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Corresponding author. Address: Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria Sacramento S/N, en La Cañada de San Urbano, CP: 04120, Almería, Spain. Tel.: +34 950 214590
Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria Sacramento S/N, en La Cañada de San Urbano, CP: 04120, Almería, SpainResearch Group of Health Sciences, CTS-451, Almería, Spain
Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria Sacramento S/N, en La Cañada de San Urbano, CP: 04120, Almería, SpainResearch Group of Health Sciences, CTS-451, Almería, Spain
Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria Sacramento S/N, en La Cañada de San Urbano, CP: 04120, Almería, Spain
Disinfection of gloves can be used during a pandemic situation when performing various procedures on the same patient or when removing personal protective equipment. If performing glove disinfection, there is a need to check the compatibility of gloves with the disinfectant product used.
Aim
To test the resistance of nitrile gloves to various disinfectant solutions.
Methods
One hundred percent powder-free nitrile gloves, composed of nitrile butadiene rubber compounds, were exposed to various disinfectants to analyse resistance. The seven most commonly used disinfectant solutions in the healthcare field were selected for testing. The effects of each disinfectant were analysed in comparison with the control group (untreated glove). For tensile testing, the thickness of each test specimen was measured with a micrometer.
Findings
Bleach solution decreased the breaking load of gloves, although to a lesser extent than disinfectants that contained ethanol.
Conclusion
Disinfectants that contain alcohol decrease the breaking load of nitrile gloves.
]. HCWs may have to perform multiple tasks on an infected patient, and must be aware of the appropriate use of personal protective equipment (PPE), as well as the proper use and removal of gloves [
]. In order for HCWs to comply with international standards, gloves would have to be removed often, hands disinfected and a new pair of gloves used to carry out subsequent activities with the same patient [
Rates of adherence to hand hygiene and gloving practices in 2 French rehabilitation hospitals by differentiation between single contacts and series of successive contacts with patients or the environment.
Händehygiene in Einrichtungen des Gesundheitswesens. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI).
]. According to the Commission, faced with the additional workload generated by COVID-19, gloves can be used for multiple procedures on the same patient if they are disinfected properly between each procedure.
Glove disinfection is not only useful for re-use for the same patient, but can also be considered as part of the process of removing PPE. The Centers for Disease Control and Prevention and the European Centre for Disease Prevention and Control (ECDC) recommend disinfecting gloves that have been used as part of PPE before removing the equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19 due to the high risk of self-contamination [
European Centre for Disease Prevention and Control Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19.
]. For this reason, HCWs must be trained in the proper use of PPE according to hospital guidelines, including techniques to safely remove equipment that protects mucous membranes [
]. Specifically, these studies found that tensile strength decreased with each alcohol-based hand rub, and combinations have relevant differences in the efficacy of disinfection. Further studies are required to clarify if the differences between the various disinfection products used are sufficient to exclude certain disinfectant solutions from glove decontamination activities in clinical settings [
]. As such, the objective of this study was to test the resistance of nitrile gloves to different disinfectant solutions.
Methods
This study used 100% powder-free nitrile gloves, composed of nitrile butadiene rubber compounds. The most commonly used disinfectant solutions in the healthcare field were selected for testing: (1) hand antiseptic (85 g ethanol/100 g) solution; (2) disinfectant for medical equipment surfaces (40.5 g ethanol + 9.20 g n-propanol/100 g); (3) water-based (2% chlorhexidine digluconate) antiseptic; (4) 1:10 bleach solution (sodium hypochlorite) (5000 ppm); (5) alcohol-based chlorhexidine digluconate antiseptic 2%; (6) hydrogen peroxide cutaneous solution (3 g/100 mL); (7) 96% ethanol; and (8) 70% alcohol.
