Gloves: The Donning of a New Era
By Adrian Corbett
A new product, now in development, is aimed at improving how gloves are donned in the future. Over the past two years a research and development firm in San Diego, Calif., Advanced Intellectual Properties, LLC (AIP), has studied the impact of hospital-acquired infections and the associated issues of antibiotic resistant strains of bacteria, hand washing, glove usage, and powder/latex allergies. The following is a summary of their findings:
According to the Center for Diseases Control and Prevention (CDC) 5-10% of patients contract infections while in hospitals, a figure that represents to between 1.75 and 3.5 million Americans each year. The rate of infection, according to one study, increased from 7.2 infections per 1,000 patient days to 9.8 from 1975 to 1995, a 36% net increase. In 1997, the CDC estimated that hospital-borne infections contributed to the deaths of more than 88,000 American patients each year--a sum greater than the combined national number of annual motor vehicle fatalities (41,900 that year) and homicides (19,800). Estimated average costs to treat these infections can range from $500, for each urinary tract infection to $40,000 for each bloodstream infection. The CDC estimates that nosocomial infections cost the healthcare industry in excess of $4.5 billion dollars annually.
Antibiotic-Resistant Strains of Bacteria
Antimicrobial resistance is a naturally occurring biological phenomenon. World Health Organization (WHO) officials report that about 14,000 people are infected and die each year as a result of drug-resistant microbes picked up in US hospitals. Globally, WHO stated that drug-resistant bacteria account for up to 60% of hospital-acquired infections.1
Although hand washing is considered by many to be the most effective means of preventing the spread of bacteria from one patient to the other, studies have shown that only about 14 - 59% of doctors and 25 - 45% of nurses regularly washed their hands between patients.2 According to studies, the main reasons for not handwashing were:3
- The amount of time needed for proper handwashing.
- The convenience and user-acceptability of handwashing and hand-drying facilities.
- The condition of the skin barrier.
When gloves are donned or removed, glove powder is released into the air for staff and patients to breathe. Powder acts as a carrier for latex proteins, a known allergen. Approximately 11% of operating room nurses, 10% of surgeons, and 8 - 12% overall of personnel who regularly use gloves develop latex allergies. Airborne powder may also promote wound inflammation, infection, granuloma, and adhesions. In addition, glove powder from non-sterile patient examination gloves may also support microbial growth and act as a carrier for endotoxins.4,5
It is readily apparent that nosocomial infections are a serious and costly problem that is exacerbated by the growing resistance to antibiotics and the powder used on gloves.
In many cases, HCWs are not donning--or changing--gloves as often as they should. One study conducted at a 255-bed university facility found that while gloves were worn 82% of the time when indicated, they were changed appropriately only 16% of the time.6
Even when an HCW does don gloves at the appropriate time (as in-between patients), if they have not washed their hands properly, there remains the possibility of bacteria transfer to the external portion of the glove, thereby increasing a patient's risk of nosocomial infection.
Recognizing the complex problems inherent in each of these issues, AIP chose to focus on the glove-donning process and to develop an automatic glove dispensing unit with the following design goals:
- Decrease the time required and increase the ease of donning gloves to promote usage.
- The unit must operate "hands-free" so that no contact is required between the external surface of the glove, or unit, that would facilitate the possible transfer of microbes.
- Allow for the use of powder-free gloves in the unit.
- Allow for the dispensing of different sizes and types of commercially available gloves within a single unit.
- The unit must be easy to operate and require minimal maintenance. The AIP's staff created a patent-pending unit, the Glove Box. This system is a self contained 110v-powered unit that is either voice-or pedal-activated and operates in the following manner:
1. Faster glove donning: The standard practice of donning a pair of gloves ranges anywhere from 15 - 20 seconds depending on the glove type (powder, powder-free, etc.) The Glove Box takes approximately 8-10 seconds to do the same job--with less frustration. How? Simply put, the user walks up to the box, selects the size of the desired glove, (i.e. large, medium, or small), after which a cover on the front of the unit opens and an expanded pair of gloves is made available for donning by the user (they simply slip their hands into them). Once the user has placed their hands inside the gloves, she then says "release glove" and the hands are removed from the box with gloves on--all in about 10 seconds or less. A nice feature is that the user can see their hands during the "autodonning" process at all times through a clear window.
2. Powder-free: The standard practice of donning a glove includes problems inherent within the elasticity and friction of the glove itself. A long-standing fix to this problem has been to powder the inside surface of the glove to reduce friction and allow easier donning. AIP's system does not require the gloves to be powdered, since it opens a pair of exam gloves using a light vacuum developed inside the box itself. The glove is inflated to a size slightly larger than the hand, making it simple for the user to insert their hand into the glove. Once the user's hands are within the inflated glove, the simple verbal command "release glove" gently releases the glove so that the user can remove his hands with a pair of snug-fitting gloves applied.
3. No external contamination:All handling of the gloves is done internally within the unit. The user easily dons a pair of gloves without touching the external glove surface. The user will have an increased level of comfort and confidence knowing that the exam or procedure can begin with a clean and fresh pair of gloves.
4. Universal Dispenser: Gloves for the Glove Box will still be packaged as a standard 100-count box. The only difference is that the box will be a different shape and the gloves will be mounted on a plastic-dispensing cartridge. With respect to manufacturing costs, the only additional costs are related to the disposable plastic frame and the time to mount the gloves on it. The plastic frame adapts to accommodate virtually all brands and styles of exam gloves. A small molded pattern in the lower corner of the plastic frame tells the unit what style of glove cartridge has been mounted into the dispenser. The glove style and size is boldly printed onto the backside of the plastic frame so it can be easily read through the window on the front of the box.
Reloading The Glove Box is simple and takes about 30 seconds. The LCD display screen on the dispenser informs the user when one particular glove size is low. Just open the corresponding door, remove the empty plastic rack and dispose of it. Next, the user opens the end of a new box of gloves, pulls the plastic rack out of the box, and inserts it into the door. The bright green latch is closed, and that's it--the unit does all the rest automatically.
5. Accommodates Multiple Sizes of Gloves: The Glove Box will be available in several configurations making it readily adaptable to fit almost any situation. The size of a standard glove box of 100 is 2" x 8" x 12". It can be either flush-mounted in the wall (for new construction) or surface-mounted just about anywhere. The system will also be available with either one, two, three or four bays, meaning that it can be loaded with up to 400 gloves of one size or 100 gloves each of four different sizes.
"With regards to nosocomial infections, we have researched industry articles and journals back 10 years, we have reviewed medical conference results and, we have also read numerous CDC reports. They all point to one common factor--the need to improve hand hygiene. If hand hygiene is one of the most important ways to reduce nosocomial infections, then it becomes obvious that there is a need for a readily available device situated at each area of need. This device could not only result in a significant reduction in the spread of diseases but also to the bottom line cost related to treating infections," said Larry Cronin, President of AIP.
Adrian Corbett is the Vice President of Advanced Intellectual Properties, LLC in San Diego, Calif.