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The changing face of hand protection - Home Study Program - Statistical Data Included

AORN Journal, August, 2002 by Peter B. Graves, Carolyn L. Twomey

The article "The changing face of hand protection" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

A minimum score of 70% on the multiple-choice examination is necessary to earn 2 contact hours for this independent study. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Aug 31, 2005.

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Send the completed application form, multiple-choice examination, learner evaluation, and appropriate fee to

AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

BEHAVIORAL OBJECTIVES

After reading and studying the article on surgical gloves, the nurse will be able to

(1) discuss the history of glove use in the health care environment,

(2) identify the health issues that health care workers have faced since the advent of universal precautions,

(3) describe the materials used to make surgical and examination gloves,

(4) explain the advantages of double gloving to provide added protection against exposure, and

(5) describe the barrier protection of the scrub or hand wash used before gloving.

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

The Changing Face of Hand Protection

Picture yourself on an airplane. The flight attendant announces that in the event of sudden decompression, a mask will fall from an overhead compartment. She instructs you to secure your own mask and then help the person next to you. Passengers often take these detailed safety routines for granted. As health care professionals, do we treat the use of personal protective equipment (PPE) in the clinical environment with the same lack of concern? Do we think about making an informed choice when we don sterile surgical gloves for a procedure? Do we then help others who may be having problems with their protective devices?

Health care professionals use a variety of surgical and examination gloves. Some are preferred more than others based on fit, feel, and comfort. Regardless of preference, all health care professionals must be confident that their gloves provide appropriate protection. Many factors, including material composition, design, and testing, influence how well gloves function and should be considered when choosing gloves, as well as other PPE.

HISTORY OF GLOVES

The first gloves were made in the late 1790s from sheep cecum and were used during gynecologic and obstetric procedures, including vaginal examinations and deliveries. (1) Resembling the modern day "finger cot," these gloves offered practitioners low-level protection because of the inherent permeability of the material. In 1839, Charles Goodyear discovered a process for adding sulfur to natural rubber and heating it to produce a stronger, more elastic material. (2) It was not until 1896, however, that William S. Halstead, MD, of Johns Hopkins Hospital, Baltimore, used Goodyear's technology to produce reusable gloves for members of his surgical team. (3) These original surgical gloves were used to protect health care workers from the harsh sterilizing chemicals used at that time.

Powdered gloves. As health care progressed from these early days, surgical gloves evolved as well. The first surgical gloves were boiled to achieve sterilization. After determining that wet, hot gloves were difficult and uncomfortable to don, researchers developed a dry process of applying powder to the gloves and then placing them in a steam sterilizer. Lycopodium, a product made from club moss spores, was the first powder used for this process. It was used for only a brief period, (4) however, because patients developed significant reactions, including adhesions, granulomas, and infections. (5)

The health care industry then moved to the use of talcum powder, which provided increased ease of donning without a significant loss of tactile sensitivity. After users discovered that talcum powder caused patient complications similar to those caused by lycopodium powder, they began to transition to the use of cornstarch in 1947. (6) Cornstarch completely replaced talcum powder by the end of the 1980s.

Today's US Pharmacopoeia (USP)-approved cornstarch begins as an ear of corn, which is processed so that all the starch particles have a standard size. Chemicals then are added to modify the cornstarch and prevent caking or clumping. These chemicals should be not more than 2% magnesium oxide with either phosphorus oxychloride or epichlorhydrin. (7) The USP monograph requires that cornstarch withstand boiling for 20 minutes without breaking down into a paste. This is a crucial element of history because when USP cornstarch first was introduced to the medical community, health care practitioners used steam sterilizers to sterilize gloves. Today, gamma irradiation has almost completely replaced ethylene oxide and steam sterilization for commercially sterilized products. As a result, using yesterday's standards for USP cornstarch with today's sterilization technology has created a problem.

Health Care Industry

The changing face of hand protection - Home Study Program - Statistical Data Included

AORN Journal, August, 2002 by Peter B. Graves, Carolyn L. Twomey

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