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Kimberly-Clark Health Care Education

Do the Gloves You Wear Afford Appropriate Barrier Protection for the Task at Hand?
Although gloves manufactured with different materials have comparable leak defect limits when removed directly from the box, their actual on-the-job barrier performance may be extremely different. Several government agencies have stressed the importance of appropriate glove barrier protection… CDC – “All health-care workers should routinely use appropriate barrier precautions to prevent skin and mucous-membrane exposure when contact with blood or other body fluids of any patient is anticipated.” 1 OSHA – “Since the reason for wearing gloves is to provide barrier protection from hazardous substances, substitute materials [synthetic or non-latex] must maintain an adequate barrier protection and be appropriate for the hazard.” 2 NIOSH – “Use non-latex gloves for activities that are not likely to involve contact with infectious materials (food preparation, routine housekeeping, maintenance, etc.).” 3

Base Glove Material
The last decade has been an intense time in glove development laboratories. Several new materials have been introduced and many more are on the horizon. The most prominent base materials currently in the market are listed in Table 1. Due to the current cost, many synthetic materials are only used in surgical gloves. Table 1 Base Glove Materials Material Natural Rubber Latex (NRL) Nitrile (NBR, Nitrile-butadiene rubber) Vinyl (PVC, Polyvinyl chloride) Polyurethane (PU) Neoprene (CR, Polychloroprene) Tactylon® (SEBS, Styrene-ethylene-butylene-styrene) Elastryn (SBR, Styrene-butadiene rubber) X X X X Surgical Gloves X X Exam Gloves X X X X

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Critical Glove Barrier Issues Volume 1 Base Glove Material Strength and Limitations In the following charts information on individual strenghts and limitations of various base glove materials is described. tear. supple. oxygen & ultraviolet light can deteriorate 8 • Not to be worn by or used on NRL allergic individuals 2.11 Comfortable 12 • Performance durability 4. oxygen 6 • Resistant to gluteraldehyde 19 • Comfortable.9 • • • • Resistant to many chemicals 4 Resistant to punctures 10.11 Resistant to abrasion 10.g. oxygen & utraviolet light can deteriorate 17 The molecular structure of the base material from which a glove is made is one of the primary determinants of barrier performance. To aid in the prediction of glove performance. All chemicals listed represent working (diluted) solutions.18 • Resistant to alcohols 4 • Resistant to many chemicals 4 Elastryn (SBR. Styrene-butadiene rubber) Strengths • Comfortable. Natural Rubber Latex Strengths • Tensile strength • Tear and puncture resistant 5 4 Nitrile Limitations • Oils can degrade • Ozone. so too may the appropriate glove choice. oxygen & ultraviolet light can deteriorate 4 • Breaks down with uncured methacrylate (e. stiffness 4 • Resistant to glutaraldehyde 6. Polyurethane Limitations • Durability • Not recommended for use in chemotherapy 15 • Not recommended for use with gluteraldehyde 9 • Susceptible to breakdown with alcohol 16 • Elasticity 4 • Tensile strength 6 6 Strengths • Resistant to abrasion • Resistant to oil 17 • Tensile strength 17 14 Limitations • Susceptible to breakdown with alcohol 4 • Can be slippery 4 • Hardens. The data has been obtained from various sources and therefore do not necessarily depict the performance of all gloves of the given particular base polymer type. low modulus 10 • Tactile sensitivity 10 Limitations • Ozone.8 Limitations • Ozone. bone cement) 4 Neoprene Strengths • Resistant to oil 8. supple.3 7 Strengths • Resistant to oils 7. material fatigue. Styrene-ethylene-butadiene-styrene) Strengths • Resistant to ozone.10 • Ozone. many different tests have been developed. 3 .6 6 Vinyl Strengths • Resistant to ozone • Resistant to oil 14 13 PU. oxygen & ultraviolet light can deteriorate 8 • Can have high modulus. supple.g. chemical contact). low modulus 10 • Tactile sensitivity 10 Limitations • Breaks down with uncured methacrylate (e. low modulus 4. Characteristics that had moderate performance in an area were not listed. 51 As challenges to barrier integrity change (snag. A discussion of these test methodologies and associated standards follows.6 • Tactile sensitivity • Elasticity 6 • Comfortable. stiffness 4. bone cement) 4 • Susceptible to oil 17 Limitations • Can have high modulus. embrittles at low temperatures 4 Tactylon® (SEBS.17.

