All About Personal Protective Equipment

It is undisputed that personal protective equipment (PPE) can protect both patients and healthcare workers (HCWs). Universal and Standard Precautions indicate when certain PPE should be worn, and how it should be disposed of. So many choices exist, though, that it’s often hard to decide what’s best for your staff.

Gloves

Effective medical gloves are crucial to control the spread of pathogens. Each medical facility must consider a number of factors before deciding on the right product. Manufacturers must continually improve their offerings, developing safer, sturdier gloves to protect HCWs’ hands. This has led to thicker gloves, latex gloves, double gloves, even gloves with a color-changing indicator to indicate a breach in the glove’s outer layer.

Barrier properties are the first consideration when selecting a glove; second to that is the concern for staff comfort and allergies or sensitivities — powder or powder-free? Latex or synthetic? Sterile or exam glove?

Staff are vulnerable to developing allergies or sensitivities to the glove or other chemicals used with it, such as powder — leading to irritant contact dermatitis or even an allergy to a particular protein. Latex in particular has been known to cause this problem. Synthetic (latex-free) gloves include nitrile, neoprene, polyisoprene, and others.

Carolyn Twomey, director of clinical affairs for Regent Medical, notes that there is a difference between a completely latex-free environment and a latex-safe environment, which is less drastic a change. “Do you really need to be latex-free?” Twomey asks. “We find that a lot of people try to go that direction, thinking that will be the simplest solution to their latex allergy issues, when in fact it’s a very difficult leap to make to be latex-free.”

She also points out that some gloves don’t “play well” with alcohol, which can be problematic if the facility utilizes an alcohol-based hand prep or scrub.

David Parks, general manager of global infection control products at Kimberly Clark®, points out that the nitrile exam glove is being continually improved. That company has made improving the nitrile glove its mission, and in January will release an enhanced version as the Sterling™ nitrile exam glove. “Our focus has been trying to find synthetic alternative solutions to the exam glove category, primarily to address a reasonably high occurrence of latex allergies. However, there has historically been a significant price point difference between natural rubber latex gloves and nitrile exam gloves.” The new glove is intended to meet that lower price point hospitals seek.

“One of the biggest issues with synthetic alternatives has been that they’re stiffer and less flexible; you give up tactile sensitivity, compared to natural rubber latex,” Parks observes. “Our expectations are that this new glove will continue that drive away from natural rubber latex to the nitrile category as healthcare facilities look for solutions to how they can address that last major hurdle in being latex-free facilities.”

Latex-free has been a concern for many healthcare facilities, and the glove market has been trying to meet that need for years. Other categories of products used in healthcare transitioned to latex-free years ago; gloves are the last latex hold-out, primarily due to comfort — fit, function and tactile sensitivity — that the synthetic market has been trying to match.

“Given the acute sensitivity (to latex) — which is prevalent in about one out of every 50 HCWs — the only true way to address the issue is to eliminate exposure to latex products,” Parks adds. “Those folks who have or develop a severe latex sensitivity have to be provided with latex alternatives. Otherwise, they run major health risks including death, depending on the severity of their sensitivity and reaction.”

For healthcare workers who have not yet developed an allergy or sensitivity to latex, low-protein rubber latex gloves are an alternative, but those are still not an option for those already with allergies. “The fundamental cause of latex allergy rather than inherent allergy to latex is constant exposure or extended exposure over a period of time, which puts HCWs at the highest risk, due to the fact that they’re exposed to latex exam gloves on a daily basis. There are a number of large healthcare facilities in the U.S. that have made the definitive decision to go latex free. They have seen the value in having a latex-free environment relative to the risk to the healthcare worker as well as the risk to patients,” he points out.

Other options in the surgical glove arena — not necessarily “new” innovations but useful to the HCW nonetheless — are the use of double gloves, or an underglove. Indicator gloves may provide a differently colored underglove, or have some sort of material between the two gloves that will provide a heightened visual appearance if there is a breach in the outer glove, Parks adds. Then is the heavier-duty orthopedic glove and the higher tactile sensitivity microgloves.

Janie Thomas, RN, BSN, MA, is an OR nurse and a clinical consultant for Ansell Healthcare, and has day-to-day experience with multiple alternatives to latex gloves. “The newest material out there would be the new polyisoprene glove, and it’s a petroleum-based, cross-linked film, which provides high strength, elasticity, and has a fit, feel, and comfort similar to latex, but it has no latex proteins, so you cannot be allergic to it.”

