key: cord-1049008-vkcfw37z authors: Garrido-Molina, José Miguel; Márquez-Hernández, Verónica V.; Alcayde-García, Alfredo; Ferreras-Morales, Carlos Alberto; García-Viola, Alba; Aguilera-Manrique, Gabriel; Gutiérrez-Puertas, Lorena title: Disinfection of gloved hands during the Coronavirus outbreak (COVID-2019) date: 2020-09-17 journal: J Hosp Infect DOI: 10.1016/j.jhin.2020.09.015 sha: efae1acabc5bb4c8c0860955e6f6cc5d2cd22bbf doc_id: 1049008 cord_uid: vkcfw37z BACKGROUND: In the current pandemic situation, glove disinfection is a process that can be used to care for the same patient or when removing personal protective equipment. For this reason, it is necessary to check compatibility data of the glove with the disinfectant product in glove disinfection. AIM: To test the resistance of nitrile gloves to different disinfectant solutions. METHODS: To analyze the resistance of nitrile gloves, firstly, the gloves were exposed to the disinfectant. The exposure to the disinfectant was analyzed comparing the control group (untreated glove) with the others. For the tensile test, the thickness of each test specimen was measured with a micrometer .100% powder-free nitrile gloves, composed of nitrile Butadiene rubber (NBR) compounds, were used. The 7 most commonly used disinfectant solutions in the healthcare field were selected. FINDINGS: A bleach solution did decrease breaking load, although to a lesser extent than disinfectants that contain ethanol in their composition. CONCLUSION: With the methods used, we have determined the influence that various disinfectants have on nitrile gloves, finding that those which contain alcohol cause a decrease in breaking load. The outbreak of the coronavirus 2019 disease in the area of Wuhan, China, has rapidly become a worldwide health crisis [1] . According to the latest data from the World Health Organization (WHO) (7th September 2020) [2] , there are 26.961.795 confirmed cases of the disease globally, with 880.955 confirmed fatalities. The infection caused by COVID-19 is mainly spread through respiratory droplets and contact [1] . Therefore, the disinfection of objects and hand-washing are essential to stop the spread of this disease [3] . Additionally, studies have shown the presence of the SARS-CoV-2 virus in saliva as well as the feces of infected patients [4, 5] . In this situation of pandemic, the greatest risk of COVID-19 is the transmission of the disease to healthcare professionals who are in direct contact with infected patients [6] . They may have to perform multiple tasks on an infected patient, therefore, they must be aware of the appropriate use of personal protective equipment (PPE), as well as proper use and removal of gloves [1, 7] . Regarding the proper use of gloves, it is important to remove them after a single use and avoid inappropriate use [8] . However, there are several clinical situations in which healthcare professionals use gloves in a routine way to carry out various procedures on the same patient [9] . In order for healthcare professionals 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 [10] . Despite this fact, this may not be realistic, and to a lesser extent in times of material shortage and crisis, such as the current pandemic situation. According to this Commission, faced with the additional workload generated by COVID-19, gloves can be used for multiple procedures performed on the same patient if they are properly disinfected. Likewise, glove disinfection is not only useful for reuse for the same patient, but it should also be considered a part of the process of removing PPE. Particularly, the Centers for Disease Control and Prevention (CDC) and the European Center 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 [12, 13] . For this reason, professionals must be trained in the proper use of PPE according to hospital guidelines, including techniques to safely remove equipment that protects mucous membranes [7]. One important aspect to consider is that, prior to glove disinfection, it is necessary to check the compatibility of the glove with the disinfecting product before using it [9] . Two studies have analyzed the integrity of glove material after repeated applications of disinfectant products [14, 15] . Specifically, these studies have found that tensile strength decreased with each alcohol-based hand rub, and combinations produce relevant differences in regards to disinfection efficacy. For this reason, additional studies are required to clarify if the differences found between the various disinfection products used are sufficiently proven to exclude these disinfectant solutions from glove decontamination activities in clinical settings [15] . Based on the above, the objective of this study was to test the resistance of nitrile gloves with different disinfectant solutions. To perform this experiment, 100% powder-free nitrile gloves, composed of nitrile Butadiene rubber (NBR) compounds were used. The most commonly used disinfectant solutions in the J o u r n a l P r e -p r o o f healthcare field were selected: 1) Hand antiseptic (85 g ethanol / 100g) solution, 2) Disinfectant for medical equipment surfaces (40.5 g etanol + 9.20 g n-propanol / 100 g) solution, 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) Ethanol 96% and 8) Alcohol at 70 %. To perform the tests, the gloves were selected from a pack of 100 Sensiflex® Lite brand 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 carried out to determine tensile properties, type 5 specimen ( Figure 1 ) using a die. From each glove, 4 specimens were obtained. They were cut in the palm and in 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 that each group contained 5 samples and no group had more than one sample from the same glove. In this way, a homogeneous and representative sampling was achieved. Table 1 shows the thickness measurements of each of the test specimens