Modulus. the less effort required for movement. twisting stopcocks on IV sets. the more easily materials of the same thickness can break when snagged or pressure is applied. snapping off enclosures or any tasks performed with gloved hands. 4 . 21 Relevance: Thickness is an important component of barrier protection consistency for both durability and chemical permeation. Values are stated as Acceptable Quality Levels (AQL). but are not limited to: Glove materials have different stretch capabilities. indicating the statistically allowed failure rate (an AQL 1. dimension and modulus requirements for natural rubber latex (NRL) and synthetic gloves. government agencies and healthcare. Thickness (ASTM D3767): The thickness of a single layer of glove is measured in millimeters (mm) utilizing a micrometer at specified locations on the upper finger. The glove is visually inspected for water leakage immediately and after a 2 to 3 minutes time period. Relevant Test Methods Some of the more relevant test methods include. For example. Relevance: Holes.Kimberly-Clark Health Care Education Physical Performance Standards and Test Methodologies The European Committee for Standardization (CEN) and the American Society of Testing and Materials (ASTM) develop glove standards. The lower the modulus. Force at break (EN 455-2): Force at break is measured in Newton to assess the amount of force applied to a glove until it breaks. palm and cuff. ridges on caps. Watertightness test for detection of holes (EN 455-1): This test is performed by placing an unused glove over the end of a vertical cylinder and filling it with 1000 ml of water. fingernails exert a tremendous amount of concentrated pressure at glove fingertips. elongation. resistance to movement or stress at 500% elongation (ASTM D412): 22 This is determined by the amount of force (effort) required to stretch the glove.5 is equivalent to 3. Relevance: The lower the force at break. The percentage the strip is stretched until the break is the ultimate elongation. Nitrile. thickness. 22 Relevance: This stretchability is very important at the microscopic level where the glove material must be able to give rather than break when stressed or snagged by instruments. Vinyl. Glove materials from top to bottom: Natural Rubber Latex. fingernails. The physical performance standards they develop establish minimum acceptable force at break.17% defects). Members of CEN and ASTM medical glove working groups include representatives from glove manufacturers. strength. testing laboratories. Ultimate Elongation (ASTM D412): The ability to stretch is determined by extending a strip of glove until it breaks. rips and/or very weak areas that rupture in the leak test indicate that barrier protection is compromised. This difference can affect in-use barrier performance.

Minimum Required Physical Standard for Examination and Surgical Gloves Material NRL surgical glove Synthetic surgical glove NRL examination glove Synthetic examination glove AQL: Acceptable Quality Level NRL: Natural Rubber Latex AQL (EN 455-1) 1. ASTM F1671-97b is a standardized test method used to assess the ability of protective clothing to resist viral penetration.. Data summaries of several studies are provided in Table 3. puncture. Table 2 EN455 . tearing and/or ripping glove material) during procedures. Although test results identify basic physical capability differences between glove material types and establish minimal acceptable standards. It is important to emphasize that these are minimal standards. Samples are pulled from the receiving chamber at various times throughout the challenge period.5 1.Critical Glove Barrier Issues Volume 1 Relevant Test Methods (continued) Relevance: This measurement enables one to predict the effort wearers will have to exert to perform tasks.g. NRL and vinyl have been the primary materials used in the medical glove industry and thus constitute the bulk of independent research testing to date. the real relevance to the healthcare professional is whether or not the glove is protective in use.5 1. The other half of the chamber is filled with receiving media. Both simulated in-use studies and actual clinical studies have been performed to evaluate glove durability.6 Force at break after accelerated ageing (EN 455-2) ≥9 ≥6 ≥6 ≥ 3. In-Use Barrier Performance Studies Provide appropriate barrier protection for the task.5 Force at break before accelerated ageing (EN 455-2) ≥ 12 ≥9 ≥9 ≥ 3.5 1. This has an indirect impact on barrier performance as hand fatigue may lead to accidents (e. A liquid suspension of the challenge virus. Table 2 specifies the minimally acceptable EN physical performance standards of unused gloves made of different materials. Detection of any virus in the receiving media indicates breakthrough and thus failure of the glove material. 5 . is placed in one side of the chamber. Phi X 174.6 Viral Penetration The viral penetration test is not required but is performed by some manufacturers. 27 A single layer of glove is placed between two halves of a test chamber.

