Torn Surgical Gloves Put Patients at Risk for Infection

TUESDAY, June 16 (HealthDay News) -- Holes in surgical gloves increase the risk of surgical site infection among patients who aren't given antibiotics before their surgery, Swiss researchers say.

In procedures lasting more than two hours, the rate of glove perforations ranges from 8 percent to 50 percent, according to a study published in the June issue of the Archives of Surgery.

Sterile gloves worn by surgical staff can be perforated by needles, bone fragments and sharp surgical instruments, and the resulting holes enable skin-borne pathogens to travel from the hands of surgical staff into patients.

In the study, Dr. Heidi Misteli and colleagues analyzed 4,417 surgical procedures performed at University Hospital Basel between 2000 and 2001, and found that sterile glove perforations occurred in 677 of the surgeries. Antibiotic therapy given before surgery to prevent infection was used in 3,233 of the surgeries, including 605 of the surgeries involving perforated gloves.

Overall, there were 188 surgical site infections (4.5 percent of surgeries), with 7.5 percent of infections occurring in procedures performed with perforated gloves and 3.9 percent occurring in procedures where gloves remained intact, the researchers found.

In surgeries where antibiotics were used, glove perforation wasn't associated with surgical site infection. Among patients who didn't receive antibiotics, surgical site infection rates were 12.7 percent when glove perforation occurred and 2.9 percent when there was no glove perforation.

"The present results support an extended indication of surgical antimicrobial prophylaxis [antibiotics] to all clean procedures in the absence of strict precautions taken to prevent glove perforation," Misteli and colleagues concluded. "The advantages of this surgical site infection prevention strategy, however, must be balanced against the costs and adverse effects of the prophylactic antimicrobials, such as drug reactions or increased bacterial resistance."

The study authors noted that procedures to reduce the risk of glove perforation -- such as double gloving and replacing gloves more frequently --are effective and safe and should be encouraged.

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Malaysia sends medical gloves to five African nations affected by Ebola

The Malaysian Government will send 20.9 million medical rubber gloves to five African nations that are affected by the deadly Ebola virus outbreak.

Malaysia will send 11 containers, each holding 1.9 million medical rubber gloves.

Liberia, Sierra Leone and Guinea will each receive three containers; Nigeria and the Democratic Republic of Congo will each receive one container.

Earlier, Prime Minister Datuk Seri Najib Razak had attended a symbolic handing-over ceremony of contribution from the Malaysian Government to the ambassadors of Ebola affected countries.

Also present was Deputy Foreign Affairs Minister Datuk Seri Hamzah Zainuddin and advisor in the Prime Minister's Department Tan Sri Dr Jamaludin Jarjis.

Others include representatives from Sime Darby, Felda, Kuala Lumpur Kepong and IOI Group plantations as well as those from Top Glove and other Malaysia Rubber Gloves Manufacturing Association (MARGMA).

In a statement issued Monday, the Prime Minister's office said some of the affected countries have appealed for help in their battle against the deadly virus, which has killed more than 2,000 people in West Africa.

It added that medical experts have cited the shortage of medical rubber gloves as a key problem in combating the outbreak.

A New Generation of Latex Gloves

More than 40,000 types of commercial products are made from natural rubber latex (NRL), an extract of the Pará rubber tree. Valued for its desirable properties, NRL is used in numerous products in the medical industry and elsewhere, including latex gloves. However, out of more than 200 proteins contained within NRL, 13 are known to be allergens. The American Latex Allergy Association estimates that up to 1 percent of the general population and 17 percent of health care workers exhibit some form of latex allergy, thus hindering their use of gloves made from this material.

Fortunately, a solution to the protein content of NRL exists. It involves the patent-protected addition of aluminum hydroxide, Al(OH)3, a well-known protein binding chemical, to latex while still in liquid form. This compound acts as a binding agent to the latex and produces protein complexes that can be removed using existing industry practices. The result is an ultra low-protein variant of NRL that retains the advantages of latex with most of the antigenic proteins removed. How is this patented aluminum hydroxide-modified NRL made, what advantages does it offer health care workers and others who wear latex gloves, and what makes it superior to standard NRL?

The treatment process for this type of modified NRL removes specific non-rubber impurities from NRL through the directed application of aluminum hydroxide. A commonly used absorbent, emulsifier, ion-exchanger, and antacid, aluminum hydroxide is commonly used in the process of water purification. It forms a jelly-like structure suspending unwanted materials in water, including bacteria.

Using traditional latex processing methods, a slurry of aluminum hydroxide can be strategically added to the harvested latex. The effective binding of protein and other non-rubber impurities from this latex emulsion to insoluble aluminum hydroxide occurs, with some of the non-rubber impurities adsorbed to the reactive surface of the aluminum hydroxide crystals.

With this patented processing step integrated into the manufacturing stage, there is no added expense of capital equipment. Reacted aluminum hydroxide complexes are removed by standard filtration and centrifugation. The remaining rubber particles retain the surrounding lipid layer, which, during subsequent maturation, improves the mechanical stability of the latex. Scientists have observed that this process yields products that exhibit greater clarity and significantly reduced odor, in addition to the removal of most of the antigenic proteins, without sacrificing the properties that give NRL advantages over synthetic alternatives. Prior industry efforts have produced reduced protein-source latex through the treatment of raw latex with enzymes, with little commercial success.

A New Latex Glove
The rise of the AIDS epidemic in the 1980s highlighted the widespread use of latex gloves to protect against infection. But for many health care professionals, the increased exposure to latex led to allergic reactions. Symptoms ranged from watery and itchy eyes to red and irritated skin, to breathing trouble and even life-threatening anaphylaxis. Some health care professionals developed dangerous latex allergies that, in some cases, limited or ended their care-providing careers. Latex gloves were also negatively perceived because of the powder associated with the gloves that left residue on users' hands and caused skin irritation.

