An Update on the Innovative Surgical Double-Glove Hole Puncture Indication Systems: Reliability and Performance.

During operative procedures, operating room personnel wear sterile surgical gloves designed to protect them and their patients against transmissible infections. The Food and Drug Administration (FDA) has set compliance policy guides for manufacturers of gloves. The FDA allows surgeons' gloves whose leakage defect rates do not exceed 1.5 acceptable quality level (AQL) to be used in operating rooms. The implications of this policy are potentially enormous to operating room personnel and patients. This unacceptable risk to the personnel and patient could be significantly reduced by the use of sterile double surgical gloves. Because double-gloves are also susceptible to needle puncture, a double-glove hole indication system is urgently needed to immediately detect surgical needle glove punctures. This warning would allow surgeons to remove the double-gloves, wash their hands, and then don a sterile set of double-gloves with an indication system. During the last decade, Regent Medical has devised non-latex and latex double-glove hole puncture indication systems. The purpose of this comprehensive study is to detect the accuracy of the non-latex and latex double-glove hole puncture indication systems using five commonly used sterile surgical needles: the taper point surgical needle, tapercut surgical needle, reverse cutting edge surgical needle, taper cardio point surgical needle, and spatula surgical needle. After subjecting both the non-latex and latex double-glove hole puncture indication systems to surgical needle puncture in each glove fingertip, these double-glove systems were immersed in a sterile basin of saline, after which the double-gloved hands manipulated surgical instruments. Within two minutes, both the non-latex and latex hole puncture indication systems accurately detected needle punctures in all of the surgical gloves, regardless of the dimensions of the surgical needles. In addition, the size of the color change visualized through the translucent outer glove did not correlate with needle diameter. On the basis of this extensive experimental evaluation, both the non-latex and latex double-glove hole puncture indication systems should be used in all operative procedures by all operating room personnel.

Revolutionary advances in adaptive seating systems for the elderly and persons with disabilities that assist sit-to-stand transfers.

The independence of elderly and arthritic patients as well as persons with disabilities is influenced considerably by their ability to stand from a chair. The presence of pain, reduced joint range of motion, stiffness, and muscle weakness often limit the ability to achieve a sit-to-stand position (STS). Realizing the enormous implications of STS performance, physicians, scientists, and industry have joined together to design and manufacture a wide variety of adaptive seating systems that facilitate therising process. These systems can be divided into three groups: those without mechanical devices, those with mechanical lifts, and those that can lift, tilt in space, recline, or rock. The design of mechanical seating systems without mechanical assists have been influenced by several factors, including chair height, armrest height, and foot position of the occupant. The evaluation of STS performance involves a variety of measurements to include joint angles and moments, speed of time to rise, functional reach and sway, and perception of patient stability (or perceived safety) in rising from a chair. These studies reported that chair seat height, use of armrest, and foot position had a major influence on the ability to do a STS movement. The use of higher chair seats resulted in lower moments at the knee and hip level. Investigators reported that lowering the chair height increased the need for momentum generation or repositioning of the feet to lower the needed moments. They found that the use of an armrest reduced the moments needed at the hip without altering the range of motion of the joints. These investigators found that repositioning of the feet influenced the strategy of STS movement, allowing lower mean extension moments at the hipwhen the foot position changed from anterior to posterior. Adaptive seating systems with lifts include the spring-booster chair spring-loaded flap seat, and ejector chair. Innovative investigators reported that increased seat height complemented by the mechanical lift enhanced STS transfers by persons with disabilities. The investigators noted that it was easier to perform STS transfer when using a mechanical lift than when rising unassisted or from a raised seat height. The latest adaptive seating system, the elevator chair, has the unique ability to assist the occupant to the STS position. The rear section of this chair remains in a fixed position to support the buttocks of the user during the mechanical lift. The front portion of the seat folds down incrementally as the chair rises to allow the feet of the user to be positioned firmly on the floor. Using an elevator chair, the height that the chair rises will vary with the length of the occupant's legs. When the user reaches a point when his/her legs are comfortably straight and the body is in an erect position, the occupant will walk unassisted from the chair. This elevator chair will soon be available with a tilt-in-space capability as well as a gently rocking motion. The elevator chairs are ideally suited for offices, waiting rooms, hospitals, long-term care facilities, and homes. While persons with disabilities appreciate the benefits of these adaptive seating systems, which allow them to achieve a STS position without assistance, healthcare personnel also value the benefits of these adaptive seating systems because they eliminate their need to lift the occupant to a standing position--an invitation for a potentially serious back injury.

Latex allergy: a life-threatening epidemic for scientists, healthcare personnel, and their patients.

Latex allergy has become a global epidemic, affecting patients, healthcare workers, and scientific personnel. Today, the incidence of latex allergy in healthcare and scientific personnel varies from 17-36%, costing billions of dollars annually to treat. Consequently, it is the purpose of this special report to describe the etiology, immunology, diagnosis, management, prevention, and litigation of cases of latex allergy. The latex allergy epidemic has been attributed to the dramatic increase in glove usage following the establishment of Universal Precautions by the Centers for Disease Control and Prevention. Because of the latex allergy epidemic, every hospital and scientific research facility should institute a comprehensive emergency treatment program for latex allergic patients, latex-safe areas in their facilities, and a prevention program that includes the wide use of latex-free gloves and the absence of powdered gloves throughout these facilities.

