Module 4: Gloves -

Hazards of glove use:

The worker factor:

After adequate hazard identification and risk assessment and knowing precisely what exposure one needs to protect against the provision of gloves at the work place still does not ensure that they will protect the worker. The worker factor needs to be accounted for.

The workers have to be educated in the use of gloves. The worker needs to know what the exposures and risks are and they must know when to select what glove for what particular task. As a doctor involved with occupational skin disease, I am appalled to hear the answers I get to the question, "why do you use gloves?". Most workers know that they are for protection, but seldom can identify the compounds for which the protection is needed. Access to this sort of information is legislated and should be available in every work situation. Also, the selection of glove size is of paramount importance and a full range of sizes should be available for workers’ selection. Education has to be more extensive than glove selection to ensure that gloves are appropriate and offer the protection required. Management and those involved in administration, ordering and supply of gloves must be equally informed so that short-cuts are not taken in the name of cost controls.

When pinholes are liable to occur, workers should be instructed on testing for pinholes prior to use. This is especially important if there is a high relative risk with significant health implications of exposure.

Gloves should only be put on once a worker has cleaned their hands. The reason for this is self-explanatory. Contaminated hands within gloves, contaminate gloves. The occlusive effects of gloves predisposed to increased absorption of products already on the hands as previously discussed. Adequate, easily available ablutions are therefore an essential component of hazard control and all glove use. Work place visits highlight the inadequate and inaccessible nature of most ablution facilities.

Workers need to be instructed on how to put on gloves especially those that have been used before, in order to prevent skin contamination.

More important, one needs to be educated in the removal of gloves. Recent work from the United Kingdom has shown that while gloves might have protected the worker during the task, 50% of those using gloves contaminated the skin surface while taking them off. Clearly, the process of putting on gloves and taking them off is crucial for their efficacy. It should be part of the orientation of any worker new to the job and regular workers need repeated reminders.

For gloves and personal protective equipment that are to be used more than once, the question of glove hygiene needs to be addressed and has its own built in hazards. In the food industry it is legislated that workers need to use gloves to ensure that the manufactured product is fit for human consumption. Gloves that are used repeatedly or shared are often kept in solutions containing disinfectants and are donned wet, introducing an additional set of hazards to the worker such as contact with disinfectants and a wet occlusive environment.

Despite the fact that one has identified the risks and exposures for which protection is required, even with the most appropriate and carefully selected glove or personal protective equipment, a new set of hazards has to be considered.

These have been addressed previously and involve the choice of gloves plus the maintenance and hygiene of gloves and personal protective equipment.

Management, workers and administrative staff need to be aware that gloves or personal protective equipment introduces a further range of hazards that can compound the original hazard if not recognised.

The hazards of glove use are varied. The most obvious being the mechanical hazards that interfere with dexterity. Cumbersome ill-fitting gloves can be caught in moving machinery leading to accidents.

Gloves and personal protective equipment are irritant to the skin. As they have to act as barriers between the skin and exposure, they are occlusive. Sweating leads to maceration of the stratum corneum and loss of barrier function. Repeated insults result in irritant dermatitis. Products used to facilitate the easy application of gloves, such as glove powder, also act as irritants. The occlusive effects of gloves can be limited by the use of cotton or silk liners, however these interfere with dexterity, sensory perception and fine motor control. They also need to be changed regularly and washed appropriately. Irritant reactions from gloves are common and not recognised.

Allergic reactions to glove products and contaminants of manufacturing have been recognised for years. However it was only the recent epidemic of type 1 latex allergy to natural rubber latex proteins precipitated by an increased demand for personal protection of the public following the AIDS epidemic that highlighted the problem. Shortcuts in the manufacturing of natural rubber latex gloves introduced a new, unsuspected, previously unrecognised, hazard. Sweating inside the glove with subsequent maceration and loss of barrier function, predisposed workers using these cheaply prepared gloves to increased risk of sensitisation and type I allergy. For initiation and control of the process of monomer polymerisation, to provide flexibility and to prolong the life span of the glove, a variety of chemicals are used in the manufacturing of gloves. These are well-recognised causes for type IV hypersensitivity reactions and contact dermatitis.

The table below lists several of the chemicals present in gloves that are known glove allergens. Many of these are represented as mixtures in the standard battery series of patch test allergens. They include the phenylenediamine dyes (yellow) often found in black rubber and accelerants and antioxidants such as mercapto mix (containing the chemicals in green), carba mix (containing the chemicals in blue) and thiuram mix (containing the chemicals in pink) in this list of glove allergens. Hypersensitivity reactions and contact dermatitis to these chemical agents have been recognised for many years. They are commonly encountered in the general population as rubber is ubiquitous and used in many settings. This is really the subject of another lecture - perhaps you could do some reading around rubber exposure for discussion in the tutorials.

Barrier creams:

Gloves are not the panacea for skin protection and contact dermatitis.

After this in depth discussion on gloves and glove hazards, what about barrier creams? The next 2 statements summarise current opinion and findings.

• If gloves are NOT the panacea for contact dermatitis, then barrier creams are NEVER a panacea for contact dermatitis.
• At best they are emollients playing a role in skin care.

Summary:

Good business sense is summarised in the statement: "control the process not the person". If you control the process you have relative control over exposures to hazards. People should never be considered "fail safe". As worker co-operation is necessary for the adequate use of gloves as personal protective equipment, they should be avoided wherever possible. Before use of the personal protective equipment is considered, all reasonable, engineering or planning manoeuvres must have failed and thus exposure cannot be avoided. Incorrectly chosen and inappropriately maintained personal protective equipment is a hazard to health. Ideally before any material or process is introduced to the work place, careful consideration should be given as to whether it might present a new hazard. Management should consider active involvement of the worker and common sense suggestions of hazard management offered by them.

There is no single item of personal protective equipment or glove that is applicable to every task and every exposure.