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Occasional Contributor
Posts: 4
Registered: ‎07-19-2011

Disinfection of gloves during compounding - a breach to glove integrity?

A recent literature search was prompted by a contradiction between our hospital's hand hygiene policy and the applicable USP 797 recommendations on hand hygiene, garbing and aseptic work practices.

 

In the literature, a number of studies and reviews warn against the use of alcohol-based disinfectants on latex and synthetic glove materials as the integrity of the glove, and therefore protection to the product and the worker, may be compromised. Some studies find that glove integrity degrades after many hours of wear and 10 or more instances of disinfection with alcohol. Other studies conclude that gloves become more permeable to chemicals and/or microbes in minutes after contact with alcohol-based disinfectants.

 

Our hospital policy is such that gloves are to be discarded and replaced with a new pair instead of disinfecting with alcohol to avoid the risk of glove degradation altogether. However, in a compounding situation, our gloves are not in direct contact with the patient, compounding a given batch usually only takes about an hour (sometimes multiple pairs of sterile surgical gloves are used in this time) and during the compounding time we sterilize gloves often with alcohol, especially prior to re-entering the ISO Class 5 area.

 

Has anyone encountered the same concern? Is the risk real when compounding is of a short duration and gloves are only disinfected a small number of times? It seems a bit onerous to constantly be changing gloves. In my search so far, latex appears to be the most resistant (of common glove materials) to alcohol exposure, however, not all gloves are equal and none are completely impervious. Any materials that provide more conclusive evidence either way would be appreciated.

Expert
Posts: 1,174
Registered: ‎02-23-2010

Re: Disinfection of gloves during compounding - a breach to glove integrity?

[ Edited ]

Christina,

 

Can you provide the citation of these studies? It would be good to be aware these studies.  I am not heard of this happening and have good experience where gloves are quite resistant to alcohol.  Latex gloves from an allergy perspective are not the best material to use.  Neoprene, isoprene and other synthetic gloves are quite durable.  There are several warnings in USP Chapter <797> about ensuring that sterile gloves are compatible with sterile 70% isopropyl alcohol (IPA) before beginning compounding manipulations. Hopefully, sterile gloves aren't worn for many hours because they should be changed when people take breaks, have lunch or doing other activities that may effect the integrity of the gloves.  You can contact the glove manufacturer and get a "cut sheet" on their gloves and their ability to withstand routine disinfection.  Thanks.   

Eric S. Kastango, MBA, RPh, FASHP

It's all about the patient.
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Occasional Contributor
Posts: 4
Registered: ‎07-19-2011

Re: Disinfection of gloves during compounding - a breach to glove integrity?

Thank you for your response, some of the articles I have found are:

 

1. http://www.jofs.in/files/1-2-10.pdf

2. http://www.ncbi.nlm.nih.gov/pubmed/10084208

3. http://www.ncbi.nlm.nih.gov/pubmed/11139160

4. http://www.cdc.gov/oralhealth/infectioncontrol/faq/protective_equipment.htm 

 

Each of these links pose concern with respect to alcohol disinfectants and the effect it may have on gloves; however, these articles are a bit outdated and I have not found anything more recent to support or refute the issue. Seeking more information from the manufacturer is likely the best route. Thanks.

Expert
Posts: 1,174
Registered: ‎02-23-2010

Re: Disinfection of gloves during compounding - a breach to glove integrity?

Christina,

 

Thanks for these links.  I am aware of the wicking phenomenon.  Please remember that prior to donning sterile glove, a surgical scrub with persistent activity (e.g., Avagard by 3M) needs to be applied which creates a "layer of antimicrobial protection".  Alcohol gel should not be applied to sterile gloves because the gel can effect the integrity of the gloves.     

Eric S. Kastango, MBA, RPh, FASHP

It's all about the patient.
Expert
Posts: 1,174
Registered: ‎02-23-2010
0

Re: Disinfection of gloves during compounding - a breach to glove integrity?

Christina,

 

I found an excellent resource from one of the glove manufacturers (Ansell) of chemical compatibility with different glove materials to different chemicals.  You will see that many of the gloves have excellent durability when exposed to IPA.    Hope this reference helps.