To perform the tests, gloves were selected from a pack of 100 Sensiflex Lite gloves. The following procedure was followed for sampling. First, dumbbell-type specimens were cut according to UNE-EN ISO 527-3 standard, which specifies how trials and tests should be performed to determine tensile properties, into type 5 specimens (Figure 1) using a die. Four specimens were obtained from each glove. Specimens were cut from the palm and the back of the glove in the direction indicated by the fingers, ensuring that the edges of the specimens were smooth and had no raised edges, discarding those that presented edge imperfections (Figure 2). The samples obtained from each glove were divided into as many groups as tests to be carried out, so each group contained five samples and no group had more than one sample from the same glove. In this way, homogeneous and representative sampling was achieved.
Figure 1Specifications of the type 5 dumbbell test specimens (UNE-EN ISO 527–3:2019). 1, indicators; b1, width of the narrow part (6 mm ± 0.4 mm); b2, width at the ends (25 mm ± 1 mm); h, thickness (≤1 mm); L0, distance between indicators (25 mm ± 0.25 mm); L1, length of the narrow part (33 mm ± 2 mm); L, initial length between jaws (80 mm ± 5 mm); L3, total length (≥115 mm); r1, smaller radius (14 mm ± 1 mm); r2, smaller radius (25 mm ± 2 mm).
Table I shows the thickness measurements of each of the test specimens by group. Once the groups were defined, the disinfectant was applied homogeneously to one face of each specimen (in order to simulate the glove disinfection process followed by health personnel). The visual effect it caused was noted. Specimens were allowed to dry for at least 2 min before performing the stress-strain test.
Exposure to the disinfectant was analysed by comparing each specimen with the control group (untreated glove) (Figure 3), following the UNE-EN ISO 527-3 standard. In order to do so, specimens were tensed along the longitudinal axis, at a constant rate, until they broke or until the strain (load) or deformation (elongation) reached a certain value, with both the strain and elongation values recorded throughout the procedure. ISO 7500–1 (tension/compression testing machines) and ISO 9513 (calibration of strain gauges used in uniaxial tests) standards were followed, as well as all of the specifications outlined in Sections 5.1.2–5.1.6 of the ISO 527–1:2012 standards.
For tensile testing, the thickness of each specimen was measured with a micrometer with sensitivity of ±1 μm. The distance between grips was adjusted to 65 mm, the test specimen was loaded correctly, and the separation speed between grips was set at 500 mm/min. Finally, load and elongation were monitored until the specimen broke.
Results
The results are based on the parameters specified in ISO 527 standard, where several other parameters of interest were recorded in addition to elongation and strain. Figure 4 shows a graphical representation of the breaking load percentage for the 45 test specimens by group.
Figure 4Breaking load for 45 test specimens by group.
Elongation at breakage was not affected, although force at breakage decreased following the application of all disinfectants containing alcohol. The gloves disinfected with 70% alcohol broke using 60.62% of the effort required to break the untreated specimen, and this was found to be the most aggressive disinfectant (Figure 5). Specimens treated with any of the alcohol-based disinfectants broke more easily that the untreated specimen; they lost at least 25% of tensile strength, and this reached almost 40% in the case of 70% alcohol solution. Hydrogen peroxide 3% was the only disinfectant that maintained the glove's tensile strength properties.
Figure 5Strength at breakage following exposure to different solutions, in comparison with the untreated test specimen (control).
The objective of this study was to test the resistance of nitrile gloves to various disinfectant solutions. Although WHO does not recommend re-using gloves, the current pandemic situation has led to a shortage of resources in the fight against COVID-19, which makes it necessary to reconsider the re-use of gloves with the same patient. In this situation, disinfection makes it safer to re-use gloves, ensuring that gloves are visibly clean and without perforations [
COVID-19 associated shortage of alcohol-based hand rubs, face masks, medical gloves, and gowns: proposal for a risk-adapted approach to ensure patient and healthcare worker safety.
