Hands down, thumbs up!

Nov. 1, 2004
Gloves ... we put them on every day without a thought. Even though gloves are an accepted part of our daily clinical armamentarium, how much thought do we give to that stretchy material ...

by Anne Nugent Guignon

Gloves ... we put them on every day without a thought. Even though gloves are an accepted part of our daily clinical armamentarium, how much thought do we give to that stretchy material that forms the barrier between our skin and the place that we call the oral cavity?

While OSHA regulations mandate that gloves be worn for all clinical procedures, these regulations were written to help protect health-care workers from contracting infectious diseases. Just putting on a pair of gloves does not ensure that you will be adequately protected from pathogens. In addition, the gloves that you put on tomorrow morning may create other health risks that could jeopardize the longevity of your career.

Gloves are designed for a variety of applications. In addition to the application, there is a long list of considerations to make when selecting the right glove, which includes fit, fabric, sanitary issues, and patient perceptions.

From an ergonomic standpoint, clinician comfort and fit should be high on your list. While glove ergonomics may not appear that critical over the length of your career, poorly fitting gloves can put you on the sidelines years before you are ready to call it quits. Even today, with all of the ergonomic information that is available, some physicians still do not equate wearing poorly fitted gloves with the development of workplace-related musculoskeletal disorders.

Properly fitted gloves should fit the hand comfortably. It is important that your gloves do not constrict the palm and provide sufficient finger length. Gloves that fit too tightly around the wrist or through the palm are considered a contributing factor in the development of a wide variety of hand and wrist cumulative trauma disorders, including carpal tunnel syndrome. Any undue pressure placed on the underlying soft tissues should be avoided. In contrast, gloves that are too large cause clinicians to tense their hands just to keep the gloves from falling off.

There is no industry-wide standard regarding glove sizes. So one company's small glove might slip comfortably onto your hand while another brand of small gloves could be impossible to wear. For most of us, it is a matter of trial-and-error, a process that many of us go through every time we go shopping for a new pair of pants. Once you know which manufacturer's clothes fit your body size and shape well, it becomes much easier to find pants that fit. Finding the right gloves for your hands is the same type of process.

Baby Boomers grew up watching, loving, and dreaming about Mickey and Minnie Mouse. Even though these beloved icons have only four fingers on each hand, in contrast to our five, their thumbs are positioned in a different plane, just like a human hand. Consider how difficult it would be to grasp an object or pick anything up if all of our fingers were arranged in a flat plane. Now, take a look at ambidextrous gloves. All five fingers are arranged in the same plane, in direct contrast to hand-specific gloves, known as right- and left-fitted, where the thumb is placed in a natural position.

Do you know what type of gloves you are wearing? If they are ambidextrous, the delicate tissues in your hand and thumb are experiencing subtle micro-strains all day long. This may seem picky, but very few health-care providers (other than dental professionals or those involved in long surgical procedures) wear gloves for a protracted period of time. Most health-care workers wear ambidextrous examination gloves for two to three minutes at a time and nothing more. For years, surgeons have worn gloves that fit the natural form of the human hand during procedures that last longer than a few minutes. Until dental professionals began to wear gloves on a routine basis, the ambidextrous glove fit the bill just fine. Now, we are the exception rather than the rule, and glove manufacturers have taken our unique situation into account.

If you are experiencing any hand or thumb pain, switch to a hand-specific glove. These gloves are manufactured to fit a specific hand. Even if you are not aware of hand discomfort at this point, it is likely that long-term use of ambidextrous gloves is not wise. Years ago, hand-specific gloves were significantly more expensive than the one-size-fits-all versions. The cost is now only slightly more than, if not comparable to, ambidextrous varieties.

More and more gloves today are being manufactured with a lightly textured grip on the fingertips or over the entire surface. Textured gloves significantly reduce the need for a tight, pinch grip, especially when wet. In essence, texture provides traction and allows us to lighten our grasp on our instruments, resulting in less overall hand fatigue.

Do you know if your gloves are clean? I don't mean sterile, but rather are they free from excessive bio-burden? Since gloves are made overseas, do the manufacturers regularly inspect the facilities? Do the manufacturers require that certain sanitary standards be maintained? These are hard questions, and reputable companies will be willing to give you answers. Don't be afraid to contact them.