.g. Physical testing may also be conducted on the glove after the permeation study is completed to determine if the physical properties have degraded. Representatives from each of the drug families are used as the chemical test challenge. (e) After contact with 70% ethanol. stretch vinyl failed at 12-20%. Basically. 6 . Top: The toxicity of chemotherapeutic drugs demands the protection provided by gloves cleared for chemo use.Kimberly-Clark Health Care Education In-Use Barrier Performance Studies (continued) Table 3 Physical Barrier Performance Studies Durability Challenge Author Rego 28 Douglas 29 Leakage Percentage Rates (ab) Vinyl 30% (c) 26% (c) 51% 85% 43% 83% 22% (d) 56% (e) 63% 53% Latex (NRL) 2% 8% 4% 18% 9% 21% 1% (d) 1% (e) 7% 3% Nitrile (f) 2% – – – – – – – – – Date 1999 1997 1994 1993 1993 1992 1990 34 Simulated Use X Clinical X Korniewicz 30 Korniewicz 31 Olsen 32 Merchant 33 Klein 16 Korniewicz X X X X X X X 1990 1989 Korniewicz 35 (a) All percentages were rounded to the nearest whole number. one layer of the glove is placed between two chambers. The drug being evaluated is placed on one side and a receiving fluid on the other. (d) Without first contacting ethanol. (b) When more than one brand of a particular material was evaluated. Chemical Barrier Testing Chemotherapy/Cytotoxic Drug Testing According to US regulations gloves sold for chemotherapy use must pass chemical permeation challenges with numerous chemotherapeutic drugs. tuck the clean glove over the cuff of the gown. Because not every chemotherapeutic drug or combination of drugs can be anticipated. one glove is inserted under the cuff. If double gloves are worn.• Rego study: Standard vinyl exhibited failure rates ranging from 26-61%. Samples are taken from the receiving fluid over several hours to determine if breakthrough has occurred. The ASTM F739 and EN 374-3 test methods are most frequently used for continuous contact permeation studies of any chemicals on thin film protective materials. and one glove goes over the cuff. (c) There did appear to be a difference in performance between standard and stretch vinyl. (f) Additional barrier studies on this fairly new medical glove material are anticipated. Considerations when addressing chemotherapy/cytotoxic guidelines may be: • Use of powder-free gloves to reduce the potential for powder absorption and aerosolisation of cytotoxic drugs • Length of glove cuff for forearm protection* • Use of double glove when appropriate • Use of sterile versus non-sterile gloves • Frequency of glove change (e. failure rates were averaged. the drugs are divided into chemical families. Right: Chemicals can penetrate gloves and put the wearer at risk. immediate if torn or punctured) • Use of gloves when disposing of contaminated linens • Proper removal and disposal of gloves *If single gloving. • Douglas study: Standard vinyl failed at 25-32%. Select gloves that resist chemical penetration. stretch vinyl failed at 22-27%.

