Sterile Latex Research Articles

A Case Report of Anaphylaxis in Health Care Personnel: The Importance of History-Taking and Occupational Health Management

The authors described a 43-year-old male Thai practical nurse (PN) who developed anaphylaxis several times between 2013 and 2019, possibly caused by jackfruit (Artocarpus heterophyllus) and eggplant (Solanum melongena) ingestion. The occupational medicine physician suspected that the anaphylaxis might be due to a cross reaction of these plants to latex protein in medical gloves as this PN had a history of contact urticaria while using disposable latex gloves in December 2014. The symptoms disappeared after he used sterile latex powdered gloves with reusable. According to the history and the result of specific IgE against latex of 28.1 KUA/L and jackfruit of 1.61 KUA/L, although no skin prick test was performed, he was then diagnosed with latex-fruit syndrome. The use of nitrile gloves and latex products avoidance were advised. At the 1-year follow-up, he had no recurrent allergic symptoms or anaphylaxis. Keywords: Anaphylaxis; Eggplant; Jackfruit; Latex allergy; Latex-fruit syndrome

Revisiting Latex Gloves in Healthcare - A Post-Market Clinical Study

Sterile Surgical Gloves are worn to prevent contamination of the patient during invasive procedures and they help prevent surgical site infections and reduce the risk of exposure to blood and body fluid pathogens for the healthcare worker. The purpose of the study was to evaluate the safety and performance of Sterile Latex Surgical Gloves- Powdered and Powder Free, Sterile Latex Gynaecological Gloves- Powdered and Powder Free. Overall, 976 subjects participated in the study, out of which sterile latex surgical gloves were used by the users in 288 cases. Sterile latex surgical gloves powder free was used by users in 291 cases. Sterile Latex Gynaecological Gloves Powdered were used by users in 201 cases and Sterile Latex Gynaecological Gloves Powder Free was used in196 cases. From the clinical safety parameter analysis, sterile latex surgical gloves were safe to use and none of the users reported safety-related issues. The overall rating given by the user for product performance was excellent for all the products. All the users agreed that the product is meeting the product quality. The overall rating given by the user for product satisfaction is Excellent. None of the users have reported any undesirable events. Keywords: gloves, latex, allergy, healthcare workers

Non-sterile examination gloves and sterile surgical gloves: which are more sustainable?

Healthcare professionals should consider environmental sustainability when using personal protective equipment (PPE). One of the most frequently used items of PPE in medical settings are gloves. This study aims to quantify the environmental impact of sterile versus non-sterile gloves using the life cycle assessment (LCA) methodology. This study used three glove types: non-sterile gloves and sterile gloves (latex and latex-free). Sixteen different environmental impact categories were used to demonstrate the impact of each glove type. Non-sterile gloves had the least environmental impact in all categories. The two types of sterile gloves, non-latex (synthetic rubber) and latex (natural rubber), performed similarly, although the non-latex gloves had a greater impact on ozone depletion, mineral use and ionizing radiation. For climate change impact, sterile latex gloves were 11.6 times higher than non-sterile gloves. This study found that for both sterile type gloves (latex and non-latex), the manufacture of the gloves contributes to the most considerable environmental impact, with an average of 64.37% for sterile latex gloves and 60.48% for non-latex sterile gloves. Using the LCA methodology, this study quantitatively demonstrated the environmental impact of sterile versus non-sterile gloves.

A Comparison of the Bacterial Contamination of the Surface of Cleanroom Operators’ Garments following Donning with and without Gloves

