Evaluation of the permeation of antineoplastic agents through medical gloves of varying materials and thickness and with varying surface treatments

Development of an experimental technique to determine the barrier performance of medical gloves when stretched

Protective clothing standards, such as test methods published by ASTM International, play an integral role in ensuring the performance of personal protective equipment. The standard tests are not without limitations and are periodically reviewed and often updated. Some tests may not be reflective of in-use conditions. A new test cell was designed using sanitary fixtures to evaluate the effect of glove stretch on barrier performance using fluorescein solution as the challenge agent for enhanced visualization and fluorometer detection. Domed-shaped and flat screens were developed to permit and limit glove stretch within the test cell. The barrier performance of glove swatches was evaluated for both stretched and unstretched states. Latex, nitrile, and vinyl glove models of various thicknesses were evaluated. The tests were conducted following pressure and time parameters specified in ASTM F903, ASTM F1670, and ASTM F1671. Fluorescein solution movement, which may occur through penetration, was measured using a fluorometer. Glove stretch caused a reduction in glove thickness ranging from 16% to 40%. Overall, 21 sample failures were found (16.7%; n = 126) regardless of test condition. Nitrile gloves provided better barrier efficacy with the lowest failure rates (2.38%; 1 failure out of 42) compared to latex (19.4%; 7 failures out of 36) and vinyl gloves (27.1%; 13 failures out of 48). Differences in failure rates between stretched and unstretched gloves were insignificant; however, the latex material showed a 2.5 times increase in failures when stretched compared to unstretched. The new test apparatus was able to differentiate between the barrier performance of different glove materials. The use of a domed screen allowed the gloves to stretch, a condition that better represents the state of gloves when in use. Analysis of samples collected from the glove surface opposite to the exposure may provide a way to assess chemical permeation in addition to penetration.

Determination of Gas Permeation Properties in Polymer Using Capacitive Electrode Sensors

The objective of this work was to develop an effective technique for characterizing the permeation properties of various gases, including H₂, He, N₂, and Ar, that are absorbed in polymers. Simultaneous three-channel real-time techniques for measuring the sorption content and diffusivity of gases emitted from polymers are developed after exposure to high pressure and the subsequent decompression of the corresponding gas. These techniques are based on the volumetric measurement of released gas combined with the capacitance measurement of the water content by both semi-cylindrical and coaxial-cylindrical electrodes. This minimizes the uncertainty due to the varying temperature and pressure of laboratory environments. The gas uptake and diffusivity are determined as a function of the exposed pressure and gas spices in nitrile butadiene rubber (NBR) and ethylene propylene diene monomer (EPDM) polymers. The pressure-dependent gas transport behaviors of four different gases are presented and compared with those obtained by different techniques. A linear correlation between the logarithmic diffusivity and kinetic diameter of molecules in the gas is found between the two polymers.

An alternative method to assess permeation through disposable gloves

Previously, we have demonstrated the capability of activated charcoal cloth (ACC) to assess dermal exposure to VOCs. Here we investigated whether ACC patches can be used as an under-glove indicator to evaluate the ingress of toluene through disposable gloves in a controlled environment, and compared these results to the amount of toluene ingress determined from the standardized test methods for determining chemical permeation through PPE. In a test chamber, with plugs for air sampling, five to six ACC patches were placed on a mannequin hand underneath disposable gloves (latex, nitrile, neoprene, polymer laminate). Three work-exposure scenarios were simulated to assess toluene ingress through the different gloves: vapor exposure; spray exposure, and immersion. The standard permeation test, using a diffusion cell, was carried with glove material of the palm, with continuous contact conditions. In all of ACC test, the order of toluene ingress was latex > neoprene > nitrile > Barrier, but for the standardized testing, the order of the neoprene and nitrile was reversed, and nitrile had higher levels of toluene ingress. These results show the need to think beyond standard testing techniques for occupational exposure to hazardous substances, and the added value of "application style" testing.

Rubbing ethanol and time of use: critical factors compromising latex gloves structure

Abstract Introduction Personal protective equipment is mandatory to protect patients and professionals from diseases, especially in the dental environment. The risk of gloves micro-perforations is imminent when using sharp instruments or cleaning them up during lengthy clinical procedures. Objective This study evaluated the integrity of sterile and non-sterile gloves before clinical use and clarified whether friction with disinfectant solution modifies surface morphology and integrity. Material and method Samples of gloves from four different brands were divided into two groups: (1) Sterile surgical gloves (n=260) and (2) Non-sterile gloves (n=260). They were scissored and placed in Ostby’s arch so that three solutions - distilled water, ethanol 70°, ethanol 96° - were rubbed with a cotton swab. After 30s, 5, 10, and 15 minutes of solution rubbing, samples were verified by a Scanning Electron Microscope. The pore sizes were measured by Image J software. Result Regardless of the brands, all gloves have been significantly affected by solutions and assessment periods. In general, remarkable changes were evident with ethanol 70° and 96°, and higher pore diameters were observed compared to distilled water. Conclusion Rubbing disinfectant solutions increases gloves’ pores sizes, and time negatively influenced its quality.

