1. ©FIOH, Riitta Jolanki 27-28.8.2003 Exposure at work and protective gloves Riitta Jolanki, D.Tech. (Chem.Eng.), Docent Senior Research Scientist, Dermatotoxicologist Finnish Institute of Occupational Health (FIOH) Department of Occupational Medicine Section of Dermatology riitta.jolanki@ttl.fi

2. ©FIOH, Riitta Jolanki 27-28.8.2003 Skin hazards at work l Chemicals –liquids and splashes (direct contact) –gases, aerosols, dusts and droplets (airborne) l Hand-washing agents, hand creams and barrier creams l Tools and gloves (nickel, rubber and rubber chemicals) l Dirty tools, surfaces, clothes and gloves l Wet work l Use of protective gloves (occlusion, etc.) l Mechanical and physical factors l Biological agents (micro-organisms)

3. ©FIOH, Riitta Jolanki 27-28.8.2003 Decreasing skin exposure l Chemicals and other skin hazards –identification, elimination or substitution l Work –technical arrangements –safe working methods ("non-touch techniques") –clean work area and tools l Worker –cleaning and care of skin –instructions (use of gloves, working methods) –recognition of skin symptoms l Preventive measures –protective gloves

4. ©FIOH, Riitta Jolanki 27-28.8.2003 Safety data sheet (SDS) l Means for manufacturer to present basic safety information on his product –single substance, mixture of substances –fully finished product l Details of all the known safety hazards presented by the product l Skin sensitizers are labelled with R-phrases –R 43 ’May cause sensitization by skin contact’ –R 42/43 ’May cause sensitization by inhalation or skin contact’ l Details of how these hazards should be managed l SDSs are of great help, they may not be exact enough from a dermato-allergist's point of view

5. ©FIOH, Riitta Jolanki 27-28.8.2003 Possible reasons for SDSs being inaccurate l Low concentration of chemicals may not be declared –in the EU, if a skin-sensitizing chemical is present at a concentration of 0.1% or more in a chemical preparation, it should be listed in the preparation's SDS l Raw materials may contain hidden impurities l Final product may contain starting materials l Decomposition of components l Contamination of residues l Manufacturing processes may be poorly controlled l Undeclared components may be added intentionally

6. ©FIOH, Riitta Jolanki 27-28.8.2003 Selection of protective gloves l Exposure (all skin hazards) –chemical, physical, mechanical and biological l Work methods and requirements l Working conditions and duration l Side effects of gloves l Worker (allergy) l Characteristics of the gloves –resistance to chemicals –side effects –cleansing properties –availability –price

7. ©FIOH, Riitta Jolanki 27-28.8.2003 Ideal gloves l Resistant to all chemicals l Dextrous in use l Comfortable to use l No side effects

8. ©FIOH, Riitta Jolanki 27-28.8.2003 Glove types l Disposable (0.007 – 0.25 mm) –surgical or examination gloves l Household (0.20 – 0.40 mm) –usually unsupported or unlined or with nappy inside l Industrial (0.36 – 0.85 mm) –usually supported or lined l Special industial –durable surface material, special supports, thick linings –wired cloths l Inner gloves (cotton, viscose, wool)

9. ©FIOH, Riitta Jolanki 27-28.8.2003 Glove materials l Rubber materials –natural rubber latex –synthetic rubber l Plastic materials l Leather l Textiles l Special materials l Combinations of different materials

10. ©FIOH, Riitta Jolanki 27-28.8.2003 Glove materials - rubber - Natural rubber latex Synthetic rubber l Nitrile rubber l Neoprene or chloroprene rubber l Butyl rubber l Fluororubber (Viton ® ) l "Styrene rubber" surgical gloves –e.g., Elastyren ® and Tactylon ®

11. ©FIOH, Riitta Jolanki 27-28.8.2003 Glove materials - plastic - l Polyvinylchloride (PVC) or vinyl l Polyethylene (PE) l Polyvinylalcohol (PVA) l 4H Gloves (5-layer laminate of PE and EVOH)

12. ©FIOH, Riitta Jolanki 27-28.8.2003 Selection of protective glove types against chemical hazards l Rubber, plastic, totally rubber- or plastic-coated textile –wet work –harmful chemicals l Leather, textile –dry work –"inert" chemicals l Rubber- or plastic-impregnated, or partly rubber- or plastic-coated textile –moist work –"inert" chemicals l Disposable gloves –health care work –laboratory work

