Exposure at work and protective gloves

1. Exposure at work andprotective gloves Riitta Jolanki, D.Tech. (Chem.Eng.), Docent Senior Research Scientist, Dermatotoxicologist Finnish Institute of Occupational Health (FIOH) Department of Occupational Medicine Section of Dermatology riitta.jolanki@ttl.fi

2. Skin hazards at work • Chemicals • liquids and splashes (direct contact) • gases, aerosols, dusts and droplets (airborne) • Hand-washing agents, hand creams and barrier creams • Tools and gloves (nickel, rubber and rubber chemicals) • Dirty tools, surfaces, clothes and gloves • Wet work • Use of protective gloves (occlusion, etc.) • Mechanical and physical factors • Biological agents (micro-organisms)

3. Decreasing skin exposure • Chemicals and other skin hazards • identification, elimination or substitution • Work • technical arrangements • safe working methods ("non-touch techniques") • clean work area and tools • Worker • cleaning and care of skin • instructions (use of gloves, working methods) • recognition of skin symptoms • Preventive measures • protective gloves

4. Safety data sheet (SDS) • Means for manufacturer to present basic safety information on his product • single substance, mixture of substances • fully finished product • Details of all the known safety hazards presented by the product • Skin sensitizers are labelled with R-phrases • R 43 ’May cause sensitization by skin contact’ • R 42/43 ’May cause sensitization by inhalation or skin contact’ • Details of how these hazards should be managed • SDSs are of great help, they may not be exact enough from a dermato-allergist's point of view

5. Possible reasons for SDSs being inaccurate • Low concentration of chemicals may not be declared • in the EU, if a skin-sensitizing chemical is present at a concentration of 0.1% or more in a chemical preparation, it should be listed in the preparation's SDS • Raw materials may contain hidden impurities • Final product may contain starting materials • Decomposition of components • Contamination of residues • Manufacturing processes may be poorly controlled • Undeclared components may be added intentionally

6. Selection of protective gloves • Exposure (all skin hazards) • chemical, physical, mechanical and biological • Work methods and requirements • Working conditions and duration • Side effects of gloves • Worker (allergy) • Characteristics of the gloves • resistance to chemicals • side effects • cleansing properties • availability • price

7. Ideal gloves • Resistant to all chemicals • Dextrous in use • Comfortable to use • No side effects

8. Glove types • Disposable (0.007 – 0.25 mm) • surgical or examination gloves • Household (0.20 – 0.40 mm) • usually unsupported or unlined or with nappy inside • Industrial (0.36 – 0.85 mm) • usually supported or lined • Special industial • durable surface material, special supports, thick linings • wired cloths • Inner gloves (cotton, viscose, wool)

9. Glove materials • Rubber materials • natural rubber latex • synthetic rubber • Plastic materials • Leather • Textiles • Special materials • Combinations of different materials

10. Glove materials- rubber - Natural rubber latex Synthetic rubber • Nitrile rubber • Neoprene or chloroprene rubber • Butyl rubber • Fluororubber (Viton®) • "Styrene rubber" surgical gloves • e.g., Elastyren® and Tactylon®

11. Glove materials - plastic - • Polyvinylchloride (PVC) or vinyl • Polyethylene (PE) • Polyvinylalcohol (PVA) • 4H Gloves (5-layer laminate of PE and EVOH)

12. Rubber, plastic, totally rubber- or plastic-coated textile wet work harmful chemicals Leather, textile dry work "inert" chemicals Rubber- or plastic-impregnated, or partly rubber- or plastic-coated textile moist work "inert" chemicals Disposable gloves health care work laboratory work Selection of protective glove types against chemical hazards

13. Permeation of chemical through protective gloves • Usually difficult to see by naked eye • Use of permeable gloves may increase skin exposure and risk of sensitization • Gloves that permeate chemicals may also permeate hazardous micro-organisms • Use of organic solvents simultaneously with allergenic chemicals shortens considerably the breakthrough time of the allergen

14. Chemicals pass through the glove material • Penetration • through wholes in glove material • Permeation • throughundamaged glove material • Degradation • chemical degrades glove material

15. Testing of glove resistance against chemicals • According to standard EN 374-3 • Breakthrough time • measures how long it took the chemical to permeate through the glove material • Permeation rate • measures the quantity of chemical that permeates an area of the material after breakthrough occurs

16. Breakthrough time • measures how long it took the chemical to permeate through the glove material • permeation rate = 1 µg·min-1·cm-2 breakthrough time time

17. Criteria for glove reuse Handling of skin sensitizers • gloves can be used for a period up to ½ times the breakthrough time after the first exposure • should then be discarded (no reuse) Handling of organic solvents • 1/5 times the breakthrough time after the first exposure cleaning and drying • reuse, discarded when physical degradation occurs

18. Disposable gloves • Natural rubber latex • Plastics (vinyl, polyethylene) - recommended • Powdered or non-powdered • Surgical gloves (sterile) • Examination gloves (nonsterile) • Chemical-protective gloves (nonsterile, inexpensive)

19. Disposable gloves for chemicals • Clean gloves from the package (no reuse) • Only for short-term or occasional handling of chemicals • Poor protecton capacity • Better protection obtained by double gloving • Change gloves often • Change gloves immediately after chemical contamination

20. Side effects of protective gloves – skin irritation – • Friction from the seams of leather and textile gloves • Occlusion, sweating, and maceration • Occlusion enhances penetration of irritants from e.g., detergents and skin care products • Agents that have penetrated the glove membrane from the outside (environmental exposure) • Agents/materials emanating from the glove itself, or remaining from glove manufacturing process • Agents remaining from the glove washing procedure (detergents and moisture) • Glove powders, ethylene oxide, etc.

