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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
Characteristics that had moderate performance in an area were not listed. low modulus 10 • Tactile sensitivity 10 Limitations • Ozone. stiffness 4. supple. oxygen & ultraviolet light can deteriorate 8 • Can have high modulus.3 7 Strengths • Resistant to oils 7.6 • Tactile sensitivity • Elasticity 6 • Comfortable.g.10 • Ozone. 3 .17.g. many different tests have been developed. low modulus 4.11 Comfortable 12 • Performance durability 4. so too may the appropriate glove choice. low modulus 10 • Tactile sensitivity 10 Limitations • Breaks down with uncured methacrylate (e. supple. stiffness 4 • Resistant to glutaraldehyde 6. 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. oxygen & ultraviolet light can deteriorate 4 • Breaks down with uncured methacrylate (e. A discussion of these test methodologies and associated standards follows.9 • • • • Resistant to many chemicals 4 Resistant to punctures 10.8 Limitations • Ozone. chemical contact). All chemicals listed represent working (diluted) solutions.11 Resistant to abrasion 10. supple. 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. bone cement) 4 Neoprene Strengths • Resistant to oil 8.18 • Resistant to alcohols 4 • Resistant to many chemicals 4 Elastryn (SBR. bone cement) 4 • Susceptible to oil 17 Limitations • Can have high modulus. Natural Rubber Latex Strengths • Tensile strength • Tear and puncture resistant 5 4 Nitrile Limitations • Oils can degrade • Ozone.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. oxygen & ultraviolet light can deteriorate 8 • Not to be worn by or used on NRL allergic individuals 2. To aid in the prediction of glove performance. oxygen 6 • Resistant to gluteraldehyde 19 • Comfortable. 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. tear. Styrene-butadiene rubber) Strengths • Comfortable. Styrene-ethylene-butadiene-styrene) Strengths • Resistant to ozone. material fatigue. 51 As challenges to barrier integrity change (snag.6 6 Vinyl Strengths • Resistant to ozone • Resistant to oil 14 13 PU. embrittles at low temperatures 4 Tactylon® (SEBS.
government agencies and healthcare. For example. 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. rips and/or very weak areas that rupture in the leak test indicate that barrier protection is compromised. the more easily materials of the same thickness can break when snagged or pressure is applied. The physical performance standards they develop establish minimum acceptable force at break. strength. but are not limited to: Glove materials have different stretch capabilities. 4 . the less effort required for movement.5 is equivalent to 3. The percentage the strip is stretched until the break is the ultimate elongation. indicating the statistically allowed failure rate (an AQL 1. Modulus. dimension and modulus requirements for natural rubber latex (NRL) and synthetic gloves. The lower the modulus. Members of CEN and ASTM medical glove working groups include representatives from glove manufacturers. 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. palm and cuff. This difference can affect in-use barrier performance. Relevance: Holes. Nitrile. fingernails exert a tremendous amount of concentrated pressure at glove fingertips. elongation. Ultimate Elongation (ASTM D412): The ability to stretch is determined by extending a strip of glove until it breaks. 21 Relevance: Thickness is an important component of barrier protection consistency for both durability and chemical permeation. Relevant Test Methods Some of the more relevant test methods include. 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. snapping off enclosures or any tasks performed with gloved hands. The glove is visually inspected for water leakage immediately and after a 2 to 3 minutes time period. Relevance: The lower the force at break. 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. testing laboratories.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. Values are stated as Acceptable Quality Levels (AQL). Glove materials from top to bottom: Natural Rubber Latex. Vinyl.17% defects). twisting stopcocks on IV sets. thickness. 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. ridges on caps.
Samples are pulled from the receiving chamber at various times throughout the challenge period. tearing and/or ripping glove material) during procedures. the real relevance to the healthcare professional is whether or not the glove is protective in use.g. 27 A single layer of glove is placed between two halves of a test chamber. A liquid suspension of the challenge virus. Phi X 174. Table 2 EN455 .5 1..6 Force at break after accelerated ageing (EN 455-2) ≥9 ≥6 ≥6 ≥ 3.6 Viral Penetration The viral penetration test is not required but is performed by some manufacturers.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) 1.5 1. ASTM F1671-97b is a standardized test method used to assess the ability of protective clothing to resist viral penetration. In-Use Barrier Performance Studies Provide appropriate barrier protection for the task.5 1. Data summaries of several studies are provided in Table 3. Table 2 specifies the minimally acceptable EN physical performance standards of unused gloves made of different materials.5 Force at break before accelerated ageing (EN 455-2) ≥ 12 ≥9 ≥9 ≥ 3. The other half of the chamber is filled with receiving media. It is important to emphasize that these are minimal standards. Although test results identify basic physical capability differences between glove material types and establish minimal acceptable standards. Both simulated in-use studies and actual clinical studies have been performed to evaluate glove durability.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. 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. 5 . Detection of any virus in the receiving media indicates breakthrough and thus failure of the glove material. This has an indirect impact on barrier performance as hand fatigue may lead to accidents (e. puncture. is placed in one side of the chamber.