grouped by group. Once the groups were defined, the disinfectant was applied homogeneously to one of the faces of the specimens (in order to simulate the glove disinfection process followed by health personnel). The visual effect it caused on them was noted. They were allowed to dry for at least 2 minutes before performing the stress-strain test. The exposure to the disinfectant was analyzed comparing the control group (untreated glove) with the others. (Figure 3 ), following the UNE-EN ISO 527-3 standards. In order to do so, the For the tensile test, the thickness of each test specimen was measured with a micrometer with a sensitivity of ± 1 micro. The distance between grips was adjusted to 65 mm, the test specimen was correctly loaded and the separation speed between grips was set at 500mm/min. Lastly, the load and elongation were monitored until break. The results of the test were based on the parameters specified in the ISO 527 standards, where several additional parameters of interest were recorded in addition to elongation and strain. Figure 4 shows a graphical representation of the breaking load % and for the 45 test specimens, by group. Simultaneously, figure 5 shows the effects of different solutions on load strength and elongation to break in regards to the untreated specimens in %. Elongation at break was not affected, although the force at break decreased with the application of all disinfectants containing alcohol in their composition, as shown in the graphs. In addition, the different compounds are shown in order, with the most unfavorable compound being alcohol at 70% The gloves disinfected with 70% alcohol broke with an effort of 60.62% of the effort needed by the untreated sample, being the most aggressive disinfectant for the glove (figure 5). All alcohol-based disinfectants needed less effort to break, losing at least 25% of the tensile J o u r n a l P r e -p r o o f strength and reaching almost 40% in the case of the 70% alcohol solution, hydrogen peroxide 3% being the solution that maintained the glove's tensile strength properties. The objective of this study was to test the resistance of nitrile gloves with different disinfectant solutions. Although the WHO does not recommend reusing 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 reuse of gloves with the same patient. In this situation, the disinfection procedure makes it safer, ensuring that the glove is visibly clean and without perforations [9, 16, 17] . The disinfection of gloved hands by healthcare professionals can considerably reduce the risk of contagion, when the gloves are designated for the entire patient care process and multiple tasks are carried out on the same patient [9,18]. Specifically, it has been shown that the efficiency of disinfection is greater for different combinations of disinfectants/gloves than for bare hands [15] . For this reason, choosing an appropriate disinfectant solution for the type of glove used is a fundamental aspect during the disinfection process. Furthermore, differences in the effectiveness of disinfectant solutions seem to depend on the material that the gloves are composed of [15] . In this study, it has been observed that the disinfectant solutions that contain alcohol do not interfere in the elongation at break, but they do interfere in the force at break of 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 it. 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, hands with alcohol-based disinfectants leads to higher rates of perforation, [15, 19, 20] finding an affirmative answer. The disinfectants mentioned 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 [20, 21] . The applications of ethanol 70º and alcohol chlorhexidine include the preparation and cleansing of intact skin prior to invasive surgical procedures, as well as performing antiseptic and surgical hand-washing [22] [23] [24] [25] [26] [27] . Previous studies, such as that of Kocent, Corke, Alajeel, and Graves [28] Considering the findings, both the use of bleach and disinfectants containing alcohol affected the breaking load of the glove, though bleach had less impact. All alcohol-based disinfectants needed less effort to break. However, these disinfectants are widely recognized for their high disinfection capabilities [29] . Previous studies have reported the importance of exploring disinfection of gloves with alcohol solutions, as these types of solutions are widely used [15] . The results of this article must not be considered without limitations. Firstly, the experiments were only performed on nitrile gloves, thus, it would be necessary to carry out additional testing with other materials. Furthermore, studies that have analyzed disinfectant use with nitrile gloves are scarce, which makes an adequate discussion difficult to achieve. However, this also highlights the novel nature of the topic. Finally, due to the current healthcare crisis, a limited number of tests have been performed, therefore, the research should be expanded to include additional testing. Additionally, it would be useful if glove manufacturers provided data about compatibility of their gloves with different types of hand-rubbing as well as disinfectant solutions. Through the methods used in this study, the influence of different disinfectants on nitrile gloves was determined, and it was found that those that contain alcohol produced a decrease in the breaking load. Therefore, products that have ethyl components can weaken nitrile gloves, increasing the risk of breaking, which could increase the self-contamination of healthcare professionals during clinical practice. It is necessary to perform more research that analyses how disinfectants affect the breaking load or elongation of nitrile gloves with the aim of minimizing the risk of spreading COVID-19 among healthcare professionals. 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