Manufacturers are attempting to reduce the level of protein in the finished latex glove to reduce exposure to these allergens. Even "low protein" gloves may cause a reaction in a person with a latex allergy.
In the June issue of RDH, we presented answers to questions about processing contaminated instruments. This article provides answers to questions about protective barriers.
* Should I be wearing long sleeves for all of my cleaning appointments?
The type/style of personal protective equipment (protective clothing, for example) needs to be determined by each office, according to the tasks being performed. A key issue is whether your skin may become contaminated during a procedure. If so, the contamination should be prevented. Thus, if the forearms will become contaminated, then consideration should be given to wearing long sleeves and protecting the skin. Spatter is generated from the ultrasonic scaler, slow-speed handpiece, and air/water syringe.
* Why should our office consider wearing powder-free gloves?
Latex allergy is an immunological response to contact with certain proteins in latex materials. Increased awareness of latex allergy among health care workers has resulted in the enhanced availability of nonlatex gloves, as well as powder-free latex gloves. The nonlatex gloves are for those who have an allergy to latex. These people need to avoid all contact with latex.
The powder-free latex gloves are not for those who have a latex allergy, but they can reduce the spread of the latex allergens. The powder (which is cornstarch) absorbs latex allergens from the gloves and can serve as a vehicle for the spread of these allergens throughout your office or building. When gloves are put on and removed some of the powder/allergens becomes airborne.
Additionally, the allergens can be transferred in the powder to any surface touched with gloved hands. This spread can increase the number of people that may be exposed to these allergens and increase the level of allergens in the environment. In turn, this might increase the number of people who become allergic to latex. Also, this spread may increase the chance that people who are already allergic to latex proteins may contact these proteins and have a reaction. People who are allergic to latex may undergo respiratory stress and have other allergy symptoms when they merely walk into a facility where powdered latex gloves are used.
* I`ve recently heard about "low protein" latex gloves. Are they for a new fad diet or do they have some real advantage?
People who have a "latex allergy" are not allergic to the latex. They`re allergic to the proteins present in the rubber tree sap that contains the latex material. These proteins remain a part of the finished latex glove and cause the sensitization and reaction in the allergic people who contact latex materials.
Glove manufacturers are attempting to reduce the level of protein in the finished latex glove to reduce exposure to these allergens. "Low protein" gloves may have less than 50 micrograms of protein per gram of glove material. A maximum level would be 200 micrograms per gram of glove material. Caution! Even "low protein" gloves may cause a reaction in a person with a latex allergy.
Unfortunately, it is not known what level of exposure to an allergen is needed for sensitization or for a reaction. This level likely differs from one allergic person to the next.
* Since I`m not performing surgery or using sterile gloves, why do I have to wash my hands just before I glove?
Washing hands before gloving will reduce the level of normal skin bacteria. As a result, fewer will multiply underneath the gloves and irritate your hands. The mixture of perspiration, skin bacteria, and chemicals on your hands under gloves may lead to irritant contact dermatitis (the most common skin reaction to gloves). Washing the hands before gloving may help this condition.
* We pay to have our used gloves, masks, cotton rolls, and patient napkins hauled away with our needle containers. Is this OK?
This is infection control overkill. There is nothing wrong with this practice, but it`s not necessary to go to this extreme unless you have some local law requiring this activity. Check with your state dental association or board of dental examiners. Regulated waste in a dental office, as defined by OSHA, consists of:
- Contaminated sharps
- Liquid blood or saliva
- Tissues/extracted teeth
- Nonsharp solid waste that is saturated or caked with blood or saliva that will release material if compressed (saturated cotton rolls, for example).
* Can I wear my regular prescription glasses when giving a prophy?
So many styles of prescription frames are available that one cannot make a blanket statement of yes or no. The key issue is that the eyeglasses worn at chairside must cover and protect your eyes when you are in the working position and spatter is being generated. Salivary droplets may go over the top or past the open sides of glasses. Clearly, side-shield attachments are needed in all instances. Those prescription glasses with smaller lenses may have to be covered with larger plastic protective eyewear to give adequate protection.
Remember that personal protective barriers are worn to prevent exposure to patients` blood and saliva. The design of the barriers chosen and the times when they are worn must reflect the need to protect against the expected and unexpected chance for exposure.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.