Right: Chemicals can penetrate gloves and put the wearer at risk. tuck the clean glove over the cuff of the gown. failure rates were averaged. immediate if torn or punctured) • Use of gloves when disposing of contaminated linens • Proper removal and disposal of gloves *If single gloving. one glove is inserted under the cuff.g. the drugs are divided into chemical families. 6 . (c) There did appear to be a difference in performance between standard and stretch vinyl. (e) After contact with 70% ethanol. (f) Additional barrier studies on this fairly new medical glove material are anticipated. Representatives from each of the drug families are used as the chemical test challenge. Physical testing may also be conducted on the glove after the permeation study is completed to determine if the physical properties have degraded. • Douglas study: Standard vinyl failed at 25-32%. one layer of the glove is placed between two chambers. stretch vinyl failed at 22-27%.• Rego study: Standard vinyl exhibited failure rates ranging from 26-61%. Because not every chemotherapeutic drug or combination of drugs can be anticipated. 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. (d) Without first contacting ethanol. The drug being evaluated is placed on one side and a receiving fluid on the other. Top: The toxicity of chemotherapeutic drugs demands the protection provided by gloves cleared for chemo use. and one glove goes over the cuff. Samples are taken from the receiving fluid over several hours to determine if breakthrough has occurred. (b) When more than one brand of a particular material was evaluated. Basically.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. stretch vinyl failed at 12-20%. 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. Select gloves that resist chemical penetration.. 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. If double gloves are worn.
This break of the natural skin barrier may enhance microbial access into the body. 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. drugs and other chemicals with which the powdered glove comes in contact – again by-passing the protective intent of the glove. Several of these practices are identified as follows. it is important to know the quality of chemical protection the glove provides. Powder can also absorb and aerosolise disinfectants. Note the elongation of the thumb and forefinger of this glove after a task that required sustained contact with an oil-based product. It is important to recognize these general indicators to help ensure the selection and maintenance of optimal glove protection. isopropyl alcohol and formalin. of course. Disinfectant and Liquid Sterilant Penetration Testing Gloved hands may routinely come in contact with numerous antiseptics. Glove powder may cause dermatitis with cracks and open lesions on the hands. Although no requirements exist for gloves. Information regarding chemical permeation must be requested directly from the manufacturer. 7 . disinfectants and/or liquid sterilants. 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. The barrier protection of any glove may be further compromised by everyday practices that include storage conditions. Facilities will vary. Characteristics of Glove Degradation There are general characteristics of glove degradation that may indicate a breakdown in the glove barrier integrity. skin care. Glove Specific: Selection of Powder-Free versus Powdered Gloves. personal habits and the inability to rapidly identify type of base material. but frequently used chemicals include gluteraldehyde. Thus. 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.Critical Glove Barrier Issues Volume 1 Chemical Barrier Testing (continued) Antiseptic.
Poor donning techniques can result in glove rips and tears. Donning Techniques.38 Length of Glove Wear. If the glove is to be used for tasks that require tape or adhesive label contact. colour). Glove length. 37. but are not limited to. Is the colour such that vinyl gloves. When you or your staff grab a glove.g. label. glove ID. 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. The halo may indicate a weakened area that can fracture during use. Observe for Clumps and Debris. Healthcare personnel should take care to don gloves correctly and avoid excessive stretching. Consider an alternate glove if adherence occurs. The rate of fatigue can be compounded by many factors that include. .Kimberly-Clark Health Care Education Everyday Practices That May Affect Glove Barrier (continued) Rapid Identification of Base Material (e. The longer a glove is worn the more vulnerable it is to barrier compromise. rigorous manipulations. A "halo effect" may be seen around debris imbedded in the glove material. 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. as forced removal may cause microscopic tears in the material. Check for the Sticking of Adhesives to the Glove. The open sores and cracks that result from dermatitis provide entry routes for micro organisms. width. “Baggy” gloves can cause wearers to execute procedures awkwardly. This effect can occasionally be seen at glove fingertips where a drop of the liquid glove material can solidify during production. The same thought process applies to brightly coloured NRL and NRL/synthetic blends where natural rubber latex and synthetic materials can be confused.. which may result in an adverse reaction. 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. Double Gloving. 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. Gloves should conform to the hands. yet allow ease of movement (low modulus) to minimize fatigue. 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. finger contour and thumb position are among the factors to consider when evaluating appropriate glove fit. for instance. accidental spills can put staff at personal risk. There should be a full range of glove sizes to accommodate all personnel. an NRL allergic individual may mistakenly grab an NRL glove. Thoroughly dry hands before sliding them into gloves. check to see if the adhesive material adheres to the glove. Or. Poor fitting gloves can interfere with the optimal performance of procedures. If infectious agents or hazardous chemicals are used.
