Gerbaudo L, Violante S, Curcio A, Violante B
Azienda Sanitaria Ospedaliera Santa Croce e Carle di Cuneo, S.S. Medico Competente, Cuneo, Italy.
G Ital Med Lav Ergon. 2007 Oct-Dec;29(4):883-9.
Within a stepwise approach to remove natural rubber latex products from the hospital of Cuneo, latex gloves for examination were completely replaced by nitrile powder free gloves. About a month after their introduction in the whole facility, 31 health care workers (HCW) presented with symptoms of dermatitis characterized by erythema, itching, dryness and chapping on the dorsum of the hands. The symptoms typically appeared 1-3 days after the first nitrile gloves employment, 1-3 hours after they were put on. On the basis of both a detailed clinical examination and specific laboratory tests a diagnosis of irritant contact dermatitis was confirmed in all symptomatic HCW. Samples of nitrile gloves were submitted for analysis by a university toxicological laboratory. Evident traces of a powder containing calcium carbonate were found inside of the gloves. Therefore the declaration of the firm that the product was absolutely powder free must be considered wrong. We suppose that frequent and prolonged contacts between the alcaline pH of the powder found in the gloves and the acid pH of the skin of the hands - together with other individual and environmental factors - could have determined the onset of the symptoms in the HCW. In spite of this adverse reaction, a significant reduction (-68%) of the incidence of latex sensitization and latex-related symptoms was observed in 2006 compared to 2005. We conclude that the complete removal of latex gloves from the workplace is a favourable preventive measure and that switching to nitrile powder free devices is a safe and cost-effective alternative to the latex gloves. However, it is always advisable to demand to the producer a formal declaration of compliance to the security standards of the medical devices.
在库内奥医院逐步淘汰天然橡胶乳胶产品的过程中，用于检查的乳胶手套已完全被无粉丁腈手套取代。在整个医院引入无粉丁腈手套约一个月后，31名医护人员出现了手部背部皮肤炎症状，表现为红斑、瘙痒、干燥和皲裂。这些症状通常在首次使用丁腈手套后的1至3天出现，戴上手套后的1至3小时内出现。基于详细的临床检查和特定的实验室检测，所有有症状的医护人员均被确诊为刺激性接触性皮炎。丁腈手套样本被提交给大学毒理学实验室进行分析。在手套内部发现了明显的含碳酸钙粉末痕迹。因此，该公司宣称产品绝对无粉的说法肯定是错误的。我们推测，手套中发现的粉末的碱性pH值与手部皮肤的酸性pH值之间频繁且长时间的接触，再加上其他个人和环境因素，可能导致了医护人员出现这些症状。尽管出现了这种不良反应，但与2005年相比，2006年乳胶致敏和乳胶相关症状的发生率显著降低（-68%）。我们得出结论，从工作场所完全移除乳胶手套是一项有利的预防措施，改用无粉丁腈手套是乳胶手套的一种安全且经济高效的替代方案。然而，始终建议向生产商索要符合医疗器械安全标准的正式声明。