It must be stressed that NRL gloves are known for their superior barrier properties and cost effectiveness. As such, they have been, and still are, widely used, particularly in health care settings where effective barrier protection is of great importance against viral transmission and infectious diseases. With the exception of vinyl or PVC gloves, which have been shown to provide lesser barrier protection, latex gloves are generally less expensive than many synthetic alternatives, such as polyisoprene, neoprene, and often nitrile.

There is thus an obvious market for this aluminum hydroxide-modified NRL in the surgical, examination, and industrial glove markets. Both surgical and examination gloves in manufacturer trials contained significantly fewer antigenic proteins than untreated control gloves. This indicates that glove manufacturers using the aluminum hydroxide-modified NRL as their raw material can adhere to ASTM glove protein compliance levels with only "pre-leaching" to remove residual compounding chemicals, thus conserving water and energy. While reducing the antigenic protein content, such gloves preserve the durability, comfort, fit, tactile sensitivity, and high resistance to puncture and tear for which NRL is known.

In August 2010, latex glove manufacturer Brightway Holdings SDN BHD Malaysia announced the successful culmination of material use evaluation trials of this aluminum hydroxide-modified NRL. Conducted at Biopro, one of Brightway's facilities in Malaysia, the results paved the way for the manufacture and market introduction of the first exam and cleanroom gloves made from this material.

The aluminum hydroxide-modified NRL not only contains significantly fewer antigenic and total proteins, but also results in a more stable, cleaner latex that requires fewer compounding additives during production. The reduction in certain non-rubber constituents that can break down over time contributes to its greater stability compared to standard NRL. Customer observations reflect the "clean" appearance and lack of odor in the expansive list of products made from this aluminum hydroxide-modified NRL.

Unlike most synthetic alternatives, aluminum hydroxide-modified NRL uses green chemistry to modify natural latex. The aluminum hydroxide-modified NRL derived from the rubber tree remains 100 percent natural. As proof, note that bacteria and fungi are capable of degrading NRL; one elegant experiment has demonstrated that latex balloons degrade equally, if not faster than, oak leaves. In contrast, many synthetic alternatives to latex, such as PVC vinyl, nitrile, neoprene, and polyurethane, which are made from petrochemical derivatives, are neither biodegradable nor compostable. The incineration of these synthetic products can lead to the liberation of toxins and carcinogens, such as dioxin, cyanide, vinyl chlorides, and hydrogen chloride. Unlike such synthetic alternatives, the aluminum hydroxide-modified NRL has minimal impact on the environment.

Another advantage to the use of this aluminum hydroxide-modified NRL is the decreased amount of water required for end-product manufacture. Within the latex-dipped goods industry, manufacturers have demonstrated increased efficiency by reducing processes such as excessive washing and leaching, typically used to reduce protein levels. This reduction can significantly lower water and energy consumption and simultaneously reduce the presence of harmful chemicals used in the manufacturing process, such as zinc in wastewater. The overall environmental impact is minimized, resulting in increased production cost savings. This aluminum hydroxide-modified NRL is slightly more expensive than traditional NRL but is priced comparably to nitrile and neoprene, other commodity-priced, albeit synthetic alternatives.

Raw, natural latex is a liquid. When dried and cured, the film dries semi-transparent yellow. Manufacturers can add whitening agents, such as titanium dioxide or calcium carbonate, to the latex to express whiteness in the finished product or to provide a white background for which color pigments can be used. A common alternative, the use of titanium dioxide, can be more expensive. Because the aluminum hydroxide-modified NRL is characteristically whiter in appearance, its use reduces the amount and cost of the whitening agents.

Collectively, these results suggest that manufacturers can achieve savings in energy and material costs when using aluminum hydroxide-modified NRL. Natural products that minimize environmental impact while maximizing economic, health, and safety benefits are critical to the sustainability of the latex industry. This need is addressed by commercializing the process of modifying NRL with aluminum hydroxide while enhancing its attributes and performance. The process of using aluminum hydroxide eliminates a significant portion of proteins and other non-rubber composition in latex, providing a cleaner, more stable raw material. In fact, the aluminum hydroxide-modified latex is the only NRL on the market today that meets the new ASTM D1076-10 Category 5 standard for a natural latex containing less than 0.5 percent non-rubber content.

The use of this aluminum hydroxide-modified latex is an option for manufacturers that are currently using standard latex across a broad scope of industries, including medical manufacturing. The performance benefits and attributes of this aluminum hydroxide-modified latex offer a unique value proposition to these manufacturers, allowing them to continue to capitalize on the green advantages of natural rubber latex. Production cost-saving opportunities using aluminum hydroxide-modified latex makes this a sensible material of choice for future generations. Balancing material acquisition and production costs, manufacturers can quantify the true cost savings of aluminum hydroxide-modified NRL.

It is clear that the development of aluminum hydroxide-modified NRL has the potential to pave the way for a new era in the use of latex gloves, both within and outside the health care arena. Caregivers prone to latex allergies may find a new class of products at their disposal. As production of aluminum hydroxide-modified NRL products ramps up in coming years, it is reasonable to expect that users and their organizations will find it a welcome alternative to standard NRL and petroleum-based synthetics.

This article originally appeared in the April 2011 issue of Occupational Health & Safety.

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Nine Myths About Disposable Safety Gloves

Disposable nitrile, natural latex, and vinyl gloves, often referred to as thin-mil gloves, are used in a variety of distinct applications. Understanding the truths about glove performance is important in selecting the right glove for each application.

Myth #1: More Texture Means Better Grip

One of the most common misconceptions about disposable gloves is that more texture results in better grip. In fact, texture has very little effect on grip. It is possible to make an extremely textured glove with low grip and a smooth-surfaced glove with high grip.

Surface treatment is the most significant factor in the grip level of a glove. Natural latex is inherently sticky, or tacky, much like glue. Without proper processing, natural latex sticks together like a large ball of adhesive. To reduce this tack, the surface must be treated. The most common surface treatments are surface chlorination and coating. Chlorination changes the surface properties and creates a hard, lower-tack shell around the glove. Coating technology adds a new, lower-tack layer to the glove.

Reality: Surface tack, or grip, can be controlled by the level of chlorination or the characteristics of the coating.

