医用手套：修订间差异

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2017年5月21日 (日) 14:42的版本

医用手套是種可拋棄式的手套，供醫護人員在醫學檢查及醫療程序中穿戴，以避免醫護人員和病患之間的交互感染^[1]。医用手套的材質很薄，沒有耐熱及保護手部避免受傷的效果。

医用手套是由聚合物製成，材料有乳胶、丁腈橡胶、聚乙烯及氯丁橡胶。医用手套主要可分為檢查用手套及手術用手套。手術用手套的尺寸非常精確，因為醫師要戴著手術用手套進行高精細度的手部動作，因此對手套的要求也就會更高。檢查用的手套有無菌的以及未消毒的，而手術用手套多半是無菌的^[2]

尺碼

一般來說，檢查用的手套是以XS(特小)、S(小)、M(中)、L(大)來區分，部分品牌設有XL(特大)。至於手術用手套，由於要求的操作靈敏度更高、穿戴時間更長，一般以手掌虎口位水平的寬度(英寸)為尺碼，由5.5號至9.0號以0.5英寸遞增，部分品牌設有5.0號。首次佩戴手術用手套的人往往需要一段時間試戴不同尺碼和品牌的手套，才能知道真正切合自己手型的款式^[3]。手掌較厚者一般需要比測量結果更大的尺碼。

無粉手套

有些医用手套內層會加玉米澱粉潤滑，以方便手套的穿脫^[4]。以往是利用石松粉（英语：Lycopodium powder）及滑石進行潤滑，但這些材質會刺激組織，因此後來已被玉米澱粉取代。不過若在手術中，玉米澱粉進入病患的體內，有可能會影響傷口的癒合。因此在手術及一些敏感性的醫學程序中，比較常使用不加粉的医用手套。目前採用的大部分手套會用乳膠氯化的加工方式來彌補未加粉的潤滑性問題。氯化除了令手套表面更順滑和容易穿脫外，還能同時除去導致過敏反應的可溶出蛋白質。不過，氯化會對乳膠的其他性能構成影響^[5]。

淘汰有粉手套

自90年代起，由於無粉手套已經很容易取得，提出取締有粉手套的聲音在醫學界不絕于耳。到了2016年，德國和英國的保健系統經已全面停止使用有粉手套。同年3月，美國食品藥物管理局發出了一份諮詢文件，倡議在美國的醫療體系也停用有粉手套^[6]^[7]。在生產和研究集成電路的無塵室，由於對空氣的懸浮粒子含量有嚴格的要求，也一早淘汰了有粉手套。

歷史

约翰霍普金斯医院在1889年開業，卡罗琳·汉普顿（英语：Caroline Hampton）是手術室的護理長^[8]，即將成為她先生的威廉·霍尔斯特德聯絡固特異橡膠公司，希望他們可以製造薄的橡膠手套以保護卡罗琳的手^[8]。1984年霍尔斯特德開始在约翰霍普金斯医院使用消毒的醫用手套^[9]^[10]

不同材質的手套

乳胶

氯丁橡胶

第一個可拋棄的医用手套是在1964年由Ansell公司（英语：Ansell Limited）製造，他們是用以往生產保險套相關技術來製造^[11]。這類手套的臨床範圍很廣，從處理人排泄物到牙科應用都有。

許多罪犯都會在犯案時戴醫用手套，這類的手套相當薄，方便手部的動作，而且一般也認為帶著手套時不論留下指紋。不過因為有些医用手套實在非常的薄，指紋可能會透過手套留在物品上，形成手套紋（英语：glove prints），因此將帶手套者的指紋留在摸過或是碰觸過的物品上^[12]^[13]。

水門案中安裝竊聽器的人為了避免在現場留下指紋，在犯案時就戴了橡皮手套^[14]。

雙層手套

雙層手套是戴兩層医用手套，以減少在醫療過程中，因為異物刺穿手套或是手套防護失效而造成感染的風險。有系統研究證實在手術過程中，雙層手套比一層的医用手套更可以避免內層手套的穿孔^[15]^[16]。考科藍的系統綜述發現，從12個隨機化臨床試驗和合共3437名參與者的數據可知，相較只佩戴單層手套而該手套破損的風險，佩戴雙層手套可減少內襯手套破損的風險達71%。平均來講，每十名醫生或護士每參與100次手術，只佩戴一層手套會遇上172次手套破損，而佩戴兩層手套則只會遇上50次。由此可見，佩戴雙層手套能顯著降低醫護人員和病人的手術風險^[17]。