Background Specialist cleanroom garments are a potential vector for transmission of microorganisms within these facilities. In order to maintain the low bioburden of such clothing it has been perceived best practice for operators to dress wearing sterile cleanroom gloves. However, the efficacy of such glove use upon the resultant bacterial contamination of the surface of cleanroom garments has not previously been evaluated. Aim To compare surface bacterial contamination of cleanroom garments following their donning by operators dressing with or without gloves. Methods Following prior handwashing and systematic donning of cleanroom clothing by operators dressing wearing either no gloves, non-sterile nitrile gloves or sterile cleanroom latex gloves, a direct agar contact method was immediately undertaken to test garment surfaces at 7 specific sites. Following incubation bacterial levels were suitably quantified. Findings Comparing levels of growth displayed on plates used to test the surface of cleanroom garments worn by operators dressing with no gloves, non–sterile gloves or sterile cleanroom gloves, no significant difference was observed between the percentage of contact plates displaying growth and the levels of growth observed on plates, from any of the sites tested. Conclusion Omission of gloves in line with a systematic handwashing procedure prior to the cleanroom garment donning process, may result in modest economic and environmental gain coupled with a slightly less burdensome procedure. However, this is reliant on rigorous adherence to handwashing protocol and assessment of associated risk factors.

Is Single Gloving Still Acceptable? Investigation and Evaluation of Damages on Sterile Latex Gloves in General Surgery.

(1) Background: The sterile latex surgical glove is an important part of protecting both the patient and the surgical team from infections. However, mechanical stress can damage the integrity of the glove material and thus may lead to infections. (2) Method: A total of 896 gloves from 448 surgeries were tested and evaluated by the water tightening test according to EN455 and ASTM D5151-19. (3) Results: From 448 surgeries, 18.8% of the interventions showed glove damage. In vascular surgery, gloves were damaged in 20.8%, in thoracic surgery 9.1%, in laparoscopic interventions 21.7%, in the subgroup hernia surgeries (TAPP) 17.6% and in open interventions 17.6%. A total of 101 damages were found on 896 gloves; one glove could have several damages. During vascular surgery, 60% of the damages were on the subordinated hand of the surgeon, and 73.3% of the damages had a size of 1 mm. In laparoscopic procedures, the subordinated hand was also more frequently affected (61.3%) than the dominant hand; 64.5% of the damages were 1 mm in size. In the hernia surgery subgroup (TAPP), no damage was larger than 1 mm; 66.7% were in the subordinated hand area. The duration of surgery had no influence on the lesion rate. (4) Conclusion: The damage rate in low impact procedures is high and represents an underestimated problem in soft tissue surgery. The use of single gloving can therefore lead to the risk of infection. EN455 and ASTM D5151-19 does not take into consideration the risk of intraoperative lesions. Double gloving and glove change algorithms should be established.

Methodology to Investigate Indigenous Solid Waste Systems and Practices in the Rural Areas Surrounding Maseru (Kingdom of Lesotho).

Solid waste management (SWM) is the greatest challenge facing environmental protection and human wellbeing in the rural communities of Maseru (Kingsom of Lesotho). A lack of formal waste management (WM) systems in rural areas of Maseru have resulted in different indigenous systems and practices of SWM. Direct observation and descriptive designs will be employed. This is a mixed methods study of qualitative, quantitative and, non-experimental. We obtained data sets from existing official census and statistics of Maseru. We sampled 693 participants from total population of 6917. We received ethical clearance from Research Ethics committee of Health Sciences at the University of Johannesburg, we recruited six field workers. We have preventive equipment (sanitizers, masks, and sterile latex gloves) for COVID-19 infections in place; we have specific design on caps, masks and bags that will identify field workers as they collect data. We will train field workers, administer questionnaires, interview, and observe participants. STATKON will analyse data. The research will share the results with the Ministry of Environment and the community in Lesotho. The results will also be used to educate the rural communities on improved WM. Where weaknesses are identified, mitigation measures can be evaluated and implemented to rectify the negative aspects and improve the systems and practices. The rural communities face challenges such as waste collection services and sanitation facilities and this fact points out that there is a gap in SWM, which favours the existence of indigenous systems and practice of SWM.

Ten cases of wound hemostasis with glove bandaging in hand skin grafting

From July 2018 to April 2019, 10 patients (8 males and 2 females, aged 5 to 53 years) who need skin grafting with 17 hands were admitted to the Fourth Medical Center of PLA General Hospital. The method of glove bandaging was used for wound hemostasis in skin grafting. After the initial hemostasis, sterile latex gloves were used as the inner cover of hand, and then pressure-wrapped with gauze. After 20 minutes, the gauze and gloves were removed in order from the near to the far, then thorough hemostasis was conducted again, and finally skin grafting was performed. The use of gloves as inner cover can avoid the adhesion of gauze fibers to the wound surface, so that it will not cause small blood vessels to re-bleed when the gauze is removed, therefore reducing the excessive use of electrocoagulation and secondary damage to the wound. As a result, blood loss can be reduced and hemostatic time can be shortened.

