Nitrile glove composition and performance-Substandard properties and inaccurate packaging information.

The durability and mechanical properties of synthetic medical gloves, such as those made from nitrile, vary drastically depending on the manufacturer. This study reports the chemical composition of several brands of nitrile gloves via FTIR and solid-state NMR analysis and relates composition to glove durability (found via GAD), mechanical performance (found via Instron), and whether the gloves meet or fail ASTM International standards. Out of the four nitrile examination glove brands tested, American Nitrile Slate brand had superior durability results and was found to be made of acrylonitrile butadiene rubber, as expected. The U.S. Medical glove brand, which was also found to be pure nitrile, had the superior tensile results, consistently reaching over 800% elongation before breaking. Although Restore Touch brand exam gloves were made of nitrile, they exhibited substandard tensile strength and durability due to the thinness of the glove, which barely met the ASTM minimum thickness value. The Vglove brand glove had the overall worst mechanical properties, did not meet ASTM requirements, and had an NMR spectrum consistent with that of a polyvinyl chloride glove, rather than nitrile. Gloves that fail to meet the minimum performance requirements should not be used for medical purposes to protect the health and safety of consumers.

Development of an experimental technique to determine the barrier performance of medical gloves when stretched.

Protective clothing standards, such as test methods published by ASTM International, play an integral role in ensuring the performance of personal protective equipment. The standard tests are not without limitations and are periodically reviewed and often updated. Some tests may not be reflective of in-use conditions. A new test cell was designed using sanitary fixtures to evaluate the effect of glove stretch on barrier performance using fluorescein solution as the challenge agent for enhanced visualization and fluorometer detection. Domed-shaped and flat screens were developed to permit and limit glove stretch within the test cell. The barrier performance of glove swatches was evaluated for both stretched and unstretched states. Latex, nitrile, and vinyl glove models of various thicknesses were evaluated. The tests were conducted following pressure and time parameters specified in ASTM F903, ASTM F1670, and ASTM F1671. Fluorescein solution movement, which may occur through penetration, was measured using a fluorometer. Glove stretch caused a reduction in glove thickness ranging from 16% to 40%. Overall, 21 sample failures were found (16.7%; n = 126) regardless of test condition. Nitrile gloves provided better barrier efficacy with the lowest failure rates (2.38%; 1 failure out of 42) compared to latex (19.4%; 7 failures out of 36) and vinyl gloves (27.1%; 13 failures out of 48). Differences in failure rates between stretched and unstretched gloves were insignificant; however, the latex material showed a 2.5 times increase in failures when stretched compared to unstretched. The new test apparatus was able to differentiate between the barrier performance of different glove materials. The use of a domed screen allowed the gloves to stretch, a condition that better represents the state of gloves when in use. Analysis of samples collected from the glove surface opposite to the exposure may provide a way to assess chemical permeation in addition to penetration.

Assessment of glove stretch and storage temperature on fentanyl permeation: Implications for standard test methods and PPE recommendations.

The National Institute for Occupational Safety and Health recommends the use of nitrile gloves with a minimum thickness of 5.0 ± 2.0 mil [0.127 ± 0.051 millimeters] in situations where it is suspected or known that fentanyl or other illicit drugs are present. However, there is limited data available on fentanyl permeation through gloves. Current test methods used to measure fentanyl permeation do not consider the effect of glove fit and flexion. Furthermore, first responders need to have PPE readily available in the field, and storage conditions may affect the protective performance of the gloves. The objective of this study was to evaluate the effects of glove stretch and storage temperatures on glove durability and barrier performance against fentanyl. Nine nitrile glove models previously shown to be resistant to fentanyl permeation were selected for this investigation. These nine models were stretched 25% in one linear direction, to consider glove fit and flexion, and tested against fentanyl hydrochloride permeation. Additionally, four of the nine glove models were stored at 48 °C, 22 °C, and -20 °C, and evaluated for tensile strength, ultimate elongation, and puncture resistance after up to 16 wk of storage and fentanyl permeation after up to 8 wk of storage. At least one sample for six of the nine tested models had maximum permeation over the test method fail threshold when stretched. The tested storage temperatures showed no effect on glove tensile strength, ultimate elongation, and puncture resistance. The findings of this study can be used to inform PPE recommendations, with consideration to storage practices and proper sizing for first responders with potential exposure to fentanyl and other illicit drugs. The results of this study can be used to assess the need for new standard test methods to evaluate the barrier performance of gloves and shelf-life determination with consideration to glove fit.

