Top Clinical Concerns Related to Surgical Gloves
Total Page：16
File Type：pdf, Size：1020Kb
Top Clinical Concerns Related to Surgical Gloves William Halstead, M.D., the great surgical innovator, introduced sterilized surgical gloves in the late 19th century, saving countless lives over many generations. Gloving material and techniques have advanced considerably since then, especially in recent years as knowledge of how to maximize safety for patients and health professionals has advanced. This article summarizes recent surgical glove innovations, relevant research and current best practices for surgical gloving. It further discusses trade-offs and concerns common in operating rooms transitioning from older gloving practices to newer, safer ones. Best Practice Trend #1: Synthetic gloves Reports of latex allergies attracted attention in the The use of latex surgical gloves is on the 1980s. The first fatal reaction was reported in 1991.1 decline, yet, in 2015, latex gloves still % Johns Hopkins Hospital, where latex surgical gloves accounted for nearly half of surgical gloves 8-12 were first used, banned their use altogether in 2008.2 sold in the United States.5 Historically, of healthcare workers are 3 gloves made with natural rubber latex have affected by latex sensitivity. Allergic reactions to latex are triggered by proteins been popular because of their comfortable found in natural rubber latex and mediated by the IgE fit and feel. The decline of latex gloves antibody. Touching latex or inhaling particles shed from sales has been accelerated, in part, by gloves can cause a reaction. Sensitivity increases over technological improvements to make time and with repeated use. This makes health care synthetic gloves more closely mimic the fit, No treatment exists professionals vulnerable. An estimated 8 to 12 percent feel and comfort of latex. of health care workers are affected by latex sensitivity.3 for an allergy to Synthetic surgical gloves are recommended natural rubber latex; The most common allergic reactions to latex are itchy by most health safety authorities, including skin, rashes (similar to poison ivy), sneezing and runny the National Institute for Occupational thus, latex avoidance noses. In addition, several hundred people suffer Health and Safety (NIOSH), the Association 4 is recommended. life-threatening anaphylaxis every year due to latex. of periOperative Registered Nurses (AORN) No treatment exists for an allergy to natural rubber and the American Academy of Allergy, latex; thus, latex avoidance is recommended. Asthma and Immunology (AAAAI).6,7 Best Practice Trend #2: Powder-free gloves Most recently, in The Food and Drug Administration’s While powdered surgical glove usage is “Medical Glove Powder Report” in 1997 declining as a result of the FDA proposal March 2016 the FDA documented adverse health effects to ban powdered gloves, as of 2015 announced a proposed that can result from glove powder.8 powdered gloves still accounted for 5 ban on powdered 15 percent of U.S. surgical glove sales. Most recently, in March 2016 the FDA A Cardinal Health survey of healthcare medical gloves stating announced a proposed ban on powdered workers (surgeons, operating room that, “...they pose an medical gloves. As stated on its website, managers and purchasing managers) the FDA determined that, “While the use found the most common reasons given by unreasonable and of powdered gloves is decreasing, they those using powdered gloves were that substantial risk of illness pose an unreasonable and substantial the gloves had worked well in the past risk of illness or injury to healthcare or injury to healthcare and no serious adverse effects had been providers, patients and other individuals observed personally.21 providers, patients who are exposed to them, which cannot and other individuals be corrected through new or Professional associations advocating the updated labeling.”9 use of powder-free gloves include the who are exposed to American College of Surgeons (ACS), them, which cannot be Some of the potential risks associated with AORN, AAAAI and the American Nurses using powder include: Association (ANA).22,23 In addition, the corrected through new United Kingdom and Germany have • Delaying wound healing and 9 banned powdered surgical gloves.24 or updated labeling.” contributing to post-operative complications such as adhesions, infections and granulomas.10-12 • Potentially contributing to longer hospital stays and increased healthcare costs.13-19 • Compromising skin health and contributing to Irritant Contact Dermatitis (ICD), which causes dry, itchy and irritated skin.20 Cardinal Healh™ Surgical Gloves cardinalhealth.com 2 Best Practice Trend #3: Double-gloving Wearing two surgical gloves significantly Surgeons report varying adjustment periods Wearing two