Characteristics of Glove Degradation There are general characteristics of glove degradation that may indicate a breakdown in the glove barrier integrity. Although no requirements exist for gloves. Facilities will vary. This break of the natural skin barrier may enhance microbial access into the body. drugs and other chemicals with which the powdered glove comes in contact – again by-passing the protective intent of the glove. it is important to know the quality of chemical protection the glove provides. disinfectants and/or liquid sterilants. Thus. The barrier protection of any glove may be further compromised by everyday practices that include storage conditions. but frequently used chemicals include gluteraldehyde. some manufacturers may choose to use the ASTM F739 and/or EN 374-3 method to evaluate the resistance of their gloves to specific chemicals. skin care. of course. It is important to recognize these general indicators to help ensure the selection and maintenance of optimal glove protection. Disinfectant and Liquid Sterilant Penetration Testing Gloved hands may routinely come in contact with numerous antiseptics. personal habits and the inability to rapidly identify type of base material.Critical Glove Barrier Issues Volume 1 Chemical Barrier Testing (continued) Antiseptic. Powder can defeat the intent of glove barrier protection by functioning as a vehicle for the transport of infectious micro organisms and interfering with the local resistance to infection in wounds where powder is deposited. Glove Specific: Selection of Powder-Free versus Powdered Gloves. Powder can also absorb and aerosolise disinfectants. Several of these practices are identified as follows. isopropyl alcohol and formalin. Note the elongation of the thumb and forefinger of this glove after a task that required sustained contact with an oil-based product. Information regarding chemical permeation must be requested directly from the manufacturer. 7 . Glove powder may cause dermatitis with cracks and open lesions on the hands. These indicators of degradation include: • Hardening or embrittlement • Loss of strength • Softening (may see extending of fingertips) • Loss of tear resistance • Tackiness • Loss of elasticity • Cracking • Change in colour Everyday Practices That May Affect Glove Barrier Glove materials are degraded by different substances.

38 Length of Glove Wear. glove ID.g. Thoroughly dry hands before sliding them into gloves. There should be a full range of glove sizes to accommodate all personnel. finger contour and thumb position are among the factors to consider when evaluating appropriate glove fit. This effect can occasionally be seen at glove fingertips where a drop of the liquid glove material can solidify during production. check to see if the adhesive material adheres to the glove. contact with various chemicals and quality of the film glove layer in areas that are difficult to coat 8 It is important to prevent the development of dermatitis. If infectious agents or hazardous chemicals are used.Kimberly-Clark Health Care Education Everyday Practices That May Affect Glove Barrier (continued) Rapid Identification of Base Material (e. The same thought process applies to brightly coloured NRL and NRL/synthetic blends where natural rubber latex and synthetic materials can be confused. If the glove is to be used for tasks that require tape or adhesive label contact. nitrile or other synthetic material? It does little good to understand the differences in barrier capability among glove materials if the material of the glove you are grabbing is not readily apparent. A "halo effect" may be seen around debris imbedded in the glove material. Or. Gloves should conform to the hands. can be differentiated from NRL gloves? Mistaken identity can lead to the use of a latex coloured vinyl glove when the barrier protection quality of an NRL was the intended selection. Observe for Clumps and Debris. . Healthcare personnel should take care to don gloves correctly and avoid excessive stretching. The rate of fatigue can be compounded by many factors that include. Consider an alternate glove if adherence occurs. The halo may indicate a weakened area that can fracture during use. an NRL allergic individual may mistakenly grab an NRL glove. which may result in an adverse reaction. label. “Baggy” gloves can cause wearers to execute procedures awkwardly. The longer a glove is worn the more vulnerable it is to barrier compromise. Double Gloving. Double gloving has been documented to significantly reduce the penetration of contaminated sharps through to the skin surface and should be considered when the risk of exposure to highly pathogenic organisms is present or as dictated by facility policies. accidental spills can put staff at personal risk. Glove length. colour). Poor fitting gloves can interfere with the optimal performance of procedures. When you or your staff grab a glove. Selection of Glove Size. is it readily apparent which type of material you are donning? Is the base glove material labelled generically as "synthetic" or does it specify vinyl. as forced removal may cause microscopic tears in the material. for instance. The open sores and cracks that result from dermatitis provide entry routes for micro organisms. 37. Poor donning techniques can result in glove rips and tears. Check for the Sticking of Adhesives to the Glove. yet allow ease of movement (low modulus) to minimize fatigue. Is the colour such that vinyl gloves.. Donning Techniques. rigorous manipulations. but are not limited to. width.

