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Objective: To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health., Design: Prospective before-after trial., Setting: An 18-bed surgical intensive care unit., Methods: During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection and Clostridium difficile infection (CDI) were determined., Results: The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P = .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters; P = .001; after patient care, 63% vs 51% of encounters; P < .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P = .10), 8.9 and 7.8 for urinary tract infection (P = .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P = .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P = .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P = .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P = .16). Hand skin health improved during phase 2., Conclusions: Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.

Background: Surgical gloves are an important phys-ical barrier between surgical staff and the pa-tient. They enable prevention of transmission of microorganisms in both directions, from the sur-geons' hands to the patient and vice versa. Besides the duration of wearing and the role within the surgical team, the integrity of gloves depends on the type of surgery performed. Therefore indicator systems and specific material enforcements of gloves at predilection sites are under discussion and furthermore, recommendations have been made for double-gloving during trauma surgical procedures. Because of varying recommendations regarding the changing interval of gloves, changes are often performed rather late or even not at all. The consequence is an increasing rate of glove perforations and an incalculable risk of infections., Material and Methods: To elaborate an objective recommendation for the time-interval of glove change, the medical literature was searched in the data bases MEDLINE and PubMed., Results: Various imprecise recommendations were expressed for the time point of glove changing rang-ing from 30 min to 180 min. Only in visceral surgery perforation rates had been correlated with the glove wearing time and the following recommendations of glove changing time points had been made: for the surgeon and first assistant at 90 min and for scrub nurses and second assistants at 150 min from the start of the operation., Conclusion: Because the perforation rate and thus the time for glove changing depend on the type of the surgery, the results found in visceral surgery can not be transferred to other surgical special-ties without additional scientific evidence. Further studies are needed that correlate the types of surgical procedures with specific perforation rates in order to provide basis for solid -recommendations helping to improve patients' and medical staff's safety., (Georg Thieme Verlag Stuttgart, New York.)

The potential for blood contact with skin puts operating room personnel at increased risk of exposure to hepatitis or HIV virus. One of the most common areas of contamination with infectious biological material is the hands and fingers due to failure of glove protection. There are varying opinions regarding the frequency of glove failure during orthopaedic procedures and the necessity of wearing two gloves for added protection. The authors performed a trial of 94 procedures involving 10 surgeons from Orthopaedic Department of Pomeranian Medical University from Szczecin, Poland to answer these questions. Outer-glove perforations occurred in 15% of the cases while inner-glove--in only 3.1% (p < 0.0001). In 5 cases there was an inner-glove defect without a corresponding outer-glove perforation. Both the duration of the operation longer than 2 hours and the type of the procedure (minor versus major) were associated with increased rates of perforation (p < 0.002 and p < 0.0007 respectively). From total amount of perforated outer-gloves, only 13 (28%) were changed by the surgeon during the operation. There was no statistically significant difference between latex and neoprene used as inner-gloves (p > 0.17) in failure rates. The authors conclude double gloving during orthopaedic procedures and changing the gloves every 2 hours may significantly reduce the operating room personnel's risk of exposure to blood borne pathogens.

Gloves, worn by the surgical team to prevent transmission of infections from and to patients, are prone to tears and perforations. This study was done to determine the frequency and sites of unrecognized glove perforation during surgical procedures. The percentage of glove perforation was 14%. Of the punctures, 73% occurred in one of four contiguous locations on the glove. We recommend glove reinforcement at these locations to provide better protection, as well as to reduce the burden of double gloving.

Health care workers (HCW) in surgery are at high risk for bloodborne infections (BBI) e.g. by hepatitis-B(HB)-, hepatitis-C(HC)- and HI-virus. On the other hand, infectious medical staff can cause nosocomial BBI in patients, too. Intact gloves provide an efficient barrier against BBI but glove perforations are common during several surgical procedures. A review of studies on glove perforations during different surgical operations was carried out with special regard to user, number and location of perforations, duration and kind of operation. We compared the results with the frequency of glove perforation during operations in 1938 single used gloves. They were collected after different surgical procedures in a department for general surgery and tested for perforation by 1-liter-water-filling method according to DIN 455/1. The product used during the period of this investigation was Sempermed sterile latex surgical glove. Most perforations were found on the index finger and thumb of the non-dominant hand. Duration of operation, role of the user (primary surgeon) and kind of operation are predictors for the incidence of glove perforations. Double gloving, endoscopic and no-touch techniques decrease the possibility of blood contact during operation. Indicator systems are useful for detection of the loss of glove integrity. Due to the high perforation rate found in this study glove change as a routine during surgical procedures should be discussed (e.g. every 30 minutes).