21. Side effects of protective gloves – skin sensitization – • Glove materials • rubber chemicals in natural and synthetic rubber gloves (e.g., accelerators and antioxidants) (ACD) • proteins in NRL gloves (contact urticaria/protein contact dermatitis, rhinitis, asthma and conjunctivitis) • chromium (tanning agents) in leather gloves (ACD) • plasticizers in PVC gloves (rarely) (ACD) • dyes (ACD) • Glove powders (rarely)

22. Side effects of protective gloves – others – • Aggravation of dermatitis by glove usage (occlusion) • Slowing of the work • Increased risk of hand accidents (getting caught in moving or revolving parts of machinery) • Increased absorption of hazardous substances through the skin (systemic adverse effects) • Impairment of hand dexterity

23. Allergen content of latex gloves. A market survey of medical gloves used in Finland in 2001 • Published by National Agency for Medicines (luonnonkumikäsineiden markkinavalvontatutkimus, TLT-INFO 1/2001, Lääkelaitos, Helsinki 2001) • More than 1000-fold differences in the allergen contents have been demonstrated • If the allergen content is low (<10 AU/ml) • only few new sesitizations • sensitized persons can continue in their present job • avoiding unexpected allergic reactions during medical investigations or care in persons unaware of their allergy

24. Gloves made of plastic or synthetic rubber materials do not contain NRL proteins

25. Non-sterile gloves for workers with CU/PCD from NRL gloves • Disposable gloves • plastic gloves (PVC or vinyl, PE or polyethylene) • synthetic rubber gloves (nitrile, neoprene) • NRL gloves with a low allergen content (<10 AU/ml) (use test) • polyethylene (PE) plastic gloves under NRL gloves (double gloving) • Household gloves • PVC • Industrial gloves • plastic (PVC, polyvinyl alcohol or PVA) • synthetic rubber gloves (nitrile, neoprene, butyl, fluororubber) • plastic laminate gloves (PE/EVOH/PE; 4H Gloves )

26. Sterile gloves for health care workers with CU/PCD from NRL gloves • Synthetic rubber gloves (e.g. neoprene) • NRL gloves with a low allergen content (<10 AU/ml) (use test) • Polyethylene (PE) plastic gloves under NRL gloves (double gloving) • NRL gloves with inner surface made of plastic material

27. Patients with CU/PCD from NRL gloves • Do not use NRL gloves when examining or caring for such patients • Use instead plastic or synthetic rubber gloves

28. Surgical gloves without NRL proteins • Neotech ja Biogel Skinsense N (Oriola Oy, Finland) • Elastyren, Dermaprene, Neolon (Tamro Finland) • Allergaard (Johnson & Johnson) • Duraprene (Baxter) • Tactylon (Procter & Gamble Hygiene)

29. Cleaning work and protective gloves • Dry work • use of gloves is not necessary • textile gloves • Wet work • household gloves made of PVC (+ inner gloves) • Organic solvents • nitrile gloves (+ inner gloves)

30. Kitchen work and protective gloves • Handling foodstuffs • household gloves made of PVC (+ inner gloves) (e.g., peeling potatoes) • disposable PVC or polyethylene gloves (e.g., making salad) • Washing dishes • household gloves made of PVC (+ inner gloves)

31. Painting and protective gloves • Water-based latex paints • textile gloves with plastic pimples on palmar side • rubber- or plastic-coated textile glove (palmar side coated) • Solvent-based paints • material that protects against the solvent, usually nitrile gloves (+ inner gloves) • Epoxy paints • only 4H gloves give excellent protection (+ nitrile outer gloves and cotton inner gloves)

32. Barrier creams • The protection given by barrier creams is questionable • Improve hand hygiene during dirty work, make hand cleaning easier • Only on healthy skin • May contain sensitizing and irritating components • May promote the retention of harmful chemicals on the skin surface (increased exposure)

33. Instructions for using protective gloves (I) • The use of protective gloves should be started simultaneously with the handling of hazardous materials • Clean and dry the hands before putting gloves on • Don't use barrier cream with gloves • Use inner cotton gloves whenever possible • Use better fitting gloves over loose or slippery gloves (PE or 4H glove) • When using double gloving, the inner glove should be ½–1 size larger • Protective gloves are meant for personal use only • If possible, restrict the use of gloves for relatively short periods (up to 30–40 minutes)

34. Instructions for using protective gloves (II) • Change gloves immediately after getting spillages or splashes inside the glove • Wash the gloves after use on both sides (gloves meant for reuse) • Cracked or hardened gloves should be discarded • Avoid unnecessary wearing of polymer gloves • Use protective gloves also at home

35. After work • Wash hands with lukewarm water • Use mild hand washing agent • After using solvent-based hand washing agent, wash your hands with water immediately, and cream the hands • Dab (don't rub) your hands dry • Cream your hands