]. The disinfection of gloved hands by HCWs can reduce the risk of contagion considerably when the gloves are designated for the entire patient care process and multiple tasks are carried out on the same patient [
]. Specifically, it has been shown that the efficiency of disinfection is greater for different combinations of disinfectants/gloves than for bare hands [
]. For this reason, choosing an appropriate disinfectant solution for the type of glove used is a fundamental aspect during disinfection. Furthermore, differences in the effectiveness of disinfectant solutions seem to depend on the material of which the gloves are composed [
]. This study found that disinfectant solutions that contain alcohol do not affect elongation at breakage, but they do affect the force required to break the nitrile gloves. This may be due to the fact that, to achieve maximum elongation, the resistance that the material opposes is less, making it easier to break. A previous study found that tensile strength in nitrile gloves was reduced by 26% and 35.3% after using ethanol-based and isopropanol-based products, respectively [
The disinfectants tested in this study have various applications in the hospital environment. Sodium hypochlorite and hydrogen peroxide are used in the disinfection of surfaces and equipment against nosocomial infections [
]. The applications of 70% ethanol and chlorhexidine include the preparation and cleaning of intact skin prior to invasive surgical procedures, and performing antiseptic and surgical handwashing [
Antiseptics and disinfectants: aiming at rational use. Recommendations of the Advisory Committee on Healthcare Associated Infections. Sociedad Chilena de Infectología.
], have demonstrated the potential for disinfection of gloves using 70% alcohol and chlorhexidine 0.5%. Specifically, they found that washing gloved hands in antiseptic solution prior to central venous line insertion reduced contamination. In addition, a study by Kampf and Lemmen [
], which used alcohol-based solutions, found that disinfection of gloved hands may substantially reduce the risk of transmission when gloves are indicated for the entire episode of patient care.
Considering the findings, the use of bleach and disinfectants containing alcohol affected the breaking load of nitrile gloves, although bleach had less impact. Following treatment with all alcohol-based disinfectants, glove specimens required less effort to break. However, these disinfectants are widely recognized for their high disinfection capabilities [
European Committee for Standardization European Norm 1500: chemical disinfectants and antiseptics. Hygienic handrub. Test method and requirements (phase 2/step 2).
European Committee for Standardization,
Brussels2013
]. Previous studies have reported the importance of exploring disinfection of gloves with alcohol solutions, as these types of solutions are widely used [
This study had several limitations. Firstly, the experiments were only performed on nitrile gloves; therefore, there is a need for further testing with other materials. Furthermore, studies that have analysed the use of disinfectant with nitrile gloves are scarce, which makes it difficult to achieve an adequate discussion. However, this highlights the novel nature of the topic. Finally, due to the current healthcare crisis, a limited number of tests were performed, and there is a need to expand the research to include additional testing. Finally, it would be useful if glove manufacturers provided data about the compatibility of their gloves with different types of hand rubs and disinfectant solutions.
In conclusion, this study determined the influence of different disinfectants on nitrile gloves, and found that disinfectants that contain alcohol reduced the breaking load of gloves. Therefore, products that have ethyl components can weaken nitrile gloves, increasing the risk of breakage, which could increase the self-contamination of HCWs during clinical practice. There is a need for further research to analyse how disinfectants affect the breaking load or elongation of nitrile gloves, with the aim of minimizing the risk of spreading COVID-19 among HCWs.
Acknowledgements
The authors wish to thank the University of Almería, Diputacion of Almeria, and Sotrafa company. The authors also wish to thank Olga Fornieles Hernández, and all those who made this research possible.
Conflict of interest statement
None declared.
Funding sources
None.
References
Centers for Disease Control and Prevention
Transmission of coronavirus disease 2010 (COVID-19).
Rates of adherence to hand hygiene and gloving practices in 2 French rehabilitation hospitals by differentiation between single contacts and series of successive contacts with patients or the environment.
Händehygiene in Einrichtungen des Gesundheitswesens. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI).
COVID-19 associated shortage of alcohol-based hand rubs, face masks, medical gloves, and gowns: proposal for a risk-adapted approach to ensure patient and healthcare worker safety.
Antiseptics and disinfectants: aiming at rational use. Recommendations of the Advisory Committee on Healthcare Associated Infections. Sociedad Chilena de Infectología.
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