nonlatex surgical gloves after they have been used in surgery and to determine HCW satisfaction. To date, 12,703 latex and nonlatex gloves from all surgical services have been collected and tested for barrier quality. This article describes the project and challenges encountered by the collaborative team of perioperative staff members and nurse researchers as they collect data.

Latex allergy and implications for urology nursing.

Latex hypersensitivity is a major occupational health concern. Health care workers as well as patients who are not yet diagnosed are the most at-risk populations. Knowledge about everyday products that may increase one's exposure to latex allergy is an important prevention strategy and will assist in decreasing the overall incidence of latex allergy among patients and health care workers.

Understanding latex allergy.

Latex allergy is an increasingly important problem in both health-care workers and patients. Predisposing factors to development of latex allergies include a history of atopy or allergy and frequent exposure to latex products. Identified allergens include latex proteins from the rubber tree that remain in manufactured products, as well as smaller molecules that remain from the latex purification and manufacturing process. Latex proteins absorbed to powder in latex surgical and examination gloves may be aerosolized and inhaled. Powder-absorbed latex proteins are thought to be important in triggering of sensitization in susceptible individuals, as well as in elicitation of symptoms in previously sensitized patients. Allergic reactions to latex can include local dermal reactions or generalized immediate hypersensitivity (anaphylactic) reactions. Pathophysiology, signs and symptoms, and treatment of each type of reaction are discussed. Measures to address latex allergy, however, must include measures to decrease exposure to latex antigens both in latex-allergic subjects, to prevent symptoms, and in naive subjects, to prevent sensitization. These measures may include finding, acceptable substitutes for latex in many products.

Latex allergy and gloving standards.

In response to universal precautions, latex gloves are used more frequently in health care settings, and more health care workers are reporting latex sensitivity or allergic reactions to natural rubber latex (NRL). As a result, there continues to be controversy about what gloves should be used in clinical practice and what are the appropriate clinical recommendations about gloving practices. This article reviews the current issues about gloving practices, addresses national standards related to gloving, and makes recommendations about future gloving practices.

[International health: a new challenge to nursing education]. / Salud internacional: el nuevo desafío para la educación de enfermería.

A survey was conducted among 110 Schools of Nursing in USA and 5 Schools in Latin America and the Caribbean (LAC) to identify the international health (IH) component in nursing education, practice and research. A significant part of U.S. schools and all 5 LAC schools have international activities, and this interest has started basically in the last 5 to 10 years. There was difference in the structure of IH activities among U.S. and LAC nursing schools, but they were similar in the type of support offered to IH initiatives. IH content in nursing education among U.S. schools was related to culture, health systems and community health; in LAC schools, IH content was related to health promotion, health policy and strategies and nursing perspectives. U.S. and LAC schools with international activities have only 10% of their faculty and students involved with IH initiatives. The nursing schools still lack courses and activities that the Schools of Public Health have implemented to deal with IH. The article observes areas that need to be strengthened so that nursing professionals can expand their leadership roles in research and practice in international health.

Nursing education and international health in the United States, Latin America, and the Caribbean.

PURPOSE: To identify international health activities in United States, Latin American, and Caribbean schools of nursing. In the international community, nurses face challenges similar to those in related professions, but without the benefit of a long tradition. There is little research about how nursing education and associated activities prepare nurses to deal with international health, and little information about the extent of international health activities in U.S. schools of nursing. DESIGN: Descriptive. METHOD: Using a questionnaire with 16 items, a survey was conducted in 1995 on a random sample of representatives from 100 university schools of nursing in the United States plus 15 schools with known international activities (10 from the United States and 5 from Latin America and the Caribbean). FINDINGS: International health as a program topic was found in one-third of U.S. schools of nursing. However, nursing curriculums do not integrate international health with other subjects. Also, partnerships with foreign institutions are incipient and international health activities are usually individual initiatives with little institutional support. CONCLUSIONS: For nurses to become major contributors to international health, nursing curriculum content must shift from "international nursing" to "international health." Programs of nursing education should include study of social, economic, and political factors that affect health care systems. Schools should develop partnership agreements.

Loss of glove integrity during emergency department procedures.

STUDY OBJECTIVE: We sought to assess the loss of integrity of the latex-glove barrier during use in the ED setting. METHODS: We conducted a prospective observational study in an urban ED and Level I trauma center. Procedures performed by ED health care workers (HCWs) were directly observed, timed, and categorized. The gloves used by the HCWs were collected and subjected to the standard US Food and Drug Administration leak test. RESULTS: Ninety-nine (7.9%) of 1,254 pairs of gloves used for observed procedures leaked, compared with 2 of 200 unworn control pairs (1.0%) and 12 of 300 pairs that were worn but not used (4.0%). Leak rates varied by manufacturer and were higher for gloves worn 20 minutes or longer (13.7%, P = .015), used for four or more procedures (50%, P < .01), or used for critical care procedures (23.5%, P < .01). Sixty-six of an additional 325 pairs of gloves collected from unobserved critical care procedures (20.3%) leaked. CONCLUSION: Loss of glove integrity occurs during the performance of ED procedures, subjecting the HCW to possible infectious-fluid exposure. Risk of glove perforation increases with duration of wear, number of procedures performed, and the performance of critical care procedures.

Improving glove barrier effectiveness.