Glove performance in a warming climate: The role of glove material and climate on permeation resistance to organophosphate insecticides.

Hands and forearms are the principal sites of dermal exposure to organophosphate insecticides, which makes glove use one of the most important components of an exposure control strategy. However, the selection of suitable gloves depends on issues such as task, type, and concentration of organophosphate as well as cost. In addition, chemical protection performance of gloves may be temperature dependent, which is of increasing concern in a warming climate. Two recommended reusable glove materials (polyvinylchloride and nitrile butadiene rubber) and one single-use glove (nitrile/neoprene) were tested for permeation resistance to actual formulations of organophosphate insecticides with active ingredients dimethoate and malathion. Chemical resistance parameters were measured using American society for testing and materials permeation test cells and compared across glove, organophosphate type, and temperature. The three gloves demonstrated comparable and adequate chemical resistance (less than one µg cm-2 min-1 for up to 8 hr exposure; 25-60 °C) for dilute forms of dimethoate and malathion, used during spraying activities. However, the single-use nitrile/neoprene glove is not designed to fully cover the elbow which limits its suitability. In permeation tests that reflect "worst case" exposure scenario to concentrated (neat) organophosphate formulations, as in mixing/loading tasks, a significant variation in chemical resistance between gloves was observed. While polyvinylchloride offered the maximum resistance, physical degradation of nitrile butadiene rubber after 3 hr of continuous exposure makes it unsuitable for handling neat dimethoate. The single-use nitrile/neoprene glove material had considerably poorer permeation resistance (up to 155-fold greater permeation and 6-fold shorter breakthrough) against neat formulations. Overall, elevated temperature (>40 °C) was shown to result in significantly greater (P < 0.05) cumulative permeation of neat formulation insecticides. This work demonstrates the variation in glove performance and potential for greater exposure risk particularly when mixing concentrated pesticides at elevated temperature conditions such as an occluded human skin or hot greenhouses. Training and guidance on testing, selection, use, and storage of gloves should consider in-use exposure scenarios and temperature-induced reduction in chemical protective performance.

Fentanyl and carfentanil permeation through commercial disposable gloves.

In 2018, the Centers for Disease Control and Prevention reported that opioid overdose deaths (including fentanyl and carfentanil) comprised 46,802 (69%) of the 67,367 total drug overdose deaths. The opioid overdose epidemic affects Americans not only at home but also in the workplace. First responders may be at risk of opioid exposure during incidents such as vehicle searches and responses to overdose calls. To reduce direct exposure to opioids and other hazardous drugs, first responders rely in part on personal protective equipment (PPE) as their last line of defense. First responders seek guidance from the National Institute for Occupational Safety and Health (NIOSH) regarding appropriate PPE selection for potential opioid exposure. There is limited empirical glove performance data for illicit drugs. Empirical data are needed to validate NIOSH's current recommendations regarding gloves to help prevent exposure to illicit drugs (i.e., powder-free nitrile gloves with a minimum thickness of 5 ± 2 mil [0.127 ± 0.051 millimeters]); however, no industry standard or test method currently exists for specifically evaluating PPE performance against fentanyl and its analogs. To understand the permeation qualities of gloves when challenged against fentanyl and carfentanil solutions, the ASTM International (formerly American Society for Testing and Materials) ASTM D6978-19 standard for chemotherapy drug glove permeation was adapted to test fentanyl and carfentanil hydrochloride solution permeation through twelve disposable glove models, including five models in which the manufacturers claim fentanyl protection. No nitrile glove models showed fentanyl or carfentanil permeation rates above the chemotherapy drug threshold criterion of 0.01 µg/cm2/min (i.e., thereby meeting the performance requirement) as calculated using the ASTM D6978-19 standard within the 240-min test. Latex and vinyl glove materials exhibited fentanyl and carfentanil permeation with permeation rates above this threshold. These findings are among the first empirical data to support NIOSH's current opioid glove recommendations and define procedures that could be used to support industry standards for evaluating opioid permeation through air-impermeable PPE materials.

