Transcript AOHP_Hand_Wellness_Workshop_Presentation_Updated_12-7

Hand Wellness Workshop
AOHP
Dec 6, 2011
Samuel McDonald,
Nursing Products
Treat your hands well
™
Ellen T. Brown, MT, CIC
• 30 years experience in health care industry
• Infection control for the past 18 years
• Employee Health Coordinator for the past 5 years
• Nationally certified in infection control
• Active member of the Association for Professionals in
Infection Control and Epidemiology
• 13 years active participation in employee safety
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Workshop Agenda
• Develop understanding of why hand wellness is a
serious occupational issue
• Provide education on the clinical aspects of
Contact Dermatitis
• Provide recommendations for reducing risks of
Contact Dermatitis
• Describe Cardinal Health’s point of view on glove
selection and usage
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Hand Wellness is a serious occupational
health issue
• Diseases of the skin is the #1 cause of occupational
illness across all professions
– Occupational skin diseases account for 15% to 20% of all reported
occupational diseases
– Occupational skin disease cases may be 10 to 50 times higher than
that reported by the Bureau of Labor Statistics
• Estimated cost to industry is over $1 billion
– Includes lost workdays and reduced productivity
– Does NOT include costs of occupational re-training or costs attributable
to the effects on quality of life
Sources: Occupational Skin Diseases/BD Lushniak; National Institute of Occupational Safety and Health (NIOSH)
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Occupational skin disease results in lost
worker productivity
• In several studies, a consistent 20% to 25% of workers
with occupational skin diseases lost time from work,
staying out an average of 9 to 11 days
• For example, a British study found that:
– 21% of patients with occupational contact dermatitis took time off work
– 16% did not improve clinically between their first and last visits to a
dermatologist or occupational physician
Source: National Institute of Occupational Safety & Health (NIOSH)
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Current state of hand wellness in the
workplace
• Lack of education on hand wellness in the workplace
• Employers are generally reactive to hand-care issues
and do not institute hand-care programs until
employee incidents occur
• People are confused with all the various glove
choices and do not always select the right gloves to
suit the right situation
Employers and workers need to be educated on hand wellness in
order to prevent skin irritations and allergic reactions in the workplace
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Anatomy of the skin
The Stratum corneum
is the upper layer of
the Epidermis
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Occupational diseases of the skin
include irritations and allergies
Chemical Allergies
Irritations
Protein Allergies
Occupational skin disease is generally characterized as
“Contact Dermatitis”
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What is “Contact Dermatitis”?
• Contact dermatitis is an inflammatory skin disease
characterized by itching, redness, and skin lesions
such as papules, edema or vesicles.
• There are two broad classes of contact dermatitis:
Irritant Contact
Dermatitis
(ICD)
Allergic Contact
Dermatitis
(ACD)
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Clinical features of ICD and ACD
Irritant
Contact Dermatitis
Allergic
Contact Dermatitis
Reaction Time After
Contact
Usually within 48 hours
Many hours to 5-6 days
Sharp Demarcation
Often typical
May occur
Frequently diminished
by 96 hours
Many days
Infrequently
Usually
Time for Clinical
Resolution
Presence of Itching
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Signs and symptoms of
Irritant Contact Dermatitis
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Redness
Burning
Itching
Pain
Dry
Crusting
Fissures
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Cracks
Hard bumps
Sores
Rash
Signs and symptoms
usually stop at the
wrist where glove
contact ceases
Irritant Contact
Dermatitis
75% to 80% of all Contact Dermatitis is classified as Irritant
Source: Menne and Maibach "Hand Eczema" CRC Press, 2000
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Potential causes of
Irritant Contact Dermatitis
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Hand soaps and antiseptics
Glove chemicals
Climate (cold, windy, or hot and arid)
Emotional stress
Inappropriate glove usage
Inappropriate hand care
People age 40 and
over have greater risk
of dry skin. However,
20-30 year olds are
experiencing an
increase in dermal
reactions.
