Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1991.

Thesis (PhD)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Healthcare workers (HCWs) wear latex gloves to protect themselves and their patients against the transmission of microbial, viral and bloodborne diseases. These individuals are primarily exposed to latex via cutaneous (direct contact) and mucocutaneous (inhalation of airborne allergens on glove powder) routes. Repeated exposure leads to the formation of circulating latex-specific IgE and subsequent sensitisation with varying clinical expression. The airconditioning system of the Tygerberg Hospital (TBH) complex was investigated for the presence of aerosolised cornstarch glove powder and proteins. Dust samples were collected from 14 areas with different levels of latex glove usage. Dust samples were spectrophotometrically compared to a calibration graph of pure glove powder. The detection of starch and proteins in all the dust samples confirmed the presence of glove powder and possibly airborne latex allergens in the airconditioning ducts. As expected, the high exposure areas showed the highest concentrations of both starch and proteins. It is possible that other proteins than latex were involved, but the confirmed high level of protein contamination should be a cause for concern. Correlation between starch and protein levels was highly significant (p<0.01) in all instances. A total of 500 questionnaires were circulated for completion by HCWs from TBH. The response rate was 69.8%. After considering specific inclusion criteria, a study group of 152 individuals was compiled (28 males, 124 females). All subjects had current latex exposure and suffered from at least three pre-defined symptoms. Serum was collected from all subjects and dermal fluid from 31 subjects. Total IgE and latex specific IgE analysis were done on all serum and dermal fluid samples. Latex-specific IgE was positive (>0.35 IU/ℓ) in 23 serum and six dermal fluid samples. Skin prick tests (SPTs)for latex were done on 59 subjects with negative serum latex-specific IgE and 34 had positive results. Twelve subjects with negative latex-specific IgE and latex SPTs underwent patch tests with the European Standard Series, a piece of latex glove and glove powder in petrolatum. Three subjects had positive results to one or more of these allergens. Western blot analysis for latex was done on all positive sera and dermal fluid collected from these subjects. Western blot analysis for latex proved to be more sensitive than the capRAST, because it was able to identify specific bands in samples with negative capRAST results. All subjects showed a band for Hev b 1, which has been confirmed as a powder-bound airborne allergen. Hev b 6.01 is associated with HCWs with cutaneous symptoms and this band was recognised by 81% of the subjects. These findings confirmed that airborne and cutaneous routes are the major routes of exposure in HCWs. According to their laboratory results, subjects were divided into the following subgroups and compared statistically: Group A (serum positive, n=23), Group B (SPT positive, n=34) and Group C (negative, n=25). Group D (withdrawn, n=70) could not be used for statistical comparisons, due to incomplete results. An overall latex allergy prevalence of 38% was found. Group A differed significantly from Group B and Group C for most clinical and special investigations. Group A and B were also combined to represent all subjects with positive results (Cohort AB). The Allergy Score and Class were highly significant when Cohort AB was compared to Group C. The selection of clinical symptoms was confirmed to be relevant and work-related deterioration on any of the symptoms should bear a high index of suspicion in the evaluation of latex allergy. Numerical indices and specific symptoms showed high positive predictive values and the Allergy Score produced statistical significance in the positive subgroups when compared to the negative subgroup. Paired statistical significance was confirmed between the Allergy Score and occupational exposure (number of years, hours and pairs per week). The areas with the highest occupational latex exposure in HCWs are the face and hands. Different occupations also have different levels of exposure and two subgroups of HCWs (16 laboratory technologists and 13 theatre staff) were investigated for sebum content on different facial areas and the palms and dorsal areas of both hands. Baseline measurements were done before putting on gloves. In 21 subjects follow up measurements were done following three to four hours of occupational exposure, but before washing their hands. Baseline and follow up values were compared for all the different anatomical regions. Levels on the forehead and cheeks increased over time, while the level on the nose decreased. All hand regions decreased significantly during occupational exposure, suggesting that glove powder contributes to dryness of the skin. In conclusion, the problem posed by latex allergy will not be solved overnight and will probably remain a major occupational hazard for years to come. It is currently not possible to avoid exposure to latex, but it is imperative to institute safety measures to prevent further sensitisation in predisposed individuals