Publish Date: March 7, 2018
Personal protective equipment (PPE) is designed to do just that—protect. However, every perioperative nurse knows where there are weaknesses in PPE barrier protection and one major area is between the gown and glove.
How many times has patient fluid seeped under your protective glove(s) and come in direct contact with your skin?
Fluid leakage at the glove and gown interface is one of the most important problems for perioperative professionals because direct contact with blood or body fluids could be life threatening, especially when caring for patients with infectious diseases, such as Hepatitis C, HIV, and viral hemorrhagic fevers such as Ebola. Also, contamination of hands and wrists could lead to colonization with drug-resistant bacteria or other germs that could be harmful to patients.
“When the glove rolls down or slips on the sleeve, the risk of exposure to blood or body fluids increases. Although some PPE with antislip properties are offered in the marketplace, the interface between the gown and the glove remains vulnerable to fluid leaks. The more concerning problem associated with the glove-gown interface occurs when gloves are pulled up over the wide and baggy cuff and sleeve of the gown,” notes Selcen Kilinc-Balci, Ph.D., MBA, a physical scientist for the National Institute for Occupational Safety and Health’s (NIOSH’s) National Personal Protective Technology Laboratory (NPPTL) in Pittsburgh, Penn.
Know the Risks
Kilinc-Balci notes two common ways for this increased exposure risk at the glove-gown interface to occur:
- Channeling – This happens when body fluids seep between the inner surface of gloves and the outer surface of the sleeve toward wrists and hands of OR personnel. She says gown cuffs are not required to be water resistant according to commonly used gown liquid barrier classification standards such as (ANSI/AAMI) PB70:2012.
- Glove movement— Glove “roll-down” or slippage can result from a low frictional interface between the interior side of the glove and the surgical gown sleeve.
Physical stresses applied on the glove-gown interface can increase the potential for these perioperative fluid exposure risks, Kilinc-Balci adds.
She also says procedural factors such as type of procedure, surgery duration, and personnel activities such as immersing hands in the patient’s body cavity can increase the chance for fluid exposure, based on preliminary research findings she and colleague Zafer Kahveci, PhD, have discovered.
Quantifying Exposure Risk
Kilinc-Balci says there is a lack of published research in this important area and believes there is a need to better understand the amount of exposure that health care personnel may face during the routine performance of occupational tasks and the factors that can influence the degree of fluid leakage.
That’s why Kilinc-Balci and Kahveci have been developing a novel testing methodology and conducting research studies to quantify fluid leakage at the glove-gown interface using a robotic arm, which can simulate perioperative movements. They have evaluated the amount of fluid leakage using this testing methodology for a number of surgical gown and glove models while considering glove material differences and single versus double gloving.
“While results of our studies are still preliminary and subject to change as we continue our research, the data, so far, suggest that soaking types of exposures such as procedures that involve placement of OR personnel hands into body cavities appear to confer higher risk of fluid leakage via the glove-gown interface versus exposures involving splashes or sprays,” Kilinc-Balci says.
She also notes that the amount of leakage seems to increase with the duration of exposure and application of pressure. Gown size is also a factor to consider.
“Select the appropriate sized gown, which is likely to minimize the roll up of gown sleeves that may result in less fluid leakage through the glove-gown interface,” Kilinc-Balci advises. She also emphasizes the importance of proper hand hygiene immediately after removing PPE because of the risks for contamination from contaminated hands due to fluid leakage through glove-gown interfaces.
Kilinc-Balci and Kahveci will be presenting study results from their glove-gown interface testing methodology on March 24 at the Global Surgical Conference & Expo in New Orleans. Their research is also slated for peer-review publication in the coming months.
CDC published guidance on the glove-gown interface during the 2014 Ebola outbreak that also emphasized the importance of ensuring the gown is sized properly. Read the complete guidance.
Check out AORN resources on the Guideline for Prevention of Transmissible Infections and Sterile Technique to learn more about evidence-based recommendations for donning personal protective equipment and selection of surgical gowns.
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