Perforations and porosity of surgical gloves. Frequency, mechanism, risk

Geotrichum capitatum is an emerging opportunistic pathogen which causes invasive disease in immunocompromized patients. We describe a patient with non Hodgkin's lymphoma and disseminated infection by G. capitatum with predominant liver involvement, which was proven by repeated positive blood cultures and a liver biopsy. Staining liver biopsy demonstrated the presence of hyphal elements consistent with G. capitatum. Combined antimycotic treatment with amphotericin B and 5-flucytosine did not eradicate the mycotic infection as shown by the persistence of liver lesions.     

A closer look at disposable gloves. An assessment of the value of vinyl, latex and plastic gloves

Research has shown that people with broken skin can be at serious risk of cross infection. A study was undertaken to assess the relative benefits of wearing vinyl, latex and plastic gloves during invasive procedures.     

Hazards of mental chronometry: An example from children's subtraction.

Chronometric analyses have frequently been used to infer the strategy people use to solve classes of problems. However, in the many situations in which people use multiple strategies, chronometric analyses can lead to incorrect conclusions about strategy uses. This was illustrated in the context of 2nd and 4th graders' simple subtraction. As in previous studies, the S. S. Woods et al (1975) chronometric model was found to fit the pattern of solution times averaged over strategies. Strategy classifications based on observation of overt behavior and immediately retrospective verbal reports, however, indicated that (a) children rarely used 1 of the 2 approaches posited by the model, (b) they used the other approach no more often on problems where they were posited always to use it than on problems where they were posited never to use it, and (c) they used a greater variety of strategies than posited by the Woods et al model. The findings raised issues about when chronometric methods can be usefully applied, how strategy use can be assessed, and how people choose among multiple strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speciation of chromium in tanned leather gloves and relapse of chromium allergy from tanned leather samples

There are concerns that wearing chromium tanned leather gloves can provoke a lapse of hand dermatitis in chromium sensitive patients. Various forms of chromium have different biological effects and the determination of total chromium (both soluble and insoluble), which often is used in clinical studies, may therefore not be an adequate measure of the adverse exposure. However, investigations, where dissolution of hexavalent chromium from leather gloves has been experimentally studied, could not been found in the literature. The aim of this pilot study was therefore to determine the total amount of chromium and the amount of sweat leachable chromium in different leather glove materials and also to apply samples of these materials in a patch test to chromium sensitive patients to see if they could provoke a reaction. The results showed tha chromium tanned leather contained about 3% (m/m) chromium. Chromium can also be found in dyed vegetable tanned leather, probably emanating from the leather dye. Small amounts (average 0.08% m/m) of leachable hexavalent chromium were found in both chromium and vegetable tanned leathers. Thus, the risk of relapse of chromium dermatitis cannot be disregarded and further studies on the causes of relapse of chromium dermatitis are necessary.     

Disposable gloves: research findings on use in practice

This article reviews the research evidence for the safety and effectiveness of disposable gloves in preventing transmission of infection. The author concludes that all nurses should have a glove policy for their unit or department to ensure the correct type of gloves are worn in appropriate situations.     

Hazards and safety in theatre

The Health and Safety at Work Act (1974) provides legislation aimed at securing the safety of everyone at their place of work, and of any other person whose safety may be at risk by their presence in that area. Responsibility rests at all levels. Management have a duty to provide a safe working environment and to provide education and training for workers. At a departmental level daily safety checks need to be carried out and continuous safety conscious management must be in evidence. At a personal level we must all work carefully, bearing in mind the particular hazards in our area to ourselves, to our colleagues and our patients. This article hopes to highlight some of the trouble spots we should already be familiar with.     

Examination gloves as barriers to hand contamination in clinical practice

OBJECTIVE: To test the effectiveness of vinyl and latex gloves as barriers to hand contamination with gram-negative organisms and enterococci during routine hospital procedures. DESIGN AND INTERVENTIONS: We studied 137 procedures during which a health care worker's gloved hand contacted a patient's mucous membrane and was thus potentially contaminated with gram-negative rods or enterococci. Quantitative hand cultures were obtained from each health care worker before and after the gloved contact using a modified glove juice method, and the exterior glove surface was also quantitatively cultured after patient contact. Used gloves were then tested for leaks using the American Society for Testing and Materials' watertight test. SETTING: Harborview Medical Center, a 330-bed city-county hospital and level I regional trauma and burn center, is both a teaching facility affiliated with the University of Washington and the major provider of care to indigent and uninsured persons in Seattle-King County, Washington. PATIENTS AND OTHER PARTICIPANTS: Respiratory therapists performing endotracheal tube care on intubated intensive care unit patients, registered nurses performing digital rectal stimulation for bowel training on patients with spinal cord injury in the rehabilitation ward, and dentists performing routine dental examinations and procedures on healthy outpatients in the dental clinic. MAIN OUTCOME MEASURE AND RESULTS: Eighty-six of the 135 gloves cultured had gram-negative rods or enterococci on the external surface after use and were thus sources of potential hand contamination. Microbial contamination of the health care worker's hands occurred in 11 (13%; 95% confidence interval, 6% to 20%) of these 86 events, and was more frequent with vinyl (10 of 42) than latex (one of 44) gloves (P < .01). After use, glove leaks were also more frequent in vinyl gloves (26 of 61) than with latex gloves (six of 70) (P < .001). Even when leaks were present, gloves prevented hand contamination in 77% of instances and quantitative counts of microorganisms contaminating hands were 2 to 4 logs less than counts on external glove surfaces. Health care workers reported awareness of the presence of glove leaks in only seven (22%) of the 32 events in which leaks were subsequently demonstrated. CONCLUSIONS: Under conditions of routine use, gloves effectively function as a protective barrier even when leaks are present. Latex gloves were less frequently associated with leaks and hand contamination. Since hand contamination occurred after 13% of exposures and cannot be readily identified by health care workers, routine hand washing should be done after each patient contact.     

Hazards of ketoconazole therapy in testotoxicosis

An eight-year-old boy with Leydig cell hyperplasia (testotoxicosis) was admitted with a three-day history of rash, vomiting and diarrhoea, followed by acute onset of breathlessness and confusion. He was shocked, with liver cell and renal failure, erythematous rash and severe interstitial pneumonitis. He had been treated with ketoconazole for four years prior to admission, receiving 1200mg daily during the preceding year. Cessation of ketoconazole therapy was associated with full clinical recovery but relapse of testotoxicosis. Ketoconazole was reintroduced cautiously at a lower dose, with no ill-effect, and reasonable control of testotoxicosis. We conclude that this boy's illness, including the interstitial pneumonitis, represented a reaction to ketoconazole which was dose-related rather than idiosyncratic.     

Hazards associated with metalworking by artists

Metalworking is the constructive sculptural application of various technologic processes for producing art from ferrous and nonferrous metals. Self-employed artists and their workplaces are not protected by governmental agencies. We describe the techniques involved in metalworking processes and discuss the physical trauma and medical syndromes associated with each process, as well as safety, prevention, and treatment aspects of the basic syndromes.