Frequent or inappropriate hand washing is the leading cause of ICD
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Improper glove usage and selection is
one of the leading causes of ICD
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Repeated donning and removal of
multiple pairs of gloves may cause a
friction-related irritation across the
dorsum of the hands
Prolonged glove-wear may result in skin
occlusion and either dryness or
maceration
Glove powder is a common cause of
irritant reactions
Other potential irritants can include
accelerators and chemicals used
during the glove manufacturing
process
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There are two types of
Allergic Contact Dermatitis (ACD)
Chemical Allergy ACD
Protein Allergy ACD
(Type IV Hypersensitivity)
(Type I Hypersensitivity)
Allergic dermatitis is estimated to constitute about 20% to
25% of all contact dermatitis
Source: Menne and Maibach "Hand Eczema" CRC Press, 2000
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Signs and symptoms of
Allergic Contact Dermatitis
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Chemical Allergy S&S
Protein Allergy S&S
(Type IV Hypersensitivity)
(Type I Hypersensitivity)
Itching
Drying
Redness
Crusting
Thickening of the skin
Hard bumps
Sores
Papules
Vesicles
Signs and symptoms may spread up
the arm, beyond the border of the
glove
Type IV will not progress systemically
•
Local: Moist, pink, raised hives often
blanched in center, urticaria
•
Systemic: May produce swollen
eyelids or face or respiratory distress
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Potential causes of
Allergic Contact Dermatitis
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Chemical Allergy Causes
Protein Allergy Causes
(Type IV Hypersensitivity)
(Type I Hypersensitivity)
Glove chemicals such as
accelerators and preservatives,
colorants, other additives
Poison ivy, poison oak
Soaps, detergents, disinfectants
Individuals with chronic eczema
Individuals who have other
allergies
•
•
Natural rubber latex protein
allergen
Individuals with a history of atopy
and contact dermatitis may be at
higher risk for developing a
sensitivity to latex
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Management of Irritant and Allergic
Contact Dermatitis
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Identify and remove the causative agent
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Do not assume the glove is the only causative agent
Allow hands to completely heal
Practice daily hand care with proper usage
and selection of soaps and moisturizers
Seek intervention from a dermatologist or an
allergist – especially for Type I protein
allergy
Address glove selection
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–
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Select gloves manufactured without natural rubber
latex such as: polyisoprene, nitrile, or vinyl
Select powder-free gloves
Select clinically proven gloves
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Hand wellness recommendations are
categorized in four key areas
Handwashing &
Selection of Soaps
Glove Donning,
Usage, and Removal
Selection & Usage of
Hand Lotions
Glove Selection
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Recommendations for hand washing
and soap selection
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•
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Hands have 100,000 colony forming units of bacteria per
square centimeter…washing hands with soap and water
reduces colony count
Select hand hygiene products with low irritancy potential
Perform hand hygiene before glove donning and after
glove removal
Be cautious of hand products with high alcohol content
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–
•
Alcohol is a drying agent which can cause contact urticaria and
allergic contact dermatitis
Make sure the alcohol-based product has proven emollients
Proper hand washing process:
1.
2.
3.
4.
5.
Remove jewelry
Wet hands
Use tepid water and a mild soap or antimicrobial agent
Use friction/rubbing hands together for 15 seconds
Rinse thoroughly and gently towel or blow dry
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Recommendations for selection and
usage of hand lotions
Skin friendly ingredients
include:
Use topical products which:
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Are free of fragrances and dyes
Have therapeutic ingredients that
can moisturize the skin
Have anti-irritant ingredients
Are water-based such as
Amino+Derm brand lotion
Have ingredients to repair the skin
barrier
Are approved for use by your
Employee Health department
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Glycerin
Alpha hydroxy acids
Sorbitol
Petrolatum
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•
•
Note: Not compatible with natural
rubber latex or synthetic
polyisoprene gloves
Ceramides
Dimethicone
Cocoa butter
Retinol
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Recommendations for glove donning,
usage and removal
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Remove all jewelry prior to glove donning
Do not use gloves that have a hole or tear
Do not reuse or reapply disposable gloves
Change gloves frequently throughout the course of
the workday – gloves may tear or develop a hole
through normal wear and usage
Strict attention must be paid when removing gloves
so that the outer surface of the glove does not
come into contact with exposed skin
Remove gloves by slowly pulling them down, one
at a time and turning them inside out
Dispose of gloves in a designated biohazard
container or receptacle if required
It is now time to complete the
Neu-Thera™ treatment
Glove Removal
1. Remove gloves
slowly, turning
them inside out.
