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Michaels BS, Ayers T, Brooks-McLaughlin J, McLaughlin RJ, Sandoval-Warren K, Schlenker C, Ronaldson L, Ardagh S. Potential for Glove Risk Amplification via Direct Physical, Chemical, and Microbiological Contamination. J Food Prot 2024; 87:100283. [PMID: 38679200 DOI: 10.1016/j.jfp.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
This review focuses on the potential direct physical, chemical, and microbiological contamination from disposable gloves when utilized in food environments, inclusive of the risks posed to food products as well as worker safety. Unrecognized problems endemic to glove manufacturing were magnified during the COVID-19 pandemic due to high demand, increased focus on PPE performance, availability, supply chain instability, and labor shortages. Multiple evidence-based reports of contamination, toxicity, illness, deaths, and related regulatory action linked to contaminated gloves in food and healthcare have highlighted problems indicative of systemic glove industry shortcomings. The glove manufacturing process was diagramed with sources and pathways of contamination identified, indicating weak points with documented occurrences detailed. Numerous unsafe ingredients can introduce chemical contaminants, potentially posing risks to food and to glove users. Microbial hazards present significant challenges to overall glove safety as contaminants appear to be introduced via polluted water sources or flawed glove manufacturing processes, resulting in increased risks within food and healthcare environments. Frank and opportunistic pathogens along with food spoilage organisms can be introduced to foods and wearers. When the sources and pathways of glove-borne contamination were explored, it was found that physical failures play a pivotal role in the release of sweat build-up, liquefaction of chemical residues, and incubation of microbial contaminants from hands and gloves. Thus, with glove physical integrity issues, including punctures in new, unused gloves that can develop into significant rips and tears, not only can direct physical food contamination occur but also chemical and microbiological contamination can find their way into food. Enhanced regulatory requirements for Acceptable Quality Limits of food-grade gloves, and the establishment of appropriate bioburden standards would enhance safety in food applications. Based on the information provided, together with a false sense of security associated with glove use, the unconditional belief in glove chemical and microbiological purity may be unfounded.
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Affiliation(s)
- Barry S Michaels
- B. Michaels Group Inc., 487 West River Road, Palatka, FL 32177, USA.
| | - Troy Ayers
- Eurofins Microbiology Laboratories Inc., Des Moines, IA 50321, USA
| | | | | | | | | | - Lynda Ronaldson
- Eagle Protect PBC, South Lake Tahoe, CA 96150, USA; Eagle Protect Ltd. Christchurch 8011, New Zealand
| | - Steve Ardagh
- Eagle Protect PBC, South Lake Tahoe, CA 96150, USA; Eagle Protect Ltd. Christchurch 8011, New Zealand
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Dugheri S, Squillaci D, Cappelli G, Saccomando V, Fanfani N, Ceccarelli J, Mucci N, Arcangeli G. Evaluation of the risk of occupational exposure to antineoplastic drugs in healthcare sector: part I - medical gloves. Arh Hig Rada Toksikol 2023; 74:187-197. [PMID: 37791676 PMCID: PMC10549893 DOI: 10.2478/aiht-2023-74-3734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/01/2023] [Accepted: 07/01/2023] [Indexed: 10/05/2023] Open
Abstract
Antineoplastic drugs (ADs) are essential tools in cancer treatment, but their cytotoxicity poses a risk to workers involved in their handling. In a hospital environment fundamental strategies for minimising exposure involve proper use of safety cabinets and closed-circuit transfer devices, along with personnel training and increased awareness of risks. However, medical gloves remain the first line of defence. In this respect the evaluation of glove materials and best choices can improve hospital safety management and prevent potential hazards and long-term consequences. The aim of this study was to assess contamination of gloves in samples taken from AD administration and preparation units of nine Italian hospitals and to raise awareness of the importance of evaluating chemico-physical properties of gloves. Our findings show that 33 % of the analysed gloves were positive for at least one AD, with contaminations ranging from 0.6 to 20,729 pg/ cm2. We proposed the alert glove values (AGVs) for each AD as a limit value for contamination assessment and good practice evaluation. Our findings also point to multiple AD contamination (43 % of positive findings in preparation units), calculated as total AGV (AGV-T), and confirm that gloves should be replaced after 30 min of AD handling, based on cumulative permeation and area under the curve (AUC), to maintain safety and limit dermal exposure.