The benefits of latex-free gloves in the operating room environment.

Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.

Glove permeation of chemicals: The state of the art of current practice, Part 1: Basics and the permeation standards.

Skin exposure to chemicals in the workplace environment is a major concern, the hands being the major exposure sites. Employers purchase gloves that have permeation data generated from permeation "standards" of the American Society for Testing and Materials International (ASTM International), European Committee for Standardization (EN), and the International Organization for Standardization (ISO) that test pieces of glove material and allow a user-defined temperature. The relevant standards based on continuous contact are ASTM F739, ASTM D6978, EN 374, EN 16523, and ISO 6529. The aim was to analyze the current state of the scientific literature on glove permeation in the 21st century up to December 2018. The introduction sets out the background, objectives and rationale of the review and its methodology followed by presentation of basic glove chemical resistance terms and Fick's first law of diffusion, the details of the major permeation standards, their comparison, their critique, their research gaps; the scientific literature on whole glove permeation, and final conclusions. The major recommendation was to harmonize all the permeation standards and perform them at realistic work conditions, especially temperature. The whole glove system would be most useful for testing the thinnest gloves.

Use of personal protective equipment in nursing practice.

A comprehensive understanding of infection prevention and control is essential for nurses when seeking to protect themselves, patients, colleagues and the general public from the transmission of infection. Personal protective equipment (PPE) - such as gloves, aprons and/or gowns, and eye protection - is an important aspect of infection prevention and control for all healthcare staff, including nurses. Its use requires effective assessment, an understanding of the suitability of various types of PPE in various clinical scenarios, and appropriate application. Understanding the role of PPE will enable nurses to use it appropriately and reduce unnecessary cost, while ensuring that the nurse-patient relationship remains central to care. This article defines PPE and its components, outlines when it should be used and details its optimal application.

Evaluation of Disposable Protective Garments against Isocyanate Permeation and Penetration from Polyurethane Anticorrosion Coatings.

BACKGROUND: Polyurethanes are a class of isocyanate-based organic coatings commonly used to control corrosion on high-value metallic structures. Despite their widespread use, dermal exposure to these isocyanate-containing coatings presents a significant occupational health risk to workers, including the development of allergic and irritant contact dermatitis and systemic sensitization. At present, little is known about the effectiveness of the protective garments commonly used to prevent dermal exposure to polyurethane coatings in construction trades. OBJECTIVES: The primary objective of this study was to measure the permeation and penetration of isocyanates from polyurethane anticorrosion coatings though a selection of protective garments. In addition, a standardized spray procedure using a fixed-position spraying technique was evaluated as an option to minimize variability in coating application. METHODS: Five disposable garment materials were evaluated for resistance to isocyanates during this study: latex gloves (0.076 mm), nitrile gloves (0.078 mm), Tyvek coveralls (0.105 mm), polypropylene/polyethylene (PP/PE) coveralls (0.116 mm), and a cotton t-shirt (0.382 mm). A permeation test cell system was used to evaluate each garment material against two products: a polyurethane zinc-rich primer based on 4,4'-methylene diphenyl diisocyanate and an aliphatic finish coating based on prepolymers of 1,6-hexamethylene diisocyanate. Glass fiber filters pretreated with 1-(9-anthracenylmethyl)piperazine were used to collect penetrating isocyanates during the 120-min test period, which were analyzed by liquid chromatography-tandem mass spectrometry. Polytetrafluoroethylene loading filters were sprayed in series with permeation test cells and analyzed gravimetrically to assess the homogeneity of coating application. RESULTS: The latex gloves demonstrated the highest rate of isocyanate permeation of all evaluated garments during testing with both coatings (primer: 27.38 ng cm-2 min-1; finish coating: 7.39 ng cm-2 min-1). Nitrile gloves were much more resistant than latex gloves (primer: 1.89 ng cm-2 min-1; finish coating: 1.26 ng cm-2 min-1) and were not permeated by the finish coating until after 15 min. The PP/PE coverall provided the most consistent resistance to both coatings (primer: 0.08 ng cm-2 min-1; finish coating: 1.27 ng cm-2 min-1), whereas the Tyvek coverall was readily permeated by the primer (primer: 3.47 ng cm-2 min-1; finish coating: 0.87 ng cm-2 min-1). The cotton t-shirt was rapidly permeated by the primer during the first 5 min of exposure (primer: 146.65 ng cm-2 min-1; finish coating: 4.64 ng cm-2 min-1). In addition, the fixed-position spraying technique used during this study demonstrated a significant reduction in loading variability within each batch of test cells when compared to manual spray application. CONCLUSION: Nitrile gloves demonstrated superior resistance to both isocyanate-containing coatings in comparison to latex gloves. Although both coverall materials were resistant to permeating isocyanate within the established thresholds, the PP/PE coverall provided more consistent resistance to both coatings. Owing to the cotton t-shirt's high rate of penetration with both coatings, it is recommended only as a secondary barrier. Study results showed that the use of fixed-position spray techniques provided consistent and reproducible results within each batch of test cells. Additional test design modifications are necessary to further reduce variability between batches and ensure more consistent coating thickness.