Reliability and performance of innovative surgical double-glove hole puncture indication systems.

During operative procedures, operating room personnel wear sterile surgical gloves designed to protect them and their patients against transmissible infections. The Food and Drug Administration (FDA) has set compliance policy guides for manufacturers of gloves. The FDA allows surgeons' gloves whose leakage defect rates do not exceed 1.5 acceptable quality level (AQL) to be used in operating rooms. The implications of this policy are potentially enormous to operating room personnel and patients. This unacceptable risk to the personnel and patient could be significantly reduced by the use of sterile double surgical gloves. Because double-gloves are also susceptible to needle puncture, a double-glove hole indication system is urgently needed to immediately detect surgical needle glove punctures. This warning would allow surgeons to remove the double-gloves, wash their hands, and then don a sterile set of double-gloves with an indication system. During the last decade, Regent Medical has devised non-latex and latex double-glove hole puncture indication systems. The purpose of this comprehensive study is to detect the accuracy of the non-latex and latex double-glove hole puncture indication systems using five commonly used sterile surgical needles: the taper point surgical needle, tapercut surgical needle, reverse cutting edge surgical needle, taper cardiopoint surgical needle, and spatula surgical needle. After subjecting both the non-latex and latex double-glove hole puncture indication systems to surgical needle puncture in each glove fingertip, these double-glove systems were immersed in a sterile basin of saline, after which the double-gloved hands manipulated surgical instruments. Within two minutes, both the non-latex and latex hole puncture indication systems accurately detected needle punctures in all of the surgical gloves, regardless of the dimensions of the surgical needles. In addition, the size of the color change visualized through the translucent outer glove did not correlate with needle diameter. On the basis of this extensive experimental evaluation, both the non-latex and latex double-glove hole puncture indication systems should be used in all operative procedures by all operating room personnel.

Ease of donning of new powder-free non-latex and latex double-glove hole puncture indication systems.

Cornstarch on surgical gloves is often used as a detackifying agent and a lubricant to facilitate glove donning. During the last century, scientific studies have demonstrated that cornstarch produces tissue injury in literally every part of the body. Because this glove lubricant cannot be removed from the glove, Dr. David Podell, an ophthalmologic surgeon, and his cousin, Howard Podell, a chemical engineer, devised the first powder-free surgical glove that could be donned easily. They coated the inner surface of the surgical glove with a methacrylate polymer lining that was bonded to the natural rubber latex. This special coating acts as a lubricant to facilitate donning with damp, wet, or dry hands. In our earlier experimental studies, we confirmed that these polymer-lined latex gloves could be donned with either wet or dry hands. More recently, the polymer-coated latex gloves were incorporated into a double-glove hole puncture indication system that accurately detected glove holes in the presence of fluid. Because this discovery has been expanded into the development of a non-latex double-glove hole puncture indication system, we have expanded our biomechanical performance studies to examine the glove donning forces of the latex and non-latex glove hole puncture indication systems. The maximum donning forces recorded for the non-latex undergloves were significantly lower than those encountered by the same respective sizes of the latex underglove. The donning forces of the thin Biogel Super-Sensitive outer gloves were remarkably similar to the donning forces of the Biogel Indicator undergloves. The thicker Biogel outer gloves encountered greater donning forces than that noted for the Biogel Super-Sensitive outer gloves. The donning forces recorded for the non-latex outer gloves were remarkably similar to those noted for the latex Biogel outer gloves. Because the results of this biomechanical performance study demonstrated that the latex and non-latex double-glove hole puncture indication systems can be easily donned by surgeons using relatively low donning forces, this study provides convincing evidence that these double-glove hole puncture indication systems can be used in all surgical procedures.

Recommendations for postexposure prophylaxis of operating room personnel and patients exposed to bloodborne diseases.

The purpose of this collective review is to discuss management of operating room personnel who have had occupational exposure to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus type I (HTLV-I). HBV postexposure prophylaxis includes starting hepatitis B vaccine series in any susceptible unvaccinated operating room personnel who sustain an exposure to blood or body fluid during surgery. Postexposure prophylaxis with hepatitis B immune globulin (HBIG) is an important consideration after determining the hepatitis B antigen status of the patient. Ideally, all operating room personnel should be vaccinated with hepatitis B vaccine before they pursue their career in surgery. Immune globulin and antiviral agents (e.g., interferon with or without ribavirin) should not be used for postexposure prophylaxis of operating room personnel exposed to patients with HCV; rather, follow-up HCV testing should be initiated to determine if infection develops. Postexposure prophylaxis for HIV involves a basic four-week regimen of two drugs (zidovudine and lamivudine; lamivudine and stavudine; or didanosine and stavudine) for most exposures. An expanded regimen that includes a third drug must be considered for HIV exposures that pose an increased risk for transmission. When developing a postexposure prophylaxis regimen, it is helpful to contact the National Clinicians' Postexposure Prophylaxis Hotline (1-888-448-4911).