13. ©FIOH, Riitta Jolanki 27-28.8.2003 Permeation of chemical through protective gloves l Usually difficult to see by naked eye l Use of permeable gloves may increase skin exposure and risk of sensitization l Gloves that permeate chemicals may also permeate hazardous micro-organisms l Use of organic solvents simultaneously with allergenic chemicals shortens considerably the breakthrough time of the allergen

14. ©FIOH, Riitta Jolanki 27-28.8.2003 Chemicals pass through the glove material l Penetration –through wholes in glove material l Permeation –through undamaged glove material l Degradation –chemical degrades glove material

15. ©FIOH, Riitta Jolanki 27-28.8.2003 Testing of glove resistance against chemicals l According to standard EN 374-3 l Breakthrough time –measures how long it took the chemical to permeate through the glove material l Permeation rate –measures the quantity of chemical that permeates an area of the material after breakthrough occurs

16. ©FIOH, Riitta Jolanki 27-28.8.2003 Breakthrough time –measures how long it took the chemical to permeate through the glove material –permeation rate = 1 µg·min -1 ·cm -2 time breakthrough time

17. ©FIOH, Riitta Jolanki 27-28.8.2003 Criteria for glove reuse Handling of skin sensitizers l gloves can be used for a period up to ½ times the breakthrough time after the first exposure l should then be discarded (no reuse) Handling of organic solvents l 1/5 times the breakthrough time after the first exposure  cleaning and drying l reuse, discarded when physical degradation occurs

18. ©FIOH, Riitta Jolanki 27-28.8.2003 Disposable gloves l Natural rubber latex l Plastics (vinyl, polyethylene) - recommended l Powdered or non-powdered l Surgical gloves (sterile) l Examination gloves (nonsterile) l Chemical-protective gloves (nonsterile, inexpensive)

19. ©FIOH, Riitta Jolanki 27-28.8.2003 Disposable gloves for chemicals l Clean gloves from the package (no reuse) l Only for short-term or occasional handling of chemicals l Poor protecton capacity l Better protection obtained by double gloving l Change gloves often l Change gloves immediately after chemical contamination

20. ©FIOH, Riitta Jolanki 27-28.8.2003 Side effects of protective gloves – skin irritation – l Friction from the seams of leather and textile gloves l Occlusion, sweating, and maceration l Occlusion enhances penetration of irritants from e.g., detergents and skin care products l Agents that have penetrated the glove membrane from the outside (environmental exposure) l Agents/materials emanating from the glove itself, or remaining from glove manufacturing process l Agents remaining from the glove washing procedure (detergents and moisture) l Glove powders, ethylene oxide, etc.

21. ©FIOH, Riitta Jolanki 27-28.8.2003 l Glove materials –rubber chemicals in natural and synthetic rubber gloves (e.g., accelerators and antioxidants) (ACD) –proteins in NRL gloves (contact urticaria/protein contact dermatitis, rhinitis, asthma and conjunctivitis) –chromium (tanning agents) in leather gloves (ACD) –plasticizers in PVC gloves (rarely) (ACD) –dyes (ACD) l Glove powders (rarely) Side effects of protective gloves – skin sensitization –

22. ©FIOH, Riitta Jolanki 27-28.8.2003 l Aggravation of dermatitis by glove usage (occlusion) l Slowing of the work l Increased risk of hand accidents (getting caught in moving or revolving parts of machinery) l Increased absorption of hazardous substances through the skin (systemic adverse effects) l Impairment of hand dexterity Side effects of protective gloves – others –

23. ©FIOH, Riitta Jolanki 27-28.8.2003 Allergen content of latex gloves. A market survey of medical gloves used in Finland in 2001 l Published by National Agency for Medicines (luonnonkumikäsineiden markkinavalvontatutkimus, TLT-INFO 1/2001, Lääkelaitos, Helsinki 2001) l More than 1000-fold differences in the allergen contents have been demonstrated l If the allergen content is low (<10 AU/ml) –only few new sesitizations –sensitized persons can continue in their present job –avoiding unexpected allergic reactions during medical investigations or care in persons unaware of their allergy