Glove and instrument changing to prevent tumour seeding in cancer surgery: a survey of surgeons' beliefs and practices.

Background: Some surgeons change gloves and instruments after the extirpative phase of cancer surgery with the intent of reducing the risk of local and wound recurrence. Although this practice is conceptually appealing, the evidence that gloves or instruments act as vectors of cancer-cell seeding in the clinical setting is weak. To determine the potential effect of further investigation of this question, we surveyed the practices and beliefs of a broad spectrum of surgeons who operate on cancer patients. Methods: Using a modified Dillman approach, a survey was mailed to all 945 general surgeons listed in the College of Physicians and Surgeons of Ontario public registry. The survey consisted of multiple-choice and free-text response questions. Responses were tabulated and grouped into themes, including specific intraoperative events and surgeon training. Predictive variables were analyzed by chi-square test. Results: Of 459 surveys returned (adjusted response rate: 46%), 351 met the inclusion criteria for retention. Of those respondents, 52% reported that they change gloves during cancer resections with the intent of decreasing the risk of tumour seeding, and 40%, that they change instruments for that purpose. The proportion of respondents indicating that they take measures to protect the wound was 73% for laparoscopic cancer resections and 31% for open resections. Training and years in practice predicted some of the foregoing behaviours. The most commonly cited basis for adopting specific strategies to prevent tumour seeding was "gut feeling," followed by clinical training. Most respondents believe that it is possible or probable that surgical gloves or instruments harbour malignant cells, but that a cancer recurrence proceeding from that situation is unlikely. Conclusions: There is no consensus on how gloves and instruments should be handled in cancer operations. Further investigation is warranted.

Testing of Disposable Protective Garments Against Isocyanate Permeation From Spray Polyurethane Foam Insulation.

Background: Diisocyanates (isocyanates), including methylene diphenyl diisocyanate (MDI), are the primary reactive components of spray polyurethane foam (SPF) insulation. They are potent immune sensitizers and a leading cause of occupational asthma. Skin exposure to isocyanates may lead to both irritant and allergic contact dermatitis and possibly contribute to systemic sensitization. More than sufficient evidence exists to justify the use of protective garments to minimize skin contact with aerosolized and raw isocyanate containing materials during SPF applications. Studies evaluating the permeation of protective garments following exposure to SPF insulation do not currently exist. Objectives: To conduct permeation testing under controlled conditions to assess the effectiveness of common protective gloves and coveralls during SPF applications using realistic SPF product formulations. Methods: Five common disposable garment materials [disposable latex gloves (0.07 mm thickness), nitrile gloves (0.07 mm), vinyl gloves (0.07 mm), polypropylene coveralls (0.13 mm) and Tyvek coveralls (0.13 mm)] were selected for testing. These materials were cut into small pieces and assembled into a permeation test cell system and coated with a two-part slow-rise spray polyurethane foam insulation. Glass fiber filters (GFF) pretreated with 1-(9-anthracenylmethyl)piperazine) (MAP) were used underneath the garment to collect permeating isocyanates. GFF filters were collected at predetermined test intervals between 0.75 and 20.00 min and subsequently analyzed using liquid chromatography-tandem mass spectrometry. For each garment material, we assessed (i) the cumulative concentration of total isocyanate, including phenyl isocyanate and three MDI isomers, that effectively permeated the material over the test time; (ii) estimated breakthrough detection time, average permeation rate, and standardized breakthrough time; from which (iii) recommendations were developed for the use of similar protective garments following contamination by two-component spray polyurethane foam systems and the limitations of such protective garments were identified. Results: Each type of protective garment material demonstrated an average permeation rate well below the ASTM method F-739 standardized breakthrough rate threshold of 100.0 ng/cm2 min-1. Disposable latex gloves displayed the greatest total isocyanate permeation rate (4.11 ng/cm2 min-1), followed by the vinyl and nitrile gloves, respectively. The Tyvek coverall demonstrated a greater average rate of isocyanate permeation than the polypropylene coveralls. Typical isocyanate loading was in the range of 900 to 15,000 ng MDI/cm2. Conclusion: Permeation test data collected during this study indicated that each type of protective garment evaluated, provided a considerable level of protection (i.e. 10-110-fold reduction from the level of direct exposure) against the isocyanate component of the SPF insulation mixture. Nitrile gloves and polypropylene coveralls demonstrated the lowest rate of permeation and the lowest cumulative permeation of total isocyanate for each garment type.

