How to choose and use disposable TPE gloves

Ⅰ. Role of gloves

　Gloves are the most frequently used personal protective equipment (PPE) in the medical setting. Gloves protect the health care worker,s fingers from contamination by infectious substances such as blood and body fluids, and prevent the transmission of microorganisms from the health care worker,s hands to the patient.
　It is unclear to what extent gloves can prevent the transmission of blood-borne pathogens (HIV, HBV, HCV, etc.) by needlesticks in health care workers. Gloves can reduce the amount of blood on the outer surface of hollow needles and suture needles by 46-86% 1, but in the case of hollow needles, the blood remaining in the inner cylinder is not affected by the gloves, so there is a risk of transmission. The effect of gloves on is unknown 2 . Factors that affect the amount of blood propagated by needle sticks have been found to be influenced by needle size and needle stick depth 1,3 .

Ⅱ. Scenes where gloves need to be worn

　From the standpoint of occupational infection prevention, the US Occupational Safety and Health Administration (OSHA) and the US Centers for Disease Control and Prevention (CDC) have established blood, other infectious substances, mucous membranes, and wounds. It is recommended to wear gloves if you expect to touch some skin 2,4 .
　Gloves are also required to care for patients with multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Pseudomonas aeruginosa (MDRP) and pathogens transmitted by contact transmission such as Clostridium difficile. Masu 2 .
　Table 1 summarizes when gloves should be used and when gloves need to be replaced under Standard Precautions and Contact Precautions.
Table 1. Timing of glove use and replacement in Standard Precautions and Contact Precautions

When to use gloves

① When direct contact with blood, body fluids, mucous membranes, wounded skin or other infectious substances is expected
② Contact with potentially contaminated skin such as stool or patients with urinary incontinence
③ When touching a contaminated or suspected patient care device or environmental surface
④ When caring for a patient carrying a pathogen transmitted by contact infection ④ -1 Gloves enter the hospital room the attachment when ④ when touching -2 patient of ④ -3 patient surrounding environmental surfaces and medical devices, when touching the articles, such as bed rails

Timing of glove change

① For each patient
② When moving hands from a contaminated body part such as the perineum to a clean body part such as the face even for the same patient
③ When contaminated
④ When damage or barrier function is impaired
Note) Continue to reuse gloves Do not wash for this reason.
* Even if you wash your hands with gloves and disinfect your hands, microorganisms will not be reliably removed from the surface of the gloves 5 .
　In addition, we cannot guarantee the perfect condition of gloves continuously.

Ⅲ. How to choose gloves

1) Types and uses of
gloves Table 2 summarizes the types and uses of gloves used in the medical field.

Table 2. Types and uses of gloves used in the medical field

type	Surgical gloves (sterilized)	Gloves for inspection / examination (sterilized / unsterilized)	Versatile gloves * 1 (not sterilized)
Use eye	{When contacting sterile tissue	When touching mucous membranes and wounds When touching moist biological substances	When touching wet biological material
Use	Invasive procedures such as surgery	When handling inspections, examinations, treatments, and contaminated equipment	Equipment cleaning, pollutant disposal, waste disposal
Contraindications / Prohibitions	Reuse prohibited	Reuse prohibited	Do not use on mucous membranes / wounds
Medical device classification * 2 (international classification * 3)	Managed medical device (class II)	General medical equipment (class I)	–

* 1 Thick gloves that can be used for cleaning and cleaning equipment, from reusable fingertips to the forearm.
* 2 The manufacture and sale of medical devices is regulated by the Pharmaceutical Affairs Law. The type of medical device is defined by the degree of risk to the human body, and the manufacturing and marketing approval also uses an examination method according to the risk classification. Surgical gloves, which are managed medical devices, are certified by a third-party certification body based on certification standards. There is a notification system for gloves for examinations and examinations, which are general medical devices.
* 3 According to the international classification GHTF (Global Harmonization Task Force), medical devices are classified into four stages, from lowest risk to class I to IV.

Standards for medical gloves

As a standard for medical gloves, there is an ASTM standard established and published by the American Society of Testing and Materials International (ASTM), which is the world,s largest standardization body. Judgment of glove holes (cracks), maximum elongation before and after deterioration, dimensions (thickness / length / width), amount of powder, etc. are specified.
In Japan, there is a standard for medical gloves set by the Japanese Industrial Standards (JIS). Table 3 summarizes the standards for medical gloves in ASTM and JIS.
ASTM and JIS standards can be searched at the URL below.
◦ ASTM standard http://www.astm.org/Standard/index.shtml
◦ JIS standard http://www.jisc.go.jp/app/JPS/JPSO0020.html

Table 3. Standards for medical gloves in ASTM and JIS

Type of standard	Types of gloves	Standard number
ASTM	Surgical rubber gloves	D3577
Rubber gloves for examination	D3578
Nitrile gloves for examination	D6319
Medical polyvinyl chloride gloves	D5250
JIS	Rubber gloves for disposable surgery	T9107
Disposable dental rubber gloves	T9113
Disposable dental vinyl gloves	T9114
Rubber gloves for disposable inspection / examination	T9115
Vinyl gloves for disposable inspection / examination	T9116

Rubber gloves for surgery are specified separately for natural rubber and other poly} in the standards of both ASTM and JIS.
ASTM screening or medical gloves include non-surgical medical applications.
JIS has set a separate standard for dental practice, and gloves for examination / examination include application to medical care other than surgery.
ASTM classifies gloves for medical examination or medical use into rubber (natural rubber only), nitrile, and polyvinyl chloride.
JIS classifies gloves for dentistry and examination / examination into rubber and vinyl and establishes standards, and in the standards for rubber gloves, it is stipulated separately for natural rubber and other poly}.

