Barrier effect of gloves against cytostatic drugs.
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Biomedical subjects
Publications and source records attributed to G A Mellström.
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The value of protective gloves in the health care environment is well known. However, these gloves are not perfect. Some are permeable to microorganisms and various chemicals, and/or result in side effects for health care professionals. Gloves that offer the greatest protection and least side effects are highly desirable. Field of application rules and regulations, materials and manufacturing, and test methods of protective gloves are described in Part I of this three part series.
The value of protective gloves in the health care environment is well known. However, these gloves are not perfect. Some are permeable to microorganisms and various chemicals, and/or result in side effects for health care professionals. Gloves that offer the greatest protection and least side effects are highly desirable. Protection against microorganisms and protection against chemicals used in health care are described in Part II of this three-part series.
The value of protective gloves in the health care environment is well known. However, these gloves are not perfect. Some are permeable to microorganisms and various chemicals, and/or result in side effects for health care professionals. Gloves that offer the greatest protection and least side effects are highly desirable. Limitations of glove use due to side effects, and glove selection and therapeutic alternatives are described in Part III of this three-part series.
In working situations where there is a possibility of acquiring blood-borne infections, the use of disinfectants is important. It is also important to use protective gloves, both to protect the skin against disinfectants and to protect against infections. Changes in the structure of the glove material may, however, interfere with the protective capability of the gloves. The influence of 4 disinfectants on the material structure and protective effect of 6 different brands of protective gloves was studied. The proposed International Organization for Standardization (ISO) standard method for determining the liquid chemical resistance of air-impermeable materials was used for permeation testing. Pieces of latex and vinyl glove were also exposed to isopropanol and ethanol for 10, 30 and 60 min and then viewed in a scanning electron microscope. Isopropanol permeated through latex and vinyl gloves in less than 10 min. The polyethylene (PE) gloves were of quite variable quality, and the breakthrough time ranged from 4 to greater than 240 min. The latex and vinyl gloves were also permeated by ethanol, but at a much lower rate. The disinfectants Blifacid, based on p-chloro-m-cresol, and Cidex, based on glutaraldehyde, did not permeate any of the gloves tested within 60 min. Isopropanol had a destructive effect on the material, which became opaque, stiff and brittle. This change in structure was verified with the scanning electron microscope. The tested gloves of latex, vinyl and PE, gave acceptable protection from contact with Blifacid and Cidex for at least 60 min. The same gloves do not give any total protection from contact with isopropanol and ethanol.
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Most current data on the protective effect of gloves against chemicals are obtained in vitro, using permeation cells. In vivo testing would give additional information on efficiency but is both expensive and time-consuming. It would therefore be valuable to know whether any definitive relationship exists between results obtained in vivo and in vitro. Gloves of natural rubber, butyl rubber and polyvinyl chloride (vinyl) were tested against 3 organic solvents, toluene, 1,1,1-trichloroethane and butanol, in vivo in guinea pigs and in vitro in permeation cells. Breakthrough times, absorption rates and steady state permeation rates were determined and compared on a relative basis. Some of the gloves that had a low degree of resistance to the test solvent in vitro nevertheless showed a rather good reducing capacity on the percutaneous absorption in vivo. However, for 2 gloves where no breakthrough was noted for butanol in vitro, permeation occurred at a degree lower than the minimum detection level. At this low concentration, the solvent was not absorbed through intact skin but through damaged skin. The breakthrough times for the 3 solvents corresponded well for the 2 test systems. The relative absorption rates and relative steady-state permeation rates varied considerably and no definitive relationship between the 2 sets of test results could be seen.
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Two permeation test cells of different sizes were used in a study of the permeation of toluene through two neoprene gloves and special neoprene sheet stock. Three flow rates of the collecting medium through the test cells were used to explore to what extent variation in flow rate would affect the breakthrough times and the steady-state permeation rate. The breakthrough time values were not affected to a significant degree by cell size or by increasing the flow rate of the collecting medium from 60 to 120 mL/min. The steady-state permeation rate values were evidently influenced by the flow rate of the collecting medium and by the size and configuration of the test cell.
The two main permeation test methods used in testing the resistance to chemicals of protective gloves are ASTM F739-85 and the draft international standard ISO/DIS 6529. In this investigation the two test cells were used following the test procedure proposed in the ASTM standard method in order to study whether the results obtained are comparable. Two chemicals, toluene and 1,1,1,-tricholorethane, were tested with three neoprene gloves and two specially prepared neoprene materials. The collecting medium was nitrogen gas in an open-loop system with flow rates of 60, 90 and 120 ml min-1. The breakthrough time and permeation rate at steady-state were calculated as described in the ASTM standard test method. Breakthrough times were not significantly influenced by the flow rate of the collecting medium. The steady-state permeation rate, however, showed greater variation and the values obtained can be compared only on relative bases.
ASTM and ISO/DIS test cells were used for permeation testing according to the procedure proposed in draft international standard ISO/DIS 6259. Two compounds, toluene and 1,1,1-trichloroethane, were tested with one neoprene glove and one made of a specially prepared Neoprene material. Different open-loop systems, direct-flow measurement and a sampling system with different gas flow rates were compared, and the effects on the test result were evaluated. The initial breakthrough (BTT) times and cumulative breakthrough times (lag-BTT) were significantly influenced only by the measurement systems. Neither cell configuration nor changes in the gas flow rate influenced them to any degree relevant for comparison of the test values on a relative basis in most cases. The permeation rates (PER) and the cumulative amount permeating per cm2 in 60 min showed significant differences between measuring systems, gas flow rates and the ASTM vs the ISO/DIS test procedures.
The increased interest in protective capacity of chemical protective clothing materials has resulted in an increasing number of reports from permeation testing, performed by various test procedures and with permeation cells of different configurations. To make it possible to compare the resultant data, it is necessary to identify what parameters will have a decisive influence on test results. The influence of various carrier gas flow rates on breakthrough time and permeation rate of acetone through gloves made of neoprene was investigated using three permeation cells of different configurations. The breakthrough times were not influenced by cell design or gas flow rate. On the other hand, both cell configuration and gas flow rate influenced the steady-state permeation rate.
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