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.
02-08-201208:08 PM - last edited on 02-08-201208:09 PM
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.
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.
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.
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.
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.
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.