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. Suggestions to minimize dermatitis sometimes associated with handwashing include the use of mild soaps and tepid (not hot) water. Similarly. Other: Dermatitis. Storage Conditions. Long fingernails can tear and rip gloves by placing a tremendous amount of pressure in a tiny area. Glove Removal. into the appropriate disposal container. jewellery removal and complete drying. For example.. ultraviolet or fluorescent light and X-ray machines create ozone. the saddle between the fingers). 42 9 . Choose gloves with low potential for causing irritant or allergic contact dermatitis. To avoid material degradation due to these factors. 39 The transfer of Herpes Simplex (Herpetic Whitlow) and Staphylococcus (MRSA) from the patient to the hands of the healthcare worker has been documented. If the glove barrier is breached. The gloves should then be dropped. There is no substitute for handwashing. thorough rinsing. avoid direct contact with surface disinfectants. Infectious organisms may contaminate the exterior surface of gloves during use. Handwashing. gloves should be stored in a cool.Critical Glove Barrier Issues Volume 1 Everyday Practices That May Affect Glove Barrier (continued) (e. It is important to follow proper glove removal techniques. 7. occupationally acquired HIV has been traced to the contact of soiled materials on chapped hands. Heat. moisture and ozone can all degrade glove materials. Healthy intact skin is an essential factor in reducing the risk of cross-contamination. Cases of transferring infectious organisms from or to the hands have occurred. sterilants or other strong chemicals with unprotected hands. light. Select mild soaps and lotions that are less likely to cause dermatitis. 41 Also. not tossed.40 Many cases of Hepatitis B Virus (HBV) from healthcare providers to patients have been reported. short nails are advised. During extended surgeries. Various types of electrical equipment such as generators.g. As the majority of micro organisms on the hand are found under and around the fingernails. the addition of water to your hands before applying soap. Healthy Skin. It should be an absolute habit for healthcare providers. dry place away from direct light and electrical generating equipment. the wearer must depend on the integrity of the skin to prevent infectious substances from gaining passage into the body.42 Long Fingernails. the practice of changing to a new pair of gloves prior to a critical procedure has been noted to reduce bacterial contamination. dermatitis is painful and may prevent adequate hand scrubbing thus leaving residual organisms on the hand. 7 Similar transfers of Hepatitis C Virus (HCV) are now being reported.
making donning more difficult. patient or family members.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. petrolatum and other petroleum-based products should not be worn under gloves. warm. 43 If the alcohol is still liquid when the glove is donned. long-term and home healthcare situations. This situation may be compounded by the fact that the moist. Straightening of the hair. touching one’s face and/or clothing may leave behind micro organisms that can be transferred to others. occlusive environment under a glove supports microbial growth. Contact. disinfectants and other substances that may contribute to irritation or a Type IV chemical allergy. Jewellery may snag. tear and puncture gloves. Moderation in fingernail length should be standard practice while wearing gloves. To perform their function of killing micro organisms. most glove materials will be susceptible to rapid degradation. Jewellery may also trap soap. Artificial Fingernails. 42 Of primary concern is the harbouring of fungi and bacteria that cannot be effectively removed even with nailbrushes. Jewellery. Stay conscious of what contaminated gloves may be touching. This is not only critical to ensure efficacy of antimicrobial activity. but noteworthy nonetheless. Lotions. it is also important in preventing glove barrier compromise. These products may weaken the glove material. 10 . 42 Hand Sanitizers. Micro organisms may collect under bracelets and rings potentially jeopardizing the health of the wearer. hand sanitizers (usually alcohol or urea formaldehyde based) must be allowed to dry on the hands before proceeding. Of somewhat less importance. Hand sanitizers are frequently used in acute. Artificial fingernails present several problems. artificial nails tend to cling to the glove surface (especially powder-free gloves). Micro organisms can dwell and even thrive between the natural and artificial nail. Lotions and barrier creams containing oils.