Coronaviruses widespread on nonliving surfaces: important questions and promising answers.

The world is facing, while writing this review, a global pandemic due to one of the types of the coronaviruses (i.e., COVID-19), which is a new virus. Among the most important reasons for the transmission of infection between humans is the presence of this virus active on the surfaces and materials. Here, we addressed important questions such as do coronaviruses remain active on the inanimate surfaces? Do the types of inanimate surfaces affect the activity of coronaviruses? What are the most suitable ingredients that used to inactivate viruses? This review article addressed many of the works that were done in the previous periods on the survival of many viruses from the coronaviruses family on various surfaces such as steel, glass, plastic, Teflon, ceramic tiles, silicon rubber and stainless steel copper alloys, Al surface, sterile sponges, surgical gloves and sterile latex. The impacts of environmental conditions such as temperature and humidity were presented and discussed. The most important active ingredients that can deactivate viruses on the surfaces were reported here. We hope that these active ingredients will have the same effect on COVID-19.

Do Longer Surgical Procedures Result in Greater Contamination of Surgeons' Hands?

A surgical site infection is a substantial cause of complications in patients. Different methods are being used to decrease surgical site infections; however, these infections still can cause complications, especially in patients undergoing longer operations (>3hours). There is evidence that the efficacy of the scrubbing material fades after 3hours. However, we do not know the longevity of hand cleanliness after application of scrubbing materials in a long operation. It can be postulated that if the surgeon's scrubbed hands are recolonized after a certain time, they may serve as a progressive source of contamination during surgery. We asked: (1) Is there a correlation between surgical duration and hand contamination at the end of surgery? (2) At what point during surgery does hand contamination reach or exceed prescrub levels? Three spine surgeons using the same scrubbing technique and materials consisting of chlorhexidine gluconate 1% solution and ethyl alcohol 61% w/w were enrolled in our study. Between December 2014 and April 2015, spine procedures of 3hours or more, which were the first case of the day, were selected for this study (20 cases). Cases in which glove changing occurred (perforations, reprepping, and redraping) or cultures obtained after scrubbing were positive (indicative of insufficient hand sanitization) were excluded (0% of cases). Twenty cases (100% enrollment) were analyzed. Surgeons' hands were swabbed with sterile cotton tip applicators and 5 mL sterile phosphate-buffered saline before hand scrubbing (prescrub), immediately after hand scrubbing (postscrub), and immediately after surgery (postoperative). Results were reported in colony-forming units per milliliter. The correlation between duration of surgery and hand recontamination was tested by regression analysis of time versus colony-forming units per milliliter. Receiver-operating characteristic curve tested the cutoff point, where recontamination occurred. With a longer duration of surgery, more colony-forming units are recovered from gloved hands at the end of surgery (R=0.94, R(2)=0.89, p=0.005). The receiver-operating characteristic curve suggested that 5hours is the cutoff point for hand recolonization. At 5hours, contamination reached or exceeded prescrub levels (area under the curve, 0.66; 95% CI, 0.23-1.0), whereas before 5hours, there was no contamination detected at the end of surgery. Our results show that duration of surgery correlates with hand recontamination and at 5hours, recolonization of a surgeon's hands become detectable. Recolonization may have started even earlier than 5hours. However, these levels are not detectable in the laboratory at earlier times. Based on this pilot study, rescrubbing is highly recommended before the fifth hour of an operation, ideally at some point between the fourth and fifth hours. We also recommend the surgical site infection rates in operations using rescrubbing should be compared with those from surgeries with just the conventional single-scrubbing technique, in a randomized controlled trial, to determine the effectiveness of this novel rescrubbing method.