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Affiliation(s)
- Stefano Dugheri
- University Hospital Careggi, Industrial Hygiene and Toxicology Laboratory, Florence, Italy
| | - Donato Squillaci
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Giovanni Cappelli
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Valentina Saccomando
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Niccolò Fanfani
- University of Florence, Mario Serio Department of Experimental and Clinical Biomedical Sciences, Florence, Italy
| | - Jacopo Ceccarelli
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Nicola Mucci
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Giulio Arcangeli
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
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Everaert S, Schoeters G, Claes K, Raquez JM, Buffel B, Vanhaecke T, Moens J, Laitinen J, Van Larebeke N, Godderis L. Balancing Acute and Chronic Occupational Risks: The Use of Nitrile Butadiene Rubber Undergloves by Firefighters to Reduce Exposure to Toxic Contaminants. TOXICS 2023; 11:534. [PMID: 37368634 DOI: 10.3390/toxics11060534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
Firefighters are exposed via multi-route exposure to a multitude of chemicals (PAHs, VOCs, flame retardants, dioxins, etc.) that may cause acute and long-term health effects. The dermal absorption of contaminants is a major contributor to the overall exposure and can be reduced by wearing appropriate personal protective equipment. As leather firefighters' gloves cannot be decontaminated regularly by wet cleaning, many Belgian firefighters wear supplementary undergloves made of nitrile butadiene rubber (NBR) to protect against the accumulation of toxicants. However, the safety of this practice has been questioned. In this commentary, the current practice and risks are outlined for the first time, assessed by an interdisciplinary working group of the Belgian Superior Health Council. As NBR sticks to the skin more at high temperatures, the contact time on removal will be prolonged, posing an additional risk for deeper burns. However, based on the physicochemical properties of NBR and the existing experience of firefighters and burn centers, it is estimated that such incidents occur relatively rarely in practice. On the other hand, the risk of repeated exposure to contaminated gloves if no undergloves are worn is unacceptable. Despite the slightly increased risk for deeper burns, it is concluded that wearing disposable NBR gloves under regular firefighters' gloves is an appropriate and effective preventive measure against toxic contamination. The nitrile butadiene rubber must always be fully covered to avoid any contact with the heat.
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Affiliation(s)
- Stijn Everaert
- Chemical Environmental Factors Group, Superior Health Council, 1060 Brussels, Belgium
| | - Greet Schoeters
- Department of Biomedical Sciences, University of Antwerp, 2650 Antwerp, Belgium
| | - Karel Claes
- Burn Center & Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jean-Marie Raquez
- Polymer and Composite Materials Department, University of Mons, 7000 Mons, Belgium
| | - Bart Buffel
- Department of Materials Engineering, KU Leuven, 8200 Bruges, Belgium
| | - Tamara Vanhaecke
- Department of In Vitro Toxicology and Dermato-Cosmetology, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Jonas Moens
- Belgian Poison Centre, 1120 Brussels, Belgium
| | - Juha Laitinen
- Pelastusopisto, Emergency Services Academy Finland, 70821 Kuopio, Finland
| | - Nicolas Van Larebeke
- Department of Radiotherapy and Experimental Cancerology, Ghent University, 9000 Ghent, Belgium
- Department of Analytical, Environmental and Geo-Chemistry, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Lode Godderis
- Center for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, 3001 Heverlee, Belgium
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Nelson DI, Phalen RN. Review of the Performance, Selection, and Use of Gloves for Chemical Protection. ACS CHEMICAL HEALTH & SAFETY 2022. [DOI: 10.1021/acs.chas.1c00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Deborah Imel Nelson