24. ©FIOH, Riitta Jolanki 27-28.8.2003 Gloves made of plastic or synthetic rubber materials do not contain NRL proteins

25. ©FIOH, Riitta Jolanki 27-28.8.2003 Non-sterile gloves for workers with CU/PCD from NRL gloves l Disposable gloves –plastic gloves (PVC or vinyl, PE or polyethylene) –synthetic rubber gloves (nitrile, neoprene) –NRL gloves with a low allergen content (<10 AU/ml) (use test) –polyethylene (PE) plastic gloves under NRL gloves (double gloving) l Household gloves –PVC l Industrial gloves –plastic (PVC, polyvinyl alcohol or PVA) –synthetic rubber gloves (nitrile, neoprene, butyl, fluororubber) –plastic laminate gloves (PE/EVOH/PE; 4H Gloves )

26. ©FIOH, Riitta Jolanki 27-28.8.2003 Sterile gloves for health care workers with CU/PCD from NRL gloves l Synthetic rubber gloves (e.g. neoprene) l NRL gloves with a low allergen content (<10 AU/ml) (use test) l Polyethylene (PE) plastic gloves under NRL gloves (double gloving) l NRL gloves with inner surface made of plastic material

27. ©FIOH, Riitta Jolanki 27-28.8.2003 Patients with CU/PCD from NRL gloves l Do not use NRL gloves when examining or caring for such patients l Use instead plastic or synthetic rubber gloves

28. ©FIOH, Riitta Jolanki 27-28.8.2003 Surgical gloves without NRL proteins l Neotech ja Biogel Skinsense N (Oriola Oy, Finland) l Elastyren, Dermaprene, Neolon (Tamro Finland) l Allergaard (Johnson & Johnson) l Duraprene (Baxter) l Tactylon (Procter & Gamble Hygiene)

29. ©FIOH, Riitta Jolanki 27-28.8.2003 Cleaning work and protective gloves l Dry work –use of gloves is not necessary –textile gloves l Wet work –household gloves made of PVC (+ inner gloves) l Organic solvents –nitrile gloves (+ inner gloves)

30. ©FIOH, Riitta Jolanki 27-28.8.2003 l Handling foodstuffs –household gloves made of PVC (+ inner gloves) (e.g., peeling potatoes) –disposable PVC or polyethylene gloves (e.g., making salad) l Washing dishes –household gloves made of PVC (+ inner gloves) Kitchen work and protective gloves

31. ©FIOH, Riitta Jolanki 27-28.8.2003 l Water-based latex paints –textile gloves with plastic pimples on palmar side –rubber- or plastic-coated textile glove (palmar side coated) l Solvent-based paints –material that protects against the solvent, usually nitrile gloves (+ inner gloves) l Epoxy paints –only 4H gloves give excellent protection (+ nitrile outer gloves and cotton inner gloves) Painting and protective gloves

32. ©FIOH, Riitta Jolanki 27-28.8.2003 Barrier creams l The protection given by barrier creams is questionable l Improve hand hygiene during dirty work, make hand cleaning easier l Only on healthy skin l May contain sensitizing and irritating components l May promote the retention of harmful chemicals on the skin surface (increased exposure)

33. ©FIOH, Riitta Jolanki 27-28.8.2003 Instructions for using protective gloves (I) l The use of protective gloves should be started simultaneously with the handling of hazardous materials l Clean and dry the hands before putting gloves on l Don't use barrier cream with gloves l Use inner cotton gloves whenever possible l Use better fitting gloves over loose or slippery gloves (PE or 4H glove) l When using double gloving, the inner glove should be ½–1 size larger l Protective gloves are meant for personal use only l If possible, restrict the use of gloves for relatively short periods (up to 30–40 minutes)

34. ©FIOH, Riitta Jolanki 27-28.8.2003 Instructions for using protective gloves (II) l Change gloves immediately after getting spillages or splashes inside the glove l Wash the gloves after use on both sides (gloves meant for reuse) l Cracked or hardened gloves should be discarded l Avoid unnecessary wearing of polymer gloves l Use protective gloves also at home

35. ©FIOH, Riitta Jolanki 27-28.8.2003 After work l Wash hands with lukewarm water l Use mild hand washing agent l After using solvent-based hand washing agent, wash your hands with water immediately, and cream the hands l Dab (don't rub) your hands dry l Cream your hands