The polyisoprene has been on the market for approximately 18 months, but is just now beginning to get a great deal of attention as a latex alternative. “Nitrile and vinyl have been out on the market for a while, and manufacturers were looking for something more comfortable to wear than those synthetics,” she explains.

The polyisoprene is available only as a sterile glove, and is therefore somewhat more expensive than a nitrile glove or vinyl glove. “But for an exam glove, there’s a neoprene exam glove that is also a petroleum-based cross-linked film, and it’s very comfortable,” Thomas says. “It provides barrier protection quite similar to latex, but has no latex proteins. It’s very strong, has good resistance to many chemicals, and neoprene has an elasticity close to latex, with high ‘memory,’ allowing it to retain its original shape, and it’s very puncture resistant.”

Asked about chemical resistance, Thomas explains that polyisoprene has fair protection against alcohol. Neoprene is available both in surgical and examination gloves, “and it is pretty good against most chemicals,” she adds. “And it can come free from chemical accelerators, so you would not have a type 4 allergy to it. A neoprene glove would be higher [in cost] than a latex glove — any of the synthetics are. That is the downside to synthetics. But they are necessary if you’re allergic to latex, or if you have a latex-allergic patient. But the recommendation is still, if you and your patient are not latex allergic, you should be wearing a low-protein, powder-free latex glove. Powder increases your chances of becoming latex allergic, because it adheres to the proteins and brings them directly to the skin and aerosolizes them into the air.

“Really, everyone should be using a powder free glove,” she continues. The powder is no longer needed to don gloves, because “all manufacturers of powder-free gloves, when removing the powder, put in an inner coating to act as a lubricant so they’re easy to don. Powder dries out your hand, increases the chance of contact dermatitis, and increases the chance of developing latex allergy.”

When asked about which glove she prefers in her work as an OR nurse, Thomas responds, “My preference would be a neoprene surgical glove — I think you get the fit, feel, and comfort of a latex glove, no chemical accelerators, and it has the best barrier in a synthetic.”

Medical Fabrics

The fabrics used in gowns are also of high import; some procedures may require a less-resistant fabric, while others might require a fabric that can repel blood and other body fluids. Does the gown keep the user cool or warm? Is it “breathable?”

Parks notes that providing excellent comfort becomes more challenging with higher levels of protection. “Clearly, the more impervious you make a product, by default the less breathable the product is going to become, and thus the higher the risk that it will be a hot garment and it’s uncomfortable to wear,” he says.

Does the fabric resist abrasion, and therefore linting? Lint or fabric particles could be risk to an open wound.

These staples include combining the best in protection and comfort, according to Parks. “We know that the more comfortable the garment is, the more likely folks are to be compliant in wearing the appropriate apparel article for the appropriate application. So those have become the basic requirements of apparel products — providing the protection that is required, and providing the comfort that is required.” Parks notes that additional factors must be considered as well. “Other great performance characteristics such as flammability resistance and abrasion resistance are also foundational requirements relative to medical fabrics,” he says.

Some manufacturers are even considering adding antimicrobial technology to gowns that already have barrier characteristics.

AAMI Standards

In terms of gowns, there is little that is truly new. However, gowns have come a long way from the old paper gowns that did little more than protect against dust. Many of them now comply with standards from the Association for the Advancement of Medical Instrumentation (AAMI), which have provided an objective measure of liquid barrier performance of protective apparel, and a classification system as well.

“The AAMI guidelines are based on industry-accepted test methods,” says Jon Behm, director of research and development for convertors at Cardinal Health. “The guidelines were developed over several years by a committee that included clinicians, leading medical organizations (e.g., the Association of periOperative Registered Nurses, the Association for Professionals in Infection Control and Epidemiology), regulatory agencies (e.g., FDA), manufacturers, and industry experts. For manufacturers, FDA recognizes the AAMI standard and requires manufacturers to submit performance data as part of the 510K approval process for applicable medical devices (i.e., surgical drapes and gowns, isolation gowns).”

The AAMI standards established clear levels of protection for isolation gowns, ranging from a level 1 to a level 4. “Level 1 offers basic dust and debris protection, and there is no real significant moisture or liquid barrier protection,” explains Parks. “On the other end of the spectrum, there is the AAMI level 4, which is an impervious gown, providing an absolute barrier to liquids.”