Organophosphorus pesticide exposure in agriculture: effects of temperature, ultraviolet light and abrasion on PVC gloves.

Elbow length PVC gloves are often recommended for protection against organophosphorus pesticide (OP) exposure in agriculture. However, performance may be reduced due to high temperature, UV exposure and abrasion. We sought to assess these impacts for two OPs under normal use and reasonable worst-case scenarios. Glove permeation tests were conducted using ASTM cells with two PVC glove brands at 23°C and 45°C for up to 8 h. Technical grade dichlorvos and formulated diazinon were used undiluted and at application strength. Breakthough of undiluted dichlorvos occurred at both 23°C and 45°C, but only at 45°C for application strength. Breakthrough of diazinon was not achieved, except when undiluted at 45°C. UV-exposed and abraded gloves showed reduced performance, with the effect being approximately two-fold for dichlorvos. Only small differences were noted between glove brands. Extra precautions should be taken when handling concentrated OPs at high temperature, or when using abraded or sunlight-exposed gloves.

Resistance of gloves and protective clothing materials to permeation of cytostatic solutions.

OBJECTIVES: The objective of the work was to determine the resistance of selected protective clothing and glove materials to permeation of cytostatics such as docetaxel, fluorouracil, and doxorubicin. MATERIAL AND METHODS: The following glove materials were used: natural rubber latex (code A), acrylonitrile-butadiene rubber (code B) and chloroprene rubber (code C). In addition, we tested a layered material composed of a non-woven polyester (PES), a polypropylene (PP) film, and a non-woven PP used for protective coats (code D). The cytostatics were analyzed by liquid chromatography with diode array detection. The tested samples were placed in a purpose-built permeation cell modified to be different from that specified in the standard EN 6529:2001. RESULTS: The tested materials were characterized by good resistance to solutions containing 2 out of the 3 selected cytostatics: doxorubicin and 5-fluorouracil, as indicated by a breakthrough time of over 480 min. Equally high resistance to permeation of the third cytostatic (docetaxel) was exhibited by natural rubber latex, acrylonitrile-butadiene rubber, and chloroprene rubber. However, docetaxel permeated much more readily through the clothing layered material, compromising its barrier properties. CONCLUSIONS: It was found that the presence of additional components in cytostatic preparations accelerated permeation through material samples, thus deteriorating their barrier properties. Int J Occup Med Environ Health 2018;31(3):341-350.

Effect of shelf aging on vibration transmissibility of anti-vibration gloves.

Anti-vibration gloves have been used in real workplaces to reduce vibration transmitted through hand-held power tools to the hand. Generally materials used for vibration attenuation in gloves are resilient materials composed of certain synthetic and/or composite polymers. The mechanical characteristics of the resilient materials used in anti-vibration gloves are prone to be influenced by environmental conditions such as temperature, humidity, and photo-irradiation, which cause material degradation and aging. This study focused on the influence of shelf aging on the vibration attenuation performance of air-packaged anti-vibration gloves following 2 yr of shelf aging. Effects of shelf aging on the vibration attenuation performance of anti-vibration gloves were examined according to the Japan industrial standard JIS T8114 test protocol. The findings indicate that shelf aging induces the reduction of vibration attenuation performance in air-packaged anti-vibration gloves.

