Pandemonium over gloves: use and abuse

“Bare” or “Gloved” Hands: A Study on the Production of Safe Food

There is no documented evidence proving that the meat products produced by “gloved” hands are safer than those produced by “bare” hands. Thus, this paper proposes to conduct a microbiological investigation to assess cross-contamination between handlers and poultry products in three distinct processing situations: without the use of gloves (bare hands), with the use of reusable gloves and using disposable gloves. The microbiological results showed that the use of hands protected by disposable gloves was significantly better (p < 0.05) compared to the use of bare hands and hands containing reusable gloves. Thus, the adoption of disposable gloves combined with good manufacturing practices training seems to be the most reliable alternative to reduce handler–food contamination during the preparation of poultry products.

Efficacy of novel antimicrobial gloves impregnated with antiseptic dyes in preventing the adherence of multidrug-resistant nosocomial pathogens

BACKGROUND

Contaminated gloves are a major source of transmission of bacteria in the hospital and food industry. We investigated the efficacy of gloves impregnated with a combination of antiseptics consisting of brilliant green dye and chlorhexidine (Gardine).

METHODS

Gardine-coated and uncoated 1-cm(2) segments of latex examination and nitrile examination gloves (Spontex, Columbia, TN) were exposed to 1.5 x 10(8) colony-forming units (CFU)/mL methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, multidrug resistant (MDR) Escherichia coli, MDR-Acinetobacter baumannii, or Candida albicans as indicated by our brief exposure method. At least 3 glove segments were tested in each group, and growth was scored as mean CFU/cm(2). Segments were dried for various time periods (30 seconds, 10 minutes, 30 minutes, and 1 hour) and streaked face down on agar plates. Plates were incubated overnight at 37 degrees C, and growth was quantitated.

RESULTS

Gardine-coated latex and nitrile gloves showed significant reduction, an average of 6 logs and 5 logs, respectively, within 30 seconds or 10 minutes when tested against MRSA, vancomycin-resistant enterococci, MDR-E coli, MDR-Acientobacter, and C albicans. Complete kill, 8-log reduction, was seen within 30 seconds for MRSA and E coli in both Gardine-coated latex and nitrile gloves.

CONCLUSION

Gloves impregnated with Gardine antiseptic dye were highly efficacious in preventing contamination of nosocomial-resistant pathogens on the outer surface of glove and may be useful in the food industry or clinical setting.

Glove barriers to bacterial cross-contamination between hands to food

Human hands are an important source of microbial contamination of foods. However, published data on the effectiveness of handwashing and glove use in a foodservice setting are limited. Bacterial transfer through foodservice quality gloves was quantified using nalidixic acid-resistant Enterobacter aerogenes (a nonpathogenic surrogate with attachment characteristics similar to Salmonella). Five transfer rates were determined: chicken to bare hand, chicken to hand through gloves, bare hand to lettuce, hand to lettuce through gloves (with low inoculum on hands), and hand to lettuce through gloves (with high inoculum on hands). At least 30 observations were made for each percent transfer rate using 30 individual volunteers. The logarithm of percent transfer data were then fit to distributions: chicken to bare hand, normal (0.71, 0.42); chicken to hand through gloves, gamma (5.91, 0.40, -5.00); bare hand to lettuce, logistic (1.16, 0.30); hand to lettuce through gloves (low inoculum), normal (0.35, 0.88); hand to lettuce through gloves (high inoculum), normal (-2.52, 0.61). A 0.01% transfer was observed from food to hands and from hands to food when subjects wore gloves and a 10% transfer was observed without a glove barrier. These results indicate that gloves are permeable to bacteria although transfer from hands to food through a glove barrier was less than without a glove barrier. Our results indicate that gloves may reduce both bacterial transfer from food to the hands of foodservice workers and in subsequent transfer from hands back to food.

Prevalence and correlates of skin damage on the hands of nurses

OBJECTIVE

To describe the prevalence and correlates of skin damage on nurses' hands.

DESIGN

Prevalence survey using self-report questionnaire of hand care regimens, problems, and skin condition, and visual examination of the hands at 30X magnification by trained investigators to evaluate degree of skin scaling.

