Evaluation of the effect of medical gloves on dexterity and tactile sensibility using simulated clinical practice tests

Understanding the effect of medical gloves on manual performance is critical for improving glove design and mitigating the impediment to surgical performance caused by gloves. Existing test methods do not correspond well with clinical and surgical tasks. Based on interviews with clinicians, two new tests were proposed: locating a pulse in a simulated blood vessel, and placing and tying sutures in simulated tissue. A pilot study was carried out using 19 clinicians employed at Sheffield Teaching Hospitals. Subjects performed each test three times, with latex and nitrile examination gloves, and without gloves, the order being randomised. In addition to objective test scores, subjects' perception of their relative performance in each condition was recorded. In the Pulse Location Test, performance was found to be significantly better without gloves, while differences between gloves were not statistically significant. Perceived performance correlated well with measured performance. In the Suturing Test, no statistically significant performance differences were found between the three hand conditions, although subjects perceived ungloved performance to be significantly better than with either the latex or nitrile gloves. The Pulse Location Test showed promise as a clinical performance evaluation tool, and could be used to improve medical glove design for better tactile performance. The discrepancy between subjects' perceived and measured performance in the Suturing Test needs further investigation to determine whether the perceived differences translate into genuine clinical performance differences that were not able to be measured using the current method, or whether the difference is purely psychological.Relevance to industryThe test methods outlined will allow manufacturers to understand the effect of gloves and glove properties on manual performance in medical tasks and improve the design accordingly. Reducing the inhibiting effect of gloves will improve safety and reduce the need to remove gloves for clinical tasks.     

The transmission of vibration through gloves: effects of push force,vibration magnitude and inter-subject variability

The extent to which a glove modifies the risks from hand-transmitted vibration is quantified in ISO 10819:1996 by a measure of glove transmissibility determined with one vibration magnitude, one contact force with a handle and only three subjects. This study was designed to investigate systematically the vibration transmissibility of four ‘anti-vibration’ gloves over the frequency range 16–1600 Hz with 12 subjects, at six magnitudes of vibration (0.25–8.0 ms^?2 r.m.s.) and with six push forces (5 N to 80 N). The four gloves showed different transmissibility characteristics that were not greatly affected by vibration magnitude but highly dependent on push force. In all conditions, the variability in transmissibility between subjects was as great as the variability between gloves. It is concluded that a standardised test of glove dynamic performance should include a wide range of hands and a range of forces representative of those occurring in work with vibratory tools.

Statement of Relevance: The transmission of vibration through anti-vibration gloves is highly dependent on the push force between the hand and a handle and also highly dependent on the hand that is inside the glove. The influence of neither factor is well reflected in ISO 10819:1996, the current standard for anti-vibration gloves.     

Short and longer duration effects of protective gloves on hand performance capabilities and subjective assessments in a screw-driving task

The study investigated short and longer duration effects of gloves on hand performance capabilities (muscle activity, dexterity, touch sensitivity, finger pinch and forearm torque strength) and subjective assessments of discomfort and ease of manipulation when performing a light assembly task. The independent variables were hand condition with four levels (wearing cotton, nylon or nitrile gloves as well as barehanded) and point of time within the 2 h duration of the task (with measurements taken at 0, 30, 60, 90 and 120 min). Participants worked with a screwdriver to fit two components together using screws. Wearing gloves significantly increased the muscle activity, pinch strength and discomfort but reduced the dexterity and touch sensitivity. There was also a significant effect of task time on the muscle activity, dexterity, forearm torque strength and touch sensitivity, which indicates that the duration of the task should be an important consideration in glove evaluation studies and in the selection of work gloves.

Statement of Relevance:It is important to evaluate the effects of gloves on hand performance capabilities in a working context so that job demands can be taken into account and the most appropriate type of glove be chosen for each task. This study gives recommendations regarding the evaluation and use of gloves for screw-driving tasks.     

Methodology for evaluating gloves in relation to the effects on hand performance capabilities: a literature review

The present study was conducted to review the literature on the methods that have been considered appropriate for evaluation of the effects of gloves on different aspects of hand performance, to make recommendations for the testing and assessment of gloves, and to identify where further research is needed to improve the evaluation protocols. Eighty-five papers meeting the criteria for inclusion were reviewed. Many studies show that gloves may have negative effects on manual dexterity, tactile sensitivity, handgrip strength, muscle activity and fatigue and comfort, while further research is needed to determine glove effects on pinch strength, forearm torque strength and range of finger and wrist movements. The review also highlights several methodological issues (including consideration of both task type and duration of glove use by workers, guidance on the selection and allocation of suitable glove(s) for particular tasks/jobs, and glove design features) that need to be considered in future research.

