Gloves in the OR Taking Safety Into Your Own Hands

What is the ‘gloves buzz’ for today? Clinician are searching for –More than barrier protection –Less dermal irritation Professional and Regulatory groups are proactive vs reactive to clinical issues Innovative manufacturers are developing new glove technologies( i.e., coated, accelerator free)

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Powder to Powder free

5 Why Eliminate Powder? Advances in manufacturing and coating technologies no longer require the use and application of powder Surgical glove manufacturers today are able to produce –cleaner, low-allergen, powder-free surgical gloves –that are comfortable to wear, –effortless to don/remove –and are versatile in grip and tactile performance Professional recommendations

6 Why Eliminate Powder? Particles of glove powder can settle on surgical suture material, instruments, drapes and sponges Once present within the surgical field, the powder may cause delayed wound healing, as well as post-operative complications including adhesions, joint inflammation, abdominal pain, blocked vessels and starch granuloma formation 1, 2 Beezhold D, Beck WC. Surgical Glove Powders Bind Latex Antigens. Archives of Surgery 1992; 127:

7 Why Eliminate Powder? Powder contamination can cause misdiagnosis, resulting in inappropriate treatment or unnecessary surgery 1 and has been shown to enhance the growth of bacteria 2 1.Giercksky K. et al. Multiple Glove Powder Granulomas Masquerading as Peritoneal Carcinomatosis. Journal of the American College of Surgeons 1994; 179: Ruhl C, Urbancic J, Foresman P, Cox M., Rodeheaver G, Zura R, Edlich R. A New Hazard of Cornstarch, an Absorbable Dusting Powder. The Journal of Emergency Medicine, July 1993, 12(1): 11-14

Addressing clinical needs Powder Concerns Many glove wearers develop skin problems (i.e. compromised skin health or dermatitis) from using powder for an extended period of time. 1. US Department of Health and Human Services, Food and Drug Administration, Center for Devices and Radiological Health. Medical glove powder report, September 1997

The FDA speaks Spring 2015 Proposal to Ban Powdered Natural Rubber Latex and Powdered Synthetic Surgeon’s and Patient Examination Gloves “ FDA has determined that a subset of surgeon and patient exam gloves that are powdered and that represent a modest share of the market present a substantial risk of illness that cannot be corrected by a change in labeling. These gloves are powdered natural rubber latex surgeon's gloves, powdered synthetic latex surgeon's gloves, powdered natural rubber latex patient examination gloves, powdered synthetic patient examination gloves, and absorbable powder for lubricating a surgeon's glove. Consequently, FDA is proposing to ban these devices” RIN=0910-AH02 9

Latex to Latex free

Clinical practice is shifting towards synthetics Surgical Glove Units CY 2013 Latex, powderedOther SyntheticPolyisopreneLatex, powder-free Surgical Glove Units CY 2015 Source: GHX Q TD – All Channels Surgical Glove Units CY 2008

Company Confidential – For internal use only 12 Why Latex Free? Reasons to Change: “The goals of prevention are two fold: to prevent reactions in individuals who are latex sensitized and to prevent initial sensitization of non-sensitized person. The only effective preventative strategy at this time is latex avoidance.” AORN Standards, Recommended Practices and Guidelines Edition “Individuals undergoing surgical interventions during infancy should be handled latex free from the very beginning of life.” Journal of Pediatric Surgery 36: , 2001

Addressing clinical needs Latex Avoidance Natural rubber latex allergy is a significant medical concern. It affects healthcare workers as well as the general population. It is estimated that 8% to 12% of healthcare workers are latex-sensitive, and workers exposed to latex gloves and other products containing natural rubber latex may develop allergic reactions. 1 1 US Department of Labor. OSHA. Healthcare wide hazards: Latex allergy. Available at:

Company Confidential – For internal use only 14 Surgical Gloves Synthetic Options Neoprene –First generation of an acceptable alternative –Next generation improved tactility and softness Polyisoprene –Most “latex like” in fit, feel, comfort and performance –Variances by manufacturer

15 –Practice and promote hand hygiene –Avoid powder –Avoid latex when and where possible especially if you have a sensitivity or allergic reaction to natural rubber latex –Consider new technologies (e.g. emollient impregnated gloves) Contact Dermatitis & Latex Allergy

Double Gloving Jeanine Nestor RN Regional Glove Specialist Infection Prevention

Why double glove? Needle sticks pose the greatest risks to the entire surgical team. In double gloving although puncture of the outer glove could be common, corresponding punctures of both the outer and inner glove are rare. Published literature strongly supports the practice of double gloving to reduce the risk of contaminated percutaneous exposure to members of the surgical team. –AORN 2007 Standards –Supported by the American Academy of Orthopaedic Surgeons and the American College of Surgeons –Centers for Disease Control and Prevention

Double Gloving Fast Facts Cuts or needle sticks may occur in as many as 15% of operations Initial intraoperative glove perforation occurs an average of 40 minutes into a procedure Double gloving reduces risk of exposure to patient blood by as much as 87% when the outer glove is punctured Volume of blood on a solid suture needle is reduced as much as 95% when passing through two glove layers “ Preventing Sharps Injuries in the Operating Room,” Berguer and Heller, Journal of the American College of Surgeons, 2004

AORN Recommended Practice IV Health care practitioners should double-glove during invasive procedures. “A systematic review of 18 clinical trials of gloving practices clearly demonstrates that double-gloving minimizes the risk of exposure of health care workers to blood during invasive procedures.”

AORN Recommended Practice IV Perforation rates of the glove closest to the skin are significantly less when wearing double gloves compared to single gloves. Perforation rates are no different when wearing single gloves compared to the outer glove when two pairs of gloves are worn. More glove perforations are detected when using a colored under-glove indicator system when compared to two pairs of standard gloves.

Surgical Gloves - Product Options Under gloves for double gloving Emollient coated “Accelerator free” ( what does that mean?)

Emollient Coated Gloves Use as an underglove or stand alone glove Meets CDC guidelines Helps to prevent and heal dermal issues associated with hand hygiene and extended glove usage.

23 Better a thousand times careful than once dead - Proverb