light.g. Handwashing. There is no substitute for handwashing. Heat. ultraviolet or fluorescent light and X-ray machines create ozone. the addition of water to your hands before applying soap. 7 Similar transfers of Hepatitis C Virus (HCV) are now being reported. Select mild soaps and lotions that are less likely to cause dermatitis.42 Long Fingernails. To avoid material degradation due to these factors. Suggestions to minimize dermatitis sometimes associated with handwashing include the use of mild soaps and tepid (not hot) water. Choose gloves with low potential for causing irritant or allergic contact dermatitis. thorough rinsing. dermatitis is painful and may prevent adequate hand scrubbing thus leaving residual organisms on the hand. 41 Also. gloves should be stored in a cool. sterilants or other strong chemicals with unprotected hands. 7. avoid direct contact with surface disinfectants. It is important to follow proper glove removal techniques. If the glove barrier is breached. Glove Removal. 39 The transfer of Herpes Simplex (Herpetic Whitlow) and Staphylococcus (MRSA) from the patient to the hands of the healthcare worker has been documented. Similarly. Various types of electrical equipment such as generators. not tossed. Healthy Skin. The gloves should then be dropped. For example. Other: Dermatitis. Infectious organisms may contaminate the exterior surface of gloves during use. the saddle between the fingers). jewellery removal and complete drying.Critical Glove Barrier Issues Volume 1 Everyday Practices That May Affect Glove Barrier (continued) (e. It should be an absolute habit for healthcare providers. Long fingernails can tear and rip gloves by placing a tremendous amount of pressure in a tiny area. into the appropriate disposal container.40 Many cases of Hepatitis B Virus (HBV) from healthcare providers to patients have been reported. During extended surgeries. Healthy intact skin is an essential factor in reducing the risk of cross-contamination. dry place away from direct light and electrical generating equipment.. As the majority of micro organisms on the hand are found under and around the fingernails. the wearer must depend on the integrity of the skin to prevent infectious substances from gaining passage into the body. A perfect barrier is meaningless if the contamination on the outside of the glove is spread throughout the environment as a result of poor removal technique. Cases of transferring infectious organisms from or to the hands have occurred. the practice of changing to a new pair of gloves prior to a critical procedure has been noted to reduce bacterial contamination. 42 9 . Storage Conditions. moisture and ozone can all degrade glove materials. short nails are advised. occupationally acquired HIV has been traced to the contact of soiled materials on chapped hands.

This situation may be compounded by the fact that the moist. it is also important in preventing glove barrier compromise. To perform their function of killing micro organisms. long-term and home healthcare situations. Contact. Artificial fingernails present several problems. Artificial Fingernails. tear and puncture gloves. making donning more difficult. This is not only critical to ensure efficacy of antimicrobial activity. occlusive environment under a glove supports microbial growth. Stay conscious of what contaminated gloves may be touching. disinfectants and other substances that may contribute to irritation or a Type IV chemical allergy. touching one’s face and/or clothing may leave behind micro organisms that can be transferred to others. These products may weaken the glove material. Hand sanitizers are frequently used in acute. hand sanitizers (usually alcohol or urea formaldehyde based) must be allowed to dry on the hands before proceeding. Lotions and barrier creams containing oils.Kimberly-Clark Health Care Education Everyday Practices That May Affect Glove Barrier (continued) Short nails provide a smaller area for micro organisms to hide under and access for scrubbing is improved. Straightening of the hair. Moderation in fingernail length should be standard practice while wearing gloves. Jewellery may snag. petrolatum and other petroleum-based products should not be worn under gloves. 42 Hand Sanitizers. Micro organisms can dwell and even thrive between the natural and artificial nail. 42 Of primary concern is the harbouring of fungi and bacteria that cannot be effectively removed even with nailbrushes. patient or family members. 10 . Jewellery may also trap soap. 43 If the alcohol is still liquid when the glove is donned. Of somewhat less importance. Jewellery. Lotions. most glove materials will be susceptible to rapid degradation. warm. but noteworthy nonetheless. artificial nails tend to cling to the glove surface (especially powder-free gloves). Micro organisms may collect under bracelets and rings potentially jeopardizing the health of the wearer.