and manage those already affected. / AFRIKAANSE OPSOMMING: Gesondheidswerkers dra lateks handskoene om hulleself en hulle pasiënte te beskerm teen die oordrag van mikrobiale, virale en bloed-gedraagde siektes. Die lateks blootstelling vind hier hoofsaaklik plaas via kutane (direkte velkontak) en mukokutane (inaseming van lug-gedraagde allergene op hanskoen poeier) roetes. Herhaalde blootstelling veroorsaak sirkulerende lateksspesifieke IgE en sensitisasie met variërende kliniese beelde. Die lugreëlingstelsel van die Tygerberg hospitaalkompleks is ondersoek vir die teenwoordigheid van handskoenpoeier (stysel) en lateks proteïene. Stofmonsters is versamel in 14 areas wat verskillende blootstellingsvlakke verteenwoordig het. Die stofmonsters is spektrofotometries vergelyk met "n kalibrasiekurwe van suiwer hanskoenpoeier. Stysel en proteïene kon in al die stofmonsters aangetoon word en het die teenwoordigheid van handskoenpoeier en moontlike luggedraagde lateks proteïene in die lugreëlingstelsel bevestig. Soos verwag kon word, het die hoogste stysel en proteïen waardes in hoë blootstellingsareas voorgekom. Hoogs beduidende statistiese korrelasies (p<0.01) tussen die stysel en proteïenvlakke kon aangedui word in alle monsters. "n Totaal van 500 vraelyste is gesirkuleer vir voltooiing deur TBH gesondheidswerkers, waarvan 69.8% voltooide vraelyste terugontvang is. Na evaluering van insluitingskriteria, is "n studiegroep van 152 individue saamgestel (28 mans, 124 vrouens). Almal het huidige lateks blootstelling en ten minste drie het vooraf gedefinieerde simptome gerapporteer. Serum is van die hele groep versamel en dermale vog van 31 proefpersone. Totale IgE en lateks-spesifieke IgE vlakke is op alle serum en dermale vog bepaal. Positiewe resultate (>0.35 IU/ℓ) is verkry in 23 serum en ses dermaIe vog monsters. Velpriktoets vir lateks is op 59 proefpersone uitgevoer en 34 daarvan het positiewe resultate opgelewer. Twaalf proefpersone met negatiewe lateks-spesifieke IgE en velpriktoets resultate het kutane plaktoetse ondergaan met die Europese Standaard Reeks, "n stukkie lateks handskoen en handskoenpoeier in petrolatum. Drie proefpersone het positiewe resultate teen een of meer van die allergene gehad. Westerse kladanalise vir lateks is op alle positiewe serum gedoen, asook die dermale vogte van hierdie proefpersone. Westerse kladanalise vir lateks blyk baie meer sensitief te wees as die capRAST, aangesien dit spesifieke bande kon identifiseer in monsters capRAST resultate. Alle monsters het "n band getoon vir Hev b 1, "n poeier-gebinde, luggedraade allergeen. Hev b 6.01 is geassosieer met gesondheidswerkers met velsimptome en hierdie band is gevind in 81% van die monsters. Hierdie resultate bevestig dat die belangrikste blootstelling aan lateks in gesondheidswerkers deur die vel en inaseming plaasvind. Proefpersone is in die volgende drie groepe verdeel volgens laboratorium resultate en statisties vergelyk: Groep A (positiewe serum, n=23), Groep B (positiewe velpriktoetse, n=34) en Groep C (negatief, n=25). Groep D (onttrek, n=70) kon nie vir betekenisvolle statistiese vergelykings aangewend word nie, as gevolg van onvolledige resultate. 'n Finale lateks allergie prevalensie van 38% is gevind. Groep A het hoogs beduidend verskil van Groep B en C vir die meeste van die kliniese en spesiale laboratoriumondersoeke. Groep A en B is gekombineer om alle proefpersone in te sluit met positiewe resultate (Kohort AB). Die Allergie Telling en Klas van Kohort AB was hoogs beduidend in vergelyking met Groep C. Die gekose simptome is bevestig as relevant en enige werksverwante verergering van simptome moet met 'n hoë mate van agterdog bejeën word in lateks allergie. Numeriese indekse en spesifieke simptome het hoë positiewe voorspellingswaardes gelewer en die Allergie Telling was hoogs beduidend in die positiewe subgroep in vergelyking met die negatiewe subgroep. Gepaarde statistiese beduidenheid is ook gevind tussen die Allergie Telling en beroepsblootstelling (jare van blootstelling, uur en paar handskoene per week). Die meeste beroepsblootstelling aan lateks in gesondheidswerkers vind plaas op die hande en gesig. Verskillende beroepe het ook verskillende blootstellingsvlakke en two subgroepe gesondheidswerkers (16 laboratorium tegnoloë en 13 teater personeel) is ondersoek vir die sebumgehalte op veskillende areas van die gesig en hande. Basislynvlakke is gemeet voordat handskoene aangetrek is en in 21 gevalle is opvolgvlakke gemeet na drie tot vier uur beroepsblootstelling, maar voor die hande gewas is. Basislyn en opvolgvlakke is met mekaar vergelyk vir al die anatomiese areas. Die voorkop en wange het 'n toename in sebumgehalte getoon, terwyl dié van die neus afgeneem het. AI die areas op die hande toon 'n hoogs beduidende afname tydens beroepsblootstelling, wat impliseer dat hanskoenpoeier moontlik bydra tot droogheid van die vel. In samevatting, die lateks allergie probleem sal nie oornag opgelos word nie en sal waarskynlik 'n belangrike beroepsrisiko bly vir die aansienlike toekoms. Totale vermyding van lateks is tans onmoontlik en daarom is dit van uiterste belang om voorsorgmaatreëls in plek te stel om verdere sensitisasie in blootgestelde individue te verhoed en die wat reeds geaffekteer is, effektief te hanteer.