Myth #2: Gloves Remain Safe Throughout Use

Throughout use, gloves can develop holes due to degradation and wear. According to one study, after only 12 minutes of simulated clinical use, natural latex and vinyl glove defect rates increased to 9 percent and 35 percent, respectively. Without proper curing and cross-linking, nitrile can swell and develop holes or defects over time. Failure is commonly observed in the crotch between the thumb and forefinger.

In addition to formulation and process, use factors, such as average wear time and application, affect the inuse defect rate. Buyers should consider the potential defect rate increase and the risk imposed. They should ask their glove suppliers for supporting studies on in-use testing. Buyers and users can perform a representative test themselves by wearing a pair of new, tight-fitting gloves for the prescribed use time and then removing and filling the gloves with water to see whether a hole developed.

Reality: Gloves degrade during use.

Myth #3: Gloves Can Be '100%' Nitrile, Natural Latex, or Vinyl

Glove suppliers frequently claim glove composition of "100%" of the respective materials. Without additives, it is practically impossible to produce a usable glove of any of these materials. Adding curatives, cross-link agents, and accelerators to nitrile and natural latex is essential to making a strong, durable glove. Vinyl requires plasticizers and activation agents. Surfactants, which help with film formulation, are another additive found in most gloves. Formulations typically require 4-10 percent of additives to make a good glove.

Reality: Claims of "100%" nitrile, natural latex, or vinyl are not accurate.

Myth #4: Fillers Always Diminish Glove Performance

Fillers are used broadly in gloves. Most manufacturers use or have the ability to use fillers to help reduce the cost of making a glove. Fillers are often difficult, but possible, to detect through advanced technologies such as Thermal Gravimetric Analysis.

Fillers help to reduce the cost of a glove and, up to certain amounts, actually can improve specific performance characteristics. For example, tear strength is significantly improved in natural latex gloves when a moderate amount of calcium carbonate is added. The key word is "moderate." Fillers up to about 15 percent are tolerable; anything above that can become detrimental to the performance and quality of the glove in use. Some manufacturers have experimented with up to 50 percent filler, with limited success.

Reality: When used in moderation, fillers can improve certain disposable glove performance characteristics.

Myth #5: All Allergy Issues Can Be Addressed by Using Nitrile or Vinyl Instead of Natural Latex

Glove-related allergies are a primary concern to many glove users. The belief that glove-related allergies are caused only by natural latex is a common one. Latex allergies are the most serious glove allergies because they can be systemic and cause anaphylactic shock. Latex allergies are also the most common type of glove allergies.

Some users confuse chemical allergies with latex allergies. There are often components in both nitrile and vinyl gloves that can elicit a chemical allergy. For example, nitrile gloves, like natural latex gloves, often use carbamates or thiazoles, which can cause a skin allergy. Certain vinyl gloves use activation agents that can also cause skin allergies. In all cases, the less a glove is washed, the more chemical residue is available for potential contact to the user. Users should consult their physician if they suspect an allergy to gloves.

Reality: Natural latex is not the only glove material that can cause allergies.

Myth #6: 'Powder-free' Means 'Clean'

Surface treatment is the most common way to remove powder from a glove. Two types of surface treatment are chlorination and the addition of a wax or polymer coating. Chlorination is the traditional process and requires gloves to be washed prior to packing. The washing process is designed to rid the gloves of residual chemicals.

Wax and polymer coatings allow a glove manufacturer to "strip and pack," avoiding the chlorination and washing process. Wax and polymer coatings can leave residual chemicals that have not been properly washed. Though not always harmful, the residual chemicals can contribute to skin sensitivity or process contamination.

Reality: The process of making a glove "powder-free" can leave residual chemicals on the glove.

Myth #7: Chemical Resistance of Powder-free Natural Latex is Similar from Glove to Glove

As discussed in myth #6, powder is removed from gloves by chlorination or coating treatment. The treatment type, or lack thereof, can affect the chemical resistance properties of the glove. For example, natural latex gloves achieve better overall chemical resistance when chlorinated. Chlorination changes the surface properties and creates a hard shell around the glove. This "plasticized" shell has proper ties slightly different from natural rubber and provides additional chemical resistance that would otherwise not be available. On the downside, over-chlorination can damage gloves, making them brittle and unusable.

Reality: Latex gloves varies from glove to glove.

Myth #8: All Disposable Gloves are Basically the Same

Disposable gloves come in several different material types. The most common types are made from nitrile, natural latex, and vinyl. Each of these types is based on commodity raw materials with price fluctuations that depend on specific market factors. In general, nitrile is often considered premium to latex, which in turn is often considered premium to vinyl. The fact is that materials are not equal in performance in all applications. Nitrile has better puncture resistance of the three and resists more chemicals overall, including oils and solvents. Latex has better tear resistance, often fits better, and provides better dexterity. Vinyl has the best electrostatic dissipation properties and resists sulfuric acid better than nitrile or latex.

Even within the same material, there are significant differences from manufacturer to manufacturer. Other factors influencing glove performance are raw materials, formulation, process, and washing. These vary significantly from glove to glove and can result in performance differences in most applications. Typically, standards for the different materials also are not harmonized. ASTM exam glove standards have different tensile strength requirements for latex, nitrile, and vinyl. Vinyl has the most relaxed strength requirement, followed by nitrile, while latex has the highest tensile strength requirement of the three.

Reality: Multiple factors affect the performance of a disposable glove.

Myth #9: Lower Priced Gloves Always Result in Cost Savings

One of the biggest mistakes made by disposable glove buyers is buying based solely on price. The overall value of a glove is much more complicated than just the price of a box. In addition to price, buyers should consider durability in the application, safety risks, and productivity.

Many gloves are not properly formulated or processed. They are often under-cured and do not last long in application. Medical exam applications consume the majority of the disposable gloves produced globally and nurses, the largest users, typically wear a single pair of gloves for only a few minutes before discarding and replacing for each patient. On the other hand, many industrial applications require 2-4 hours of continuous use of a single pair of gloves. This extended length of time stresses the glove longer and can lead to failures in a glove that would not normally happen during a short, routine medical exam. For longer use times, it is important to choose a glove that is properly formulated and processed to withstand the application. A 10 percent savings can quickly be negated by a glove that lasts only half the time.