Eric S. Kastango, MBA, RPh, FASHP

It's all about the patient.
Occasional Contributor
Posts: 4
Registered: ‎05-25-2010
0

Re: Disinfection of gloves during compounding - a breach to glove integrity?

Hello,

 

Our facility had concerns over the integrity of our gloves after questionable fingertip sampling so we created what we thought was a creative study.  After compounding was completed we would take the used gloves and fill them with water like a ballon to see if they maintained their integrity.  Our testing led us to change glove manufacturers after being unhappy with the amount of gloves that failed (leaked water).  It solved the problem with fingertip testing, and we continue the leak testing as part of quality assurance.

 

Take care,

Brian

Expert
Posts: 1,174
Registered: ‎02-23-2010
0

Re: Disinfection of gloves during compounding - a breach to glove integrity?

Brian,

 

Great job and a super example of investigative science!  The integrity of gloves and gauntlets are the most important elements (they are the weakness link, especially in a negative-pressure isolator) of an isolator in terms of maintaining a robust compounding environment.  Leak testing and glove and gauntlet inspection should be a routine (daily) quality assurance activity performed when using an isolator.    Thanks for this post and the reminder that you need to verify that the gloves you are using can withstand the routine disinfection practices with sterile IPA.   Gel or foam IPA should not be used because they contain other ingredients/chemicals that can affect the material integrity of the gloves.

Eric S. Kastango, MBA, RPh, FASHP

It's all about the patient.
Occasional Advisor
Posts: 9
Registered: ‎05-21-2012
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Re: Disinfection of gloves during compounding - a breach to glove integrity?

Do I recall correctly that the chapter (797) went back and forth about sterile gloves or not? Chemo gloves that were not sterile were a lot more resistant to the sterile ones we use now. 

 

Isn't it true that as soon as we start compounding and touch a non sterile item (say the cover of the syringe even if sterile ROH applied, not sterile) our glove just became non-sterile.

 

I personally found that even the non-chemo gloves non sterile were stronger than sterile ones.

 

Gowns are not sterile they are in the critical area often times. Is that OK?

 

Thanks

Judith

Expert
Posts: 1,174
Registered: ‎02-23-2010
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Re: Disinfection of gloves during compounding - a breach to glove integrity?

Judith,

 

Gloves need to be sterile and manufacturers now make sterile chemo gloves.  Many aspects of the chapter went through a lot of back and forth.  Gowns don't need to be sterile but clean.  The most critical point in the compounding process is how we use our hands and how they interact with the various surfaces that need to maintain their sterility or need to be rendered practically sterile through robust disinfection practices using a sterile disinfectant such as IPA.  Wiping down components and routinely disinfecting sterile gloves after they touch something is better than starting with dirty gloves and trying to make them sterile.

Eric S. Kastango, MBA, RPh, FASHP

It's all about the patient.
Occasional Advisor
Posts: 9
Registered: ‎05-21-2012
0

Re: Disinfection of gloves during compounding - a breach to glove integrity?

Hi Eric, 

 

Thanks for your reply,

 

I do not know why you would state "starting with dirty gloves", gloves are inspected when one places them on, and immediately disinfected, also I remember seeing an article about it in the past. As a matter of fact it is the same article that you referenced in another post.

This one 

Am J Health Syst Pharm. 2007 Apr 15;64(8):837-41.

Effect of two work practice changes on the microbial contamination rates of pharmacy-compounded sterile preparations.


Where do you get that the conclusion was that sterile gloves were superior? 
Here is the conclusion:

CONCLUSION:
The use of protective chemotherapy gloves that were repeatedly disinfected with IPA decreased the contamination rate of pharmacy-compounded sterile preparations.
- I do not see sterile gloves or even sterile IPA as part of the conclusion here.
In my opinion and experience the old blue chemo gloves were very resistant and allowed for constant disinfection with IPA. The sterile gloves (maybe because exposed to heat during sterilisation) do not appear to be able to resist too much alcohol spraying on them and have a tendency to break and expose the skin more if alcohol sprayed on them too much.
Maybe that is why the good old heavy duty blue gloves with constant disinfecting of IPA (which appear to be the key) in this study came out ahead.
Let me know your thoughts.
Judy