In surgical gowns, Kimberly-Clark offers a color-coded gown — the color represents the level of protection as red, yellow or green (for the lowest level of protection).

Masks

Masks fall into two categories — the respirator type of mask, which provides high levels of filtration, and very secure sealed fits for the face. This is the highest level of protection. The second category is that which offers a standard level of protection — standard surgical procedure masks. A tier in between those complements both families with a fluid shield line developed as an added protection for fluid resistance, or for spreading fluid impact during high-fluid procedures.

The SARS and flu scare two years ago brought about the innovation of child-specific masks. Heretofore, children with respiratory symptoms were outfitted with ill-fitting adult-sized masks. “There was not a child-sized face mask out there,” Parks observes. His company developed a child-sized face mask, and is now partnering with Disney to provide Disney-licensed graphics on outer face masks.

One area of innovation is providing bundling of products specific to the healthcare facility’s seasonal needs. The current influenza and cold season necessitates a greater number of respiratory hygiene stations — which can include facial tissues, alcohol-based hand sanitizer, and masks in sizes for both adults and children. Parks says that his company now provides “bundling” of these items to be presented to incoming patients and their families at the point of entry — emergency rooms, physicians’ offices, urgent care centers, and the like. Not only does the bundling solution protect the patient and family members, but it also provides safety for the healthcare worker and allows them to better comply with standard protocols for isolation protection or standard usage of personal protective equipment.

Product vendors are generally available to provide education on one product alone or a host of products in one “family.” Take advantage of this cost-free education to help narrow your choices and determine which will best suit your facility’s needs.

Products for Protection

Ansell Healthcare

Ansell introduced its new addition to their popular Derma Prene® glove line — the Derma Prene® PI surgical glove. Safe for use by latex sensitive healthcare professionals and patients, Derma Prene PI gloves are made from synthetic polyisoprene and are light green in color for instant latex-free identification. Derma Prene PI surgical gloves are also powder-free to help eliminate powder-related post-operative complications. The reduced thickness of Derma Prene gloves provides enhanced tactile sensitivity in the fingertips, while making double gloving easier and more comfortable. In addition, their smooth finish allows for worry-free instrument and suture handling.

(800) 952-9916
www.ansell.com

Kimberly-Clark® Health Care

KC’s surgical gowns will now be visually branded to identify and select the right gown for the right procedure. The Kimberly-Clark Color-Key is made up of three color-coded components; including neck bands, individual gown packages and tie cards. The Color-Key’s three colors denote different types of surgical gowns; yellow for non-reinforced surgical gowns, green for fabric reinforced surgical gowns and red for impervious-type surgical gowns. Tie cards will feature the Kimberly-Clark Color-Key, providing an added measure to confirm the type of gown the colored neckband represents.

(800) KC-HELPS
www.kchealthcare.com

Arcoa

The OneGlove Cuff-First Dispenser offers the convenience of one glove at a time — each glove is dispensed singularly, with one hand. There are ten gloves packed into plastic disposable dispensers, and they can be slipped into clip-on holders or placed in a pocket. The benefits are immediate access to personally sized gloves, and undispensed gloves cannot be contaminated by the user or anyone else. The glove is designed to be cost-effective, as the right glove is available in the right size at the right time, and there is no lost time or labor spent looking for a particular box of gloves.

(800) 748-5529
www.arcoa.com

Sempermed

Sempermed’s new Syntegra SIS Surgical Glove is manufactured with a patented styrene-isoprene-styrene copolymer that lacks processing accelerator chemicals, which have been identified as the cause of most glove-related sensitivities. A chlorination-free formula eliminates the slippery feel and strong odor often associated with chlorinated gloves. For those who prefer added protection, Sempermed’s Syntegra can be double-gloved.

(800) 366-9545
www.sempermedusa.com

MAXAIR®

Then there is the MAXAIR®, a hose-free personal respiratory protection system. Bio-Medical Devices International Inc. (BMDI)’s system is designed to offer both protection and comfort. It is designed to protect from dust and mist particles, as well as aerosolized and bloodborne pathogens, with a NIOSH efficiency level of N100. It protects the entire face, head and neck. The system is useful for outbreaks or infection control environments — such as severe acute respiratory syndrome (SARS), drug-resistant tuberculosis, avian influenza, hantavirus and other communicable diseases.

(800) 44-DEVICE
www.bmdi.com

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