參考資料

^ Medical Gloves and Gowns. FDA. [2010-03-10]. Medical gloves are disposable gloves used during medical procedures. Medical gloves help prevent contamination between caregivers and patients. Some are designed to prevent contact with certain chemotherapy drugs. Medical gloves include examination gloves, surgical gloves, and medical gloves for handling chemotherapy agents (chemotherapy gloves). These gloves are regulated by the Food and Drug Administration (FDA). FDA makes sure that manufacturers of these devices meet performance criteria such as leak resistance, tear resistance, etc.
^ Personal Protective Equipment FAQ. Centers for Disease Control and Prevention. [2013-06-08].
^ Surgical Gloves Size Chart (手術用手套尺碼表. [2017-05-21].
^ Glove manufacturing. Ansell.eu. [2012-12-14].
^ Medical Glove Powder Report (报告). U.S. Food and Drug Administration. September 1997 [June 2, 2016].
^ 引用错误：没有为名为lowes的参考文献提供内容
^ FDA proposes ban on most powdered medical gloves. FDA. March 21, 2016.
^ ^8.0 ^8.1 S. Robert Lathan. Caroline Hampton Halsted: the first to use rubber gloves in the operating room. Proc (Bayl Univ Med Cent). 2010 Oct; 23(4): 389-392. PMID 2943454.
^ Hopkins Ceases Use Of Latex Gloves During Surgery. WJZ-TV. January 15, 2008 [2010-03-03]. A surgeon at Johns Hopkins Hospital is credited with being the first to introduce the rubber surgical glove back in 1894.
^ Rubber Gloves. Johns Hopkins Hospital. January 14, 2008 [2010-03-03]. William Stewart Halsted, The Johns Hopkins Hospital’s first surgeon in chief, is credited as the first to develop and introduce rubber surgical gloves in the United States. That was in 1894, five years after the institution opened.
^ 100 Years of Australian Innovation - latex gloves. [2010-03-07]. In 1945, Ansell designed and built the first automatic dipping machine, which produced 300 dozen pairs of synthetic gloves in eight hours. Ansell introduced disposable surgical gloves in 1964, which won the company an Export Award in 1967. International expansion over the next two decades saw Ansell become the world's largest producer of latex gloves for household and medical use.
^ Weather & Time. Do latex gloves conceal fingerprints? If so, Why?. Chacha.com. [2012-12-14].
^ Personal Identification: Fingerprints. ScienceMan.org. [2012-12-14].
^ Watergate. Spartacus.Schoolnet.co.uk. [2012-12-14].
^ Tanner, J; Parkinson, H. Double gloving to reduce surgical cross-infection. The Cochrane Library. 2002, (3): CD003087. PMID 12137673. doi:10.1002/14651858.CD003087.
^ Tanner, J; Parkinson, H. Double gloving to reduce surgical cross-infection. The Cochrane Library. 2006, (3): CD003087. PMID 16855997. doi:10.1002/14651858.CD003087.pub2.
^ Mischke, C; Verbeek, J. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. The Cochrane Library. 2014, (3): CD009573. PMID 24610769. doi:10.1002/14651858.CD009573.pub2.

[1] Medical Gloves and Gowns. FDA. [2010-03-10]. Medical gloves are disposable gloves used during medical procedures. Medical gloves help prevent contamination between caregivers and patients. Some are designed to prevent contact with certain chemotherapy drugs. Medical gloves include examination gloves, surgical gloves, and medical gloves for handling chemotherapy agents (chemotherapy gloves). These gloves are regulated by the Food and Drug Administration (FDA). FDA makes sure that manufacturers of these devices meet performance criteria such as leak resistance, tear resistance, etc.

[2] Personal Protective Equipment FAQ. Centers for Disease Control and Prevention. [2013-06-08].

[3] Surgical Gloves Size Chart (手術用手套尺碼表. [2017-05-21].

[4] Glove manufacturing. Ansell.eu. [2012-12-14].

[5] Medical Glove Powder Report (报告). U.S. Food and Drug Administration. September 1997 [June 2, 2016].

[lowes-6] 引用错误：没有为名为lowes的参考文献提供内容

[7] FDA proposes ban on most powdered medical gloves. FDA. March 21, 2016.

[lathan-8] 8.0 ^8.1 S. Robert Lathan. Caroline Hampton Halsted: the first to use rubber gloves in the operating room. Proc (Bayl Univ Med Cent). 2010 Oct; 23(4): 389-392. PMID 2943454.

