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Gloves: The Donning of a New Era
By Adrian Corbett
Anew product, now in development, is aimed at improving how gloves are donned inthe future. Over the past two years a research and development firm in SanDiego, Calif., Advanced Intellectual Properties, LLC (AIP), has studied theimpact of hospital-acquired infections and the associated issues of antibioticresistant strains of bacteria, hand washing, glove usage, and powder/latexallergies. The following is a summary of their findings:
According to the Center for Diseases Control and Prevention (CDC) 5-10% ofpatients contract infections while in hospitals, a figure that represents tobetween 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 to9.8 from 1975 to 1995, a 36% net increase. In 1997, the CDC estimated thathospital-borne infections contributed to the deaths of more than 88,000 Americanpatients each year--a sum greater than the combined national number of annualmotor vehicle fatalities (41,900 that year) and homicides (19,800). Estimatedaverage costs to treat these infections can range from $500, for each urinarytract infection to $40,000 for each bloodstream infection. The CDC estimatesthat nosocomial infections cost the healthcare industry in excess of $4.5billion 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 areinfected and die each year as a result of drug-resistant microbes picked up inUS hospitals. Globally, WHO stated that drug-resistant bacteria account for upto 60% of hospital-acquired infections.1
Although hand washing is considered by many to be the most effective means ofpreventing the spread of bacteria from one patient to the other, studies haveshown that only about 14 - 59% of doctors and 25 - 45% of nurses regularlywashed their hands between patients.2 According to studies, the mainreasons for not handwashing were:3
When gloves are donned or removed, glove powder is released into the air forstaff and patients to breathe. Powder acts as a carrier for latex proteins, aknown allergen. Approximately 11% of operating room nurses, 10% of surgeons, and8 - 12% overall of personnel who regularly use gloves develop latex allergies.Airborne powder may also promote wound inflammation, infection, granuloma, andadhesions. In addition, glove powder from non-sterile patient examination glovesmay also support microbial growth and act as a carrier for endotoxins.4,5
It is readily apparent that nosocomial infections are a serious and costlyproblem that is exacerbated by the growing resistance to antibiotics and thepowder used on gloves.
In many cases, HCWs are not donning--or changing--gloves as often as theyshould. One study conducted at a 255-bed university facility found that whilegloves were worn 82% of the time when indicated, they were changed appropriatelyonly 16% of the time.6
Even when an HCW does don gloves at the appropriate time (as in-betweenpatients), if they have not washed their hands properly, there remains thepossibility of bacteria transfer to the external portion of the glove, therebyincreasing a patient's risk of nosocomial infection.
Recognizing the complex problems inherent in each of these issues, AIP choseto focus on the glove-donning process and to develop an automatic glovedispensing unit with the following design goals:
1. Faster glove donning: The standard practice of donning a pair ofgloves 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 samejob--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 ofgloves is made available for donning by the user (they simply slip their handsinto them). Once the user has placed their hands inside the gloves, she thensays "release glove" and the hands are removed from the box withgloves on--all in about 10 seconds or less. A nice feature is that the user cansee their hands during the "autodonning" process at all times througha clear window.
2. Powder-free: The standard practice of donning a glove includesproblems inherent within the elasticity and friction of the glove itself. Along-standing fix to this problem has been to powder the inside surface of theglove to reduce friction and allow easier donning. AIP's system does not requirethe gloves to be powdered, since it opens a pair of exam gloves using a lightvacuum developed inside the box itself. The glove is inflated to a size slightlylarger than the hand, making it simple for the user to insert their hand intothe glove. Once the user's hands are within the inflated glove, the simpleverbal command "release glove" gently releases the glove so that theuser can remove his hands with a pair of snug-fitting gloves applied.
3. No external contamination:All handling of the gloves is doneinternally within the unit. The user easily dons a pair of gloves withouttouching the external glove surface. The user will have an increased level ofcomfort and confidence knowing that the exam or procedure can begin with a cleanand fresh pair of gloves.
4. Universal Dispenser: Gloves for the Glove Box will still bepackaged as a standard 100-count box. The only difference is that the box willbe a different shape and the gloves will be mounted on a plastic-dispensingcartridge. With respect to manufacturing costs, the only additional costs arerelated 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 examgloves. A small molded pattern in the lower corner of the plastic frame tellsthe unit what style of glove cartridge has been mounted into the dispenser. Theglove style and size is boldly printed onto the backside of the plastic frame soit 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 displayscreen 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 ofit. Next, the user opens the end of a new box of gloves, pulls the plastic rackout 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 beavailable in several configurations making it readily adaptable to fit almostany situation. The size of a standard glove box of 100 is 2" x 8" x12". It can be either flush-mounted in the wall (for new construction) orsurface-mounted just about anywhere. The system will also be available witheither one, two, three or four bays, meaning that it can be loaded with up to400 gloves of one size or 100 gloves each of four different sizes.
"With regards to nosocomial infections, we have researched industryarticles and journals back 10 years, we have reviewed medical conference resultsand, we have also read numerous CDC reports. They all point to one commonfactor--the need to improve hand hygiene. If hand hygiene is one of the mostimportant ways to reduce nosocomial infections, then it becomes obvious thatthere 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 ofdiseases 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.