Productivity is another very important factor when considering the savings of one glove over another. Often, workers will be more productive with gloves that fit well, have good grip, and lower hand stress. In addition, beware of lower-quality gloves that fail, causing injury and the resulting cost associated with workplace accidents. Productivity and prevention are important factors when considering the economics of glove use.

Reality: Many factors determine the "value" of a disposable glove.

Conclusion Choosing the right glove type or source is not as simple as reviewing a specification or buying at the lowest price. A number of critical factors should be considered. Understanding the truths about glove performance is important in selecting the right glove for each application.

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How to Choose the Right Medical Gloves

Like any healthcare professional, those working in small medical offices know that protection against blood and other bodily fluids is essential for preventing disease and the transmission of illnesses. Medical gloves are one of the first lines of defense.

In general, medical gloves are made of polymers like latex, nitrile rubber, vinyl, neoprene and polyisoprene. Each material has its own strengths and benefits and is best suited for specific types of work. Before you place an order, it’s important to know which type of glove will best meet your needs.

Latex
For jobs that require extended wear times, latex exam gloves are a good choice. Latex offers great performance and the best comfort and fit of any glove type. However, some people have allergic reactions to latex, which is a major downside to choosing this material. And latex is weak against some chemicals used in medical and industrial settings. Also worth noting: Latex rubber is a natural product, so fluctuating raw material costs can cause pricing to change rapidly.

Nitrile Rubber
Advances in technology have allowed manufacturers to use nitrile rubber to re-create the feel of a latex glove while eliminating allergy concerns. Nitrile exam gloves have become a go-to alternative partly because they are more puncture- and abrasion-resistant than latex. And because nitrile gloves are also more resistant to chemicals, they are a good choice for tough medical and industrial jobs, or jobs where chemicals are involved.

Vinyl
Vinyl exam gloves are the most cost-effective choice for small medical offices. These gloves excel at short-term jobs where comfort is not a concern, frequent glove changes are required and a basic barrier will suffice. Vinyl gloves have the lowest puncture and chemical resistances.

Vinyl gloves are less elastic than latex and nitrile, so when you choose this type, you sacrifice comfort and fit. That said, manufacturers have made advancements to improve the fit and feel of vinyl gloves, which has allowed multiple generations of them to exist in the market. For example, 3G vinyl (a patented third-generation stretch vinyl) is the most advanced to date.

Neoprene
In the surgical field, you will often find neoprene gloves. This latex-free alternative provides protection from harsh chemicals, acids, solvents, oil, grease and much more, and is another economical choice.

Polyisoprene
Polyisoprene is a synthetic rubber formulation also found in some surgical gloves. These gloves have the benefit of being nearly identical to latex gloves in terms of fit and feel. When comfort, protection and tactile sensitivity are important, polyisoprene gloves offer an edge over neoprene surgical gloves.

Other Things to Consider When Purchasing Medical Gloves

Beyond the glove’s material, it’s important to consider whether you want the gloves to be powdered or nonpowdered. Powdered gloves have a powder-like substance, such as cornstarch, inserted into the glove to act as a lubricant, making it easier to put them on and take them off. Nonpowdered gloves typically use a polymer coating. The disposable glove industry has been trending away from powdered gloves due to concerns about residue contamination.

You can also find gloves that have a coating of organic aloe to moisturize hands during use. Hand washing and constant glove wearing can cause skin irritation, which sometimes leads healthcare professionals to stop following proper hand-washing procedures. Natural body heat activates the aloe so hands stay soft and smooth throughout the gloves’ use.

An Essential Part of the Uniform

Medical gloves are an essential part of the uniform for many workers in small healthcare offices. Getting the right gloves for the job is critical and can make all the difference in day-to-day work.

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Frequently asked questions on Ebola virus disease

1. What is Ebola virus disease?
Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a severe, often fatal illness, with a death rate of up to 90%. The illness affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees).

Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan.

The origin of the virus is unknown but fruit bats (Pteropodidae) are considered the likely host of the Ebola virus, based on available evidence.

2. How do people become infected with the virus?
Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has occurred through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. It is important to reduce contact with high-risk animals (i.e. fruit bats, monkeys or apes) including not picking up dead animals found lying in the forest or handling their raw meat.

Once a person comes into contact with an animal that has Ebola, it can spread within the community from human to human. Infection occurs from direct contact (through broken skin or mucous membranes) with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people. Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments that have become contaminated with an Ebola patient’s infectious fluids such as soiled clothing, bed linen, or used needles.

Health workers have frequently been exposed to the virus when caring for Ebola patients. This happens because they are not wearing personal protection equipment, such as gloves, when caring for the patients. Health care providers at all levels of the health system – hospitals, clinics and health posts – should be briefed on the nature of the disease and how it is transmitted, and strictly follow recommended infection control precautions.

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Persons who have died of Ebola must be handled using strong protective clothing and gloves, and be buried immediately.

People are infectious as long as their blood and secretions contain the virus. For this reason, infected patients receive close monitoring from medical professionals and receive laboratory tests to ensure the virus is no longer circulating in their systems before they return home. When the medical professionals determine it is okay for the patient to return home, they are no longer infectious and cannot infect anyone else in their communities. Men who have recovered from the illness can still spread the virus to their partner through their semen for up to 7 weeks after recovery. For this reason, it is important for men to avoid sexual intercourse for at least 7 weeks after recovery or to wear condoms if having sexual intercourse during 7 weeks after recovery.

3. Who is most at risk?
During an outbreak, those at higher risk of infection are:

• health workers;
• family members or others in close contact with infected people;
• mourners who have direct contact with the bodies of the deceased as part of burial ceremonies; and
• hunters in the rain forest who come into contact with dead animals found lying in the forest.