2. Be sure to use
one glove to
remove the
other.
3. Never let the
outside of a
glove touch
your exposed
skin.
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Glove selection can be very confusing
Latex?
Ambi?
Clean vs.
Sterile?
Therapeutic
Gloves?
Hand
Specific?
Vinyl?
Polyisoprene?
Nitrile?
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Who is Cardinal Health?
•
Leading provider of innovative products and services
to health care and other industries
•
More than $50 billion in annual revenues (2003)
•
#16 on the Fortune 500 (2009)
•
#1 in category, Fortune's "America's Most Admired
Companies" (2004)
•
#11 on Business Week's “Best Performing
Companies” (2003)
•
Forbes Platinum List: The Best Big Companies (2003)
•
50,000+ employees on five continents
•
World headquarters near Columbus, OH
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Glove material technology has
significantly evolved
Polyisoprene
Latex/Nitrile
Blend
Stretchy
Nitrile
Nitrile and
Neoprene
Vinyl
Natural
Rubber Latex
Evolution of
Glove Material
Technology
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Glove materials play a key role when
comparing durability and comfort
Glove Durability
Natural
Rubber Latex
High
Esteem™ CP
Polyisoprene
Tensile
Strength
Nitrile
Glove Comfort
High
Low
Low
Elongation
High
Comfort
= Material breaking points
Low
Esteem™ CP
Polyisoprene
Natural
Rubber Latex
Nitrile
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Select the “RIGHT” gloves for the
“RIGHT” situation
Laboratory Gloves
Cleanroom
Vinyl
Nitrile + Skin
Enhancement
Properties
Latex
Sterile or Non-sterile
Latex + Skin
Enhancement
Properties
Nitrile
Neoprene
Stretchy
Nitrile
Polyisoprene
Vinyl
Nitrile/Latex Blend
Latex
Nitrile
Neoprene
Glove types can be Hand Specific or Ambidextrous
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Cardinal Health’s approach to glove
selection: Fit, Feel and Function
Fit
Feel
Function
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Select a glove that is sized to fit your hand
Select hand specific gloves when possible
•
Select comfortable, flexible gloves which will not
contribute to hand fatigue
Select gloves with low irritancy potential
Consider gloves that have clinically proven
moisturizing and re-hydrating properties
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Select gloves with good tensile strength and elasticity
Clean vs. Laboratory vs. Sterile environment
Understand potential chemicals handled by operators
Consider synthetic gloves
Hand
Specific
Glove Size
Ambidextrous
Glove Size
5½
X-small
6-6½
Small
7-7½
Medium
8-8½
Large
9
X-large
Select the “RIGHT” glove for the “RIGHT” situation
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Cardinal Health’s Scientific & Production
Products has the broadest portfolio of gloves
CR10™ Nitrile PF Ambi
CR100® NitrilePF HS
-6 -6
• All sterile gloves are gamma irradiated to 10
sterility assurance level
CP100™ Nitrile PF Ambi
STERILE
CP100BT™ Latex PF Ambi
CP100BT™ Latex PF HS
Multi-Flex® CC100™ Latex PF HS
Multi-Flex® Latex PF HS
Laboratory Gloves
-6 -6
• All sterile gloves are gamma irradiated to 10
sterility assurance level
CR100® Vinyl PF Ambi
Protegrity ® CP Latex/ Nitrile PF HS
Multi- Flex® Latex PF HS
• Ideal for laboratory environments in a full range
of industries and institutions including
pharmaceutical, biotechnology, medical device,
general electronics, food and beverage,
chemical processing, and universities
CR100® Latex PF HS
CR100® Latex PF HS
• Specifically designed for use in pharmaceutical,
biotechnology, medical device, and
semiconductor/disc drive industries