Practitioner Summary: The relevant literature on the effects of protective gloves on different aspects of hand performance was reviewed to make recommendations for the testing and assessment of gloves, and to improve evaluation protocols. The review highlights research areas and methodological issues that need to be considered in future research.     

A methodology for integrated performance analyses of vibration reducing gloves

This study proposes a methodology for evaluating the integrated performance of vibration reducing (VR) gloves considering four measures. These include manual dexterity, distributed palm and fingers vibration transmission and grip strength preservation, which generally pose conflicting design requirements. The weights for the conflicting performance measures are identified for the given work conditions, classified according to the frequency ranges of predominant tool handle vibration (low and high), as defined in ISO-10819 together with the assembly/disassembly tasks. An index of weighted measures is formulated for identifying the most desirable VR glove for the given work condition. The results showed the greatest weighting for the fingers vibration response for high-frequency vibration spectra. Higher weightings for palm vibration and muscles' activity, were obtained for low-frequency vibration spectra, while the weighting for manual dexterity increased when coupled with manual tasks. An integrated performance index is identified and applied to rank nine different VR gloves and a conventional glove with known individual performance measures for identifying the most desirable glove. The vibration reducing gloves included: five gloves with gel vibration isolation materials, denoted as gel1, …, gel5; two gloves with air bladder vibration isolation material, denoted as air1 and air2; one hybrid glove comprising air pocket vibration isolation material in the palm region and gel in the fingers regions, denoted as hybrid; and a rubber glove. The gel2, air2 and hybrid gloves, made of air bladder or viscoelastic gels, showed superior integrated performance for high- and low-frequency vibration spectra among the ten alternatives. The fabric and rubber gloves revealed best integrated performance for the multiple tasks in conjunction with the low-frequency vibration spectrum.     

How do medical gloves affect manual performance? Evaluation of ergonomic indicators

Medical gloves have a direct effect on the safety of clinical staff and patients as well as optimal performance. Thus, it is necessary to identify the quantitative impact of gloves on hand performance indicators. This study aimed to investigate the effect of medical gloves on manual performance. This study was conducted on 40 hospital clinical staff. The participants’ dexterity, tactile sensitivity, and grip strength were evaluated with and without gloves and were compared by Purdue pegboard, two-point discrimination, and dynamometer tests. Additionally, the participants were required to rate their performance under different conditions using the visual analogue scale. The results showed that medical gloves had a significant effect on all studied indices. Double gloving caused the most significant reduction in touch sensitivity. Grip strength was also significantly reduced by the use of inappropriate gloves. Despite its negative effects on the ergonomic indices, single gloving provided the same functional performance as did the condition without gloves.Relevance to industryDespite a significant decrease in manual performance, single gloving can be a good alternative for the condition without gloves with regard to individuals’ mental performance. The present study results also indicated that medical gloves had a significant impact on ergonomic indicators related to manual performance. Hence, it is necessary to consider manual function dimensions when designing gloves.     

A critical review of glove and hand research with regard to medical glove design

Research from a number of areas was surveyed, including hand function; skin friction; manual performance testing; glove comfort, fit and durability; and user perception. The relevance of the research to medical glove design was discussed. It was concluded that, while an understanding has been gained of the factors that affect glove performance in general, specific application to thin rubber gloves has not been well explored. The focus in glove performance testing has also been on simple tasks such as pegboards, which do not necessarily assess the fine dexterity required in many surgical tasks. Recommendations were made for the development of a new battery of tests specific to medical gloves that would simulate real medical tasks and could produce repeatable results and have sufficient resolution to differentiate between glove types.     

The development and evaluation of an ergonomic glove

The primary intent of this study was to determine if a hand glove could be designed on a criterion of selective protection. Force distribution patterns on the palmar side of hand were obtained from various studies to develop zones of hand that needed protection. A new design for gloves was developed based on the principle of selective protection, where protective material is introduced in varying levels over different parts of the glove, in order to provide protection where it is most needed, and at the same time preserve the desirable dexterity and strength capabilities of the barehand, optimizing the trade-off between protection and performance. Two pairs of prototype gloves incorporating different levels of protection were fabricated and tested using a battery of performance tests and an algometer test for pressure sensitivity. The test battery comprising four dexterity tasks and a maximal voluntary grip strength task was used to assess a number of glove conditions, including the two prototype gloves developed. The results indicate that the performance of the prototype gloves are comparable, and that the performance times for the double glove and the two prototype gloves tested were not significantly different. For the grip strength, the two prototype gloves were better than the double glove. The assembly task performance for the prototype II (laminar glove) was significantly lower than that of the other glove types tested. It appears that gloves of variable thickness can be developed to afford adequate protection at zones of most need. Glove manufacturers are recommended to use an ergonomic approach in the design of gloves. Such an approach, besides protecting the safety objective of gloves, could enhance productivity considerably.     