[9] Hopkins Ceases Use Of Latex Gloves During Surgery. WJZ-TV. January 15, 2008 [2010-03-03]. A surgeon at Johns Hopkins Hospital is credited with being the first to introduce the rubber surgical glove back in 1894.

[10] Rubber Gloves. Johns Hopkins Hospital. January 14, 2008 [2010-03-03]. William Stewart Halsted, The Johns Hopkins Hospital’s first surgeon in chief, is credited as the first to develop and introduce rubber surgical gloves in the United States. That was in 1894, five years after the institution opened.

[11] 100 Years of Australian Innovation - latex gloves. [2010-03-07]. In 1945, Ansell designed and built the first automatic dipping machine, which produced 300 dozen pairs of synthetic gloves in eight hours. Ansell introduced disposable surgical gloves in 1964, which won the company an Export Award in 1967. International expansion over the next two decades saw Ansell become the world's largest producer of latex gloves for household and medical use.

[12] Weather & Time. Do latex gloves conceal fingerprints? If so, Why?. Chacha.com. [2012-12-14].

[13] Personal Identification: Fingerprints. ScienceMan.org. [2012-12-14].

[14] Watergate. Spartacus.Schoolnet.co.uk. [2012-12-14].

[pmid12137673-15] Tanner, J; Parkinson, H. Double gloving to reduce surgical cross-infection. The Cochrane Library. 2002, (3): CD003087. PMID 12137673. doi:10.1002/14651858.CD003087.

[pmid16855997-16] Tanner, J; Parkinson, H. Double gloving to reduce surgical cross-infection. The Cochrane Library. 2006, (3): CD003087. PMID 16855997. doi:10.1002/14651858.CD003087.pub2.

[pmid24610769-17] Mischke, C; Verbeek, J. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. The Cochrane Library. 2014, (3): CD009573. PMID 24610769. doi:10.1002/14651858.CD009573.pub2.

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@@ 第38行： / 第38行： @@
 == 雙層手套 ==
-雙層手套是戴兩層医用手套，以減少在醫療過程中，因為異物刺穿手套或是手套防護失效而造成感染的風險。有系統研究證實在手術過程中，雙層手套比一層的医用手套更可以避免內層手套的穿孔<ref name=pmid12137673>{{Cite journal | pmid = 12137673| year = 2002| author1 = Tanner| first1 = J| journal = The Cochrane Library| issue = 3| pages = CD003087| last2 = Parkinson| first2 = H| doi = 10.1002/14651858.CD003087| title = Double gloving to reduce surgical cross-infection}}</ref><ref name=pmid16855997>{{Cite journal | pmid = 16855997| year = 2006| author1 = Tanner| first1 = J| journal = The Cochrane Library| issue = 3| pages = CD003087| last2 = Parkinson| first2 = H| doi = 10.1002/14651858.CD003087.pub2| title = Double gloving to reduce surgical cross-infection}}</ref>。
+雙層手套是戴兩層医用手套，以減少在醫療過程中，因為異物刺穿手套或是手套防護失效而造成感染的風險。有系統研究證實在手術過程中，雙層手套比一層的医用手套更可以避免內層手套的穿孔<ref name=pmid12137673>{{Cite journal | pmid = 12137673| year = 2002| author1 = Tanner| first1 = J| journal = The Cochrane Library| issue = 3| pages = CD003087| last2 = Parkinson| first2 = H| doi = 10.1002/14651858.CD003087| title = Double gloving to reduce surgical cross-infection}}</ref><ref name=pmid16855997>{{Cite journal | pmid = 16855997| year = 2006| author1 = Tanner| first1 = J| journal = The Cochrane Library| issue = 3| pages = CD003087| last2 = Parkinson| first2 = H| doi = 10.1002/14651858.CD003087.pub2| title = Double gloving to reduce surgical cross-infection}}</ref>。[[考科藍]]的系統綜述發現，從12個隨機化臨床試驗和合共3437名參與者的數據可知，相較只佩戴單層手套而該手套破損的風險，佩戴雙層手套可減少內襯手套破損的風險達71%。平均來講，每十名醫生或護士每參與100次手術，只佩戴一層手套會遇上172次手套破損，而佩戴兩層手套則只會遇上50次。由此可見，佩戴雙層手套能顯著降低醫護人員和病人的手術風險<ref name=pmid24610769>{{Cite journal | pmid = 24610769| year = 2014| author1 = Mischke| first1 = C| journal = The Cochrane Library| issue = 3| pages = CD009573| last2 = Verbeek| first2 = J| doi = 10.1002/14651858.CD009573.pub2| title = Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel}}</ref>。
 ==參考資料==