Evaluation of Two Types of Vascular Bundles for Revascularization of Avascular Tissue

Implantation of vascular bundles into ischemic tissue as a means of revascularization has been performed for many decades, but there is considerable confusion regarding its clinical utility. We believe that the varying results quoted in the literature are a result of using bundles that are different from each other. We propose that vascular bundles are of 2 types: a parallel pipe type and an axial flap type. We propose that in rats, the femoral arteriovenous bundle represents a parallel pipe type and the epigastric bundle an axial flap type. We propose that if ligated and implanted into an isolated sterile environment, the parallel pipe type of vascular bundle will thrombose, whereas the axial flap type of bundle will remain patent and demonstrate neovascular sprouting. The study was carried out in 20 rats. Femoral and epigastric bundles were dissected, ligated with 10-0 nylon, and implanted into a tubing of sterile latex. The bundles were analyzed at various time intervals by both gross and histologic examination. The femoral bundle did not demonstrate any arteriovenous cross-communication under magnification, confirming its status as a parallel pipe type. The epigastric bundle demonstrated a rich plexus of arteriovenous channels, confirming its status as an axial flap type. A distinct adherent thrombus was seen at 24 hours in all the ligated femoral bundles and was still present at 3 weeks; none of these demonstrated evidence of neovascular sprouting. The ligated epigastric bundles remained patent in all specimens with no evidence of thrombosis, and all demonstrated exuberant neovascular sprouting. Our experiment establishes that there are at least 2 distinct types of vascular bundles in the rat. It also indicates that parallel pipe type of vascular bundles implanted into latex tubing thrombose and do not demonstrate neovascularization. On the other hand, under the same circumstances axial flap bundles remain patent and demonstrate exuberant neovascularization.

Trapeziectomy with a Capsular Interposition Flap

Ann R Coll Surg Engl 2009; 91: 344–350 345 ultrasound unit to identify and locate foreign bodies prior to exploration either in the emergency department or in theatre. Using the probe, the exact depth and location of the foreign body (including proximity to surrounding structures) is calculated. Prior to exploration, the skin is marked. The ultrasound probe can also be used intra-operatively in conjunction with a sterile latex cover to identify and locate residual fragments.

The Final Steps in Converting a Health Care Organization to a Latex-Safe Environment

In a follow-up to a previous article, which described the approach at The Johns Hopkins Medical Institutions to establishing a latex-safe environment, subsequent efforts to convert all the sterile gloves to nonlatex products and thereby complete the implementation of a latex-safe program are reported. Before the complete conversion to nonlatex sterile gloves, operating room use had increased to approximately one-third of our total sterile glove use during the preceding four years. The final stages of the conversion involved both consistent follow-through with education, training, and personnel involvement at all levels and a change in the culture of the medical facility. New and improved nonlatex glove products were coming to the market, and their costs were decreasing because of increased supply and competition. Five synthetic neoprene or polyisoprene gloves-two from one manufacturer and three from the second manufacturer-were evaluated in glove trials. Overall, by manufacturer, a similar rate of acceptance among the various sterile nonlatex gloves (74.2% versus 78.1%) was found. However, to ensure that all users were satisfied, contracts were awarded to both vendors. The weekend before the conversion date of May 1, 2007, all old powdered sterile latex gloves were replaced with the new stock of nonlatex sterile gloves. Once financial and logistical concerns were addressed, conversion to a latex-safe environment entailed readying the organization for the change in organizational culture. Key factors were (1) general acceptance from all the chiefs of the surgical departments; (2) centralization for all purchases of medical supplies, including sterile gloves, through corporate purchasing; and (3) ongoing education and vigilance.