Bakgrund: I litteraturen finns evidens att använda dubbla lager av operationshandskar vid all kirurgi för att förebygga smittspridning mellan patient och personal samt för att förebygga vårdrelaterade infektioner. Operationshandskar kan ha olika tjocklek och taktil känsla beroende på latex eller latexfritt material. Trots att evidens finns att använda dubbla lager operationshandskar förekommer variation i användandet. Syfte: Syftet med studien var att undersöka om operationssjuksköterskor och kirurger väljer enkla eller dubbla handskar vid operationer, samt hur de motiverar sitt val. Metod: Operationssjuksköterskor och kirurger från två operationsavdelningar i Mellansverige undersöktes i en tvärsnittsdesign med intervjustödda enkäter. Flera deltagare intervjuades flera gånger. Resultat: Totalt inkluderades 66 deltagare i studien och 137 intervjuer genomfördes. Nästan hälften av deltagarna motiverade sitt val av handskar med rutin eller vana. Vid samtliga ortopediska operationer användes dubbla handskar. Enkelt lager av handskar användes i högre grad då endast latexfria handskar fanns att tillgå, och den dominerande motiveringen var då att det var mer svårarbetat med dubbla handskar. Slutsats och klinisk betydelse: Användandet av enkla respektive dubbla handskar skiljer sig mellan verksamheterna och mellan yrkeskategorierna. Dubbla handskar användes av samtliga deltagare på den avdelning där skriftliga riktlinjer angående dubbla handskar fanns formulerade. Enkla handskar användes i högre grad då endast latexfria handskar fanns att tillgå. Resultatet i föreliggande studie indikerar att riktlinjer angående dubbla handskar, samt latexfria handskars sämre taktila förmåga kan ha betydelse för hur operationspersonal väljer operationshandskar. / Background: In the literature, there is evidence of the usage of double layered surgical gloves during all surgical procedures in order to prevent the spread of infection between the patient and medical personnel, as well as, to prevent clinical infections. Double layered surgical gloves can have different thickness and tactile feeling depending on latex or latex-free material. Aim: To investigate if operating room nurses and surgeons choose single or double gloving for operations, as well as, how they motivate their choices. Method: Operating room nurses and surgeons from two different operation departments in the middle of Sweden were examined in a cross-sectional design with interview-supported questionnaires. Some participants were interviewed several times. Results: In total, 66 participants were included in the study and 137 interviews were conducted. Almost half of the participants motivated their choice of gloves routinely or habitually. In all orthopedic operations, double gloves were used. Conclusion and clinical implications: The usage of single as opposed to double-gloving differs between departments and between different categories of profession. The majority of participants chose to use double gloves. Double gloves were more frequently used on the ward where written guidelines regarding double gloves were formulated. Single gloves were more commonly used in the pediatric surgery department, where only latex-free gloves were available for use. The result in the present study indicates that guidelines regarding double gloves can be significant for how operation personnel choose surgical gloves.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-03-16T17:11:05Z No. of bitstreams: 1 Joviria Marcia Ferreira de Oliveira Padilha.pdf: 1968331 bytes, checksum: b469b4bab4f213247f9b3817b0d25da6 (MD5) / Made available in DSpace on 2017-03-16T17:11:05Z (GMT). No. of bitstreams: 1 Joviria Marcia Ferreira de Oliveira Padilha.pdf: 1968331 bytes, checksum: b469b4bab4f213247f9b3817b0d25da6 (MD5) Previous issue date: 2014 / Mestrado Profissional em Enfermagem Assistencial / A infecção relacionada à assistência à saúde (IRAS) é considerada um problema de saúde pública em esfera mundial. Assim, torna-se preponderante a intervenção nos cuidados e prevenção destes agravos. Diante desta prerrogativa, o estudo tem como objeto: a precaução de contato a partir de uma tecnologia educacional (TE), visando o uso de luvas pelos profissionais de enfermagem. Objetivo geral: propor uma TE em forma de mídia audiovisual visando à adequação e/ou adesão dos profissionais de enfermagem às medidas de precaução de contato, foco em luvas. Objetivos específicos: identificar os fatores que interferem na adesão e/ou adequação às medidas de precaução de contato na utilização das luvas de procedimentos e estéreis pela equipe de enfermagem; elaborar uma TE visando adesão e adequação dos