The purpose of the present study was to compare five different types of examination and surgical gloves physically and microbiologically before and after use in clinical dentistry. The prevalence of perforations was examined by the water inflation technique, and adhesion of bacteria to the glove surfaces was determined by use of a standard procedure with Streptococcus salivarius ATCC 13419. The effect of handwashing with a non-medicated soap and disinfectant soaps was finally examined. About 3% of the unused latex--and Elastyren gloves had perforations, while 6-7% of the unused vinyl gloves showed pinholes. Ten handwashes with a non-medicated soap did not affect the physical integrity of any of the glove types, while the disinfectant soap BLIX deteriorates about one third of the Elastyren gloves after 10 washes. In contrast, another disinfectant soap Hibiscrub did not affect these gloves. After use in clinical dentistry all vinyl gloves had perforations, while the other four types seemed unchanged. S. salivarius adhered to unused gloves of all types except for the hypoallergenic latex glove Biogel D. Highest numbers of cultivable bacteria were found for the non-sterile latex gloves and Elastyren gloves. The bacterial contamination was easily removed from all types by handwashing. Repeated handwashing decreased the adherence of S. salivarius to the non-sterile latex gloves and Elastyren gloves. After use in dental practice the adherence of S. salivarius seemed to be unchanged in relation to the situation, when the gloves were only washed up to 10 times. For the Biogel D gloves an increase in adherence of S. salivarius from zero before clinical use to a level comparable with the other glove types after clinical use was observed. Based on the findings in this study and compared with previous studies general recommendations for use of gloves in dental practice are formulated.

Barrier precautions are a fundamental component of any infection control strategy and a critical aspect of all isolation systems. Because many infections are transmitted from patient-to-patient via the hands of personnel, gloves and gowns are widely recommended to provide an extra measure of protection against cross-infection. It is not clear whether gloves are superior to handwashing (if performed obsessionally) in this respect, and there is little evidence that gowns confer additional benefit. These concerns notwithstanding, barrier precautions can substantially reduce the risk of some infections, such as respiratory syncytial virus disease. On the other hand, the modes of transmission of many infections are complex (e.g. with rotavirus) or controversial (e.g. with rhinovirus), and, even though hands are involved in transmission, barrier precautions alone may not suffice to prevent spread. Moreover, neither gloves nor gowns can prevent nosocomial infections caused by endogenous microbial flora; perhaps this explains the limited efficacy of barrier precautions in reducing the endemic rate of infection due to bacteria such as Pseudomonas aeruginosa in intensive care units. Barrier precautions may also fail if colonized patients are not identified promptly. One potential solution to this problem is 'body substance isolation' (BSI), in which all patients are considered to be potential carriers of nosocomial pathogens whether or not they have been cultured or have developed a clinical infection. In BSI barrier techniques are used when any potentially contaminated patient material is handled. BSI also provides barrier protection from bloodborne pathogens for personnel.(ABSTRACT TRUNCATED AT 250 WORDS)

The Food and Drug Administration (FDA) is issuing a final rule to: (1) Define adulteration for patient examination and surgeons' gloves; and (2) establish the sample plans and test method the agency will use to determine if these gloves are adulterated as defined by the rule. With the prevalence of human immunodeficiency virus (HIV) infection and the risk of clinical transmission of other infections, the importance of the quality of an effective barrier to the transmission of infection in health care settings is crucial. The public health will benefit through improved quality control of these protective barriers.

Procedure gloves are considered to be important to prevent infections when handling potentially contaminated items. We tested two sorts of vinyl- and 4 sorts of polyethylene-copolymer-gloves, 20 gloves of each, towards the ability of Proteus mirabilis ATCC 15143 to penetrate the glove material. The gloves were fastened in bottles containing 700 ml sterile nutrient broth and then filled with 300 ml of a bacteria suspension having a density of 10(8) cfu/ml. The samples were taken directly and 0.5, 1, 2, 3, 4, 6 and 24 h after starting the test. Immediately after the inoculation in 10 to 85% of the gloves a migration of Proteus mirabilis could be detected. After 24 h the rate was 25 to 90%! The penetration of Escherichia coli-lambda-phages (10(6) pfu/ml) was investigated in a similar arrangement. Here 20 to 90% of the gloves were previous in the first 5 to 10 min. Additionally tested latex gloves were impermeable up to 4 h after inoculation. The results of this study lead to the conclusion that it is necessary to improve glove materials. To examine the impermeability for microorganisms the methods used in this investigation are recommended as quality control procedures.

Study Objective: To evaluate the effectiveness of three different types of handcleansing agents in decontaminating gloved hands that were inoculated with a series of four nosocomial pathogens., Design: A controlled, experimental trial., Setting: Tertiary care referral center., Patients or Other Participants: Five healthy volunteers participated in all portions of the study., Interventions: A standard concentration of one of four representative nosocomial pathogens was placed on the gloved hand, spread, and allowed to dry. One of three different handcleansing agents--a nonmedicated soap, a 60% isopropyl alcohol preparation, or 4% chlorhexidine gluconate--was used to cleanse the gloves, which were cultured using a broth-bag technique. The gloves were then removed and the hands were cultured in a similar manner., Measurements and Main Results: The handwashing agents reduced the median log10 counts of organisms to 2.1 to 3.9 after an inoculation of 10(7) colony forming units. The proportion of positive glove cultures for Staphylococcus aureus, 8% to 100%; Serratia marcescens, 16% to 100%; and Candida albicans, 4% to 60% varied greatly after use of the different handcleansers (P less than 0.001), and varied considerably for Pseudomonas aeruginosa, 20% to 48% (P = 0.085). After the gloves were removed, the differences among the observed proportions of hands contaminated with the test organisms varied from 5% to 50%, depending on the handcleansing agent used (P less than 0.001)., Conclusions: In the era of universal precautions these data suggest that it may not be prudent to wash and reuse gloves between patients. Further, handwashing is strongly encouraged after removal of gloves.