More research is needed to understand if some groups, such as immuno-compromised people or those with other underlying health conditions, are more susceptible than others to contracting the virus.

Exposure to the virus can be controlled through the use of protective measures in clinics and hospitals, at community gatherings, or at home.

4. What are typical signs and symptoms of infection?
Sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.

Laboratory findings include low white blood cell and platelet counts, and elevated liver enzymes.

The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. The patients become contagious once they begin to show symptoms. They are not contagious during the incubation period.

Ebola virus disease infections can only be confirmed through laboratory testing.

5. When should someone seek medical care?
If a person has been in an area known to have Ebola virus disease or in contact with a person known or suspected to have Ebola and they begin to have symptoms, they should seek medical care immediately.

Any cases of persons who are suspected to have the disease should be reported to the nearest health unit without delay. Prompt medical care is essential to improving the rate of survival from the disease. It is also important to control spread of the disease and infection control procedures need to be started immediately.

6. What is the treatment?
Severely ill patients require intensive supportive care. They are frequently dehydrated and need intravenous fluids or oral rehydration with solutions that contain electrolytes. There is currently no specific treatment to cure the disease.

Some patients will recover with the appropriate medical care.

To help control further spread of the virus, people that are suspected or confirmed to have the disease should be isolated from other patients and treated by health workers using strict infection control precautions.

7. What can I do? Can Ebola be prevented?
Currently there is no licensed vaccine for Ebola virus disease. Several vaccines are being tested, but none are available for clinical use right now.

Raising awareness of the risk factors and measures people can take to protect themselves are the only ways to reduce illness and deaths.

Ways to prevent infection and transmission

While initial cases of Ebola virus disease are contracted by handling infected animals or carcasses, secondary cases occur by direct contact with the bodily fluids of an ill person, either through unsafe case management or unsafe burial practices. During this outbreak, most of the disease has spread through human-to-human transmission. Several steps can be taken to help in preventing infection and limiting or stopping transmission.

• Understand the nature of the disease, how it is transmitted, and how to prevent it from spreading further. (For additional information, please see the previous questions about Ebola virus disease in this FAQ.)
• Listen to and follow directives issued by your country’s respective Ministry of Health.
• If you suspect someone close to you or in your community of having Ebola virus disease, encourage and support them in seeking appropriate medical treatment in a care facility.
• If you choose to care for an ill person in your home, notify public health officials of your intentions so they can train you and provide appropriate gloves and personal protective equipment (PPE), as well as instructions as a reminder on how to properly care for the patient, protect yourself and your family, and properly dispose of the PPE after use.
• When visiting patients in the hospital or caring for someone at home, hand washing with soap and water is recommended after touching a patient, being in contact with their bodily fluids, or touching his/her surroundings.
• People who have died from Ebola should only be handled using appropriate protective equipment and should be buried immediately.

Additionally, individuals should reduce contact with high-risk infected animals (i.e. fruit bats, monkeys or apes) in the affected rainforest areas. If you suspect an animal is infected, do not handle it. Animal products (blood and meat) should be thoroughly cooked before eating.

8. What about health workers? How do they protect themselves from the high risk of caring for sick patients?
Health workers treating patients with suspected or confirmed illness are at higher risk of infection than other groups.

• In addition to standard health care precautions, health workers should strictly apply recommended infection control measures to avoid exposure to infected blood, fluids, or contaminated environments or objects – such as a patient’s soiled linen or used needles.
• They should use personal protection equipment such as individual gowns, gloves, masks and goggles or face shields.
• They should not reuse protective equipment or clothing unless they have been properly disinfected.
• They should change gloves between caring for each patient suspected of having Ebola.
• Invasive procedures that can expose medical doctors, nurses and others to infection should be carried out under strict, safe conditions.
• Infected patients should be kept separate from other patients and healthy people, as much as possible.

9. What about rumours that some foods can prevent or treat the infection?
WHO strongly recommends that people seek credible health advice about Ebola virus disease from their public health authority.

While there is no specific drug against Ebola, the best treatment is intensive supportive treatment provided in the hospital by health workers using strict infection control procedures. The infection can be controlled through recommended protective measures.

10. How does WHO protect health during outbreaks?
WHO provides technical advice to countries and communities to prepare for and respond to Ebola outbreaks.

WHO actions include:

• disease surveillance and information-sharing across regions to watch for outbreaks;
• technical assistance to investigate and contain health threats when they occur – such as on-site help to identify sick people and track disease patterns;
• advice on prevention and treatment options;
• deployments of experts and the distribution of health supplies (such as personal protection gear for health workers) when they are requested by the country;
• communications to raise awareness of the nature of the disease and protective health measures to control transmission of the virus; and
• activation of regional and global networks of experts to provide assistance, if requested, and mitigate potential international health effects and disruptions of travel and trade.

11. During an outbreak, numbers of cases reported by health officials can go up and down? Why?
During an Ebola outbreak, the affected country’s public health authority reports its disease case numbers and deaths. Figures can change daily. Case numbers reflect both suspected cases and laboratory-confirmed cases of Ebola. Sometimes numbers of suspected and confirmed cases are reported together. Sometimes they are reported separately. Thus, numbers can shift between suspected and confirmed cases.

Analyzing case data trends, over time, and with additional information, is generally more helpful to assess the public health situation and determine the appropriate response.

12. Is it safe to travel during an outbreak? What is WHO’s travel advice?
During an outbreak, WHO reviews the public health situation regularly, and recommends any travel or trade restrictions if necessary.

The risk of infection for travelers is very low since person-to-person transmission results from direct contact with the body fluids or secretions of an infected patient.

WHO’s general travel advice

• Travelers should avoid all contact with infected patients.
• Health workers traveling to affected areas should strictly follow WHO-recommended infection control guidance.
• Anyone who has stayed in areas where cases were recently reported should be aware of the symptoms of infection and seek medical attention at the first sign of illness.
• Clinicians caring for travelers returning from affected areas with compatible symptoms are advised to consider the possibility of Ebola virus disease.

