Gloves for Protection ===================== Authors Olsen RJ. Lynch P. Coyle MB. Cummings J. Bokete T. Stamm WE. Institution Department of Epidemiology, Harborview Medical Center, Seattle, WA. Title Examination gloves as barriers to hand contamination in clinical practice. Source JAMA. 270(3):350-3, 1993 Jul 21. Abstract OBJECTIVE--To test the effectiveness of vinyl and latex gloves as barriers to hand contamination with gram-negative organisms and enterococci during routine hospital procedures. DESIGN AND INTERVENTIONS--We studied 137 procedures during which a health care worker's gloved hand contacted a patient's mucous membrane and was thus potentially contaminated with gram-negative rods or enterococci. Quantitative hand cultures were obtained from each health care worker before and after the gloved contact using a modified glove juice method, and the exterior glove surface was also quantitatively cultured after patient contact. Used gloves were then tested for leaks using the American Society for Testing and Materials' watertight test. SETTING--Harborview Medical Center, a 330-bed city-county hospital and level I regional trauma and burn center, is both a teaching facility affiliated with the University of Washington and the major provider of care to indigent and uninsured persons in Seattle-King County, Washington. PATIENTS AND OTHER PARTICIPANTS--Respiratory therapists performing endotracheal tube care on intubated intensive care unit patients, registered nurses performing digital rectal stimulation for bowel training on patients with spinal cord injury in the rehabilitation ward, and dentists performing routine dental examinations and procedures on healthy outpatients in the dental clinic. MAIN OUTCOME MEASURE AND RESULTS--Eighty-six of the 135 gloves cultured had gram-negative rods or enterococci on the external surface after use and were thus sources of potential hand contamination. Microbial contamination of the health care worker's hands occurred in 11 (13%; 95% confidence interval, 6% to 20%) of these 86 events, and was more frequent with vinyl (10 of 42) than latex (one of 44) gloves (P < .01). After use, glove leaks were also more frequent in vinyl gloves (26 of 61) than with latex gloves (six of 70) (P < .001). Even when leaks were present, gloves prevented hand contamination in 77% of instances and quantitative counts of microorganisms contaminating hands were 2 to 4 logs less than counts on external glove surfaces. Health care workers reported awareness of the presence of glove leaks in only seven (22%) of the 32 events in which leaks were subsequently demonstrated. CONCLUSIONS--Under conditions of routine use, gloves effectively function as a protective barrier even when leaks are present. Latex gloves were less frequently associated with leaks and hand contamination. Since hand contamination occurred after 13% of exposures and cannot be readily identified by health care workers, routine hand washing should be done after each patient contact. In addition to the JAMA article that John provided which looked at the leakage rate of vinyl vs latex gloves to bacteria similar studies have been done using viruses with substantially similar results (1). Sterile surgical gloves do appear to have less liklihood of leaking compared to non-sterile gloves (2). Although even the latter may leak (3). Double gloving reportedly does not significantly lessen the likelihood of contamination but I would recommend it nonetheless in selected cases. In particular I had an experience several years ago while doing a particularly bloody delivery in the ED of having the (sterile) glove of my dominant hand rupture while in the vagina. I've been double gloving for these types of exams and procedures ever since. H. Louzon MD (1) Korniewicz DM, Laughon BE, Cyr WH, Lytle CD, Larson E Leakage of virus through used vinyl and latex examination gloves. J Clin Microbiol 1990 Apr;28(4):787-8 A total of 480 examination gloves (240 vinyl and 240 latex) were stressed by using manipulations designed to mimic patient care. At the highest use level, 38 (63%) of 60 vinyl gloves leaked bacteriophage phi X174 compared with 4 (7%) of 60 latex gloves. At lower use levels, there was no statistically significant difference in leakage. (2) Yangco BG, Yangco NF What is leaky can be risky: a study of the integrity of hospital gloves. Infect Control Hosp Epidemiol 1989 Dec;10(12):553-6 One thousand six-hundred and eighteen medical gloves were tested to determine whether, with current increased demands, these gloves are of high quality, i.e., free of leaks. The risk of exposure to potentially infected fluids when using leaky gloves was also estimated. Using a four-stage leak test, no significant difference was found between 64 of 790 (8.1%, range 0% to 44.4%) unsterile latex gloves and 11 of 210 (5.2%, range 1.7% to 21.7%) unsterile vinyl gloves (p = .21). Sterile surgical gloves (7 of 618, 1.13% [range 0% to 3%]) had fewer leaks compared to unsterile latex and vinyl gloves combined (p less than .0001). The safranin test was positive in 27 of 28 (96.4%) leaky gloves tested, indicating a high risk of exposure to potentially infected fluids when leaky gloves are used. Because of these findings, elements of "universal precautions" such as changing gloves after each patient contact and good handwashing after using gloves should be carefully observed. There is a need for the Food and Drug Administration to establish more stringent guidelines for manufacturing gloves and to verify compliance with these guidelines. (3) DeGroot-Kosolcharoen J, Jones JM Permeability of latex and vinyl gloves to water and blood. Am J Infect Control 1989 Aug;17(4):196-201 Two thousand four hundred medical gloves were evaluated for leakage. Types of gloves examined (number of brands) included sterile latex (seven)sterile vinyl (four), nonsterile latex (six), and nonsterile vinyl (seven).Sampling was done from one box of each brand. Fifty gloves from each box were filled with 300 ml of water (the standard test used by the American Society for Testing and Materials). An additional 25 cm pressure was applied to water-filled gloves. Another 50 gloves of each box were donned and dipped into a basin that contained heparinized human blood. Only four brands of sterile latex surgeon's gloves proved nonpermeable to water and blood.Other brands showed leakage that ranged from 1% to 52%. Analysis of proportions of pairs of gloves permeable to water or blood indicated a strong statistical association of nonsterile packaging or packaging in suction kits with increased leakage rates. These findings affirm that gloves can be regarded only as a means of reducing the risk of gross soilage from blood or body fluids. Quality control standards to ensure more uniform glove quality are needed. (4) Korniewicz DM, Kirwin M, Cresci K, Sing T, Choo TE, Wool M, Larson E Barrier protection with examination gloves: double versus single. Am J Infect Control 1994 Feb;22(1):12-5 In a series of experiments, the barrier integrity of single and double vinyl and latex examination gloves were tested for dye and water leaks after being placed under stress. A total of 886 examination gloves (385 vinyl: single, 199; double, 186; and 501 latex: single, 290; double, 211) were tested with a standardized clinical protocol designed to mimic patient care activities. Leakage rates for single or double gloving were significantly higher for vinyl than for latex gloves. Single vinyl gloves were significantly more likely to leak than were double vinyl gloves (51.3% and 19.7%, p < 0.0001). However, there were essentially no differences in leakage rates for single or double latex gloves (4.1% and 3.8%, p = 1). Significantly higher rates of leakage were identified with the water leak test than with the dye test for vinyl (p < 0.001) but not for latex (p = 0.22) gloves. For vinyl but not latex gloves, there were significant differences in leakage rates by brand. We conclude that double gloving offers little advantage during routine procedures associated with minimal stress to the gloves or when latex gloves are worn.