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January, 2011


Copyright 2011 Center for Phlebotomy Education, Inc.
 All rights reserved. View our copyright policy.

 

Feature: Ten Truths about Gloves

Gloves are an integral part of personal protective equipment for healthcare professionals assigned blood specimen collection responsibilities, and are a key component of every infection control program. But how much do you know about the quality and limitations of the gloves you wear? Do you inspect every pair that you don? Do you know the glove type that is most likely to leak? Do gloves have an expiration date? To test your knowledge, answer the true/false statements below:

  1.  According to the U.S. Food and Drug Administration (FDA), manufacturing standards state that it's acceptable for patient examination gloves to have holes.

    True – In 2006, the FDA lowered the defect rate for patient examination medical gloves to 2.5 percent.(1,2) This means that up to three exam gloves in a lot of 500 can be defective and still  comply with the FDA’s standard. Because defects may occur during the manufacturing process, every pair of gloves should be inspected before use.

  2. Hot, sweaty hands can compromise the integrity of latex gloves.

    True – In approximately 50 minutes, heat and perspiration emitted by the hands can break down latex to the point that viruses such as hepatitis B and HIV can penetrate. To ensure uncompromised barrier protection, a latex glove should not be worn for more than 30 minutes.

  3. Compared to latex and nitrile, vinyl is less likely to leak and allow penetration of organisms.

    False – Vinyl gloves are more likely to leak and allow pathogens to pass through when compared to latex and nitrile. Nitrile is superior to latex and vinyl in terms of resisting perforation. But when holes do occur in nitrile gloves, they enlarge much quicker. From a material integrity standpoint, latex or nitrile gloves are preferable to vinyl for clinical procedures that require manual dexterity and/or involve more than brief patient contact.(3)

  4. Chemicals can dissolve gloves.

    True – The most common types of gloves used in clinical laboratories are susceptible to the effects of a variety of chemicals. No one glove material is resistant to all chemicals. For example, some petroleum-based hand lotions can dissolve latex. If unsure about a particular chemical’s effect on the gloves you wear, check the chemical penetrance charts published by the glove manufacturer.

  5. Latex gloves should be dated when opened and discarded after three months.

    True – Latex can be compromised by a variety of environmental factors, including exposure to:

    • ozone;
    • x-rays;
    • UV light;
    • temperatures above 33 degrees Celsius;
    • humidity levels exceeding 40 percent.

    To prevent latex degradation, gloves should be stored in a cool and dry environment, free from electrical equipment or light sources. Date individual boxes when they are opened and discard any remaining gloves after three months.(1)

  6. Latex gloves have been known to spontaneously combust.

    True - In 1996, the FDA issued a public health advisory after the spontaneous combustion of latex gloves caused four fires in different states.(4) The fires occurred in warehouses where large quantities of non-sterile, powder-free, latex gloves that had been imported from China were stored on pallets. The most important contributing factors identified were extreme heat and the bulk of gloves stored, with the FDA making the following recommendations:

    • Avoid a large inventory of powder-free latex gloves.
    • Remove shrink wrap from pallets of stacked cartons.
    • Restack/reconfigure cartons to promote cooling ventilation.
    • Regularly check gloves for signs of deterioration, such as discoloration, brittleness, tackiness, or an acrid chemical odor.
    • Rotate glove stock using “first-in-first-out” practices.
  7. Latex particles can become airborne if powder is present in latex gloves.

    True – When powder is present in latex gloves, the protein responsible for latex allergies can attach to it. When gloves are removed, the particles can become airborne for up to five hours and serve as a route of exposure to others who are sensitive to latex. Because of the potential for respiratory reactions in allergic individuals, it is generally recommended that latex gloves containing powder be avoided. However, advancements with latex glove manufacturing technologies provide the option of powder-free latex with lower protein content.(3)

  8.  The reactions associated with latex allergy are always mild.

    False – The reactions experienced in patients and healthcare workers sensitive to natural rubber latex can range from mild to life-threatening.(3) The number of healthcare workers experiencing latex allergies or hypersensitivity is estimated to be 2 to 17 percent.(3) The FDA has received reports of 16 healthcare worker deaths directly attributable to exposure to medical devices that contain latex.(5)

  9. The barrier integrity of any glove may be compromised by routine practices.

    True – Jewelry, long fingernails, and artificial nails may snag or puncture gloves and should be avoided. Incompatible hand lotions may compromise the glove’s integrity and improper donning, such as pulling too hard on gloves, may tear them. If the fit is too loose, the glove may catch on equipment or other objects. If too tight, the glove is subject to tear due to excessive stress.(3)