2) Point glove selection
to the glove material, there natural rubber latex, nitrile, polyvinyl chloride, chloroprene, neoprene, those polyurethanes throat various materials 7 . When choosing gloves, understand the characteristics of these materials and consider the barrier effect, fit, and allergens that are suitable for your work. Typical gloves used in the medical field include natural rubber latex, nitrile, and polyvinyl chloride. Table 4 summarizes the characteristics and uses of these gloves. Leak rate of gloves after the same operation, latex gloves 0-4%, 1-3% nitrile gloves and to lower the vinyl gloves has been reported that high and 26 to 61% 9 . Therefore, vinyl gloves should only be used for short-term work with low risk of contamination.

Table 4. Characteristics and uses of glove materials (Refer to Reference 7)

Main material (raw material)	Natural rubber latex (rubber tree sap)	Nitrile (oil)	Polyvinyl chloride (petroleum)
Use	Detailed work such as surgery using fingertips	Latex allergy countermeasures, tests, examinations, care, handling of chemicals, etc.	Latex allergy countermeasures, less risk of contamination by infectious substances, short-time work
Barrier effect	It has excellent strength and durability. It is strong against holes, but if it is sharp, it will have holes. Has a protective effect against detergents.	Has excellent resistance to perforations and tears. Excellent protective effect against chemicals.	Vulnerable to holes and tears. It is sharp and easily punctured. Sensitive to chemicals.
Feeling of wearing	High elasticity and good fit. Excellent fit.	High elasticity and good fit. It feels a little more oppressive than latex and is inferior in fit.	Elasticity is low. The size around the wrist is loose.
Allergen	Latex proteins, chemicals (vulcanization accelerators, etc.)	Chemical substances (vulcanization accelerator, etc.)	Chemical substances (plasticizers, etc.)
Economical	Cheap	Somewhat expensive	Cheapest

Note) For the handling of anti-cancer drugs , refer to the Guidelines for Aseptic Preparation of Injectables and Anti-Cancer Drugs 8 published by the Japan-Hospital Pharmacist Association . 3) Skin damage caused by gloves Latex skin damage caused by gloves is caused by latex allergy (type I allergy / immediate hypersensitivity) caused by proteins contained in natural rubber latex, and chemical substances added during the manufacturing process of gloves. Allergic contact dermatitis (type IV allergy / delayed hypersensitivity) that occurs, not an allergic reaction, but an irritant contact caused by the powder of gloves rubbing or drying the skin or the irritation of chemical substances added during the manufacturing process. I have tactile dermatitis 7,10 . Latex allergy is a more serious reaction than other glove-induced skin disorders. Symptoms appear within minutes of contact with natural rubber products, such as itchy skin, erythema, and urticaria, runny nose, sneezing, eye irritation, itchy throat, bronchial asthma, and rarely anaphylaxis. Causes a shock 10 . Contact with allergens occurs not only through percutaneous contact with gloves, but also due to the scattering and exposure of powder with latex allergens. As a preventative measure against latex allergies in healthcare professionals, the use of non-latex gloves such as nitrile gloves or powder-free gloves with low protein content is recommended by the National Institute of Occupational Safety and Health. Recommended by Occupational Safety and Health (NIOSH) and the Domestic Latex Allergy Safety Measures Guidelines 2009 (Japan {Latex Allergy Study Group) 10,11 . In the real {been Survey of latex allergy all health care workers 1,512 employees of the university hospital in the country as a target, 3.3% have been diagnosed with a latex allergy 12 . Irritation contact dermatitis is the most frequent reaction caused by gloves. The preventive measure is to avoid contact with irritants, but it is important to avoid contact with strong cleaning agents and chemicals in daily life and to perform hand care. If you do the hand care, hand lotion, which was composed mainly of oil, care must be taken because it can affect, such as the strength of the natural rubber latex gloves 13 . 4) Surgical gloves Surgical gloves prevent the fingers of the surgical staff from being contaminated with the patient,s blood and body fluids, and the bacteria (resident bacteria and passing bacteria) on the staff,s fingers from the staff,s fingers to the patient You can get it to propagate. Regarding double-wearing gloves during surgery, the risk of pinholes is greater when wearing a single (single) surgical latex glove than when wearing double gloves. It has been reported: OR4.10 (95% CI: 3.30 to 5.09) 14 . In addition, also in the CDC guidelines, double mounting of the gloves, and that the contact of the patient,s blood or body fluids and the finger has reduced this Togawaka, than in the case of the single of gloves 15 . When changing gloves during surgery, gloves must be changed as soon as safety permits if the barrier function of the gloves is impaired, such as when a hole is made in the gloves. However, it is difficult to notice the pinhole occurrence of gloves during surgery 16 . Indicator system gloves of the pin hole, the single or standard surgical latex gloves can be confirmed easily pinhole than double the mounting 14 . Indicator system gloves are made by wearing standard latex gloves on top of colored (usually green) latex gloves, and when the outer gloves have pinholes, the moisture from the surgical field is removed from the outer and inner gloves. Gloves that can be seen as bright green stains in between. The frequency of occurrence of pinholes, to become higher as the operating time is longer, you should exchange the gloves in the three to four hours or more of surgery 17 .

Ⅳ. Guidance points

●Be prepared to select gloves (types and materials) suitable for your work and to use the size suitable for you.

●After mounting, check for damage.

●After use, be aware that the outside of the gloves is contaminated, and remove them immediately without touching the surrounding environment.

●When removing gloves, be careful not to touch the outside of the gloves with your bare hands. Also, if you remove it vigorously, it may contaminate your fingers and surroundings, so remove it gently.

● After removing the gloves, perform hand hygiene. This is because infectious agents can enter through unrecognized crevices and contaminate fingers when removing gloves.

● Knowledge of latex allergy is required.