- Nelson-Imel IH Consulting, LLC, Boulder, Colorado 80303, United States
- Occupational Safety and Health Program at University of Houston Clear Lake, 2700 Bay Area Boulevard, Houston, Texas 77058, United States
| | - Robert N. Phalen
- Occupational Safety and Health Program at University of Houston Clear Lake, 2700 Bay Area Boulevard, Houston, Texas 77058, United States
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Wood-Black F, Blayney MB, Reid M, Martin JA, Zinn SR, Bay AV, Kwong AJ. Highlights: Safety Culture Conversations, Anaphylaxis Induced by Peptide Coupling Agents, Biological Safety Cabinet Explosion in a Biochemistry Laboratory, and More. ACS CHEMICAL HEALTH & SAFETY 2021. [DOI: 10.1021/acs.chas.1c00033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Michael B. Blayney
- Research Safety, Northwestern University, Evanston, Illinois 60208, United States
| | - Marc Reid
- School of Chemistry, Department of Pure & Applied Chemistry, University of Strathclyde, Glasgow G11XL, United Kingdom
| | - Jessica A. Martin
- Department of Chemistry, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Sarah R. Zinn
- Department of Chemistry, University of Chicago, Chicago, Illinois 60637, United States
| | - Anna V. Bay
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208-001, United States
| | - Ada J. Kwong
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208-001, United States
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Prediction of the permeability of antineoplastic agents through nitrile medical gloves by zone classification based on their physicochemical properties. J Pharm Health Care Sci 2020; 6:23. [PMID: 33292621 PMCID: PMC7604926 DOI: 10.1186/s40780-020-00179-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Permeability of antineoplastic agents through medical gloves is an important factor that must be considered for the appropriate selection of gloves. However, predicting the permeability of antineoplastic agents through medical gloves based on their physicochemical properties remains difficult. Thus, this study aimed to elucidate the relationship between the physicochemical properties and permeability of antineoplastic agents through medical gloves. Additionally, we tried to predict the risk of permeation of antineoplastic agents through medical gloves based on physicochemical parameters. METHODS Ten antineoplastic agents (carboplatin, carmustine, cisplatin, cyclophosphamide, doxorubicin, etoposide, fluorouracil, ifosfamide, oxaliplatin, and paclitaxel) with varying physicochemical properties were investigated, and their permeation rates (PRs) through nitrile medical gloves of varying thicknesses (0.05, 0.07, and 0.1 mm) were measured using a continuous flow in-line cell device. We also determined the apparent permeation clearance (CLP,app) values of the antineoplastic agents based on their PRs at 240 min (PR240) and assessed the relationship between CLP,app and physicochemical parameters [molecular weight (MW) and logarithm of octanol-water partition coefficient (LogP)]. RESULTS The CLP,app values of the 10 antineoplastic agents through nitrile medical gloves (0.05 mm thickness) were significantly correlated with their MWs, but not their LogP values (P = 0.026 and 0.39, respectively; Spearman's rank correlation). This finding indicated that the rates of diffusion of the antineoplastic agents in the glove material showed greater effects on CLP,app than the rates of absorption into the glove surfaces within 240 min of exposure. We then classified the 10 antineoplastic agents into 3 zones (Zone A, high LogP/low MW drugs; Zone B, high LogP/high MW drugs; and Zone C, low LogP) and found that Zones A, B, and C corresponded to high (PR240 > 10 ng/min/cm2), moderate (PR240 < 10 ng/min/cm2), and low (no detectable permeation) permeation risk, respectively. CONCLUSIONS The permeation risk of antineoplastic agents through nitrile medical gloves within the actual continuous wearing time in clinical settings could be predicted using MW and LogP values. We believe that the proposed zone classification of antineoplastic agents will be a useful tool for predicting the permeation risk of antineoplastic agents through medical gloves.
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