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Putting on gloves in the fight against AIDS.

Putting on gloves in the fight against AIDS

Gloves - and skill - are all that stand between laboratorians and the viral, bacterial, and infectious agents they handle all day. This latex barrier, finally accepted in the lab, is now an integral part of sound laboratory practice.

As indispensable as gloves have become, they represent only one component in the health care worker's protective arsenal. Other weapons against on-the-job exposure include biosafety education, biosafety engineering design, safety equipment, and the crux of the matter: compliance. Although compliance has soared in the last three years, much room for improvement remains concerning the proper use of gloves.

OSHA holds that it is the employer's responsibility to provide any necessary protective supplies, equipment, and devices. Yet in many instances, medical technologists must point out this fact to skeptical administrators. If that is the case in your laboratory, you might ask OSHA for a copy of its Feb. 27, 1990, enforcement procedures concerning occupational exposure to HBV and HIV (OSHA Instruction CPL 2-2, 44B), which spells out employers' obligations. Fines for non-compliance with safety regulations can easily run into thousands of dollars. This fact alone should help even the most unenlightened employer to see the light.

Providing safety equipment and supplies is one thing; getting employees to use them is another. Even after the CDC's 1987 announcement that three health care workers had contracted the AIDS virus on the job, laboratorians balked at donning "bulky and uncomfortable" gloves. Technologists complained about the loss of dexterity and about shoddy materials that did not stand up to the rigors of routine lab work.

Technologists who tried to comply, faithfully wearing gloves all day, often fell victim to dermatoses. We have seen cases in our lab that seemed to have come right out of the dermatology journals. Up to a full third of our laboratorians developed dermatoses. * Quality of gloves. Glove integrity is a major concern for laboratorians, who demand to know the point of wearing gloves that don't really protect them. We knew that some gloves were uncomfortable and that others tore almost as they emerged from the package - or when the technologist tried to put them on. To respond to our worried staff, we decided to test the quality of several brands of nonsterile gloves typically purchased by labs. * Clinical trial. We tested more than 5,000 gloves, two brands made of vinyl and three of latex, over the course of one month. More than 500 gloves were tested straight out of the box under standardized conditions.

Integrity was evaluated against standards from the American Society for Testing and Materials (ASTM). We attached the gloves to the bottom of a PVC cylinder, securing them with elastic bands. We then poured 300 ml of water into each glove and let them all stand for five minutes. (The ASTM now recommends using 1,000 ml of fluid in factory testing.)

When the timer went off, we carefully checked each glove for leaks. Most defects were easy to see. Some gloves, especially the vinyl ones, had ripped while being removed from the package. A few that initially appeared to be free of leaks developed pinpoint drops while standing. When this happened, we wiped the drops away and took another look to see whether drops continued to form. If water could penetrate these gloves, we reasoned, a virus would have no trouble doing so.

The results were dramatic. The vinyl gloves performed abysmally. The two vinyl brands posted failure rates of 6 per cent and 3 per cent, respectively, straight out of the box. The latex gloves did much better; in these, not a single pre-use defect was identified. * Field tests. An additional 3,278 gloves were put to the test at the bench. Each day we delivered a fresh supply of a single brand of gloves to the accessioning, hematology, and microbiology areas so that we could assess performance in three different types of lab work. The next day each department received a different brand.

The gloves used in accessionning had the highest failure rates. The constant labeling, twisting, tube-top removal, and writing and the great extent of manual manipulation took a toll. Microbiologists experienced the fewest glove failures at the bench.

We asked laboratorians to wear the gloves throughout their usual routines. On average, a pair of gloves lasted an hour, and each technologist used about five pairs of gloves per shift. At the end of the workday, we collected the used gloves and put them through the water test.

Figure I shows the post-use failure rate. The vinyl gloves did not stand up; their failure rates were 38.1 per cent and 30.6 per cent. The latex gloves did much better, with failure rates ranging from 2.9 to 15.9 per cent for the three brands. The Safeskin Hypo-Allergenic latex glove, with a failure rate of 2.9 per cent, significantly and consistently outperformed all other brands. The failure rate doubled for the next-best latex glove and was 10 times greater for the better of the two vinyl brands. * Qualitative performance. More subtle aspects of glove performance are more difficult to measure. Poor-quality gloves do little for morale. Laboratorians asked to use them are likely to feel that their safety is considered unimportant both to the manufacturer that made the product and to the administrators who bought them. This feeling may increase the fear of contracting an occupationally acquired disease.

It is demoralizing for lab administrators to try to enforce a glove policy that requires employees to wear gloves for their own benefit only to hear complaints that the gloves tear before they reach anyone's hands. Even worse is to face irate technologists waving their hands, raw with dermatitis, in your face and demanding to know why it is necessary to put up with this. Thirty per cent of our laboratorians contracted mild to moderate cases of dermatitis. All we could recommend was that they try various hand creams and wear the cotton glove inserts.