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Are There Hidden Dangers in Food Prepared with Latex Gloves? - See more at:

If you have a latex allergy, you could be in danger of having an allergic reaction at your local family restaurant. Recent studies have found that latex gloves worn during food preparation can shed latex proteins into the food in amounts large enough to cause reactions.

The studies were a result of multiple reports from latex-allergic individuals who claimed that they had experienced allergic reactions from eating food at restaurants that used latex gloves. One study done at the Guthrie Research Institute found that fingerprints of latex proteins were detectable on cheese and lettuce that were handled with latex gloves. No latex proteins were found on lettuce handled with vinyl gloves. You can read the abstract from this study here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11061040&dopt=Abstract

Awareness of this problem is increasing, thanks to state legislation and education by food industry associations. The following is a list of recent developments.

• Oregon has banned the use of latex gloves in food service facilities.
• The Arizona Department of Health Services has updated the requirements for food safety in restaurants and other food establishments, and has included the rule that "people...handling foods that are ready to eat without additional cooking must use utensils or non-latex gloves..." (http://www.azdhs.gov/phs/oeh/pdf/fy02_activity_summary.pdf)
• Rhode Island has banned the use of latex gloves in food service establishments and stores licensed by the Office of Food Protection. (http://www.health.ri.gov/environment/food/foodallergy.php)
• The State Assembly of New York passed a bill that requires any food service establishment that uses latex gloves to provide written notice to consumers as follows: "Latex gloves are used by staff in the preparation and conveyance of food in this establishment. If you are allergic to latex products, please take appropriate precautions."
• The State Senate and House of Massachusetts amended the General Laws by adding a section stating that latex gloves are banned from every food service business and that any establishment not in compliance can be assessed a fine up to $100.

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Glove use

Q. Can staff wear gloves instead of cleaning their hands?
A. No. Gloves are not a substitute for handwashing or hand disinfection. Glove usage should be appropriate for the task in hand and removed at the end of the task for which they were worn.

The WHO Guidelines on Hand Hygiene in Health Care emphasise that the use of gloves does not replace the need for hand cleansing by either handrub or handwashing and that gloves should be removed after caring for a patient. It is also emphasised that the same pair of gloves should not be worn for the care of more than one patient. The advice goes even further, indicating that when wearing gloves they should be changed or removed during patient care if moving from a contaminated body site to a clean body site within the same patient.

Q. Do you need to clean your hands if you wear gloves?
A. Yes. Gloves used in healthcare may have holes in them allowing infectious agents to pass between the carer’s hands onto the patient, in either direction. Additionally, the hands of someone wearing rubber or latex gloves are well suited to bacterial growth, being warm and moist. Hands should be cleaned before and after every care activity and after any activity that may result in them being contaminated (ie, after exposure to body fluids), regardless of whether gloves are used.

Q. Should hands be cleaned with soap and water rather than cleansed with alcohol handrub after gloves are removed?
A. The Center for Disease Control (CDC) guidelines state that use of alcohol handrubs is ok after disposable gloves are used. The alcohol handrub supplier should advise whether their product will adversely impact on skin if used immediately after glove removal.

Q. Can alcohol be used on gloved hands?
A. No. Staff should not use the alcohol handrub whilst gloves are on their hands. This will not replace the need for gloves to be changed. Also the integrity of the glove may be breached, posing an infection risk (the product supplier can advise on this).

The WHO guidelines make it clear that the use of gloves does not replace the need for hand cleaning by either handrub or handwashing. If alcohol handrubs are used after glove removal, it is very important that staff allow the alcohol to dry properly before donning gloves again.

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Glove

Gloves can protect both patients and healthcare workers from exposure to infectious agents that may be carried on hands (Duckro et al 2005). As part of standard precautions, they are used to prevent contamination of healthcare workers’ hands when (Siegel et al 2007):

• anticipating direct contact with blood or body substances, mucous membranes, non-intact skin and other potentially infectious material; and
• handling or touching visibly or potentially contaminated patient-care equipment and environmental surfaces (Boyce & Pittet 2002; Bhalla et al 2004; Duckro et al 2005).

The capacity of gloves to protect healthcare workers from transmission of bloodborne infectious agents following a needlestick or other puncture that penetrates the glove barrier has not been determined (Siegel et al 2007).

Gloves are an essential component of contact precautions (in particular for patients with MROs) (see Sections B2.2.3 and B3.1.2) and may also be used as part of droplet precautions (see Section B2.3.3).

When and how should gloves be worn?
As with all PPE, the need for gloves is based on careful assessment of the task to be carried out and the related risk of transmission of microorganisms to the patient and the risk of contamination of the healthcare worker’s clothing and skin by the patient’s blood and body substances (Pratt et al 2001; Clark et al 2002). Risk assessment includes consideration of:

• who is at risk (whether it is the patient or the healthcare worker);
• whether sterile or non-sterile gloves are required, based on contact with susceptible sites or clinical devices and the aspect of care or treatment to be undertaken;
• the potential for exposure to blood or body substances;
• whether there will be contact with non-intact skin or mucous membranes during general care and invasive procedures; and
• whether contaminated instruments will be handled.

When gloves are worn in combination with other PPE, they are put on last (see Section B1.2.7).

When should gloves be changed?
International guidance suggests that changing of gloves is necessary:

• between episodes of care for different patients, to prevent transmission of infectious material (Pratt et al 2001; Siegel et al 2007);
• during the care of a single patient, to prevent cross-contamination of body sites (CDC 1995; Boyce & Pittet 2002); and
• if the patient interaction involves touching portable computer keyboards or other mobile equipment that is transported from room to room (Siegel et al 2007).

Prolonged and indiscriminate use of gloves should be avoided as it may cause adverse reactions and skin sensitivity (Pratt et al 2001; Clark et al 2002).

Hand hygiene should be performed before putting on gloves and after removal of gloves. Single-use gloves should not be washed, but discarded.