profissionais de enfermagem às medidas de precaução de contato, foco em luvas, a partir das falas dos profissionais; validar uma TE em forma de mídia audiovisual, visando adequação e adesão às medidas de precaução de contato com foco nas luvas. Metodologia: pesquisa de abordagem quantiqualitativa do tipo metodológica. O cenário da pesquisa foi o Hospital Universitário Antônio Pedro da Universidade Federal Fluminense. Os participantes foram 66 profissionais distribuídos em quatro etapas do estudo. Para elaboração e validação da TE, a coleta de dados ocorreu nas quatro etapas. A 1ª etapa: realizaram-se entrevistas e a análise temática segundo Bardin. Critérios de inclusão: profissionais de enfermagem da clínica cirúrgica, diaristas ou plantonistas, estatutários ou contratados, em exercício. Critérios de exclusão: profissionais em férias e/ou licenças médicas; 2ª etapa: elaboração da TE a partir das categorias que emergiram da primeira etapa; 3ª etapa: validação de TE. Nesta etapa foram utilizados instrumentos de validação, escala Likert, respondidos por juízes especialistas e público alvo. Os itens do instrumento analisados receberam diferentes valorações em cada bloco, sendo considerados válidos os itens que obtiveram concordância maior ou igual a 70% pelos avaliadores desta etapa; 4ª etapa: adequação da TE a partir da avaliação dos profissionais. Resultados: a partir da fala dos profissionais emergiram três categorias, a saber: Conhecimento geral acerca do uso de luvas; A utilização das luvas na prática de enfermagem e suas implicações; Avaliação do material das luvas. A partir destas categorias, foi elaborada uma TE em forma de mídia audiovisual, cuja validação dos resultados atingiu índice de concordância superior a 80%. Conclui-se que a elaboração e aplicação de TE voltadas para o ensino e aprendizagem do profissional são primordiais para a segurança do paciente, do profissional e do ambiente, minimizando os riscos de infecções cruzadas / The Infection related to health care (IRAS) is considered a public health problem in the whole world. Thus, a major intervention in the care and prevention of these diseases is of utmost importance. In the view of this prerogative, the current object of this study is: the contact precautions as an educational technology (ET), to the use of gloves by nursing professionals. Overall objective: to propose an ET in audiovisual media format in order to improve adhesion/adjustments of nursing professionals to contact precautions, focusing in the use of gloves. Specific objectives: to identify the factors that influence in adherence and/or adequacy for contact precautions with the use of procedure and sterile gloves by nursing staff; to develop an ET aiming at adherence and adequacy of nursing professionals to contact precautions, focusing in the use of gloves, from the speeches of professionals; to validate an ET in audiovisual media format, aiming to adequacy and adherence to contact precautions focused in the use of gloves. Methodology: Research with quantiqualitative approach of methodological type. The research scenario was the Antônio Pedro University Hospital, Fluminense Federal University. Participants were 66 professionals divided into four stages of the study. For development and validation of ET, data collection occurred in all the four stages. 1st stage: interviews and Bardin’s thematic analysis were conducted. Inclusion criteria: nurses of surgical clinic department, resident or day labor, statutory- or private-contracted, and currently active. Exclusion criteria: professionals on vacation and / or in sick leave; 2nd stage: preparation of the ET based the categories that emerged from the first stage; 3rd stage: ET validation. At this stage the Likert scale and validation instruments were used, answered by expert judges and target audience. The instrument items analyzed received different valuations in each block, being considered as valid the items with agreement levels greater than or equal to 70% by the evaluators of this stage; 4th stage: adequacy of ET by the evaluation of professionals. Results: from the speech of professionals emerged three categories, namely: General knowledge about the use of gloves; the use of gloves in nursing practice and its implications; analysis of the glove material. From these categories, an ET was prepared in audiovisual media format, and the validation of its results reached an agreement index higher than 80%. It is concluded that the development and application of an ET facing professional education and learning are essential for the safety of patients, professionals and the environment, minimizing the risk of cross-infection