Influenza pandemics can be expected to occur, on average, three to four times each century when new virus subtypes emerge and are readily transmitted from person to person.

• In the 20th century, the great influenza pandemic of 1918-1919, called the Spanish Flu, caused an estimated 40 to 50 million deaths worldwide.1 The Spanish Flu is known as one of the most deadly pandemics in human history.2
• The Asian Flu pandemic occurred in 1957-58 and killed 70,000 people in the U.S., and nearly one million worldwide.
• The pandemic of 1968-69, named the Hong Kong Flu, resulted in approximately 34,000 deaths; this pandemic is known as the mildest flu pandemic in the 20th century.

Today, annual influenza epidemics cause 36,000 deaths and approximately 226,000 hospitalizations in the United States.3 Experts agree that another influenza pandemic is inevitable and possibly imminent.4

Influenza outbreaks occur annually due to minor changes in surface proteins of the viruses. These changes allow the newly developed virus to evade the immunity humans have developed after previous infections, or in response to vaccinations. When a major change occurs spontaneously in either one or both of the viruses’ surface proteins, a completely new virus is developed, rendering everyone susceptible. If this new virus has a capacity for transmission from one person to another, a pandemic will occur.5

Origins of a potential pandemic

During the last few years, the world has faced several threats with pandemic potential, making the occurrence of the next pandemic a matter of time.6 During 2004, large parts of Asia experienced unprecedented outbreaks of highly pathogenic Avian influenza caused by the H5N1 virus in poultry. At the same time, health officials were swift to restore confidence with the public that the H5N1 virus, deadly to birds, was incapable of infecting humans on an extensive scale, and that few, if any, cases of human-to-human transmission of the virus had occurred. Multiple countries were conscious of the negative economic impact this could have on the poultry industry, so they quickly reassured the public that eating poultry was safe.

Avian influenza A (H5N1) infections occurred in both poultry and humans, and marked the first time an Avian influenza virus had ever been found to transmit directly from birds to humans. During this outbreak, 18 people were hospitalized and six died. To control the outbreak, authorities killed about 1.5 million chickens to remove the source of the virus. H5N1 has pandemic potential because it may eventually alter into a form that is contagious in humans.

Infection control measures for influenza A

According to the Centers for Disease Control and Prevention (CDC), influenza A is transmitted via droplets, meaning person-to-person, direct contact, or via aerosol (sneezing, coughing, talking, etc.). Due to the high mortality rate that could be linked to a pandemic situation, the World Health Organization (WHO) recommends that airborne precautions be adhered to when caring for any suspected case of influenza A.7

In addition, informed use of personal protective equipment (PPE) is a critical component of any infection control program. Wearing protective garments is essential for all healthcare workers caring for any patient with influenza A. Transmission of the influenza A virus may occur through direct contact or indirect contact with respiratory secretions, such as when touching surfaces contaminated with influenza virus and then touching the eyes, nose, or mouth. Adults can spread influenza to others from the day before getting symptoms to approximately five days after symptoms start.

Medical & examination glove use for healthcare personnel

Wear gloves if hand contact with respiratory secretions, blood, bodily fluids, excretions, or potentially contaminated surfaces is anticipated. Put on clean gloves just before touching mucous membranes and/or non-intact skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Properly remove PPE when leaving the patient’s room in order to prevent the spread of microorganisms. When removing gloves, avoid touching the contaminated side of the glove with unprotected hands. When removed properly, both gloves should remain inside out and then be dropped directly in an appropriate container. Gloves should never be flicked, snapped, or tossed upon removal. And, of course, avoid touching your face, mouth, and nose to prevent the spread of illness.

Protecting glove integrity

Gloves should be changed if they come into contact with chemicals or materials that might harm them, such as acids, alkalis, disinfectants, or sterilants. Gloves should never be washed or disinfected with intent to reuse. Petroleum-based products, such as hand lotions, cause latex gloves to degrade. Therefore, if using latex gloves, use water-based products, or check with the manufacturer’s guidelines for compatibility to be sure.

