Abdul Kadir, Ph D Deputy Chief Executive Officer

Malaysian Rubber Export Promotion Council

Know yourKnow yourmedical gloves for medical gloves for better protection better protection and patient careand patient care

Outline

�What are medical gloves?� How gloves prevent contamination� Glove material comparisons� Hazards of vinyl gloves� Latex protein allergy� Standard Malaysian Glove (SMG)

What are medical gloves?

Medical gloves are disposable gloves used during medical procedures

• Medical gloves are single-use items

• Decontamination and reprocessing for reuse should be avoided

Main typesof medical gloves

Surgical

Use for conducting surgical procedures

ExaminationUse in:

• Medical examinations

• Diagnostic & therapeutic procedures

• Handling of contaminated medical materials

How gloves prevent infection� Gloves prevent contamination of the hands of

healthcare personnel when touching blood, body fluids, secretions, mucous membranes, and non-intact skin� Gloves reduce the likelihood that microorganisms

present on the hands of healthcare personnel will be transmitted to patients

Failure to change gloves between patient contacts is an infection control hazard

Wearing gloves does not replace the need for hand rubbing and washing

Gloves can be:• Powdered or powder-free• Sterile or non-sterile

Examination gloves

Powdered or powder-free

Surgical gloves

Powdered or powder-free Sterile

Non-sterile

Sterile • Powdered gloves are coated with corn starch

• Powder-free gloves are chlorinated or have a synthetic coating

Use of sterile exam gloves

Invasive insertion

Sterile dressing changes

End stage renal

disease treatment

Treating immune-

compromised individuals

FDA potential warning on powdered gloves

Warning: Powdered gloves may lead to foreign body reactions and the formation of granulomasin patients. In addition, the powder used on gloves may contribute to the development of irritant dermatitis and Type IV allergy, and on latex gloves may serve as a carrier for airborne natural latex leading to sensitization of glove users.

Glove materials

Material Examination Surgical

Natural rubber √ √Nitrile √ √

Vinyl √

Polyurethane √ √

Polyisoprene √

Polychlorprene √

Styrene butadiene √

Styrene-ethylene-butylene-styrene √

General properties of gloves made from different materials

Natural rubber Nitrile Vinyl

Durability

Puncture & tear resistance

Comfort and fit

Flexibility

Tactile sensitivity

Grip

Detection of holesin gloves� Introduce 1000 cm3

water into the glove

� Observe for leaks immediately

� If the glove does not leak immediately, make a second observation after 2 to 4 minutes

Simulated use conditions

Manipulation Repetition

1. Attach and remove a capped needle to a Luer-Lok syringe 30 times

2. Connect and disconnect a Luer-Lok syringe to intravenous tubing

8 times

3. Manipulate a stopcock 8 times

4. Wrapping, taping and unwrapping a blunt object 2 times

Percentage failure of glovessubject to water leak test

Glove material New After ‘use’

Natural rubber 2.0 1.8

Nitrile 3.0 2.8

Vinyl 4.8 29.8

Failure of vinyl gloves

after simulated use increased by

520%

Rego A and Roley L, American Journal of Infection Control, Volume 27, Number 5, 1999.

Limited useof vinyl gloves

Vinyl gloves are appropriate only for short-term tasks that involve minimum stress on the gloves and low risk of exposure to blood and other infectious materials

DEHP in vinyl gloves

� Used as a plasticizer in vinyl gloves

� Causes abnormal development of the male fetus

� Is a potential endocrine disruptor

� Shown to cause irregular rhythms of cardiac cells in culture

http://www.chemsystems.com/about/cs/news/items/PERP%200708S4_Plasticizers.cfm

Sanctions against DEHP

q US Department of Health and Human Services (DHHS) and Environmental Protection Agency (EPA) label DEHP as potential carcinogen and reproduction toxin

qMany countries have banned DEHP in children’s toys

q Japan and the European Union have banned DEHP in food service gloves

q DEHP is banned in California’s Safe Drinking Water and Toxic Enactment Act of 1986

Latex protein allergy

qNatural rubber latex (NRL) contains proteins

qSome of the proteins are allergens

qSensitization to NRL is caused by direct contact

qPrevalence of latex allergy in the general public is 1% and in healthcare workers from 0.6% to 10%

Symptoms of latex protein allergy

q Local or systemic urticaria

q Hay fever-like symptoms

q Abdominal cramps

q Difficulty in breathing

q Rapid heart rate

q Drop in blood pressure

q Anaphylactic shock

Solution toallergy problem

NR Nitrile

§ A voluntary certification scheme for latex examination gloves

§ Establishes requirements for:ü Freedom from holesü Physical propertiesü Protein contentü Powder content

§ Operated by the Malaysian Rubber Board, an ISO/IEC Guide 65 body, authorized by Standards Malaysia

§ Assurance that SMG gloves comply with the requirements of the SMG specification

Standard Malaysian Glove Scheme

POWDER-FREE POWDERED

SMG meets American and European standards for physical properties

SMG Type StandardType I AmericanType II European

SMG powder contentrequirements (mg/glove)

Powder-free 2

Powdered 150

SMG protein contentrequirements (μg/dm2)

Powder-free 50

Powdered 200

Practical considerations in glove use

Change glove if …

• The integrity of a glove is compromised and complemented with hand hygiene

Use double gloves if …

• There is a need to take precautions against HBV, HCV and HIV for long surgical procedures (>30 minutes)

• Performing procedures in contact with large amounts of blood and other body fluids

• Undertaking high risk orthopaedic procedures

Conclusion

� Gloves prevent contamination and the spread of infection by providing an effective barrier against microorganisms

� There are many different types of gloves and selecting the right ones for use will result in better infection control and protection of the healthcare personnel

Thank you More information on medical gloves

is available at the following websites:

www.latexglove.info

www.smg-gloves.com

www.mrepc.com