Resistance of medical gloves to permeation by methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), and 1,4-butanediol dimethacrylate (1,4-BDMA)

Glove permeation of chemicals: The state of the art of current practice-Part 2. Research emphases on high boiling point compounds and simulating the donned glove environment

This second part of the review of the 21st century literature on glove permeation is divided into the following major themes; permeation data and mathematical models, exposure/risk assessment, and manufacturer data. The major issues in the literature were the demonstrations that increasing temperature and applying forces increased permeation; and that glove manufacturer data were sometimes not reproducible. Double gloving of disposable gloves was found to be effective in resisting chemical permeation for short periods of time. Harmonization of standards and commercial glove classifications were called for at conditions that were closer to the temperature and applied forces actually present in the workplace, including whole glove testing and quantitative rather than just qualitative criteria. More research was recommended in each section and subsection with particular emphasis on defining the efficiency of solid phase collection devices, and more data in areas like exposure to cosmetics, household products, liquid foods, drinks, and cleaning liquids. More research in exposure assessment for permeated chemicals with sensors on the inner glove surface and on the skin was called for. Finally, it was decided that the state of the art of current practice was in a situation that needed the permeation standards, research, and the permeation charts of glove manufacturers to be at conditions that better reflected those encountered by workers with donned gloves.

Surgical glove bacterial contamination and perforation during total hip arthroplasty implantation: when gloves should be changed

INTRODUCTION

Double gloving is recommended in orthopedic surgery, notably in total hip arthroplasties (THA) to prevent contamination of the surgical site.

HYPOTHESIS

Systematic glove changes during the key phases of hip prosthesis implantation reduce the frequency of occult perforations and bacterial loading of glove surfaces.

PATIENTS AND METHODS

During 29 THA implantation procedures, we evaluated the bacterial contamination of the outer glove surface and its perforation rate. Contaminations were sought by placing the gloved fingertips on blood geloses (incubation, 48 h at 37°C), and perforations were sought using a water test (NF EN 455-1).

RESULTS

One intervention was excluded from the study because an initial contamination was detected, leaving 28 cases analyzed. Fifteen interventions (53.6%) presented contaminated geloses (26 contaminated glove changes for 3.38% of the gloves used). These contaminations were found on the gloves of all of the gloved personnel, with no distinction as to the right or left side. Thirty-eight percent of the contaminations occurred during joint reduction, whereas the other surgical stages grouped 15-26% of the contaminations (P<0.05). Twenty-nine bacteria were identified: 62% coagulase-negative staphylococci (16% of which were methicillin-resistant). Twenty-eight perforations were identified (3.5% of the gloves used), 67.8% of which were located on the operator and 64.3% on the dominant side. Eighty percent of the perforations occurred during the "surgical incision" and the "cup and stem implantation" stages (respectively, 5.0% and 5.5% of the gloves used during the surgical time) (P<0.05), without being associated with an increased risk of bacterial contamination. At the 12-month clinical follow-up, no infectious complications were found. On the gloves worn by the 20 surgical team members contaminated during these 28 surgical procedures, replacing contaminated gloves with new sterile gloves rendered all the bacteriological samples of the subsequent surgical stages negative in 16 cases (80%).

DISCUSSION

Increasing the number of outer glove renewals, notably during certain surgical stages at risk for contamination (prosthesis reduction) or perforation (surgical incision/femoral cementing) can reduce the risk of contamination and perforation. The bacteria isolated suggest a cutaneous origin. Regularly changing gloves has resulted in a sterile state in 80% of cases. LEVEL OF EVIDENCE AND TYPE OF STUDY: Level III prospective diagnostic study.

Proportionate cancer mortality in methyl methacrylate-exposed orthopedic surgeons compared to general surgeons

Methyl methacrylate (MMA), a volatile liquid used to make dentures, hearing aids, joint prostheses, and medical adhesives, has been associated with colorectal carcinomas in acrylic sheet manufacturing workers. A case-control proportionate cancer mortality investigation was conducted to determine cancer death differences in orthopedic surgeons performing total joint replacements (TJRs) (MMA-exposed cases) and general surgeons not performing TJRs (unexposed controls). The American Colleges of Orthopedic Surgeons and General Surgeons provided complete demographic information on 468 male orthopedic surgeons and 1,890 male general surgeons who died during 1991-2001. Decedent data was submitted to the National Death Index for matching with underlying causes of death on state death certificates. Proportionate differences in ages at death, deaths from cancer, and deaths from site-specific cancers were analyzed for statistically significant differences by unpaired, two-tailed t tests for continuous variables and by both proportionate cancer mortality ratios and Yates-corrected chi squares for categorical variables. Orthopedic surgeons died of cancer more often (χ (2) = 7.699, P = 0.006) and at younger (t = 5.53, P < 0.001) ages (mean = 69.4 years) than general surgeons (mean = 79.2 years). For site-specific cancers, orthopedic surgeons died of esophageal cancer (χ (2) = 4.372, P = 0.037) and myeloproliferative malignancies (χ (2) = 4.369, P = 0.037) more often than general surgeons. Orthopedic surgeons are chronically exposed to MMA and are proportionately more likely to die from cancer, especially esophageal and myeloproliferative cancers, than general surgeons. MMA-exposed healthcare workers may be at increased risks of untimely deaths from site-specific malignancies.

Occupational hazards in orthodontics: A review of risks and associated pathology

The purpose of this article was to review the occupational hazards related to the practice of orthodontics. A systematic approach was used to include all risks involved in an orthodontic practice. The classification of hazards was based on major sources of risks by system or tissue and by orthodontic office area (dental chair, laboratory, sterilization area, x-ray developing area). Potentially hazardous factors relate to the general practice setting; to specific materials and tools that expose the operator to vision and hearing risks; to chemical substances with known allergenic, toxic, or irritating actions; to increased microbial counts and silica particles of the aerosols produced during debonding; to ergonomic considerations that might have an impact on the provider's muscoleskeletal system; and to psychological stress with proven undesirable sequelae. The identification and elimination of these risk factors should be incorporated into a standard practice management program as an integral part of orthodontic education. Professional organizations can also assist in informing practitioners of potential hazards and methods to deal with them.