Ultrasound-Guided Trigger Point Injections in the Cervicothoracic Musculature: A New and Unreported Technique

Background: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under diagnosed and under treated medical problems encountered in clinical practice. Trigger points are commonly seen in patients with myofascial pain which is responsible for localized pain in the affected muscles as well as referred pain patterns. Correct needle placement in a myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve myofascial pain. In obese patients, these injections may not reach the target tissue. In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we describe an ultrasound-guided trigger point injection technique to avoid this potential pitfall. Office based ultrasound-guided injection techniques for musculoskeletal disorders have been described in the literature with regard to tendon, bursa, cystic, and joint pathologies. For the interventionalist, utilizing ultrasound yields multiple advantages technically and practically, including observation of needle placement in real-time, ability to perform dynamic studies, the possibility of diagnosing musculoskeletal pathologies, avoidance of radiation exposure, reduced overall cost, and portability of equipment within the office setting. To our knowledge, the use of ultrasound guidance in performing trigger point injection in the cervicothoracic area, particularly in obese patients, has not been previously reported. Methods: A palpable trigger point in the cervicothoracic musculature was localized and marked by indenting the skin with the tip of a plastic needle cover. The skin was then sterile prepped. Then, using an ultrasound machine with sterile coupling gel and a sterile latex free transducer cover, the musculature in the cervicothoracic spine where the palpable trigger point was detected was visualized. Then utilizing direct live ultrasound guidance, a 25-gauge 1.5 inch needle connected to a 3 mL syringe was placed into the muscle at the exact location of the presumed trigger point. This guidance helps confirm needle placement in muscle tissue and not in an adipose tissue or any other non-musculature structure. Results: The technique is simple to be performed by a pain management specialist who has ultrasound system training. Conclusion: Ultrasound-guided trigger point injections may help confirm proper needle placement within the cervicothoracic musculature. The use of ultrasound-guided trigger point injections in the cervicothoracic musculature may also reduce the potential for a pneumothorax by an improperly placed injection. Key words: Trigger point injection, myofascial pain, ultrasound

Evaluation of Wraps Covering the Distal Aspect of Pelvic Limbs for Prevention of Bacterial Strike‐Through in an Ex Vivo Canine Model

To determine differences in bacterial strike-through for materials commonly used to cover the distal aspect of the pelvic limb during operative site preparation. Randomized block design; ex vivo model. Canine cadaveric pelvic limbs (n=40). Pelvic limbs (n=40) were randomly assigned to 4 treatment groups: Group 1=Vetrap+sterile Coban; Group 2=latex glove+Vetrap+sterile Coban; Group 3=latex glove+Vetrap+sterile Coban+sterile latex glove+sterile Coban; and Group 4=latex glove+Vetrap+sterile disposable drape+sterile Coban. Limbs were contaminated with a standardized bacterial solution and routinely prepared using the assigned distal leg wrap. Bandages were fluid challenged with a saline (0.9% NaCl) solution-soaked laparotomy sponge for 30 seconds. The wrap surface was sampled for microbial culture before surgical preparation, immediately after, and 60 minutes after applying a sterile leg wrap. Bacterial growth occurred in all Group 1 cultures, 90% of Group 2 cultures, and none of the Group 3 and 4 cultures, 60 minutes after applying the sterile wrap. A distal leg wrap of Vetrap+sterile Coban is not effective in preventing bacterial strike-through. If similar results occur in the live animal, then a sterile impermeable barrier must be incorporated into the distal leg wrap to prevent bacterial strike-through.

An inflated condom as a packing device for control of haemorrhage.

Intractable hemorrhaging in the left and right upper quadrants, the pelvic area, and, especially, the liver is an acute, life-threatening condition. Practitioners typically gain control through firm tamponade of the bleeding site with dry laparotomy packs. This approach, however, has many disadvantages. An alternative approach is described and recommended for consideration when intra-abdominal tamponade is required and relaparotomy is not anticipated. A 22-Fr catheter is inserted through a stab wound and a sterile latex condom is ligated proximal to the filled catheter reservoir. The condom is then partially filled with sterile saline and the abdomen closed. After closure, intra-condom pressure is gradually increased to approximately 40 cmH20. The surrounding structures are smoothly covered during expansion and adequate packing is obtained. The balloon is deflated gradually and left in place temporarily after correction of coagulopathy and stabilization of the patient's general condition. Should rebleeding occur, the condom may be reinflated; if not, it is removed. This practice saves lives without obstructing closure of the abdominal wall, losing their tamponading effect once wet, requiring relaparotomy for removal, increasing the risk of would infection and incisional hernia, pack adherence to the wound, and increased risk of intra-abdominal infection associated with using dry laparotomy packs.