  10. Gloves provide no protection against a needlestick.

    False - Studies show that when a contaminated needle pierces a glove, the material of the glove wipes off up to 86 percent of the blood from the needle before it passes into your tissue. That means you have a lesser inoculation of whatever virus could be in the blood that you’re exposed to.(6)

References

  1. Davis, D. Gloves: Lab Safety: Uncommon Knowledge About Common Objects. Lab Med 2008;39(9):576.
  2. U.S. Department of Health and Human Services. Food and Drug Administration. 21CFR800.20; Subpart B—Requirements for Specific Medical Devices; Patient examination gloves and surgeons' gloves; sample plans and test method for leakage defects; adulteration. Link. Accessed 1/11/11.
  3. Experts Address Glove-Related Latex Allergies. Inf Cntrl Today. Link. Accessed 1/12/11.
  4. U.S. Department of Health and Human Services. Food and Drug Administration. FDA Public Health Advisory: Potential risk of spontaneous combustion in large quantities of patient examination gloves. June 27, 1996. Link. Accessed 1/11/11.
  5. Latex Allergy: an emerging healthcare epidemic. Applied Medical. http://www.appliedmedical.com. Accessed 11/12/11.
  6. Ernst D. Ballance L. (ed) Blood Specimen Collection FAQs. Center for Phlebotomy Education. Corydon, Indiana. 2008.

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This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 12th year of publication, are reading about this month:

  • Feature Article: How to Become a Better Phlebotomist: Reducing Recollections
  • Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in December including these stories:
    • CMS Physician Signature Requirement Delayed
    • Employees Resign over Mandatory Flu Shot Policy
    • Needlesticks Make 2011 Top 10 Hazards List
    • Laboratory Technician among 50 Best Careers
    • Study Shows Antiseptic Hand Wipes More Effective Than Hand Rubs
    • Former Phlebotomist’s Career Path Leads to Executive Position
  • According to the Standards: Syringes versus tube holders and butterflies
  • Tip of the Month: The Facts about Climate Change
  • CE questions (institutional version only).

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.

Featured Product
Phlebotomy Channel

In response to a growing demand for streaming educational videos and presentations, the Center for Phlebotomy Education announces the launch of the Phlebotomy Channel™. Beginning this month, the Center's Applied Phlebotomy Video Series as well as the first of the Phlebotomy Best Practices Lecture Series can be accessed anytime, through any computer with a high-speed Internet connection.

"Our customers have been clamoring for years for the ability to stream our training videos to their staff and students, many of whom are remote to the facility or campus," says Dennis J. Ernst MT(ASCP), the Center's director. "The Phlebotomy Channel delivers the best in preanalytical training videos and lectures to our customers for about two dollars per view. There's no need to involve their IT department and, best of all, no need to entrust their coveted DVDs to other departments, hoping they'll be returned."

Healthcare facilities and academic institutions simply purchase 150—or more—viewings of the titles of their choice based on the nature of their staff or classes. The purchasing facility/institution will receive a login/password combination to login to Phlebotomy Central, and once in Phlebotomy Channel, links to specific videos can be generated for sharing assigned videos and lectures with their staff or students, with an alternate password for sharing. The videos and lectures can be viewed at the user’s convenience from any computer with high-speed Internet access. When the number of views purchased by the facility has been exhausted, additional viewings are available for purchase in increments of 50.

For more information, or to order, call 866.657.9857 or go to PhlebotomyChannel.tv.

Phlebotomy Channel

Featured FAQ
Hematoma Prevention

Q: I am looking for any study showing the use of cohesive bandages like Coban™ on patients on heparin or Coumadin. Have you ever seen a study or recommendation to support their use?

A: No, but their use makes good sense. Just make sure you and those who work with you and for you don’t consider such wraps as a substitute for applying pressure or observing the site prior to application.

 Use it in conjunction with the practice of observing the site for hematoma formation for several seconds (5-10) after releasing pressure, but before applying the wrap. Too many folks are in such a hurry to bandage that they don't take time to observe for bleeding beneath the surface of the skin. To them, a wrap might be considered as a substitute for that step, and allow them to think that any bleeding will be absorbed by the wrap.

There should be a two-point check for bleeding: 1) look for bleeding from the puncture site and 2) check for hematoma formation. Failing to observe for a hematoma formation beneath the surface of the skin can cause serious complications, including nerve injury. In the CLSI venipuncture standard, this observation step is required for all patients, not just those on blood thinner.

Each month, PT-STAT! will publish one of the hundreds of phlebotomy FAQs in the growing database of questions and answers available in Phlebotomy Central, the members-only section of the Center for Phlebotomy Education's website. For information on joining Phlebotomy Central, click here.