Prediction of the permeability of antineoplastic agents through nitrile medical gloves by zone classification based on their physicochemical properties

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 (CL_P,app) values of the antineoplastic agents based on their PRs at 240 min (PR₂₄₀) and assessed the relationship between CL_P,app and physicochemical parameters [molecular weight (MW) and logarithm of octanol-water partition coefficient (LogP)].

RESULTS

The CL_P,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 CL_P,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.

Fentanyl and carfentanil permeation through commercial disposable gloves

In 2018, the Centers for Disease Control and Prevention reported that opioid overdose deaths (including fentanyl and carfentanil) comprised 46,802 (69%) of the 67,367 total drug overdose deaths. The opioid overdose epidemic affects Americans not only at home but also in the workplace. First responders may be at risk of opioid exposure during incidents such as vehicle searches and responses to overdose calls. To reduce direct exposure to opioids and other hazardous drugs, first responders rely in part on personal protective equipment (PPE) as their last line of defense. First responders seek guidance from the National Institute for Occupational Safety and Health (NIOSH) regarding appropriate PPE selection for potential opioid exposure. There is limited empirical glove performance data for illicit drugs. Empirical data are needed to validate NIOSH's current recommendations regarding gloves to help prevent exposure to illicit drugs (i.e., powder-free nitrile gloves with a minimum thickness of 5 ± 2 mil [0.127 ± 0.051 millimeters]); however, no industry standard or test method currently exists for specifically evaluating PPE performance against fentanyl and its analogs. To understand the permeation qualities of gloves when challenged against fentanyl and carfentanil solutions, the ASTM International (formerly American Society for Testing and Materials) ASTM D6978-19 standard for chemotherapy drug glove permeation was adapted to test fentanyl and carfentanil hydrochloride solution permeation through twelve disposable glove models, including five models in which the manufacturers claim fentanyl protection. No nitrile glove models showed fentanyl or carfentanil permeation rates above the chemotherapy drug threshold criterion of 0.01 µg/cm²/min (i.e., thereby meeting the performance requirement) as calculated using the ASTM D6978-19 standard within the 240-min test. Latex and vinyl glove materials exhibited fentanyl and carfentanil permeation with permeation rates above this threshold. These findings are among the first empirical data to support NIOSH's current opioid glove recommendations and define procedures that could be used to support industry standards for evaluating opioid permeation through air-impermeable PPE materials.

Permeation measurement of 27 chemotherapy drugs after simulated dynamic testing on 15 surgical and examination gloves: A knowledge update

Purpose

Exposure to anticancer drugs is one of the known risks for people working in specialist oncology units. Wearing gloves is a vital form of personal protection. The aim of this study was to assess, in close to real use dynamic conditions, the permeability of 15 surgical and examination gloves made from different materials when exposed to 27 anticancer drugs included in the list from international Guides and Recommendations.

Methods

Gloves were tested by using controlled dynamic conditions replicating flexion and extension movements that mimic typical clinical applications. Tests were performed at 37°C or at 43°C for 30 min and anticancer drugs were tested at the highest concentration used in clinical practice. To determine the permeation rate, the quantification of anticancer drugs was performed with selective and sensitive analytical methods such as inductively coupled plasma-mass spectroscopy and liquid chromatography-mass spectrometry.

Results

All the gloves met the EN 16523-1 European standard (1000 ng/(min.cm2)). The penetration rate of busulfan, carmustine and thiotepa exceeded the ASTM D-6978-05 American standard (10 ng/(min.cm2)) with several surgical and/or examination gloves. This standard was met in all of cases when double gloving was used. Breakage of several nitrile gloves was observed in relation with the excipient used by drugs suppliers.

Conclusions

Permeation is a complex multifactorial phenomenon. However, we have suggested that the thickness of the glove and three physicochemical parameters (molecular weight, topological polar surface area and hydrogen bond donor) of the drug were the main parameters affecting permeation.

