Infection Control Manual

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Page updated 30 September 2006

Glove Usage

General Comments

Note that non-sterile gloves protect the worker not the patient. If you employ good hygiene practices and clean your hands properly, you do not need gloves for most clinical purposes. When gloves are put on, they acquire your hand flora, so if you want gloved hands to be properly decontaminated, first, clean your hands properly before putting them on and secondly, rub the gloved hands with alcohol gel.

Gloves have a dual role:

Gloves should be worn when dealing with body fluids, secretions and excretions, and for nursing patients in source isolation. Gloves must be changed after nursing patients in source isolation or when they have been contaminated. They should be removed immediately and discarded into yellow plastic waste bags and hands should be washed and dried thoroughly to remove allergenic components of the glove material before the next task.

If, in special instances, gloves need to be worn for long periods of duty, then gloved hands must be washed and dried, or rubbed with alcohol gel with the same frequency as ungloved hands.

Important: Make a risk assessment of the procedure and decide whether to wear gloves. Choose your gloves according to the procedure to be carried out:

For aseptic techniques (mainly in the operating theatre, but also whenever an aseptic procedure is done at ward level), choose sterile gloves. For all other procedures, if gloves are considered necessary to protect the carer from contact with blood or other body fluids, choose non-sterile gloves. Remember that organisms from the hands get onto the gloves when they are put on and organisms picked up during a procedure are put back onto the hands when they are removed. Therefore gloves are no substitute for hand hygiene. Gloves can be disinfected by washing or applying alcohol gel (which does not degrade NRL gloves over >1hr of use.)

Gloves must fit properly. For this reason non-elastic gloves (plastic and vinyl) are generally not satisfactory. Tight gloves increase the risk of dermabrasion and finger muscle fatigue. Long term wearing of gloves leads to air occlusion and excessive sweating

Powdered gloves are now discouraged. If provided they must be returned to stores as not suitable. Gloves should be low in extractable proteins (<50mcg/g) and residual chemicals (<0.1% w/w). Gloves deteriorate with time and should not be used >3y after manufacture.

Gloves other than domestic (eg Marigold-type) are single use only. They must be discarded as clinical waste (yellow bag) except after food handling. There must be sufficient supplies of appropriate glove types and sizes in clinical areas.

Perforations

In surgery, perforations of gloves occur in 13-43% of operations. Double gloving is recommended for exposure prone procedures especially when perforation is a risk. Using two colour gloves will indicate perforation and the inner glove generally remains intact.

Activity Choose Alternative
All Surgery Sterile Latex Nitrile or polypropylene
All aseptic procedures with blood exposure
Sterile pharmaceutical procedures
   
Non aseptic procedures with exposure to blood
Handling sharps
Handling cytotoxics
Handling disinfectants
Tasks which may pull, twist or stretch gloves
Non-sterile latex Non-sterile nitrile or polypropylene
Handling aldehydes. Non-sterile nitrile or polypropylene  
Aseptic procedures, contact with blood unlikely Sterile vinyl  
Short-lived and non-manipulative tasks
Low risk of contact with blood
Tasks unlikely to pull, twist or stretch gloves
Cleaning with detergent
Non-sterile vinyl  
Food handling Non-sterile polythene  
Cleaning Domestic quality (e.g. Marigolds)  

Glove Materials

Material Notes
Natural rubber latex NRL

Long standing use

Close fitting

Established impermeable to blood borne viruses

Can reseal

Comfortable

Contain many chemicals and >200 proteins which may cause sensitisation

NRL with hydrogel

Easy to put on

Nitrile (acylonitrile)

Good biological barrier and resistant to glutaraldehyde

Similar chemical range as NRL

Occasional sensitivity seen

Difficult to sterilise

Release cyanide on incineration

Tactylon (multipolymer synthetic styrene-ethylene-butadine-styrene)

Similar elasticity and strength to NRL

No NRL proteins and chemicals

Rapidly broken down with non-solid methacrylates (eg bone cement)

Neoprene (polychloroprene)

Good alternative to NRL

Vinyl (polyvinyl chloride)

Lower strength than NRL

Increased permeability to viruses

Leakage rate up to 63%

Inflexible

Cheap

Reserve for activities with no blood contact, brief activities with no glove stress

Incineration leads to vinyl chloride (carcinogenic)

Polythene (ethylene co-polymer)

Heat sealed seams likely to split

Ill-fitting

Thin

Tear easily

Do not resist stress

85% permeable within 10’ of use

No indications for clinical use

Cornstarch powder

Replaced talc

But may also cause peritonitis and granulomas

When airborne as dust may carry chemicals from NRL

May contaminate prosthetic materials and act as a nidus of infection

Must not be used

NOTE: Polythene gloves are not recommended.

Sensitisation

If gloves supplied cause irritation, then staff must consult Occupational Health or Infection Control Nurse. It is wise to take an example of the glove and its name with you if visiting OH to discuss this problem. Reactions to gloves must be reported to the Medical Devices Agency by Occupational Health.

Natural latex gloves are associated with hypersensitivity reactions in between 6 and 18%. Alternative materials are therefore used. The preferred alternative material for sterile surgical gloves is synthetic nitrile/polypropylene and for non-surgical procedures is vinyl.

Natural rubber has many chemicals added during processing. These are partially washed off after the gloves have been made. However, residual chemicals may be allergenic. Cornstarch increases leaching of chemicals from rubber. Atopic people (with eczema and asthma) and those allergic to foods (eg avocado, passion fruit, banana, chestnut and potato) are more likely to be sensitised. Frequent use increase risk of sensitisation. Patients may be sensitive if repeatedly exposed. Their notes should be marked.

Carers with suspected allergy must go to Occupational health for advice. Once sensitized, many household effects may cause problems. Type 1 hypersensitivity is dangerous (risk of anaphylaxis) so appropriate precautions must be taken and a risk assessment be performed as to appropriateness of employment. It is almost impossible to construct an NRL-free environment.

Notes

Handcream. It is advisable to carry one's own personal tube of hand cream. Do NOT use multi-dose pots of cream, as these may become contaminated.

Skin lesions.
If any member of staff has a hand lesion, or experiences skin problems associated with handwashing, he or she should consult the Occupational Health Department. If skin problems such as eczema are present, then staff should report to the Occupational Health Department or ICN or manager for advice. Staff with eczema are at high risk of acquiring resistant hospital-associated staphylococci.

Cuts and abrasions on the hands must be adequately covered with an impermeable dressing when starting duty.

 

References

HSC 1999/186. Latex medical gloves and powdered latex medical gloves: reducing the risk of allergic reaction to latex and powdered medical gloves. United Kingdom Department of Health. 1999.

MDA DB 9601. Latex Sensitisation in the Health Care Setting (Use of Latex Gloves). United Kingdom Department of Health. Medical Devices Agency. 1996.