Gloves

GLOVES are used in medicine to achieve asepsis or to protect the hands from contamination during various non-aseptic examinations and procedures. The impossibility of achieving sterility using any of the numerous methods of preparing hands for surgery (see Antiseptics and Asepsis) prompted the introduction of gloves. The latter were first proposed in 1897. Rubber gloves were proposed by Zoege von Manteuffel, and thread gloves by Mikulicz. There are indications that gloves were used as early as 1889 by Halsted. Thread gloves are currently little used, because when moistened they become easily permeable to bacteria; this inconvenience can be partly eliminated by frequent changing. Thread gloves are most suitable during manipulations not associated with their wetting (handing instruments, dressings, etc.), as well as for wearing them over rubber ones for greater preservation of the latter and for holding and extracting slippery viscera. But this lowers tactile sensitivity. Thread gloves are sterilized in an autoclave. Rubber gloves, in view of their impermeability, fully resolve the question of the surgeon's hand sterility. Gloves are made of rubber of various thicknesses, upon which their strength and the degree of reduction in the sense of touch depend. There are various sizes of gloves. It is very important to use sizes corresponding to the dimensions of the hand, because gloves of too large a size do not fit the fingertips sufficiently, as a result of which sensation is significantly reduced and finger work is hindered; conversely, tight gloves very quickly cause a feeling of numbness, especially if they are thick-walled. In America, gloves are made from a plaster cast taken of the operator's hand. Thick gloves are usually used for anatomical work, autopsies, and in purulent surgery. In operations where the sense of touch plays a very important role, gloves made of thin rubber (Fig. 1 and 2) (down to condom-weight) are used. The most convenient and durable in this respect are the French Chaput gloves. They are made of good, thick rubber, and their essential feature is that they do not restrict finger movements, do not tire them, and do not impair tactile sensitivity. This is achieved by the fact that the fingers of the Chaput gloves are extremely short and wide. If a Chaput glove is worn correctly, it reaches halfway up the forearm, and the rubber stretched at the tips of the fingers becomes as thin as a condom. Gloves are worn on hands washed and treated by one of the accepted methods. For easier donning of gloves, the hands are moistened with alcohol, sterile glycerin, or talc is poured into the glove, but then the hand must be completely dry. Before removing a glove, it is best to stretch it with water under the washbasin tap—this facilitates removal and thereby protects the glove from tearing. Before removing the gloves, they are thoroughly washed with soap and water so that drops of blood or other protein substances do not dry on them, which greatly spoils the rubber. Gloves can be sterilized in an autoclave or by boiling. The first type of sterilization is more reliable, but the gloves subsequently become stiff, quickly lose their elasticity, and tear. When sterilizing in an autoclave, it is necessary to thoroughly dust the inside of the gloves with talc, otherwise they may stick together. Boiling is performed in plain water for 15 minutes. Gloves are placed in the sterilizer wrapped in napkins so that the rubber does not touch the walls and bottom of the sterilizer. A special glove boiler (Fig. 3 and 4), designed for this purpose, was devised by the French paramedic Leclerc. When boiling, one must take care that air does not remain in the fingers, otherwise the fingers float and are not exposed to the temperature sufficiently. The advantages of rubber gloves are so obvious that it is difficult to object to their use. Their widespread adoption speaks to the practicality of gloves. Küttner wrote in 1911 that 53% of surgeons operate on all cases in gloves, 34% in septic cases, 7% in septic and some aseptic cases, and only 6% without gloves. The disadvantages of rubber gloves are generally considered to be 1) a decrease in touch, 2) their high cost, and 3) tearing of the gloves during surgery. The first drawback is largely eliminated by using thin gloves and especially Chaput gloves. The high cost of gloves is offset by good wound healing and consequently a reduction in other expenses—for dressing materials and patient care. Contamination of the wound during a tear of the glove due to the leakage of 'glove juice' is possible and represents the most serious drawback. Only with careful attention to gloves during the operation and their rapid replacement can the entry of bacteria into the wound be avoided. Gloves are especially useful in wartime conditions, as their use allows one to quickly obtain sterile hands, and also makes it possible to move from an infected wound to an aseptic one. In pathoanatomical practice, gloves have also become widespread. Gloves are especially recommended during autopsies of congenital syphilitics (i.e., in maternity hospital practice), since the respective corpses often abound in spirochetes. The shape of gloves for pathologists has recently been modified in the sense that they can be worn on either hand, i.e., both (front and back) halves of the gloves are glued strictly along the midline, including the thumb. Before putting on the gloves, hands should be dusted with talc.

F. Yanishhevsky. Gloves from a hygienic point of view. The basic hygienic requirements for gloves boil down to the following. Gloves must protect the hands in the cold season from excessive heat loss. In summer, gloves must be hygroscopic and breathable to easily absorb moisture from the skin and quickly release and expel the products of skin evaporation (sweat accumulated on the skin can always contain a certain amount of bacteria). Gloves must protect the skin from mechanical damage: scratches, abrasions, etc., and prevent the penetration of dirt and dust. With appropriate strength, gloves must be soft, elastic, and pliable so as not to destroy the capacity for maximum touch, and must fit the hand and fingers evenly and easily. The wrist joint must be covered by them. A narrow, tight glove promotes improper blood circulation and easier cooling in the cold season. Constriction of the hand by tight fasteners also leads to circulatory disturbances, stagnation, and edema. Fasteners and seams must not rub and irritate the skin. Gloves, being easily soiled by contact with various objects, must be easily cleanable, and summer gloves must be washable. In addition to gloves used in everyday life, gloves can have a special purpose as special clothing, i.e., aiming to protect against various influences of the industrial process: chemical reagents—acids, alkalis (chemical production), temperature influences—radiation (glass and metallurgical production), various mechanical irritations, friction (tram drivers, chauffeurs, earthworks), and a number of other special hazards requiring protection of the hands (electrical engineering, radiology, etc.). Depending on the various seasons, the material of the gloves varies. Usually, gloves for winter are made of wool, fur, or down as the most porous materials containing a larger amount of air, and therefore less thermally conductive and more heat-retaining (see table). Coefficient of heat conduction (in small cal.) (according to Rubner). Air..................

0.0000684

Rabbit skin (fur outward) ....

0.0000682

For autumn and spring, leather gloves with or without lining are more convenient, and finally for summer—cotton, linen, silk. For special clothing, gloves are mostly made of leather, asbestos-impregnated canvas, rubber, etc. The shape of gloves varies: gloves having a compartment for each finger, and mitten-gloves having one common compartment for all four fingers and a separate one for the thumb. In terms of heat retention, the latter shape has the advantage, because air as a poor heat conductor surrounds the fingers in a larger layer and more evenly here, but in terms of free finger function and preservation of touch, such a shape is inconvenient.