As a result of our study, we no longer purchase vinyl gloves. We have been using the top-ranking latex glove for several months now, and the staff is pleased. We have observed a dramatic improvement in attitude, confidence, and compliance. Bench workers report that the gloves tear less, last longer, fit better, and cause no irritation. Price is comparable with that of others.

Many chronic cases of dermatitis cleared up soon after the switch. A change to that brand's powder-free glove banished dermatitis entirely. Not a single case of dermatitis caused by the powder-free gloves has been reported by the approximately 1,600 technologists in our facility's various laboratories.

Our study demonstrated a significant variation in glove integrity in terms of the type of material used and the brand purchased. Testing confirmed the superior performance of latex gloves, both directly out of the box and after extensive use at the bench. The methodology is simple and could be duplicated in any laboratory. Fifteen or 20 pairs of gloves should be sufficient for a representative sample, especially when you consider that these gloves have supposedly already passed muster in factory testing. * Protection counts. It is impossible and foolish to downplay the importance of gloves to health care professionals. The Centers for Disease Control stunned the medical world when it announced the suspected transmission of HIV to a patient by a dentist wearing mask and gloves. Perhaps the equipment was not disinfected properly. Nevertheless, glove failure is a distinct possibility.

Employers have been charged with providing a safe working environment. To accomplish this, they may have to set up education and training programs to convince stubborn staffers to do what is good for them. Providing gloves that are comfortable and impermeable would constitute a good start. Fear of occupational exposure to AIDS and other blood-borne diseases is rampant. The profession can ill afford to lose more technologists.

General references:

Alpert, L.I. OSHA: New player in the battle against AIDS. MLO 22(4): 43-48, April 1990. Barman, M.R. AIDS precautions in practice. MLO 22(4): 24-33, April 1990.

Blackwell, H.; Brown, J.W.; Gulow, L.; et al. Focus on gloves: First line of defense in universal precautions. Presented at the annual meeting of the National Committee for Clinical Laboratory Standards, Washington, D.C., March 29, 1990. Abstract 03, p. 48.

Brown, B.L., and Brown, J.W. The Third International Conference on AIDS: Risk of AIDS in healthcare workers. Nurs. Management 19(3): 33-35, 1988.

Brown, J.W. Lab-related findings from the Sixth International AIDS Conference. MLO 22(8): 59-65, August 1990.

Brown, J.W.; Feeney, K.; and Gauch, R. Attitudes of medical technologists towards the acquired immunodeficiency syndrome. Abstract E746. Presented at the Fifth International AIDS Conference, Montreal, June 1989.

Brown, J.W., and Haider, M. Motivating and retaining clinical laboratory scientists in the face of adversity. Clin. Lab. Sci. 2(6): 338-340, 1989.

Brown, J.W., and Haider, M.H. The risk of AIDS to laboratorians: An update. MLO 22(4): 43-48, April 1990.

Centers for Disease Control. Recommendations for prevention of HIV transmission in health-care settings. MMWR 36(2S): 1S-16S, Aug. 21, 1987.

Centers for Disease Control. Possible transmission of HIV to a patient during an invasive dental procedure. MMWR 39:489-493, 1990.

Centers for Disease Control. Update: Human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. MMWR 36(19): 285-289, 1987.

Centers for Disease Control. Update: Universal precautions for prevention of human immunodeficiency virus, hepatitis B virus, and other blood-borne pathogens in health-care settings. MMWR 37:377-388, 1988.

Friedland, G.H.; Saltzman, B.R.; Rogers, M.F.; et al. Lack of transmission of HTLV-III/LAV infection to household contacts of patients with AIDS or AIDS-related complex with oral candidiasis. N. Engl. J. Med. 314:344-349, 1986.

National Committee for Clinical Laboratory Standards. "Protection of Laboratory Workers from Infectious Disease Transmitted by Blood, Body Fluids, and Tissue." NCCLS Document M29-T. Vol. 9, No. 1, 1989.

Resnik, L.; Veren, K.; Salahuddin, S.Z.; et al. Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments. JAMA 255: 1887-1891, 1986.

U.S. Department of Health and Human Services. "Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-care and Public Safety Workers: A Response to P.L. 100-607, the Health Omnibus Programs Extension Act of 1988." Washington, D.C., U.S. Government Printing Office, February 1989.

PHOTO : The authors check one of more than 5,000 gloves tested in their study. If drops of water appeared, the glove was wiped and rechecked. Subsequent formation of drops (left) caused the glove to be considered permeable to viruses.

PHOTO : Figure I Glove integrity after routine lab use

One reason for the poor integrity of vinyl gloves tested may have been their lack of elasticity. These gloves tend to rip so easily that simply removing them from the package intact can be problematic.

Dr. Brown is director of mircobiology and health and environmental affairs and Blackwell is associate manager of health and environmental affairs at Roche Biomedical Laboratories, Raritan, N.J.
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Author:Brown, James W.; Blackwell, Helen
Publication:Medical Laboratory Observer
Date:Nov 1, 1990
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