1. Chapter 19 Gloves and Latex Allergies
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2. Hand Hygiene Hand-washing guidelines
Wash your hands each time before you put on gloves and immediately after you remove gloves.
Wash your hands when you inadvertently touch contaminated objects or surfaces while barehanded.
Always use liquid soap during hand washing. Bar soap should never be used because it may transmit contamination.
For most routine dental procedures, such as examinations and nonsurgical procedures, an antimicrobial soap can be used.
For surgical procedures, you should use a germicidal surgical scrub product.
When washing hands, strive to use hands-free faucets, which are activated either with foot pedals or electronically. 2
Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2

3. Fig Areas of the hand not thoroughly washed because of poor hand-washing technique. (From Samaranayake LP, Essential microbiology for dentistry, ed 3, New York, 2007, Churchill Livingstone.)
Notice the areas most frequently missed.
When washing hands, start with the frequently missed areas to ensure thorough washing. 3
Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3

4. Hand Hygiene Hand-washing guidelines
Dry hands well before donning gloves.
Keep nails short and well manicured; rings (except for wedding rings), fingernail polish, and artificial nails are not to be worn at work.
Microorganisms thrive around rough cuticles and can enter the body through any break in the skin.
Dental personnel with open sores or weeping dermatitis must avoid activities involving direct patient contact and handling contaminated instruments or equipment until the condition on the hands is healed.
Jewelry and long nails can puncture gloves, creating the potential for disease transmission.
Powder in gloves can accumulate in jewelry clasps and crevices, causing damage.
For healthcare providers using gloves, what is the maximum length for fingernail tips? 4
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5. Alcohol-Based Hand Rubs
Waterless antiseptic agents are alcohol-based products that are available in gels, foams, or rinses.
They do not require the use of water. The product is simply applied to the hands, which are then rubbed together to cover all surfaces.
These products are more effective at reducing microbial flora than a plain soap, or even an antimicrobial hand wash.
Concentrations of 60% to 95% are the most effective. Higher concentrations are actually less effective.
They contain emollients that reduce the incidence of chapping, irritation, and drying of the skin.
These products are very “dose sensitive.” This means that you must use the amount that is recommended.
Just as when you are using soap and water, remember to thoroughly apply the alcohol hand rub on areas that are frequently missed.
What are the three advantages of using alcohol-based hand rubs over washing hands with soap and water?
Ask students whether they can think of any other advantages. 5
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6. Alcohol Rub Locations
Installed in a manner that minimizes leaks and spills.
If in corridor, the corridor must be at least 6 feet wide.
Installed properly in exit corridors, do not decrease fire safety.
Installed in a manner that adequately protects against access by vulnerable populations.
Dispenser capacity is limited to 0.3 gal (1.2L), maximum of 0.5 gal (2L), and no more than 10 gal (37.8L) in a single smoke compartment.

7. Hand Care Recommendations
For most routine dental procedures, such as examinations and nonsurgical procedures, wash your hands with either a nonantimicrobial or antimicrobial soap and water.
If your hands are not visibly soiled, you may use a waterless alcohol-based hand rub.
For surgical procedures, you should perform a surgical scrub using either a nonantimicrobial or antimicrobial soap and water, dry your hands, and apply an alcohol-based surgical hand rub.
The practice of general dentistry most likely uses a combination of routine hand washing with soap and water and alcohol-based, waterless hand rubs.
Evidence suggests that alcohol-based antiseptic hand rubs are more effective at decontaminating the hands than washing with soap and water alone.
Remember, if your hands are visibly soiled you must wash with soap and water before applying an alcohol-based hand rub. 7
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8. Fig. 19-13 Water-based hand products will not break down latex gloves
Fig Water-based hand products will not break down latex gloves. (Courtesy Essential Dental Systems, Hackensack, NJ.)
Why is it important for a healthcare professional to use hand lotion?
Having intact skin is the best defense against infection.
What is meant by the caption above, “Hand lotions must be compatible with glove material”? 8
Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8

9. Ingredients Alcohols Chlorhexidine (CHG 2%-4%) Iodophors
Excellent brad-spectrum antimicrobial activity in concentrations of 60-95%
Fast Acting
Chlorhexidine (CHG 2%-4%)
Good to Excellent against bacteria and viruses
Intermediate acting, Persistent activity
Iodophors
Excellent against activity, good against viruses
Intermediate activity
Phenol Derivatives
Excellent to Fair against various bacteria
Intermediate acting

10. Ingredients Continued…
Quaternary Ammonium Compounds
Good to Fair against bacteria and viruses
Slow acting, used only with alcohols
Triclosan
Excellent against viruses, Excellent to good against bacteria
Intermediate acting
U.S. Food and Drug Administration (FDA) regulations do not allow the use of triclosan (chlorinated aromatic compound linked to muscular function impairment in animals) as an active ingredient in "leave on" hand sanitizer.