Recommendations

7 Wearing of gloves
Gloves must be worn as a single-use item for:

• each invasive procedure;
• contact with sterile sites and non-intact skin or mucous membranes; and
• activity that has been assessed as carrying a risk of exposure to blood, body substances, secretions and excretions

Gloves must be changed between patients and after every episode of individual patient care.

8 Sterile gloves
Sterile gloves must be used for aseptic procedures and contact with sterile sites.

What type of gloves should be worn?
Non-sterile single-use medical gloves are available in a variety of materials, the most common being natural rubber latex (NRL) and synthetic materials (e.g. nitrile). NRL remains the material of choice due to its efficacy in protecting against bloodborne viruses and properties that enable the wearer to maintain dexterity (Pratt et al 2001; Clark et al 2002). However, sensitivity to NRL in patients, carers and healthcare workers may occur (see below) and must be documented. A local policy is required on using alternative glove types when patients have latex allergies.

The selection of glove type for non-surgical use is based on a number of factors (Korniewicz et al 1994; Bolyard et al 1998; Korniewicz & McLeskey 1998; Ranta & Ownby 2004):

• the task to be performed (i.e. glove type should be fit for purpose and aim to avoid interference with dexterity, friction, excessive sweating or finger and hand muscle fatigue);
• anticipated contact with chemicals and chemotherapeutic agents; and
• personal factors, such as latex sensitivity and size.

Facility policies for creating a latex-free environment should also be taken into account.

Table B1.7: Selection of glove type

Sources: Derived from Kotilainen et al 1989; Korniewicz et al 1989; Korniewicz et al 1993; Rego & Roley 1999; Pratt et al 2001; Korniewicz et al 2002; Sehulster & Chinn 2003; Siegel et al 2007; Queensland Health 2010.

Latex allergy
Latex allergy is a reaction to certain proteins in latex rubber. The amount of latex exposure needed to produce sensitisation or an allergic reaction is unknown. However, current understanding of latex allergy is as follows (NIOSH 1998):

• increasing the exposure to latex proteins increases the risk of developing allergic symptoms — most people who are allergic to latex have had frequent exposure to latex over many years; the majority are nurses, doctors, dentists or patients who have had a number of operations;
• in sensitised people, symptoms usually begin within minutes of exposure; but they can occur hours later and can be quite varied — mild reactions involve skin redness, rash, hives, or itching; more severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat, and asthma (difficult breathing, coughing spells, and wheezing); and rarely, shock may occur although a life-threatening reaction is seldom the first sign of latex allergy; and
• the risk of latex allergy is influenced by the amount of protein/allergen and powder in the latex glove; not by powder alone (Hunt et al 2002).

Healthcare workers with latex allergies should inform their managers to ensure that their work areas can be latex free.

If latex gloves are used, they should be non-powdered due to the risks associated with aerosolisation and an increased risk of latex allergies.

Removing and disposing of gloves
Gloves (other than utility gloves) should be treated as single-use items. They should be put on immediately before a procedure and removed as soon as the procedure is completed.

When removing gloves, care should be taken not to contaminate the hands. After gloves have been removed, hand hygiene should be performed in case infectious agents have penetrated through unrecognised tears or have contaminated the hands during glove removal (Olsen et al 1993; Tenorio et al 2001; Boyce & Pittet 2002).

Gloves must not be washed for subsequent re-use — infectious agents cannot be removed reliably from glove surfaces and continued glove integrity cannot be ensured. Glove re-use has been associated with transmission of methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacilli (Doebbeling et al 1988; Maki et al 1990; Olsen et al 1993).

Gloves should be disposed of as soon as they are removed, with disposal complying with local policies and standards.

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THE FIRST GLOBAL PATIENT SAFETY CHALLENGE
Clean Care is Safer Care

GLOVE USE (technical)

Evidence and different considerations on glove use
It is widely recommended that health-care workers (HCWs) wear gloves for two main reasons: (i) to prevent microorganisms which may be infecting, commensally carried, or transiently present on HCWs’ hands from being transmitted to patients and from one patient to another; (ii) to reduce the risk of HCWs themselves acquiring infections from patients.

The effectiveness of gloves in preventing contamination of HCWs’ hands and helping to reduce transmission of pathogens has been confirmed in several clinical studies.

Nevertheless HCWs should be informed that gloves do not provide complete protection against hand contamination. Bacterial flora colonizingpatients may be recovered from the hands of up to 30% of HCWs whowear gloves during patient contact. In such instances, pathogens presumably gain access to the caregivers’ hands via small defects in gloves or bycontamination of the hands during glove removal.

The impact of wearing gloves on adherence to hand hygiene policies has not been definitively established, since published studies have yielded contradictory results. Several studies found that HCWs who wore gloves were less likely to cleanse their hands upon leaving a patient’s room. In contrast, other studies proved the direct opposite. The recommendation to wear gloves during an entire episode of care of a patient undergoing isolation precautions could actually lead to HCWs missing opportunities for hand hygiene

Use of gloves
Gloves should be worn during all patient-care activities that may involve exposure to blood or body fluids contaminated with blood. In addition, gloves should be worn in activities that include contact with potentially infectious material other than blood, such as mucous membranes, and non-intact skin or during outbreak situations, as recommended by specific requirements for Personal Protective Equipment (PPE).

The unnecessary use of gloves in situations when their use is not recommended represents a waste of resources without necessarily leading to a reduction of cross-transmission and may also result in missed opportunities for hand hygiene.

It is important that HCWs are able to correctly select the most appropriate type of gloves to be worn and to differentiate between specific clinical situ ations when gloves should be worn and changed and those where their use is not recommended (see pyramid overleaf).

Glove reprocessing must be strongly discouraged and should be avoided, even if it is common practice in many health-care settings in developing countries where glove supply is limited. At present no standardized, validated and affordable procedure for safe glove reprocessing exists. Every possible effort should be made to prevent the occurrence of glove reuse in health-care settings. This includes educational activities to reinforce the need to reduce inappropriate glove use, purchasing good quality disposable gloves and replenishing stocks in time. Further research is needed to identify a standardized glove reprocessing procedure, to evaluate the integrity of different glove material when exposed to different products used for hand antisepsis or handwashing (e.g. alcohol, chlorhexidine, or iodine solutions) and to develop a valid evaluation process for settings practicing or planning the reprocessing of gloves, in order to minimize this practice.