Often, gloves contain some type of powder, such as talc or cornstarch. The powder facilitates taking the glove on and off. Some clinicians develop dermatitis because the powders absorb moisture. The end result can be dry, itchy skin, and brittle nails. Many people conclude that they are allergic to latex when the powder is the real culprit. In this case, wearing powder-free gloves should eliminate the dermatitis issues. If skin irritation persists, it is important to be tested specifically for latex allergies rather than making a self-diagnosis.

In order to combat dry skin, some clinicians use copious amounts of hand lotions or creams throughout the clinical day. Years ago, I even used petroleum jelly to combat the dryness.

Now, we know how risky this can be. Petroleum-based products, which are found in many lotions, degrade latex gloves. Make sure you check the ingredients listed on the product labels.

Finally, gloves can be a fashion statement. Gloves come in colors, from soft pink to wild purple. If you are so inclined, you can even match the color to your scrubs.

Gloves now come with fragrance or flavor. Have you taken a whiff of your gloves lately? Eau de latex is hardly a relaxing smell to most. Can you imagine how captivating grape or mint might be to a really anxious toddler? Don't forget to remind them that Mickey wears gloves just like you!

Often, at big meetings, it is possible to sample different sizes and different manufacturers' gloves at a single booth. Many companies are willing to send samples so you can evaluate their products before purchasing a case full of gloves. Read the journal ads or check the Internet for contact information.

Since there are more than 300 manufacturers of gloves, there is certainly a great chance that you can find one that gives you the perfect fit. Perfect fit equals practicing in the comfort zone.

Glove materials: Latex and the alternatives

Latex is the most commonly used material in glove manufacturing. While natural rubber latex gloves offer clinicians the most precise fit, it is important to remember that a glove that fits snugly can compress the delicate nerves, muscles, tendons and ligaments. Over time, repeated micro-traumas, which include soft-tissue compression, could result in long-term or permanent workplace-related musculoskeletal disorders.

With the growing numbers of healthcare workers and patients who have true sensitivities to natural latex rubber products, a variety of gloves made from alternative materials are now available. Many practices and educational institutions are also establishing latex-free environments in order to reduce exposure to patients as well as workers.

While vinyl is the least expensive alternative to latex, several things should be considered before using these gloves in a healthcare setting. First, vinyl gloves are not manufactured to provide a good ergonomic fit but rather to provide a barrier. Secondly, once one begins to use these gloves, the PVC begins to develop microscopic breaks. According to a number of research studies, the failure rate of vinyl gloves ranges from 30 to 70 percent, which is much higher than other synthetic materials. Additional research indicates that blood-borne pathogens pass through these breaks.

In consideration of these findings, vinyl gloves are not a reasonable choice for a clinician concerned with barrier protection and long-term ergonomic health. Once this information came to light, one major glove manufacturer discontinued selling vinyl gloves to health-care providers. If you have vinyl gloves in your office, consider using them for low-risk applications that are short in duration, like changing solutions in the X-ray processor.

Other latex-free alternatives include chloroprene and nitrile. While initially neither material provided the specific fit of latex, there have been significant strides in these synthetic materials. Chloroprene gloves offer a reasonable alternative to latex but are limited with respect to stretching without sagging, so the fit is not as precise. Also, there is less tactile sensitivity with chloroprene than with latex.

Nitrile gloves are safe for those sensitive to latex; however, this material feels thick and stiff to many clinicians and as a result, tactile sensitivity is compromised. In addition, nitrile gloves often feel hot and the fabric sags over time, resulting in poor glove fit. On the upside, nitrile is puncture resistant and, therefore, a great choice for gloves used to process sharp instruments in the sterilization area.

Science to the rescue again! Polymer chemists understand how to work magic with things like gloves. One company has developed a nitrile glove that still exhibits great puncture resistance but feels stretchy and thin like latex without the compression. Since this breakthrough, a number of clinicians who previously wore latex gloves have switched to this product.

Anne Nugent Guignon, RDH, MPH, is an international speaker, has published numerous articles, and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston, Texas, since 1971. You can reach her at [email protected] or (713) 974-4540 and her Web site is www.ergosonics.com.