Experimental glaucoma in the primate induced by latex microspheres

The injection of sterile latex microspheres into the anterior chamber of the eye is presented as a simple and cost effective method for inducing chronic elevation of intraocular pressure (IOP) and experimental glaucoma in primates. The microspheres produce elevated IOP primarily by restricting the outflow of aqueous humor through the trabecular meshwork located in the chamber angle. Different levels and durations of elevated IOP can be obtained by altering the frequency and number of microspheres injected. In comparison with other primate models of experimental glaucoma, the approach described here has the advantages of producing chronic elevations of IOP without the need for expensive ophthalmic equipment and personnel, surgical intervention or intraocular inflammation, and without compromising visibility of the optic disc, which is necessary for clinical assessment of the onset and progression of the disease.

Survival of human coronaviruses 229E and OC43 in suspension and after drying onsurfaces: a possible source ofhospital-acquired infections

Strains OC43 and 229E of human coronaviruses (HCoV) cause one-third of common colds and hospital-acquired upper respiratory tract HCoV infections have been reported in premature newborns. To evaluate possible sources of infection, virus survival was studied in aqueous suspensions and on absorptive and non-absorptive surfaces representative of a hospital environment. Virus susceptibility to chemical disinfection with standard products was also characterized. Virus survived in saline solution for as long as six days but less in culture medium, with or without added cells. After drying, HCoV-229E infectivity was still detectable after 3h on various surfaces (aluminum, sterile latex surgical gloves, sterile sponges) but HCoV-OC43 survived 1h or less. Of the various chemical disinfectants tested, Proviodine® reduced the virus infectious titre by at least 50%. This study suggests that surfaces and suspensions can be considered as possible sources of contamination that may lead to hospital-acquired infections with HCoV and should be appropriately disinfected.

Intraoperative transesophageal echocardiography for pediatric patients with congenital heart disease.

Intraoperative transesophageal echocardiography for pediatric patients with congenital heart disease.

Application of guidelines for occupational HIV infection control during delivery in Italy

Objective: We surveyed the attitudes of Italian obstetricians toward the application of HIV infection control guidelines during labour and delivery proposed by the Italian National Committee for HIV Infection. Study design: We identified 66 obstetric centres affiliated to the AOGOI (Association of Italian Gynecologists and Obstetricians). A postal questionnaire was sent to 752 physicians in charge in the centres. Results: A total of 419 clinicians (55.7%) completed and returned the form to the coordinating centre. Obstetricians were directly asked about the need for routine adoption of the Italian guidelines for delivery of women with positive or unknown HIV status (indicating the routine use during delivery of protective glasses, impermeable garments, mask and sterile latex gloves, the washing of hands with detergent solution after using gloves and collection of needles and sharp instruments in suitable containers). A total of 319 (76.1%) clinicians agreed that all these procedures should be adopted. In clinical practice, however, obstetricians declared that the use of latex gloves and collecting needles in suitable containers were always adopted, `washing hands after using gloves' less frequently, and other procedures such as protective impermeable garments, glasses and mask were infrequently applied.

Two methods of testing surgical gloves for perforations: Perceived and unperceived glove perforations during vascular surgery

Abstract The purpose of this study was to evaluate perceived versus unperceived glove perforations during vascular surgery using the FDA water test procedure and a newer more sensitive fluorescent dye technique. The two techniques were also compared to determine the degree of sensitivity of the fluorescent dye technique with the FDA water test. Three hundred five (305) gloves from a vascular surgery team were analyzed post‐surgically for perforations. One hundred fifty‐five (155) sterile surgical latex gloves and 150 non‐sterile latex gloves were collected and evaluated first using the FDA water leakage method then using a fluorescent dye technique. The fluorescent dye technique employs the use of a black light to examine the gloves following the addition of fluorescing dye to the original water in the glove. This technique makes it possible to detect even smaller perforations than detected by the FDA method. The dye technique was more sensitive in detecting perforations than the water technique approved ...