Inspect the glove by trapping air within. 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. clumps and debris anywhere on the glove. Then. Obtain the Declaration of Conformity. • When evaluating gloves. She is the Director of Scientific Affairs and Clinical Education for Kimberly-Clark Health Care in Roswell. Fill the used gloves with water to see if they leak. her MBA from the University of LaVerne. but they are not predictive of in-use glove barrier protection once the glove is challenged with rigorous.Critical Glove Barrier Issues Volume 1 Summary Out-of-the-box failure rates (AQLs for water leaks) are important for immediate risk reduction. 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. CA and her BS from Brigham Young University. The base material of the glove. • Obtain data on residual chemical levels to select gloves that present less of a risk for developing hand dermatitis. PhD Received her Doctorate in Comparative Pathology from the University of California at Davis. ask for the specific base glove material. perform rigorous tasks for the longer durations encountered. gluteraldehyde and other commonly used chemicals. Kathleen B. prolonged or chemically incompatible procedures. pinching the cuff closed and looking for thin areas. GA. She is the Manager of Clinical Education for Kimberly-Clark Health Care in Roswell. The determinants of glove barrier protection are complex. UT. Obtain viral penetration test data. Wava Truscott. RN. Make certain the test data represent the actual gloves to be purchased. TN. Although the base material of a glove presents certain performance capability limits. rendering data received not necessarily applicable. there are significant variations among gloves made of the same material from different manufacturers. 11 . Table 4 Glove Barrier Integrity: Evaluation Guideline • • • • • • • • • • • • • What is the base glove material? Important: If it is a synthetic material. manufacturing quality requirements and various on the job practices can adversely alter assumed barrier efficacy. grade the fit and feel. Stoessel. GA. especially looking at the fingertips and between the fingers. RI and her master’s degree in education from Memphis State University. Table 4 incorporates issues that have been reviewed in this document and may be beneficial when evaluating gloves for barrier integrity. obtain data from the manufacturers on testing performed by independent laboratories for the gloves under evaluation. • 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. Prior to purchase and use. MS Commander USN (retired) received her Bachelor’s degree in nursing from Salve Regina University.
approved December 2000. C D. Lynch. 24." American Journal of Infection Control. "Natural and Synthetic Rubber. "Examination Gloves as Barriers to Hand Contamination in Clinical Practice. UK. "In-use barrier integrity of gloves: Latex and nitrile superior to vinyl. "Selecting Surgical Gloves. Fisher. 1988. Feb. H. Merchant. 1996. D. "Barrier protection with examination gloves: Double versus single. T." American Industrial Hygiene Association Journal. 1990. 1999." Journal of Clinical Microbiology. "Risk of exposure of surgical personnel to patients’ blood during surgery at San Francisco General Hospital. Cummings. Twelfth Edition." Nursing Standard. Butz. Our goal is to provide quality products that completely meet your needs time after time. Northampton NN5 7QP. K. ASTM Designation: D5250-00. approved August 2001. approved November 1996. V29. Molinari." Infection Control and Hospital Epidemiology." BioTechniques." Morbidity and Mortality Weekly Report. Protective Gloves for Occupational Use. Glove Use Guidelines. Tay Eng Choo. 2000. Rubber Technology. CRC Press. Rainey. ASTM Designation: D3577-00. 8. "Barrier Durability of Latex and Vinyl Medical Gloves in Clinical Settings.kchealthcare. April 2000. P. Vanderbilt Company. Korniewicz. Larson. V. T. J. V 38. J. Commitment to Excellence If. Your input will result in a concerted effort on our part to meet your requirements. No 3. S. "Safe use and handling of gluteraldehyde-based products in health care facilities. Scientific & Industrial Business Pascalstraat 15. 20. Brown. F. 18. No 5. Pickett.. pp 105. published April 1998. L. W. ICNA. 13. 1993. No 10. 41. Kimberly-Clark N. published December 1996. Olsen. 29.001. No 5. J. 1999. JB. W. 34. J. Sullivan K. © 2001 KCC. Goddard." Current Content News. June 1997. Korniewicz. W H. V 66. Standard Test Method for Resistance of Protective Clothing Materials to Permeation by Liquids or Gases Under Conditions of Continuous Contact. J. T. "Hand Washing and Skin Preparation for Invasive Procedures. Belgium T +32 (2) 711 26 50 F +32 (2) 711 26 90 E hceurope@kcc. 1995. Hawley’s Condensed Chemical Dictionary. Standard Specification for Rubber Surgical Gloves. 