By Anne Nugent Guignon, RDH, MPH
When it comes down to something as simple as gloves, there is a lot to take into consideration. Typically, if things start to happen with the hands, gloves are the first item that gets the blame. If you're a problem solver, then you are going to enjoy this discussion, which involves an all-too-common scenario.
Last fall, a hygienist named Jane contacted me about a glove issue. Previously, she had determined that latex gloves created dermatitis issues for her. After discussions with her doctor, she switched to nitrile. To save money, the practice purchased the gloves in bulk, a total of 20 boxes.
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Within weeks of using these new nitrile gloves, she started having serious skin problems. Her hands got sore, red and dry, often cracking after continuous days at work. Whenever she had more than a week off, her hand issues would clear up. The problems returned, though, as soon as she started back in clinical.
At first glance, one would think the gloves were the problem, but any good epidemiologist looks at both the obvious suspects and other factors that could be affecting the hands.1,2 To further the investigation, I asked Jane the following four questions regarding what she used on her hands in the clinical setting:
- What are the brand names of the gloves, hand wash and soap, or hand sanitizer?
- Was the glove powdered or nonpowdered?
- How does she dry her hands? On cloth or paper towels, or a wall-mounted hand dryer?
- Did she use a hand lotion, and what kind?
Jane reported using a nonpowdered nitrile glove and a liquid antimicrobial hand wash that contains 4% chlorhexidine gluconate as an active ingredient. The MSDS sheet for the hand wash contains a warning that the product could cause skin sensitivity or an allergic reaction. Research has shown that frequent exposure to chlorhexidine can lead to dry skin, and 4% detergent preparations create a higher risk for dermatitis issues than lower concentrations. In addition, hot water increases the risk for dryness, as does the number of times a day that the hands are washed.1,3-5
In addition to these questions, the actual manufacturing process can play role in glove dermatitis issues. Some glove companies go to great lengths to have clean manufacturing facilities; others do not, so the actual product may carry an unknown bioburden. Cornstarch is the powder used by most companies today. But powders, by their very nature, absorb moisture, which can lead to dry skin. A series of chemicals are used in the manufacturing process. Based on the actual process, there may be some lingering residue left on the gloves that can cause skin irritation.
Jane's physical location is an additional factor that comes into play. She lives in a high desert area, so the humidity is low, and it was wintertime.6 Central heating further dries the air, exacerbating the problem. In addition to the location, the long workdays that are packed with patients leads Jane to constantly wash her hands.
Jane ordered some gloves samples from Microflex. As soon as she started using the Xceed and Ultraform samples, her skin issues cleared. In Jane's case, switching gloves clearly was the solution.
But the story does not end here. Jane's doctor does all of the ordering, and he hit the ceiling when he found out the price of these two brands of nitrile gloves. Unfortunately, he did not understand that both Xceed and Ultraform packages have more gloves than a typical 100-count box -- 250 for Xceed and 300 for Ultraform, so the net cost is actually around 60 percent less than more traditional gloves. Additionally, nitrile gloves have a much lower failure rate from unexpected fabric tears, a feature that also lowers cost.
In addition to saving money and creating a healthier work environment for Jane, these gloves don't take additional storage space and are not adding as much bulk to the landfills, environmental considerations that are noteworthy. While eliminating the dermatitis was important in Jane's case, the biggest overall benefit of these two gloves has to do with hand safety.
Both versions were submitted to an independent laboratory that does ergonomic product testing. Both products have earned an ergonomic certification from New York-based US Ergonomics, a firm that specializes in testing products for ergonomic benefits. The company grants certification when a product "provides measurable ergonomic benefits to the anticipated users by improving comfort and fit and by minimizing the risk factors that may contribute to the development of ergonomic injuries." Both Xceed and Ultraform are made with very thin, stretchy nitrile that minimizes compression to the hand and significantly reduces stress to the thumb by allowing it to remain in its natural geometric plane, a significant benefit to any dental professional.
While I haven't heard the final resolution from Jane, I urge any of you who are having glove issues to explore other brands. If you find a glove that fits and you meet resistance from someone in your office, step back and consider your own health. If you need to purchase your own gloves, just do it. Your personal safety and well-being are critical, as well as the cornerstone of your clinical comfort zone.
ANNE NUGENT GUIGNON, RDH, MPH, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.
References
1. Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings. MMWR 2002;51.
2. Gallagher R, Sunley K. Appropriate glove use in dermatitis prevention. Nursing Times; 108: 37, 12-14.
3. Larson E, Girard R, et al. Skin reactions related to hand hygiene and selection of hand hygiene products. Am J Infect Control. 2006 Dec;34(10):627-35.
4.Kampf G, Löffler H. Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review. Ind Health. 2007 Oct;45(5):645-52.
5. Bissett L. Skin care: an essential component of hand hygiene and infection control.
Br J Nurs. 2007 Sep 13-27;16(16):976-81.
6. Callahan A, Baron E, et al. Winter season, frequent hand washing, and irritant patch test reactions to detergents are associated with hand dermatitis in health care workers.
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