RN. GA. her MBA from the University of LaVerne. Fill the used gloves with water to see if they leak. Prior to purchase and use. The base material of the glove. • When evaluating gloves. Kathleen B. CA and her BS from Brigham Young University. perform rigorous tasks for the longer durations encountered. there are significant variations among gloves made of the same material from different manufacturers. Although the base material of a glove presents certain performance capability limits. Then. She is the Director of Scientific Affairs and Clinical Education for Kimberly-Clark Health Care in Roswell. TN. Make certain the test data represent the actual gloves to be purchased. pinching the cuff closed and looking for thin areas. The determinants of glove barrier protection are complex. grade the fit and feel. 11 . ask for the specific base glove material. Inspect the glove by trapping air within. gluteraldehyde and other commonly used chemicals. clumps and debris anywhere on the glove. manufacturing quality requirements and various on the job practices can adversely alter assumed barrier efficacy. • Ask if the test data supplied represents the gloves to be received or if the gloves are actually purchased from others and thus a mixed bag. Stoessel. but they are not predictive of in-use glove barrier protection once the glove is challenged with rigorous. obtain data from the manufacturers on testing performed by independent laboratories for the gloves under evaluation. Perform inspections for glove defects as well as in-use tests to see if the gloves can maintain protection during the tasks for which they are being selected. rendering data received not necessarily applicable. prolonged or chemically incompatible procedures. Wava Truscott. Obtain the Declaration of Conformity. PhD Received her Doctorate in Comparative Pathology from the University of California at Davis. GA. Is the base material clearly displayed on the glove or packaging? Is the colour confusing the distinction between the natural rubber latex (NRL) and synthetic gloves? What is the manufacturer’s AQL specification for water leaks in unused gloves? What is the force at break? What is the ultimate elongation? Is the glove easy to double don? Does the glove come in enough sizes to comfortably fit all personnel well? Is the glove (NRL or synthetic) powder-free? Obtain the permeation data on alcohol. Table 4 Glove Barrier Integrity: Evaluation Guideline • • • • • • • • • • • • • What is the base glove material? Important: If it is a synthetic material. MS Commander USN (retired) received her Bachelor’s degree in nursing from Salve Regina University. She is the Manager of Clinical Education for Kimberly-Clark Health Care in Roswell. • Obtain data on residual chemical levels to select gloves that present less of a risk for developing hand dermatitis. Obtain viral penetration test data. RI and her master’s degree in education from Memphis State University. UT. especially looking at the fingertips and between the fingers. Table 4 incorporates issues that have been reviewed in this document and may be beneficial when evaluating gloves for barrier integrity.Critical Glove Barrier Issues Volume 1 Summary Out-of-the-box failure rates (AQLs for water leaks) are important for immediate risk reduction.