17. Gerberding. 7. Thompson. 19. E. Gershey E. V 59. Bokete. "Synthetic Surgical Gloves.com www. Quality Control Procedures and Implications for Health Care Workers." JAMA. October 1997. Third Edition. Korniewicz. December 1989. May 1987./S. J. published February 2000. 97-135). V 297. Standard Specification for Rubber Examination Gloves. A. "Penetration of gluteraldehyde through glove material: Tactylon ‘ versus natural rubber latex. "Virus Penetration of Examination Gloves.. "The Risks and Challenges of Surgical Glove Failure. D. September 3.A. CDC. 36. 38. "Surgical Glove Failures in Clinical Practice Settings. Preventing Allergic Reactions to Natural Rubber Latex in the Workplace (DHHS [NIOSH] Publication No. V 66. A. Health Care Europe Belgicastraat 17. Johnson. Korniewicz. Pitten. Cyr. 2000. 25. E. E. No 2. published October 2001. Maibach. Larson. V 270. 28. "Disposable gloves: research findings on use in practice. CDC. Epidemiologic Notes and Reports. No 2. Coyle. All rights reserved. "Leakage of Latex and Vinyl Exam Gloves in High and low risk clinical settings. 1987. No 19. Chapman & Hall. 1999. Simon. Standard Specification for Nitrile Examination gloves for Medical Application. please contact: Kimberly-Clark Health Care U. MMWR 36(SU02). 2. pp 672-676. Schecter. Chapter 19. Douglas.com Kimberly-Clark. August 1990. Recommendations for prevention of HIV transmission in health-care settings. M. Morton." American National Standard. approved May 1999. Huggins. "Does wearing two pairs of gloves protect operating theatre staff from skin contamination?. E. E. W. HC213/00-UK . January 8. D." Nursing Research. published August 1999." Am Ind Hyg Assoc Journal. Dallington. 35. Cresci. Feb-March 2000. 30. 10. N. Lewis." BMJ. M." AORN Journal. No 3. K. B. V 36. No 2." Occupational Skin Disease. Gantz. 15. Wool. September 1999. V 3. A. K. "Integrity of Vinyl and Latex Procedure Gloves. Avato. R. Saunders Company. Heathfield Way. "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. No 2. 3. 1994. Herdemann. A. V58. approved December 1997. Rabussay. 16. H. ASTM Designation: D3767-96. 1930 Zaventem. "A Hand in the Glove: Lessons Learned About Glove Selection. Guin. R. approved July 1997. Kotilainen. T. V 322. 43. R. United Kingdom T +44 (1604) 591 993 F +44 (1604) 759 639 Kimberly-Clark N. 27. approved January 2000 published February 2000. V 9. published February 1998. 26." Infection Control Today. Third Edition." American Journal of Dentistry. M. American Journal Infection Control. No 4. 1994. published January 2001. Van Nostrand Reinhold Company.V. Klein. National Institute for Occupational Safety and Health. V 54. 21. E. 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The Netherlands T +31 (0) 318 697 697 F +31 (0) 318 697 690 * Registered Trademark or Trademarks of Kimberly-Clark Corp. 1997. Standard Test Method for Resistance of Materials Used in Protective Clothing to Penetration by Blood-Borne Pathogens Using Phi-X174 Bacteriophage Penetration as a Test System. "The Integrity of Latex Gloves in Clinical Dental Practice. Belgicastraat 17. pp 787-788. Party. R. Tian Sing. Laughon. ASTM Designation: D412-98. Matta. Cresci. Korniewicz. Standard Practice for Rubber – Measurement of Dimensions. Guin." Surgical Services Management. Larson. The Vanderbilt Rubber Handbook. V 149. Littell. GA 30076 or its affiliates. Lehman. for any reason. A. Roswell. D. Franz. 1996. K2 House.B. J. Suite 211. V14. No 1. Hinsch. D. R. 1990. V 30. 40. 32. our products do not meet your expectations. J. Larson. 42. 9. For more information. Rego. 14. 1999." Arch Intern Med. V 27.K. 11. 6716 AZ Ede. AM. M. Principles and Practice." 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. . . 5 • Chemical Barrier Testing . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . 2 • Physical Performance Standards and Test Methodologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 • In-Use Barrier Performance Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 • Glove Barrier Integrity: Evaluation Guideline . . . . . . 7 • Everyday Practices That May Affect Glove Barrier . . . . . . . . . . . . . . . . . . . These issues include: • Base Glove Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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. . . . 4 • Viral Penetration . . . 6 • Characteristics of Glove Degradation . . .
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