• Low levels of particulate andextractables
CR100® BT Latex PF HS
Esteem® CP Polyisoprene PF HS
Cleanroom Gloves
Multi-Flex® Latex PF Ambi
Multi-Flex® Vinyl PF Ambi
Multi-Flex® Latex PWD HS
Multi- Flex® Latex PWD HS
Esteem® with Neu-Thera™ Nitrile PF Ambi
Nitrile PF Ambi
Esteem® Extra Protection Nitrile PF Ambi
Vinyl PWD Ambi
Esteem® T Stretchy Nitrile Bagged PF Ambi
Latex PF Ambi
Esteem® T Stretchy Nitrile PF Ambi
Flexam® Latex PWD Ambi
Esteem® Stretchy Nitrile PF Ambi
NON-STERILE
Multi-Flex® T Nitrile PWD Ambi
Esteem® Vinyl PF Ambi
Insta-Gard® Vinyl PFAmbi
Insta-Gard® Vinyl PWD Ambi
Positive Touch® with Neu-Thera™ Latex PFAmbi
Positive Touch® T Latex PFAmbi
Flexam® T Latex PF Ambi
Insta-Gard® Latex PF Ambi
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Cardinal Health is the world’s leading
technology innovator of gloves
Esteem® CP
Synthetic Polyisoprene:
Fit, Feel, Protection, and Comfort of latex without the
natural rubber proteins and allergens
Protegrity™ CP
Neu-Thera™
Latex/Nitrile Blend:
Triple layered with the Protection and Durability of nitrile
and the Comfort of natural rubber latex
Nitrile or Latex with Neu-Thera™:
First and only gloves clinically proven to Protect,
Restore, Smooth, and Moisturize your hands
Esteem® Stretchy
Nitrile
“Stretchy” Nitrile:
Special formulation designed with Durability
of nitrile and superior Comfort you will not
find in any other nitrile glove
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Cardinal Health is the benchmark of quality
in the glove manufacturing industry
•
ISO 13485 certified
•
FDA regulated facilities
•
Class 10 cleanroom maintained in accordance with FDA regulations
•
Quality systems regulations of FDA (21CFR part 820)
– cGMP (Current Good Manufacturing Practices)
– All systems validated and proceduralized
– International Standards EN46001
– Lot traceability to the raw material
•
Monthly environmental viable air & surface monitoring
•
Quarterly bioburden testing
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Sterility levels validated at 10-6 SAL
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Sterile assurance according to AAMI/ISO Standards
•
40 years glove manufacturing experience
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Cardinal Health’s gloves adhere to the
strictest levels of specification
Specification Example: Acceptable Quality Level for Glove Pinholes
GLOVE
FDA
SPECIFICATION
ASTM
SPECIFICATION
CARDINAL
SPECIFICATION
Latex Sterile
2.5
1.5
1.09
Synthetic Sterile
2.5
1.5
1.09
General Use Latex
4.0
2.5
1.5
PF General Use Latex
4.0
2.5
1.5
Vinyl General Use
4.0
2.5
1.5
Nitrile General Use
4.0
2.5
1.5
If you’re not using Cardinal Health’s gloves, we will be
happy to perform a quality evaluation for you
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Cardinal Health also manufactures a wide
variety of hand-care and hand-hygiene products
•
Amino+Derm® Moisturizers and Soaps
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•
•
Specifically engineered to aid in the prevention of skin
irritations and to help maintain healthy, intact skin
BioSoft™ Alcohol Gel Hand Antiseptic with
Moisturizers
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99.999% bacterial kill in 15 seconds
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Requires no rinsing, dries quickly
–
No sticky residue
Anti-microbial Hand Scrub Solutions and Brushes
–
Traditionally utilized in surgery but applicable to the Scientific
marketplace
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Next Steps:
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Thank You