Environmental Contamination and Occupational Exposure of Algerian Hospital Workers

Guidelines are in place to assure limited occupational exposure to cytostatic drugs. Even though this has led to a reduction in exposure, several studies reported quantifiable concentrations of these compounds in healthcare workers. In this study, we evaluated occupational exposure to cytostatic drugs in hospital workers from the University Hospital in Tlemcen, Algeria. Monitoring was performed by collecting wipe samples from surfaces, objects, personal protective equipment (gloves and masks) and from the skin of employees at an Algerian university hospital. Wipe samples were analyzed with ultra-performance liquid chromatography coupled to a mass spectrometer. Concentrations ranged from below the limit of quantification up to 208.85, 23.45, 10.49, and 22.22 ng/cm² for cyclophosphamide, ifosfamide, methotrexate and 5-fluorouracil, respectively. The highest values were observed in the oncology department. Nowadays, there are still no safe threshold limit values for occupational exposure to cytostatic agents. Therefore, contamination levels should be kept as low as reasonably achievable. Yet, healthcare workers in this hospital are still exposed to cytostatic agents, despite the numerous guidelines, and recommendations. Consequently, actions should be taken to reduce the presence of harmful agents in the work environment.

Double gloving of disposable nitrile gloves exposed to diethylene glycol mono-n-butyl ether

Double gloving of disposable gloves is now commonplace in healthcare settings when extra protection is needed against aqueous solutions and especially for antineoplastic drugs in isotonic aqueous media. In the present study, an ASTM F739 2.54 cm cell with closed-loop water collection without recirculation at 35 °C in a moving tray water bath was used to test the permeation of diethylene glycol mono-n-butyl ether (DGBE) through four types of disposable nitrile gloves that were singly and doubly layered in the permeation cell. Samples were taken over 8 hr for capillary gas chromatograph-mass spectrometer quantitation. The breakthrough time (t_n) at a permeation of 250 ng/cm² increased as thickness increased for single layers, but the steady-state permeation rates P_s in µg/cm²/min did not always decrease with increasing thickness. The double-layer t_n, P_s and thickness were also more variable relative to a single layer. The thinnest glove with 80 [Formula: see text]m thickness showed a t_n = 0-5 min whereas its double layer was 15-20 min. The thickest glove of 132 µm exhibited a t_n = 10-15 min but its double layer was t_n = 45-55 min. The adjusted double-layer average t_n divided by the adjusted single-layer average t_n was 4.0 ± 0.8. The adjusted average single-layer P_s divided by the adjusted average double-layer P_s was 3.5 ± 0.8. Other results showed that the average glove swelling was <10%; microscopic and leak testing indicated no penetration and reflectance infrared analysis also showed no chemical changes on the inside glove surfaces. Thus, the permeations were adjudged to obey Fick's First Law of Diffusion to allow calculation of diffusion coefficients D in cm²/min. The average single-layer D divided by the average double-layer D was 1.3 ± 0.2. Double gloving in the field is therefore also probably more protective than single gloving against DGBE for the four types of disposable nitrile gloves tested.

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.

Validation of cleaning procedures used in an Italian Hospital Pharmacy for antineoplastic drug decontamination: a new tool for industrial hygiene

BACKGROUND

Current Italian regulations and procedures for surface decontamination of antineoplastic drugs (ADs) are not clear. Therefore, most hospital pharmacies follow internal procedures as an interpretation of the recommended handling guidelines.

OBJECTIVES

Our study compared 7 different cleaning procedures after controlled contamination of the work surface of a biological safety cabinet workbench in an Italian hospital oncology pharmacy (HOP) to determine which of them is more efficient and practical. Moreover, in order to approximate operative routine and improve risk awareness, cleaning procedures were carried out by the personnel that usually operate in the HOP.

METHODS

Measured quantities, i.e. a drop (100 μL) of 5-FluoroUracil, IPhosfamide, CycloPhosphamide and Gemcitabine, were deposited on the work surface within precisely delimited areas. Following the wipe-test analysis using UPLC-MS/MS, the cleaning efficacy was calculated based on the ratio of the residual concentration of the AD, after the cleaning procedure, to the concentration of each AD before the procedure.

RESULTS

Tested cleaning procedures were: 1) Hypo-Chlor®, hot water and Farmecol70®; 2) Hypo-Chlor® and hot water; 3) Farmecol70®; 4) Surfa'Safe SH® and hot water; 5) Amuchina® 10%, hot water and Farmecol70®; 6) Incidin® Oxyfoam and hot water; 7) liquid Marseille soap, hot water and Farmecol70®. Within the studied HOP, the Marseille soap was evaluated to be the optimal choice due to its efficacy, low cost, and the very short contact time needed before rinsing.

DISCUSSION

The application of the protocol for procedure validation suggested here could be used in every HOP as a reliable industrial hygiene tool to demonstrate the validity of the chosen cleaning procedure.