by ANNE GUIGNON, RDH, MPH
Wearing gloves during clinical procedures is a price we pay for ensuring clinician and patient safety. While cross-contamination is a serious issue, something as seemingly innocuous as gloves has a great potential to create unnecessary stress leading to musculoskeletal damage and injuries.
Two decades ago, health-care workers responded to the HIV epidemic by adding barriers in the form of gloves, masks, face shields, and clinical jackets. Those who worked for decades without these devices now had to adapt to the fit and feel of these protective layers. There was a lot of confusion during the first few years. Sterile surgical gloves were readily available, high quality exam gloves were hard to find, and latex was the only fabric.
Dermatitis issues started cropping up in response to latex, the powder used in some gloves or chemicals used during manufacturing. Significant allergies ended careers for those susceptible to this plant-based protein.
Wearing latex gloves is analogous to encasing your hand, fingers, and wrist in a giant rubber band. Compression holds latex gloves in place, but there is a dark side to this stretchy material. Delicate nerves and blood vessels are affected from being squeezed hour after hour. Just as it is important to move away from latex from an allergy or dermatitis perspective, it is also a good idea to discontinue using gloves that contain powder. Powder dries the skin, making it more vulnerable to breaks, creating a direct pathway for irritation and possible infection.
A recent study of 1,200 hygienists demonstrated both the dominant and non-dominant hands are at risk for developing a musculoskeletal disorder. Thirty-six percent of those who reported an MSD had pain in their dominant hand, and 32% had issues with their non-dominant hand, the one typically used in cheek retraction with a mouth mirror.1 The relative risk for hand fatigue or pain is elevated for those using a tight pinch grip with static postures over a protracted period of time. Factor in vibration from automated tools, the exaggerated hours we wear gloves, dull hand instruments, force applied to remove deposits, stressful hand postures, lack of breaks or rest periods, back-to-back hard patients, and long clinical days. Add in lifestyle issues such as household tasks, incessant keyboarding, long periods of driving, as well as predisposing risk factors such diabetes, depression, or alcohol abuse, and we are headed for a physical implosion.
Carpal tunnel syndrome is a condition caused by continued irritation and compression of the nerves and blood vessels traveling through the wrist. CTS is only one of a number of wrist, hand and finger disorders common to our profession. Many dental professionals have arthritis, particularly in the thumb joint, and other disorders involving various fingers or the entire hand.
Surgery can often correct a damaged hand, but it does not guarantee one will be able to resume all former activities. There are dental professionals whose post-surgical lives are forever altered. Careers have been lost with devastating financial outcomes, and some clinicians still have the same pre-surgical symptoms. Many clinicians have paid a high physical price for practicing dental hygiene coupled with daily living activities and recreational pursuits that they love.
Examining the Hand Geometry
Ergonomists recognize that wearing gloves increases the effort it takes to perform manual tasks. A 2009 study demonstrated that thicker gloves decrease grip force while increasing forearm muscle activity, resulting in reduced tactile sensitivity. More effort was required to bend a gloved hand as compared to a bare hand.2 Haslegrave and colleagues concluded wearing gloves significantly increased muscle activity, pinch strength, and discomfort while reducing dexterity and tactile sensitivity.3 In addition, task duration reduced dexterity, forearm torque strength, and touch sensitivity.3,4 Wrist postures were also negatively affected when performing a task that requires both manipulation and force exertion.4
The majority of all dental hygienists participating in a 2010 gloves survey reported using ambidextrous gloves, a design that forces the thumb into the same geometrical plane as the other fingers in the hand.5 Hand geometry varies per person. Fingers can be slender, fat, short, or long. Palm sizes and shapes differ, as does wrist size. To reduce hand pain, many clinicians switched to hand specific gloves, but these are only available in latex. Gloves are made from a variety of fabrics on hand formers, however there is little standardization in the size of these formers, so one company's small-sized glove won't necessarily be the same size or shape as a small glove from a competing company.
Consider the fact that dental health-care workers have grown accustomed to wearing gloves hour after hour, day after day. Several months ago, Cindy Purdy, RDH, BS, and I were invited to help a group of 40 sales and marketing professionals understand the ergonomic challenges of clinical practice. We used products graciously donated by Microflex and Crosstex for the exercise. Everyone put on gowns and facemasks. Then they put a heavy, inflexible nitrile glove on their dominant hand and a new, thin flexible version on the other. The group was surprised at how confining it felt to wear PPE and that there could be such a difference in how different gloves felt.
Over the past two years, there have been many improvements in gloves. Microflex has gone the extra mile, creating several nitrile brands that are extremely thin, stretchy, and do not force the thumb into an unnatural posture. The company sought out and gained a special ergonomic certification from an independent firm that specializes in testing products to verify their new nitrile formulas reduce hand stress. Interestingly, there are slight differences in the sizing of these two brands. It is easy to request samples to determine the best fit for your hand. My personal comparison of the two indicated that I wear a small in one product and a medium in the newer version.
Our personal experiences with gloves reflect the findings of the ergonomists. Your hands are one of your most precious tools, so I urge you to take your gloves s eriously and look for the best fit and feel possible. Your career is based on the decisions you make and the actions you take. Your comfort zone is in your hands. RDH
References
1. Guignon AN, Purdy CM. Dental hygiene 2012 - workplace demographics, practice habits, injuries and disorders, academic awareness and professional attitudes. Unpublished data collected October/November 2012. https://www.surveymonkey.com/s/5K87Z25.
2. Willms K, Wells R, Carnahan H. Glove attributes and their contribution to force decrement and increased effort in power grip. Hum Factors. 2009 Dec;51(6):797-812.
3. Dianat I, Haslegrave CM, Stedmon AW. Short and longer duration effects of protective gloves on hand performance capabilities and subjective assessments in a screw-driving task. Ergonomics. 2010 Dec;53(12):1468-83.
4. Dianat I, Haslegrave CM, Stedmon AW. Using pliers in assembly work: short and long task duration effects of gloves on hand performance capabilities and subjective assessments of discomfort and ease of tool manipulation. Appl Ergon. 2012 Mar;43(2):413-23.
5. Guignon AN. What's happening to your hands? RDH. 2010 Aug:3(8):40,42.
ANNE NUGENT GUIGNON, RDH, MPH, provides popular programs, including topics on bioflms, 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.
Past RDH Issues