 

Survey Says
Selecting Sharps Safety Devices

Last month, visitors to our website were asked what their facility's most important criterion is when selecting sharps safety devices for use in blood collection. Topping the list of responses at 48 percent was internal product evaluations. Next was staff preference, cited by 28 percent of respondents. Coming in a distant third was the price of the product (8%).  

A comment supporting staff preference as the determining factor concluded that “if they do not like it, they won’t use it”. Although the cost of a sharps safety device should not be the only reason a product is selected, price and purchasing contracts may influence a facility’s decision, as indicated by the survey comments below.

Sample Comments:

  • “Staff has input into device evaluation and selection but the device also must meet safety requirements. Pricing is the last consideration, but it can’t be so pricy that we would have no way to pay for the supply.”
  • “Staff preference and pricing are also considered.”
  • “Internal evaluations determine selection, but it must also in most cases be on the hospital’s group purchasing contract.”

One survey participant summed up their facility’s device selection criteria this way: A) That [the product] meets all current safety standards . B) That it meets the needs of all users (group evaluation by all users-staff preference). C) Pricing/inclusion in purchasing contract.”

For facilities subject to OSHA regulations, devices must be selected based on employee feedback (29 CFR 1910.1030(c)(1)(v)) and be evaluated for appropriateness for each procedure and effectiveness in preventing occupational exposures to blood and other potentially infectious materials. If the availability and variety of devices is restricted, the employer may be in violation of these requirements. According to OSHA, selecting a safer device based solely on the lowest cost is not appropriate. Selection must be based on employee feedback and device effectiveness.(1)

Facility types represented in last month’s survey include: hospital (76%); physician office laboratory (8%); public health department, academic/educational institution, health maintenance organization, and traveling health service (4% each).

Reference

  1. U.S. Department of Labor and Occupational Health and Safety Administration (OSHA). Standard Interpretations, Nov. 21, 2002. Link. Accessed 1/7/11.

This month’s survey question:
Does your facility use papoose boards to restrain infants and toddlers?

 

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What Should We Do?

[Editor’s Note: This month, "What Would You Do?“ becomes "What Should We Do?". Instead of asking readers to offer solutions to our hypothetical scenarios, "What Should We Do?" gives you the opportunity to ask our team of technical experts for advice on your most pressing phlebotomy challenges. Whether technical or management in nature, we'll carefully consider solutions and suggestions based on the industry's best practices so that you and those in other facilities with the same problem can benefit, all the while maintaining your facility's anonymity. What Should We Do? is your opportunity to ask us for suggestions on the best way to handle your real-life dilemmas.]

 

This Month’s Case Study:
One Size Doesn’t Fit All

Barbara from Indiana asks: “…Our problem is this: the blood safety collection devices that fit on our blood culture bottles do not fit into the wall-mounted sharps containers in the patient’s hospital room. They are also so large, it is not practical to have a sharps container with that large of a mouth on the phlebotomy tray. What do we do?”

 

What you don’t want to do is pinch, force, or manipulate in any way the collection device being discarded in order to make it fit through the opening of a sharps container.

As blood collection devices in use at your facility evolve, periodically assess the design of the sharps containers your facility is currently using in patients’ rooms. According to a study appearing in the December 2010 issue of American Journal of Infection Control, sharps containers have been associated with sharps injuries, and more than 90 percent of those injuries are related to container design. The authors of the study found that a sharps container with an enhanced aperture design can significantly lower such injuries. By converting to sharps containers with improved engineering the study group experienced a reduction in sharps exposures by up to 81 percent.(1)

Because no single container type meets the disposal containment needs for every facility, the National Institute for Occupational Safety and Health (NIOSH) provides guidance for selecting sharps disposal containers and evaluating their efficacy. In its document, Selecting, Evaluating and Using Sharps Disposal Containers, NIOSH establishes criteria and provides tools for evaluating the performance of sharps disposal containers.(2)

References

  1. Grimmond, T, Bylund, S, Anglea C, et al. Sharps injury reduction using a sharps container with enhanced engineering: A 28 hospital nonrandomized intervention and cohort study. Am Jrnl Inf Cntrl 2010;38(10):799-805.
  2. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH). Selecting, Evaluating, and Using Sharps Disposal Containers. Atlanta, Georgia; January, 1998. DHHS (NIOSH) Publication No. 97-111. http://www.cdc.gov/NIOSH/sharps1.html#top Accessed 1/10/11.

 

 

Wanted:

Your most challenging phlebotomy situations and work-related questions.

Send your submission to WSWD@phlebotomy.com and you just might see it as a future case study.

 

 

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PT STAT! is a free, monthly educational service provided by the Center for Phlebotomy Education, Inc., the most respected authority in phlebotomy. For a complete company profile and product list for all healthcare professionals who perform, teach or manage specimen collection procedures, visit us on the Internet at: http://www.phlebotomy.com.
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