PPE Review

Focusing on personal protective equipment

Healthcare workers (HCWs) in the endoscopy suite are at constant risk of exposure to infectious agents and other workplace hazards. In addition to being vigilant and mindful of patient safety, HCWs must take appropriate measures to ensure their own well-being. A large part of this effort involves the use of personal protective equipment (PPE) that is safe, effective and reliable.

“Protective equipment that is ignition-resistant and fluid-resistant should be a requirement in the endoscopy suite,” says Jay Sommers, PhD, director of clinical and scientific documentation at Kimberly-Clark Health Care. “Endoscopic procedures use high energy devices and a lot of liquids, so splashing can occur when a connection is opened or broken.”

The Centers for Disease Control and Prevention’s (CDC) “Guidance for the Selection and Use of Personal Protective Equipment in Healthcare Settings” recommends three criteria in selecting PPE:

• Type of anticipated exposure
• Durability and appropriateness of the PPE for the task
• Proper fit

With these factors in mind, HCWs can evaluate PPE in different categories to make a selection that best suits their needs.

“There are many points that should be considered in glove selection,” says Deborah Davis, technical director, gloves, for Cardinal Health. “Most importantly, gloves should be selected based on the type of procedure being performed. Gloves should also be evaluated based on the length of time the glove will be worn and any sensitivity the wearer has. In a study comparing the resealability of various glove materials, gloves were pierced in the fingertips using suture needles and tested using the American Society for Testing and Materials (ASTM) medical glove water leak test,” Davis continues. “Cardinal Health’s Esteem synthetic polyisoprene surgical gloves had the lowest failure rate of zero to 3 percent. Other synthetic polyisoprene surgical gloves had failure rates of 59 percent to 69 percent. Similarly, Cardinal Health’s Protegrity triple-dipped latex surgical glove had the lowest failure rate of the latex gloves tested, 6 percent to 19 percent. Competitive products had a failure rate of 41 percent to 59 percent.”

The material used in the manufacture of gloves is a major consideration. Strength and durability are vital relative to the nature of the procedure the gloves are being used for. The material must also be tolerable and comfortable for the clinician.

“Cardinal Health’s Esteem synthetic surgical gloves are formulated with synthetic polyisoprene,” says Davis. “Its properties are nearly identical to those of natural rubber latex. The tensile strength, which is very important during endoscopic and gastroenterologic procedures, exceeds the ASTM standard for both natural rubber latex and synthetics. The Esteem gloves immediately conform to the hand for an extremely soft, comfortable fit.”

Wava Truscott, PhD, director of scientific affairs and clinical education at Kimberly-Clark Health Care points out that nitrile is among the strongest materials available for exam gloves and is an excellent choice for most procedures. Nitrile gloves are ideal for clinicians who are allergic or sensitive to latex and who perform tasks or procedures involving prolonged exposure to blood, body fluids, chemotherapeutic agents, cleaning solutions and other chemicals.

“Nitrile also has the benefit of being resistant to any breakdown from oil-based products,” Truscott says. “Nitrile would be an excellent product to use if you are working with a lubricant, milking tubing or performing various procedures requiring contact with an oil-based substance, Oils can breakdown latex where you’ll notice your fingertips getting tacky or elongated, whereas nitrile does not.”

With the myriad of choices in the glove category, HCWs must verify that they know exactly what they are using. The concept of color coding may be useful in this respect.

“It is important that the person grabbing a glove knows whether it is a latex or synthetic glove,” Truscott continues.

“Latex gloves should not be colored to look like synthetic gloves and vice versa. Healthcare workers need to be able to automatically recognize a synthetic versus a latex glove. This color differentiation will help lower the risk of accidentally pulling the wrong glove which could result in barrier protection issues as well as latex allergy issues. This issue was the driving force that led Kimberly-Clark SAFESKIN® to introduce PURPLE NITRILE™.”

Kimberly-Clark also offers SAFESKIN PF surgical gloves. These powder-free gloves are designed to help reduce glove powder complications and aerosolization of potentially harmful substances. The addition of a polymer coating that is easy on the skin is designed to allow easy damp or dry-hand donning. The gloves meet or exceed all ASTM standards for surgical gloves.

