Glove Selection Occupational Hazards To Health Care Workers August 1, 2002 Susan Wilburn

Why Wear Medical Gloves? History of Medical Glove Use 1900s Halstead in surgery for nurses 1987 CDC Universal Precautions 1991 OSHA Bloodborne Pathogens Standard

Hierarchy of Controls Elimination – Substitution Engineering Controls Administrative and Work Practice Controls Personal Protective Equipment

NIOSH Latex Allergy Alert June 1997 WARNING! Workers exposed to rubber gloves and other latex-containing products may develop allergic reactions such as skin rashes, nasal or sinus symptoms, asthma and in rare instances shock.

Latex Allergy: Type I Immediate Hypersensivity 1979: First reports in literature : Latex glove use and reactions –11.8 billion exam and 1.8 billion surgical gloves use in US –FDA reports > 1,000 systemic reactions to latex –FDA reports 15 deaths

Types of Glove-Associated Reactions Irritant Contact Dermatitis Allergic Contact Dermatitis (Type IV Delayed Hypersensitivity) Latex Allergy IgE-mediated response (Type I Immediate Hypersensitivity)

Glove Needs Chemical BarrierViral Barrier

Glove Selection Meeting existing standards and guidelines Prevents illness and exacerbation of existing problems

Standards and Guidelines OSHA CDC NIOSH ASTM FDA

CDC Guidelines “adequate barrier protection”

OSHA Bloodborne Pathogens Standard, CFR Gloves shall be worn.. hand contact with blood, other potentially infectious materials, mucous membranes and non-intact skin Appropriate PPE in appropriate sizes Hypoallergenic gloves, glove liners, powderless gloves or similar alternatives shall be readily available to those employees who are allergic to the gloves normally provided

OSHA PPE Standard 29 CFR and Select the most appropriate glove for a particular application and determine how long it can be worn Know the performance characteristics of the gloves relative to the specific hazard anticipated

OSHA Technical Information Bulletin Potential for Allergy to Natural Rubber Latex Gloves, 1998 Reduce unnecessary exposure to natural rubber latex protein for all workers Choose latex gloves with lower protein Selecting powder-free gloves offer additional benefit of reducing systemic allergic responses Provide suitable alternatives to latex gloves

NIOSH Alert

Criteria for Glove Selection In Use issues User Preferences Match glove to user criteria through in-use performance evaluation

Criteria for Glove – In Use Exposure to infectious organisms Physical stress/durability (orthopoedic surgery) Chemical resistance (drugs, disinfectants)

Glove Standards American Society for Testing & Materials (ASTM) FDA

Safety Medical Devices Act No Viral or Chemical barrier testing required AQL Water Leak –Surgeon’s gloves = 2.5% –Exam gloves = 4 % Proposed Powder and Protein Labeling –Powder non > 120 mg per glove –Protein maximum 1,200 mcg per glove

ASTM Glove Standards ASTM F 1671 – 97a viral penetration ASTM F Chemical permeation

Chemical Sensitizers Low Thiuram, Carbamates, Thiazole –Negative Modified Draize-95 –Negative patch test

Glove Materials Vinyl (poly vinyl chloride) Polyurethane Natural Rubber Latex (powdered or non) Neoprene (chlorinated) Nitrile Elastryn Polyisoprene

Glove Performance Permeation tests with Latex, PVC, Latex/neoprene and nitrile to Cyclophosphamide, Ara-C, vincritine, methotrexate, daunomycin –All drugs permeated all glove materials: highest permeation with PVC, lowest with Nitrile

Glove Selection Best Practices Oregon Health Division partnership Kaiser-Permanente Emery University Postal Worker and Airport Personnel

Oregon Strategic Plan for Reducing Occupational Dermatitis Joint labor-management, public-private, intergovernmental partnership to eliminate latex use in food service based on occupational dermatitis worker’s comp claims Oregon Health Division Occ & Enviro Liberty Northwest Insurance Oregon Restaurant Association UFCW, Local 555 County health departments environmental services in 5 counties

Hospital Best Practices Kaiser-Permanente Eliminated latex and vinyl exam gloves; substitute with Nitrile Emery University Eliminated latex and saved $ on workers’ compensation

Purchasing Products for Safety Management commitment Worker involvement Health and safety committee involved in surveillance & glove selection decision; work with purchasing to set criteria for RFP to include independent testing of viral and chemical barrier

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