Perioperative staff members depend on surgical gloves to prevent disease transmission between themselves and patients, but these gloves frequently fail during use. Three approaches can make surgical gloves more effective barriers: preventing glove failures, monitoring glove integrity, and improving glove quality. Failure prevention includes modifying surgical techniques, improving instruments and equipment, streamlining teamwork, selecting the most appropriate gloves, double gloving, and performing preventive glove changes. Glove integrity monitoring can be performed visually or by feel, by wearing glove pairs with color-puncture indicators, or by using electronic monitoring devices. Glove quality improvements must be accompanied by testing methods that reflect in-use conditions. A glove rating system that is based on in-use performance may enhance glove safety substantially.

The risks and challenges of surgical glove failure.

The relationship between infection control standards and surgical gloving practices is an important issue in combating infectious disease. For their own and their patients' protection, health care personnel must rely on the barrier qualities of gloves more than ever before. Both surgical and examination gloves fail frequently, which puts health care providers and patients at risk of acquiring fluid-borne pathogens. This paper discusses current guidelines, the risk of infection by viral and bacterial pathogens, controversial issues involving gloving practices, and recommendations to improve infection control practices.

Surgical glove failures in clinical practice settings.

Health care personnel often pay little attention to the barrier effectiveness of the surgical gloves they use in clinical settings. They may assume that all surgical gloves provide adequate protection against the transfer of bloodborne pathogens, chemicals, or mutagenic substances. Perioperative staff members frequently are unaware that their surgical gloves have failed until they find blood on their hands after operative procedures are completed. In this first article of a three-part series, the authors review current surgical glove testing standards, define surgical glove failure, and describe the reasons that surgical glove failure occurs in clinical practice settings.

Barrier protection and latex allergy associated with surgical gloves.

Latex continues to be the material of choice for surgical gloves because it is resealable and flexible, and it maintains the wearer's tactile sensitivity. The use of latex gloves for barrier protection may need to be reevaluated in light of the increasing number of individuals who are sensitive to latex. Hospital personnel can use low-allergen gloves or nonlatex gloves when caring for patients with known sensitivity to latex; however, only nonlatex gloves may be effectives at reducing or preventing anaphylactic reaction. Health care facilities must develop policies and procedures for dealing with latex-sensitive patients and health care workers.

Evaluation of a hemodialysis patient education and support program.

This study examined the effects of a hemodialysis educational and support program (HESP) on patients' physical and psychosocial adaptations to end stage renal disease. The study employed a pretest/posttest modified Solomon experimental design with control group. Data were collected at 3-month intervals following the educational intervention. Results of the study indicated that nurses can have an impact on the patient learning experience by providing support and one-to-one teaching sessions, and actively involving patients in their own care. Additionally, nurses can facilitate active patient learning through enhanced teaching methods.

Barrier protection with examination gloves: double versus single.

In a series of experiments, the barrier integrity of single and double vinyl and latex examination gloves were tested for dye and water leaks after being placed under stress. A total of 886 examination gloves (385 vinyl: single, 199; double, 186; and 501 latex: single, 290; double, 211) were tested with a standardized clinical protocol designed to mimic patient care activities. Leakage rates for single or double gloving were significantly higher for vinyl than for latex gloves. Single vinyl gloves were significantly more likely to leak than were double vinyl gloves (51.3% and 19.7%, p < 0.0001). However, there were essentially no differences in leakage rates for single or double latex gloves (4.1% and 3.8%, p = 1). Significantly higher rates of leakage were identified with the water leak test than with the dye test for vinyl (p < 0.001) but not for latex (p = 0.22) gloves. For vinyl but not latex gloves, there were significant differences in leakage rates by brand. We conclude that double gloving offers little advantage during routine procedures associated with minimal stress to the gloves or when latex gloves are worn.

Leakage of latex and vinyl exam gloves in high and low risk clinical settings.

The purpose of this study was to compare leakage rates of used latex and vinyl examination gloves from high and low risk clinical units. A total of 4838 latex and 1008 vinyl examination gloves were collected and tested by the Food and Drug Administration (FDA) watertight leak test: three brands of latex [Brand A: n = 2920; Brand B: n = 284; Brand C: n = 1634; and one brand of vinyl gloves (Brand D: n = 1008]. Seventy percent of latex gloves and 46.7% of vinyl gloves were collected from the high risk units. In general, there were no significant differences in leakage rates for vinyl gloves between high and low risk units. However, latex gloves leaked significantly more often at stress levels 2 and 3 from the high risk units as compared to the low risk units (X2 = 24.6, p < .0001). Regardless of level of stress and duration worn, 85.3% (860/1008) of used vinyl gloves and 18.4% (891/4838) of used latex gloves leaked, p < .001). There were significant differences in leakage rates between the three brands of latex gloves (Brand A, 9.8%; Brand B, 25.1%; Brand C, 30.9%, p < .001). Although latex gloves leaked slightly more frequently as stress level increased, glove material (latex or vinyl) and brand of glove were the most important predictors of leakage.

Effectiveness of glove barriers used in clinical settings.

Gloves are the most common barrier used to prevent the transmission of microorganisms between patients and nurses, and clinicians should be familiar with factors that affect glove choice, including the type of unit, exposure to bloodborne pathogens, tasks performed, and personal safety. In addition to selecting the proper gloves for clinical practice, nurses can play an important role in the evaluation, quality control, and development of new effective barriers for hand protection.