Keep gloves in their original packaging until needed, and always follow manufacturers’ suggested storage temperatures and guidelines to ensure optimal life of the latex glove. Typically, gloves should be stored in a cool, dry location at 50 - 72˚F (10 - 20˚C).

Medical glove selection

The two primary considerations should be barrier protection and allergen content. To maximize barrier effectiveness, it is good practice to choose a glove manufacturer that is reliable and experienced, to ensure the gloves will be of consistent quality and regularly available.

Latex

Latex remains the gold standard for hand barrier protection due to its strength, proven barrier protection, elasticity, fit, feel, comfort, and relatively low cost. With the availability of low-protein, powder-free gloves, many clinicians are confidently continuing to wear gloves made of latex. Latex gloves are recommended as the first choice for barrier protection in the healthcare environment, except for wearers who are allergic to latex proteins. Latex is available in both surgical and examination gloves.

Latex-free gloves

For healthcare workers allergic to latex, the preferred recommendation would be a latex-free material of nitrile or neoprene (polychloroprene). In independent testing for barrier properties, studies showed that nitrile, neoprene, and latex gloves are comparable in barrier properties during in-use performance testing.8

Nitrile

Nitrile is a petroleum-based, cross-linked film. It is extremely strong with puncture resistance superior to all glove films. Nitrile’s elasticity is good and the gloves tend to conform to the shape of the wearer’s hands over time. There are no latex proteins in nitrile; therefore, there is no chance of latex allergy with use. Nitrile is available in examination gloves.

Neoprene

Neoprene is a petroleum-based, cross-linked film and provides barrier protection similar to latex. Neoprene contains no latex proteins, and is available without chemical accelerators, making it a great choice for those with allergies. It is a strong material, with good resistance to many chemicals, and provides great comfort.

Neoprene’s elasticity is close to that of latex and it possesses a very high memory, enabling the film to retain its original shape, and is somewhat puncture resistant. Neoprene is available in both surgical and examination gloves.

Polyisoprene

Polyisoprene is a petroleum-based, cross-linked film that provides high strength, elasticity, and comfort. It contains no latex proteins, but contains some curing agents that can cause allergic reactions. Polyisoprene is durable and somewhat puncture resistant, providing good barrier protection, but is more permeable than latex and is recommended as a preferred alternative to latex if nitrile is not available. Polyisoprene is available in surgical gloves.

Polyvinyl chloride (PVC)

Many hospitals provide a latex-free material called polyvinyl chloride, commonly referred to as “vinyl,” as a choice for examination gloves. PVC is a petroleum-based film without latex proteins, but it is not molecularly cross-linked. Because it lacks cross-linking, the individual molecules of vinyl tend to separate when the film is stretched or flexed. This causes small holes and breaches to form during glove donning and normal use. Studies have shown that 63 percent of vinyl examination gloves permitted leakage of a test virus after normal use, compared with 7 percent of latex examination gloves.9 Vinyl is the weakest of the glove films, with poor elasticity, memory, and fit. Because of these inadequate physical properties, vinyl would not be an acceptable choice of glove to use during a pandemic event. Vinyl should only be used for low-risk applications that do not involve bodily fluids, bloodborne pathogens, or viruses. Vinyl is available in examination gloves.

In the past century, the world experienced three global outbreaks, or pandemics, of influenza. The latest appearance and persistence of the emerging influenza virus in birds in Asia and its infection of a limited number of humans with a high mortality rate has raised concern among scientists and public health professionals about the possibility of another pandemic influenza.10 Influenza A will continue to be a threat to our health and well-being. As healthcare professionals, we all need to carefully consider how we can take the steps necessary to ensure that our patients are safe from infection and that we also protect ourselves as well. Appropriate PPE, coupled with proper infection control measures, will help you in optimizing your protection.

Lori Jensen is a clinical consultant at Ansell Healthcare. She joined Ansell in 2002 in the West Region with 12 years experience in the medical field.

Luce Ouellet has been a registered nurse since 1984 at the Montreal general hospital, Canada in the neurosurgery intensive care unit. A clinical consultant for Ansell, she works with healthcare professionals on matters pertaining to glove management and utilization, latex allergies, latex protocols and glove evaluations.