Key messages for glove use:

• Gloves are effective in preventing contamination of HCWs’ hands and helping reduce transmission of pathogens.
• Gloves do not provide complete protection against hand contamination.
• HCWs should be reminded that failure to remove gloves may contribute to the transmission of organisms.
• If the integrity of a glove is compromised (e.g., punctured), it should be changed as soon as possible.
• HCWs should be trained in planning the sequence of procedures in a rational manner which limits the use of gloves and to use non-touch techniques as much as possible during care. The emphasis should be on minimizing the need for glove use and change.
• In some published studies, vinyl gloves more frequently had defects than did latex gloves, the difference being greatest after use.
• It is appropriate to have more than one type of glove available.
• Use of petroleum-based hand lotions or creams may adversely affect the integrity of latex gloves and some alcohol-based handrubs may interact with residual powder on HCWs’ hands.
• The unnecessary use of gloves in situations where their use is not appropriate should be avoided

Recommendations on glove use:

• The use of gloves does not replace the need for hand cleansing by either handrubbing or handwashing.
• Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, or nonintact skin will occur.
• Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient.
• When wearing gloves, change or remove gloves in the following situations: during patient care if moving from a contaminated body site to a clean body site within the same patient; after touching a patient; after touching a contaminated site and before touching a clean site or the environment.
• Avoid the reuse of gloves. If gloves are reused, an adequate and validated reprocessing method needs to be developed to ensure glove integrity and microbiological decontamination.
• Double gloving in countries with a high prevalence of HBV, HCV and HIV for long surgical procedures (>30 minutes), for procedures with contact with large amounts of blood or body fluids, for some high-risk orthopedic procedures, is considered an appropriate practice.

Gloves must be worn according to STANDARD and CONTACT PRECAUTIONS. The pyramid details some clinical examples in which gloves are not indicated, and others in which clean or sterile gloves are indicated. Hand hygiene should be performed when appropriate regardless of these indications for glove use.

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Glove Selection Guide

Summary: Use this checklist to choose the appropriate type of protective glove for your job. The Glove Selection Chart also provides advantages and disadvantages for specific glove types. This guidance was prepared for laboratory researchers but may also be helpful for other people working with hazardous materials.

Once selected, glove use requirements for your lab should be posted in your Chemical Hygiene Plan flipchart under the Standard Operating Procedures section.
Questions about glove selection?
Please contact the Office of Environment, Health and Safety at 642-3073 or [email protected].

Glove material	Intended use	Advantages and disadvantages	Example Photos
Latex (natural rubber)	Incidental contact	Good for biological and water-based materials. Poor for organic solvents. Little chemical protection. Hard to detect puncture holes. Can cause or trigger latex allergies
Nitrile	Incidental contact (disposable exam glove) Extended contact (thicker reusable glove)	Excellent general use glove. Good for solvents, oils, greases, and some acids and bases. Clear indication of tears and breaks. Good alternative for those with latex allergies.
Butyl rubber	Extended contact	Good for ketones and esters. Poor for gasoline and aliphatic, aromatic, and halogenated hydrocarbons.
Neoprene	Extended contact	Good for acids, bases, alcohols, fuels, peroxides, hydrocarbons, and phenols. Poor for halogenated and aromatic hydrocarbons. Good for most hazardous chemicals.
Norfoil	Extended contact	Good for most hazardous chemicals. Poor fit (Note: Dexterity can be partially regained by using a heavier weight Nitrile glove over the Norfoil/Silver Shield glove.
Viton	Extended contact	Good for chlorinated and aromatic solvents. Good resistance to cuts and abrasions. Poor for ketones. Expensive.
Polyvinyl chloride (PVC)	Specific use	Good for acids, bases, oils, fats, peroxides, and amines. Good resistance to abrasions. Poor for most organic solvents.
Polyvinyl alcohol (PVA)	Specific use	Good for aromatic and chlorinated solvents. Poor for water-based solutions.
Stainless steel Kevlar Leather	Specific use	Cut-resistant gloves. Sleeves are also available to provide protection to wrists and forearms. (If potential for biological or chemical contamination: wear appropriate disposable gloves on top of your cut-resistant gloves and discard after use).
Cryogenic Resistant Material Leather	Specific use	For use with cryogenic materials. Designed to prevent frostbite. Note: Never dip gloves directly into liquid nitrogen.
Nomex	Specific use	For use with pyrophoric materials. Consider wearing a flame-resistant glove such as a Nomex 'flight' glove with a thin nitrile exam glove underneath.

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Foreword

This second edition of the ADA Guidelines for Infection Control incorporates a number of changes that have arisen since the publication of the first edition in 2008, including the release in October 2010 of the National Health and Medical Research Council (NHMRC) Australian Guidelines for the Prevention and Control of Infection in Healthcare .It is the intention of the Australian Dental Association Inc. (ADA) that these infection control guidelines will be updated every three years to ensure that they remain aligned to the evidence base of infection control.

The current edition of the ADA Guidelines is the result of over 20 years of dedicated work by the members of the ADA’s Infection Control Committee. During that time the Committee has assisted external expert bodies such as the NHMRC and the Communicable Diseases Network of Australia (CDNA) help define safe practice. Quite fittingly, the ADA Guidelines are now recognised as a key source of information for the NHMRC Guidelines, and have been identified by the Dental Board of Australia as a major resource for dental practitioners.

The production of this document has required a considerable effort over a long period. Special thanks and acknowledgment are due to the current members of the ADA’s Infection Control Committee (chaired by Professor Laurence Walsh) for their generous donation of time and their technical advice and expertise in preparing this document.

The ADA declares that no conflict of interest existed in the development of these guidelines, and that they have been developed independently without any corporate interest or sponsorship.

F Shane Fryer
President
Australian Dental Association Inc.

To view the complete guidelines click here to download the document.