surgical reduces infection risk to operating room are needed to optimize protection, tactility gloves significantly personnel.25 The second glove protects and dexterity when starting to double 35 reduces infection against bloodborne pathogens when the glove. To address tactile and comfort, outer glove is punctured.26 specialized designs now differentiate risk to operating undergloves and outer gloves. Undergloves room personnel.25 Operating rooms are the hospital are an average of 15 percent thinner than environment with the greatest outer gloves. Synthetic gloves may include concentration of sharp objects. Perforation an inner coating to reduce slippage and 27 of surgical gloves is common. By their contain a low-protein formula to make final year of training, 99 percent of surgical donning and removing gloves easier. residents at two Canadian teaching hospitals had suffered a needle-stick In addition, using differently-colored The interior glove reduces injury.28 A separate study found glove undergloves helps to improve occupational exposure to patient blood perforations occurred in 44.5 percent of safety. Research shows that most punctures by as much as gastrointestinal surgeries, 34.7 percent are tiny and identified only after surgery, of orthopedic surgeries and 31.1 percent not at the time of the incident.36 Colored % of gynecological operations.29 Up to 16 undergloves — that contrast with outer percent of injuries from sharp instruments gloves — increased awareness of 30 87when the outer glove occur in hand-to-hand transfers. Hepatitis perforations to synthetic outer gloves is punctured.30 B, hepatitis C and HIV are common serious from 12 percent to 56 percent and reduced risks. Follow-up to percutaneous injury is time to awareness from 67 seconds to 42 expensive: about $600 without prophylactic seconds.37 drug treatment and $3,000 with it.27 For relatively low cost, double-gloving Colored undergloves — helps provide a high level of protection. The interior glove reduces exposure to patient that contrast with blood by as much as 87 percent when the outer gloves — outer glove is punctured.30 Double-gloving increased awareness of is recommended for invasive surgeries by the Centers for Disease Control and perforations to synthetic Prevention (CDC)31 and the Occupational outer gloves from 12 Safety and Health Administration (OSHA)32 as well as AORN 33 and ACS. 34 percent to 56 percent and reduced time to awareness from 67 seconds to 42 seconds.37 Cardinal Healh™ Surgical Gloves cardinalhealth.com 3 Best Practice Trend #4: Allergy awareness Healthcare workers The shift from latex to synthetic has Treatment for skin irritation must accurately dramatically reduced allergic reactions to respond to the cause, not a hunch. Focus often blame synthetic surgical gloves.38 Medical providers still first on common non-immunologic gloves for the reaction experience allergic reactions on hands reactions, such as soaps and vulnerability when other factors are and wrists, primarily from irritant contact from damaged skin. Approved moisturizers, dermatitis, a non-immunologic response rehydrating products and glove liners the more likely cause of to an irritant or skin damage. Healthcare can help. The use of jewelry, fragrances, skin irritation.39 workers often blame synthetic gloves detergents and other products more for the reaction when other factors are common irritants than synthetic gloves.41,42 the more likely cause of skin irritation.39 If ACD is suspected, the glove user should Potential irritants include products related have a patch test done to isolate the to medical practice (harsh anti-microbial cause of the immune response. Patch soaps, surgical scrub brushes) and those tests exist for all accelerants and are very outside the work environment (detergents, reliable for diagnosing ACD. Switching to fragrances). Seasonal weather changes, non-accelerant gloves should be done frequent hand-washing and wearing if it is determined that the accelerant jewelry contribute to susceptibility to non- causes an immune response. However, immunologic dermatitis.40 “glove shopping” — frequently switching gloves as a response to a dermatitis — is Allergic contact dermatitis (ACD), an counterproductive because it does not immunologic response to a chemical, allow time for adjusting to new gloves causes irritation in smaller number of or provide an understanding of delayed cases. Although not life-threatening, ACD allergic reactions. As in medicine generally, can be a problem for healthcare workers. an accurate diagnosis is a prerequisite for Rashes, dryness and other symptoms can the right cure. be acute or chronic and appear 48 hours after exposure to the irritant. The source of hypersensitivity can be elusive because more than 4,000 chemicals are known to have the potential