No 16. 1993. "Microbial penetration of gloves following usage in routine dental procedures. K2 House. 37." Arch Intern Med. CRC Press. J. ASTM Designation: D6319-00a. "Latex and Vinyl Examination Gloves. 1997. Matta. V 38. Goddard. 1990. CDC. Quality Control Procedures and Implications for Health Care Workers. Littell. Larson. D. V 270. C. Avato. C D. For more information. Saunders Company. "Leakage of Virus through Used Vinyl and Latex Examination Gloves. April 2000. No 4. Recommendations for prevention of HIV transmission in health-care settings. V29. Cresci. D." JAMA. Preventing Allergic Reactions to Natural Rubber Latex in the Workplace (DHHS [NIOSH] Publication No. Molinari. 11.B. Coyle. K. "Examination Gloves as Barriers to Hand Contamination in Clinical Practice. Van Nostrand Reinhold Company. Rabussay. ASTM Designation: D3767-96. 1996." Journal of Clinical Microbiology. No 176. Cyr. May 1987. Kirwin." The New England Journal of Medicine. Chapter 19. Glove Use Guidelines. 5. Heathfield Way. A. 1999. 15. Fisher. "Natural and Synthetic Rubber. 10. "In-use barrier integrity of gloves: Latex and nitrile superior to vinyl. published February 2000. 1930 Zaventem. 1996. 1999. Lehman. 1994. No 3. pp 787-788. for any reason. Rubber Technology. J. D. Third Edition. 1999. N. September 1999. 34. 4." Current Content News. R. "Leakage of Latex and Vinyl Exam Gloves in High and low risk clinical settings. H. Roswell. J. Kimberly-Clark N. L. Mellstrom. ASTM Designation: F1671-97b. Bokete. Health Care Europe Belgicastraat 17. V 5. approved November 1996. "Selecting Surgical Gloves. June 21. approved December 1997. "Integrity of Vinyl and Latex Procedure Gloves. 39. G. Kirwin. V 66. 25. published April 1998. A. T. "Update: Human Immunodeficiency virus Infections in Health-Care Workers Exposed to Blood of Infected Patients. a wholly-owned subsidiary of Kimberly-Clark Corporation. Korniewicz. No 4. please let us know your comments or suggestions for improvement. P. 6. Tian Sing." AORN Journal. 97-135)." American National Standard." Infection Control Today.." American Journal of Dentistry. J. No 5. "Safe use and handling of gluteraldehyde-based products in health care facilities. M." APIC. June 1997." BioTechniques. 36. UK. 42. 1995. Morton. "The Risks and Challenges of Surgical Glove Failure.A. Lewis. W. approved June 10. "Surgical Glove Failures in Clinical Practice Settings. our products do not meet your expectations. Sullivan K. Franz." Morbidity and Mortality Weekly Report. Korniewicz. SAFESKIN Group (Thailand). "Barrier protection with examination gloves: Double versus single. V 59. V 322. P. Belgium T +32 (2) 711 26 50 F +32 (2) 711 26 90 E hceurope@kcc. Standard Practice for Rubber – Measurement of Dimensions." BMJ. October 1997. Vanderbilt Company.Wahlberg. Suite 211. Korniewicz. 19. approved July 1997. No 3. W.References and Authors 1. October. 1993. D." Am Ind Hyg Assoc Journal. R. Standard Specification for Rubber Examination Gloves. M. Larson. No 10. Belgium. 27. M. No 4. H. "Standard and Special Testes for the Barrier Integrity of Medial Gloves: Part I: The Use and Abuse of Vinyl Gloves by Health Care Workers Allergic to Latex. M. Standard Test Method for Resistance of Protective Clothing Materials to Permeation by Liquids or Gases Under Conditions of Continuous Contact. Dallington. Feb. G. Principles and Practice. ASTM Designation: D3578-01. Northampton NN5 7QP. V 27. Douglas. 24. Hinsch. D. Party." APIC Infection Control and Applied Epidemiology. Standard Specification for Polyvinyl chloride Gloves for Medical Application. A. R. M. No 2. Guin. Brinker. pp 105. Laughon. R. Thirteenth Edition. W. published August 1999. M. V 6. A. Standard Specification for Rubber Surgical Gloves. published February 1998. ASTM Designation: D5151-99. Merchant. Twelfth Edition. Simon. D. V 36. Herdemann. August 1990." Contact Dermatitis 1994. "Glove Me Tender. 13. Francis. 1999. 38. Gantz. 