Hand hygiene compliance in a universal gloving setting.

BACKGROUND: The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting. METHODS: This nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital. RESULTS: A total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus. CONCLUSION: It is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.

Evaluating polymer degradation with complex mixtures using a simplified surface area method.

Chemical-resistant gloves, designed to protect workers from chemical hazards, are made from a variety of polymer materials such as plastic, rubber, and synthetic rubber. One material does not provide protection against all chemicals, thus proper polymer selection is critical. Standardized testing, such as chemical degradation tests, are used to aid in the selection process. The current methods of degradation ratings based on changes in weight or tensile properties can be expensive and data often do not exist for complex chemical mixtures. There are hundreds of thousands of chemical products on the market that do not have chemical resistance data for polymer selection. The method described in this study provides an inexpensive alternative to gravimetric analysis. This method uses surface area change to evaluate degradation of a polymer material. Degradation tests for 5 polymer types against 50 complex mixtures were conducted using both gravimetric and surface area methods. The percent change data were compared between the two methods. The resulting regression line was y = 0.48x + 0.019, in units of percent, and the Pearson correlation coefficient was r = 0.9537 (p ≤ 0.05), which indicated a strong correlation between percent weight change and percent surface area change. On average, the percent change for surface area was about half that of the weight change. Using this information, an equivalent rating system was developed for determining the chemical degradation of polymer gloves using surface area.

Examining the Usefulness of ISO 10819 Anti-Vibration Glove Certification.

Anti-vibration gloves are commonly worn to reduce hand-arm vibration exposure from work with hand-held vibrating tools when higher priority and more effective controls are unavailable. For gloves to be marketed as 'anti-vibration' they must meet the vibration transmissibility criteria described in the International Organization for Standardization (ISO) standard 10819 (2013). Several issues exist with respect to the methodology used for glove testing as well as the requirements for glove design and composition in ISO 10819 (2013). The true usefulness of anti-vibration gloves at preventing hand-arm vibration syndrome (HAVS) is controversial, given that their performance is dependent on tool vibration characteristics and the anthropometrics of workers in real working conditions. The major risk associated with the use of anti-vibration gloves is that it will give employees and employers a false sense of protection against the negative effects of hand-transmitted vibration. This commentary examines the limitations of the current international standards for anti-vibration glove testing and certification, thereby calling into question the degree of protection that anti-vibration gloves provide against HAVS, and cautioning users to consider both their benefits and potential drawbacks on a case-by-case basis.

Deconstructing the relative benefits of a universal glove and gown intervention on MRSA acquisition.

BACKGROUND: The 20-site Benefits of Universal Glove and Gown (BUGG) study found that wearing gloves and gowns for all patient contacts in the intensive care unit (ICU) reduced acquisition rates of meticillin-resistant Staphylococcus aureus (MRSA). The relative importance of gloves and gowns as a barrier, improved hand hygiene, and reduced healthcare worker (HCW)-patient contact rates is unknown. AIM: To determine what proportion of the reduction in acquisition rates observed in the BUGG study was due to improved hand hygiene, reduced contact rates, and universal glove and gown use using agent-based simulation modelling. METHODS: An existing agent-based model to simulate MRSA transmission dynamics in an ICU was modified, and the model was calibrated using site-specific data. Model validation was completed using data collected in the BUGG study. A full 2k factorial design was conducted to quantify the relative benefits of improving each of the aforementioned factors with respect to MRSA acquisition rates. FINDINGS: Across 40 simulated replications for each factorial design point and intervention site, approximately 44% of the decrease in MRSA acquisition rates was due to universal glove and gown use, 38.1% of the decrease was due to improvement in hand hygiene compliance on exiting patient rooms, and 14.5% of the decrease was due to the reduction in HCW-patient contact rates. CONCLUSION: Using mathematical modelling, the decrease in MRSA acquisition in the BUGG study was found to be due primarily to the barrier effects of gowns and gloves, followed by improved hand hygiene and lower HCW-patient contact rates.