11. Personal Protective Equipment
OSHA requires the employer to provide employees with the appropriate personal protective equipment (PPE) without charge to the employee.
Examples of PPE
Protective clothing
Surgical masks
Face shields
Protective eyewear
Disposable patient-treatment gloves
Heavy-duty utility gloves
PPE should be comfortable and functional. For example, if eyewear is too tight or too loose and fogs up, a dental assistant should try different models and brands until he or she finds one that fits properly.
What is the purpose of PPE? 11
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12. Fig. 19-14 Appropriate clinical attire consists of long-sleeved gowns, gloves, and eyewear.
There are many examples of proper infection control in this photo. (Ask students to name them.) 12
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13. Gloves
Because dental personnel are most likely to come into contact with blood or contaminated items with their hands, gloves may be the most critical PPE.
You must wear a new pair of gloves for each patient, remove them promptly after use, and wash your hands immediately to avoid the transfer of microorganisms to other patients or the environment (CDC guideline).
Consult with the glove manufacturer regarding the chemical compatibility of the glove material and the dental materials you use (CDC guideline).
Some putty impression materials may not be compatible with the powder found in gloves.
Review manufacturer’s guidelines for handling material while maintaining good infection control. 13
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14. Fig. 19-23 Nonsterile exam gloves. (Courtesy Crosstex, Dallas, TX.)
Notice that the clinician is properly placing the glove over the sleeve to eliminate exposed skin, therefore eliminating a possible portal for contaminants.
Nonsterile examination gloves are used most frequently for patient care. 14
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15. Gloves Guidelines for the Use of Examination Gloves
All gloves used in patient care must be discarded after a single use.
These gloves may not be washed, disinfected, or sterilized; however, they may be rinsed with water to remove excess powder.
Latex, vinyl, or other disposable medical-quality gloves may be used for patient examinations and dental procedures.
Torn or damaged gloves must be replaced immediately.
Properly fitting gloves are essential for good patient care.
Ambidextrous glove sizes range from XS to XL.
Right- and left-handed gloves have a much better fit; however, they are more expensive. 15
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16. Gloves Guidelines for the Use of Examination Gloves
Do not wear jewelry under gloves. (Rings harbor pathogens and may tear gloves.)
Change gloves frequently. (If the procedure is long, change gloves about once each hour.)
Remove contaminated gloves before leaving the chairside during patient care and replace them with new gloves before returning to patient care.
Hands must be washed after glove removal and before regloving.
Removing contaminated gloves before leaving the chairside assures the patient that gloves are being changed for each person. 16
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17. Gloves Damaged During Treatment
Gloves are effective only when they are intact (not damaged, torn, ripped, or punctured).
If gloves are damaged during treatment, they must be changed immediately. The procedure for regloving is:
Excuse yourself and leave the chairside.
Remove and discard the damaged gloves.
Wash hands thoroughly.
Reglove before returning to the dental procedure.
Gloves can be torn or ripped during the manufacturing process. Always inspect both gloves before starting a procedure. 17
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18. Gloves Damaged by Dental Materials
The chemical you come in contact with on a daily basis may damage your gloves.
Because so many dental materials are available on the market, you should consult the glove manufacturer about the compatibility of the glove material with various chemicals.
Healthcare providers who experience any skin irritation in response to latex gloves may want to try products from different manufacturers. 18
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19. Overgloves
Overgloves, which also are known as “food handler” gloves, are made of lightweight, inexpensive clear plastic.
These may be worn over contaminated treatment gloves (overgloving) to prevent the contamination of clean objects handled during treatment.
Overgloves are discarded after a single use.
Overgloves can greatly reduce cross-contamination and should be easily accessible in each treatment area.
The following situations necessitate the use of overgloves:
During a procedure you must open a cabinet door to retrieve an instrument you forgot to lay out on the table.
You must open a drawer during a procedure.
You must take a phone call (and use the receiver) during a procedure. 19
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20. Sterile Surgical Gloves
Sterile gloves should be worn for invasive procedures involving the cutting of bone or significant amounts of blood or saliva, such as oral surgery or periodontal treatment.
Sterile gloves are supplied in prepackaged units to maintain their sterility before use.
They are provided in specific sizes and are fitted to the left or right hand.
Sterile surgical gloves are of a higher quality than treatment gloves and therefore more costly. CDC guidelines, and some state dental boards, require surgical gloves for surgical procedures.
Some healthcare professionals choose to wear two pairs of sterile surgical gloves, but this is not necessarily a CDC recommendation. 20
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21. Utility Gloves Utility gloves are not used for direct patient care.
Utility gloves must be worn:
When the treatment room is being cleaned and disinfected between patients.
While contaminated instruments are being cleaned or handled.
For surface cleaning and disinfection.
Utility gloves may be washed, disinfected, or sterilized and reused.
Used utility gloves must be considered contaminated and handled appropriately until they have been properly disinfected or sterilized.
Appropriately sized utility gloves should be used to ensure good dexterity.
After utility gloves are washed and disinfected, they should be hung on a hook until thoroughly dry before further use. 21
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22. Fig. 19-25 Utility gloves are used when instruments are prepared for sterilization.
Notice the assistant is properly wearing the utility gloves over the lab coat’s sleeves. Why is she doing this?
Utility gloves should be thick enough to withstand instrument punctures. 22
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23. Non–Latex-Containing Gloves
Healthcare providers or patients may experience serious allergic reactions to latex.
For the person who is sensitive to latex, there are gloves made from vinyl, nitrile, and other non–latex-containing materials.
Many dental clinics/offices are going latex-free to create a safer environment for those who are sensitive to latex. 23
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24. Latex Allergies
The use of natural-rubber latex gloves has proved one of the most effective means of protecting the dental worker and the patient from the transmission of disease.
The number of healthcare workers and patients who have become hypersensitive to latex has increased dramatically.
There are three common types of allergic reactions to latex.
Two types involve an immune reaction and one type involves only surface irritation
Be certain to review the patient’s medical history to determine whether he or she is allergic to latex before starting a procedure.
Some patients may not be aware that they are allergic to latex; watch for symptoms. 24
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25. Causes of Latex Allergies
Natural Rubber Latex is a milky liquid produced by lactiferous plants or trees.
Foods Allergies
Kiwi
Chestnuts
Bananas
avocado
Latex is present in many materials used in the dental office, such as the elastic ear loops of masks and prophylaxis angle cups.
What are the symptoms of an immune reaction to latex?
Is your office prepared if a patient has such an immune reaction? 25
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26. Symptoms of Latex Allergy
Hives or welts
Localized swelling
Sunny nose, sneezing, headache, sore throat
Wheezing, shortness of breath
Abdominal cramps, chest tightness
Anaphylaxis (life threatening allergic reaction)