7. A. S. pp 672-676. CDC. Klein.com www. Rabussay. D. 21. 22. "Penetration of gluteraldehyde through glove material: Tactylon ‘ versus natural rubber latex. B.kchealthcare. No 19. April 1990. All rights reserved. Korniewicz. ASTM Designation: D3577-00. December 1989. ASTM Designation: F739-99." Nursing Research. J. "Virus Penetration of Examination Gloves. Laughon. approved January 2000. V 28." Infection Control and Hospital Epidemiology. Standard Test Methods for Vulcanized Rubber and Thermoplastic Elastomers – Tension. 29. "Risk of exposure of surgical personnel to patients’ blood during surgery at San Francisco General Hospital.V. Thompson." Occupational Skin Disease. V 66. V 54. American Journal Infection Control. E. 35. 28. please contact: Kimberly-Clark Health Care U. Butz. Scientific & Industrial Business Pascalstraat 15. H. AAMI. 1993. 1987. Wool." American Industrial Hygiene Association Journal.. approved December 2000. Our goal is to provide quality products that completely meet your needs time after time. "A Hand in the Glove: Lessons Learned About Glove Selection. K. Maibach. E. 3. Feb-March 2000. "Synthetic Surgical Gloves. J. No 1. Inc. V 3. ASTM Designation: D412-98. B. Standard Specification for Nitrile Examination gloves for Medical Application. "Does wearing two pairs of gloves protect operating theatre staff from skin contamination?. T. GA USA. 41. approved January 2000 published February 2000. 23. Brown. 20. 1994. No 2. Protective Gloves for Occupational Use. 30. United Kingdom T +44 (1604) 591 993 F +44 (1604) 759 639 Kimberly-Clark N. Stamm. Mosby-Tear Book. 2. 2000." Surgical Services Management. Kramer. 9. 31. V 149." AORN Journal. Belgicastraat 17. 32.. HC213/00-UK . 1930 Zaventem. Chapman & Hall. 8. Third Edition. 1990. published June 1999. Ohm. Korniewicz. J. V 9. A. Schecter. Your input will result in a concerted effort on our part to meet your requirements. R. Korniewicz. No 2-3. V 11. 1988. 2000. Tarkington. Commitment to Excellence If. No 2. September 3. Standard Test Method of Detection of Holes in Medical Gloves. No 25. F. 43. Roswell. E. JB. 12. "Barrier Durability of Latex and Vinyl Medical Gloves in Clinical Settings. T. Guin. November 1997. 1999. E. Cresci. National Institute for Occupational Safety and Health. pp 22-26." Health Devices. Lytle. J. April 1992. E. ICNA.001. V 21. Gershey E. Rego. Olsen. A. Kotilainen. T. V 297. E. 16. July 21. Epidemiologic Notes and Reports. The Vanderbilt Rubber Handbook. 18. K. Roley. The Netherlands T +31 (0) 318 697 697 F +31 (0) 318 697 690 * Registered Trademark or Trademarks of Kimberly-Clark Corp. "Hand Washing and Skin Preparation for Invasive Procedures. 26. May/June 1989. Lynch./S. Larson. J. ECRI. 17. No 2. Larson. V14. Tay Eng Choo. "The Integrity of Latex Gloves in Clinical Dental Practice. Pitten. No 5. Larson. February 1997. GA 30076 or its affiliates. Cummings. OSHA Technical Information Bulletin: Potential for Allergy to NRL Gloves and other Natural Rubber Products.K. D." 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. . . . . . . . . . . . . . . . . . . . . . .Volume 1 Volume 1 Kimberly-Clark Health Care Education FirstHAND Critical Glove Barrier Issues TABLE OF CONTENTS This publication will review glove barrier issues that are critical to prudent glove selection and end-user practices in the healthcare setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . These issues include: • Base Glove Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 • In-Use Barrier Performance Studies . . . . . . 4 • Viral Penetration . . . . . . . . . . . . . . . . . 11 . . . . . 6 • Characteristics of Glove Degradation . . . . . . . 7 • Glove Barrier Integrity: Evaluation Guideline . . 2 • Physical Performance Standards and Test Methodologies . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 • Everyday Practices That May Affect Glove Barrier . . . . . . . . . . . . . . . . . . . . . . 5 • Chemical Barrier Testing . .