When used in conjunction with gowns, ill-fitting gloves may compromise barrier protection by slipping down on the arm during a procedure. In response to this key issue, Regent Medical offers Biogel® Optifit™, a powder-free surgical glove line designed with a precision- tailored fit that forms to the contours of the arm, to help maintain the glove’s optimum position with disposable or reusable gowns.

Biogel Optifit gloves will be available in both latex and non-latex options. Like all gloves in the Biogel product group, Biogel Optifit gloves are powder-free and contain a polymer coating for ease of donning with damp or dry hands.

Many HCWs know that the condition of their own skin can also be greatly affected by frequent and extended glove use. Options that target this issue do exist in the glove market.

“A major, more recent consideration is the glove wearer’s skin condition,” Davis points out. “Contact dermatitis is a growing concern for nurses and other healthcare professionals. The average age of a nurse is 50. As people age, the skin becomes drier and the individual is at a greater risk for dermatitis. Nurses should look for gloves with emollient coatings, like Cardinal Health’s surgical gloves with Neu-Thera™. Esteem with Neu-Thera gloves are treated with a proprietary formulation that was designed for and tested by health care professionals. Extensive clinical testing has shown that these gloves will protect hands from moisture loss, restore smooth texture and health condition of hands, moisturize skin for deep-down relief and soothe dry, flaking and irritated skin.”

Davis also advises a big-picture perspective in choosing a product. “In selecting gloves, healthcare professionals should look for manufacturers that meet or exceed industry standards, for manufacturers with a good track record and a history of product innovation.”

The Association of periOperative Registered Nurses (AORN)’s “Recommended Practices for Use and Selection of Barrier Materials for Surgical Gowns and Drapes,” specifies that barrier materials should be resistant to penetration by blood and other infectious fluids under normal conditions. They should also resist combustion and be as lint-free as possible.

Kimberly-Clark’s ULTRA surgical gown line is designed to provide HCWs with an advanced combination of protection and comfort. It offers advanced protection against fluid penetration and rapid flame spread, plus softness and low-linting, according to the company. The gowns feature a raglan sleeve design and generous sizing. Kimberly-Clark offers a full line of ULTRA gowns ideal for a wide range of applications: non-reinforced, fabric-reinforced, zoned-impervious, impervious and specialty.

The Association for the Advancement of Medical Instrumentation (AAMI) has developed guidelines to aid in determining the type of protection that should be offered for a particular procedure. The guidelines are based on four levels, with Level I offering the most basic level of protection and Level IV the most advanced.

“We’ve launched two new surgical gowns,” says Lisette Swenson, U.S. brand manager for Mölnlycke Health Care. “The first one is the BARRIER® Fluid Protection Plus surgical gown. That’s AAMI level III, and then the BARRIER Surgical Gown II. Both of these gowns are fluid-impervious and the Surgical Gown II is highly repellant. Both provide high level protection but they’re very cool and breathable, and yet cost-effective.”

Swenson notes that technological advances have expanded the availability of powerful protection. “It used to be that the higher level of protection, the more expensive the gown got,” she says. “With the new fabric technologies, we were able to develop a gown with high protection but that was very cool and comfortable.”

“AORN’s guidelines recommend that endoscopic procedures should be operated in a manner that minimizes exposure to blood and other potentially infectious materials, droplets, noxious fumes, gases or surgical smoke,” says Sommers. “A fluid-shield mask can protect against exposure to blood and other fluids, while surgical apparel like Kimberly-Clark’s ULTRA surgical gown line has barrier properties that protect against blood strikethrough and ignition while being comfortable to wear.”

Kimberly-Clark’s wide range of styles and breathable, fluid-resistant fabrics are designed to give HCWs choices where comfort and protection are needed in a variety of tasks and procedures, according to the company. When the exposure to fluids is higher, such as with endoscopic procedures, the Kimberly-Clark Fluid Protection surgical masks meet the ASTM standard for fluid resistance in face masks.

For bronchoscopies and gastro cases, Swenson recommends Mölnlycke’s BARRIER® Ear-Loop Extra Protection Plus mask and the BARRIER® Extra Protection Plus mask. The masks are designed to offer high breathability for comfort, yet provide excellent bacterial filtration properties, thereby offering a high degree of protection. “Our masks with the visor are very comfortable; we have it both in a tie string and an ear loop,” says Swenson. “The ear loop mask tends to be very popular in the endo lab.”

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