27. Irritant Dermatitis
Irritant dermatitis, a nonimmunologic process (does not involve the body’s immune system), is caused by contact with a substance that produces chemical irritation of the skin.
The skin becomes reddened, dry, irritated, and, in severe cases, cracked. Irritant dermatitis can be reversed by identifying and correcting the cause of the problem.
This is not an allergic reaction. Rinsing your hands with cool rather than hot water after you wash your hands helps to close the pores and minimize irritation dermatitis. 27
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28. Fig. 19-28 Irritant dermatitis.
This photo depicts the red, cracked, irritated skin caused by direct contact with latex or another irritant, such as chemicals. 28
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29. Type IV Allergic Reaction
The most common type of latex allergy, type IV sensitivity, is a delayed contact reaction, and it involves the immune system.
It may take as long as 48 or 72 hours for the red, itchy rash to appear.
Reactions are limited to the areas of contact and do not involve the entire body.
An immune response is produced by the chemicals that are used to process the latex used in manufacturing the gloves, not by the proteins in the latex.
Many healthcare workers mistake this type of reaction for a latex allergy.
The patient should get an allergy test from a physician to rule out any confusion. 29
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30. Type I Allergic Reaction
This is the most dangerous type of latex allergy, and it can result in death.
The reaction comes in response to the latex protein in the glove (in contrast to the reaction to chemical additives in type IV reactions).
A severe immunologic (immune system) response usually occurs 2 to 3 minutes after the latex allergens make contact with the skin or mucous membranes.
Because this type of latex reaction is so severe, every dental office must have a first-aid kit and an established emergency protocol.
What causes death in this type of allergic reaction? 30
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31. Treatment of Latex Allergies
There is no specific cure for latex allergy.
The only options are prevention, avoidance of latex-containing products, and treatment of the symptoms.
Anyone who suspects that he or she has an allergy to latex should see a qualified healthcare provider to have a test to confirm the allergy.
Once a latex allergy has been diagnosed, the affected person should practice latex avoidance in all aspects of his or her personal and professional life.
Gloves made of nonlatex materials such as vinyl and nitrile should be used with a latex-sensitive patient. 31
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32. Treatment
Remember…
When a latex allergy has been diagnosed in one employee in the dental office, all staff members should use practices to minimize the use of latex-containing products. These practices include the wearing of powder-free gloves by all dental staff members to minimize the risk of airborne latex particles.
When treatment gloves are removed or snapped off, they release airborne latex particles that can trigger an allergic reaction. Therefore patients can experience a type I allergic reaction with or without direct latex contact. 32
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33. Latex-Sensitive Patients
In the healthcare setting, patients with latex allergies should be treated with the use of alternatives to latex.
Vinyl gloves and nonlatex rubber dams should be available in all dental offices.
Ask students the following question:
If you have a patient with a latex allergy, when should you schedule his or her appointment? 33
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