SETTING

Four hospitals: two in the Mid-Atlantic and two in the northern United States.

PARTICIPANTS

Convenience sample of 410 nurses working 30 hours or more per week in acute care units.

OUTCOME MEASURES

Damage to skin of the hands.

RESULTS

Approximately one fourth of subjects (n = 106) met the criteria for currently damaged hands; 85.6% (n = 351) reported ever having skin problems. Damage was not correlated with age (p = 0.43), sex (p = 0.14), or skin type (p = 0.25), type of soap used at home (p = 0.58), reported duration of handwashing (p = 0.12), or glove brand (p = 0.90), but was significantly correlated with the type of soap used at work (p = 0.01), number of hand washes per shift (p = 0.0003), number of times gloves were worn (p = 0.008), and study site (p = 0.009). Variables significantly predictive of skin damage in a logistic regression analysis were type of soap used at work and number of times gloves were worn (p = 0.04). Geographic location was not a factor, because both the highest and lowest prevalence of skin damage occurred in the northern study institutions.

CONCLUSIONS

Damage to skin of the hands is a common and potentially serious problem among nurses, and is associated with gloving and handwashing practices rather than with geographic or demographic factors. Efforts to improve skin condition must focus on improving products and identifying any interactive effects between hand care products and glove materials and brands.

Risks and issues for the health care worker in the human immunodeficiency virus era

The perception of degree of risk can vary markedly from actual risk. About 5% of the cases of AIDS and HIV infection in the United States have occurred in health care workers, a percentage that has remained stable over time. Nearly all of these infections are related to lifestyle factors, not occupational risk. The rise of occupational transmission is greatest with parenteral injuries. If there is an HIV risk to patients, it appears to be very much smaller than the risk to workers although it has received even more publicity. Apprehension exists concerning the future framework of the medical care delivery system and who will care for whom. The sensitive handling of legitimate fears and the balancing of conflicting risks will continue to be a challenging task in the decades ahead.

Reality of glove use and handwashing in a community hospital

BACKGROUND

Since the advent of universal precautions and body substance isolation, few studies have examined the relationship between glove use and handwashing.

METHODS

During a 5-month period in 1991, 477 structured observations were conducted on 19 patients care units at a community teaching hospital during each of three shifts. Patient care contacts were defined as either high level or low level according to potential for blood or body fluid contact.

RESULTS

Health care workers were potentially exposed to body fluids (high-level contact) on 152 occasions. Eighty-eight percent of all high-level contacts were limited to the hands; 47% of these contacts occurred during the night shift. Handwashing occurred after 32% of high-level contacts. Health-care workers wore gloves in 57% of high-level contacts. Rates of handwashing and glove use varied markedly among patient care units. Correct handwashing (> or = 9 seconds) occurred after 20% of contacts when health care workers wore gloves but after only 3% of high-level contacts when gloves were not used (p = 0.004).

CONCLUSIONS

Despite universal precautions or body substance isolation, educational efforts, and written policies, rates of handwashing and glove use are inadequate in cases of potential blood and body fluid contact. The perceived need for gloves may encourage handwashing.

Use of gloves and handwashing behaviour among health care workers in intensive care units. A multicentre investigation in four hospitals in Denmark and Norway

Glove use and handwashing frequencies (HW) were observed in intensive care units (ICU) in two university hospitals in Denmark and two in Norway. The study included a total of 1632 patient procedures performed by 325 persons. Handwashing (HW) has become an important part of general barrier precautions. Earlier studies have shown that health care workers (HCW) far too often neglect to wash their hands after patient procedures when handwashing is strongly recommended. Despite earlier claims that increased glove use in hospitals would discourage handwashing, our results showed that HCW washed their hands more often after glove use (57%) than when gloves had not been used (40%). This significant difference in HW frequency was also noted when similar procedures were carried out by HCW with or without gloves. This might be a matter of personal discomfort after wearing gloves, but could also be due to differences in awareness of hygienic aspects of patient care. In the two countries gloves were used on average at 17% of the procedures, but were not used appropriately for dirty procedures. The results of this study indicate that more effective methods for the implementation of appropriate glove use and HW should be emphasized.