Transmission of vibration through gloves: effects of material thickness

It might be assumed that increasing the thickness of a glove would reduce the vibration transmitted to the hand. Three material samples from an anti-vibration glove were stacked to produce three thicknesses: 6.4, 12.8 and 19.2 mm. The dynamic stiffnesses of all three thicknesses, the apparent mass at the palm and the finger and the transmission of vibration to the palm and finger were measured. At frequencies from 20 to 350 Hz, the material reduced vibration at the palm but increased vibration at the finger. Increased thickness reduced vibration at the palm but increased vibration at the finger. The measured transmissibilities could be predicted from the material dynamic stiffness and the apparent mass of the palm and finger. Reducing the dynamic stiffness of glove material may increase or decrease the transmission of vibration, depending on the material, the frequency of vibration and the location of measurement (palm or finger).

Practitioner Summary: Transmission of vibration through gloves depends on the dynamic response of the hand and the dynamic stiffness of glove material, which depends on material thickness. Measuring the transmission of vibration through gloves to the palm of the hand gives a misleading indication of the transmission of vibration to the fingers.     

Tool-specific performance of vibration-reducing gloves for attenuating palm-transmitted vibrations in three orthogonal directions

Vibration-reducing (VR) gloves have been increasingly used to help reduce vibration exposure, but it remains unclear how effective these gloves are. The purpose of this study was to estimate tool-specific performances of VR gloves for reducing the vibrations transmitted to the palm of the hand in three orthogonal directions (3-D) in an attempt to assess glove effectiveness and aid in the appropriate selection of these gloves. Four typical VR gloves were considered in this study, two of which can be classified as anti-vibration (AV) gloves according to the current AV glove test standard. The average transmissibility spectrum of each glove in each direction was synthesized based on spectra measured in this study and other spectra collected from reported studies. More than seventy vibration spectra of various tools or machines were considered in the estimations, which were also measured in this study or collected from reported studies. The glove performance assessments were based on the percent reduction of frequency-weighted acceleration as is required in the current standard for assessing the risk of vibration exposures. The estimated tool-specific vibration reductions of the gloves indicate that the VR gloves could slightly reduce (<5%) or marginally amplify (<10%) the vibrations generated from low-frequency (<25 Hz) tools or those vibrating primarily along the axis of the tool handle. With other tools, the VR gloves could reduce palm-transmitted vibrations in the range of 5%–58%, primarily depending on the specific tool and its vibration spectra in the three directions. The two AV gloves were not more effective than the other gloves with some of the tools considered in this study. The implications of the results are discussed.Relevance to industryHand-transmitted vibration exposure may cause hand-arm vibration syndrome. Vibration-reducing gloves are considered as an alternative approach to reduce the vibration exposure. This study provides useful information on the effectiveness of the gloves when used with many tools for reducing the vibration transmitted to the palm in three directions. The results can aid in the appropriate selection and use of these gloves.     

Short and longer duration effects of protective gloves on hand performance capabilities and subjective assessments in a screw-driving task

The study investigated short and longer duration effects of gloves on hand performance capabilities (muscle activity, dexterity, touch sensitivity, finger pinch and forearm torque strength) and subjective assessments of discomfort and ease of manipulation when performing a light assembly task. The independent variables were hand condition with four levels (wearing cotton, nylon or nitrile gloves as well as barehanded) and point of time within the 2 h duration of the task (with measurements taken at 0, 30, 60, 90 and 120 min). Participants worked with a screwdriver to fit two components together using screws. Wearing gloves significantly increased the muscle activity, pinch strength and discomfort but reduced the dexterity and touch sensitivity. There was also a significant effect of task time on the muscle activity, dexterity, forearm torque strength and touch sensitivity, which indicates that the duration of the task should be an important consideration in glove evaluation studies and in the selection of work gloves. STATEMENT OF RELEVANCE: It is important to evaluate the effects of gloves on hand performance capabilities in a working context so that job demands can be taken into account and the most appropriate type of glove be chosen for each task. This study gives recommendations regarding the evaluation and use of gloves for screw-driving tasks.     

Vibration-reducing gloves: transmissibility at the palm of the hand in three orthogonal directions

Vibration-reducing (VR) gloves are commonly used as a means to help control exposures to hand-transmitted vibrations generated by powered hand tools. The objective of this study was to characterise the vibration transmissibility spectra and frequency-weighted vibration transmissibility of VR gloves at the palm of the hand in three orthogonal directions. Seven adult males participated in the evaluation of seven glove models using a three-dimensional hand–arm vibration test system. Three levels of hand coupling force were applied in the experiment. This study found that, in general, VR gloves are most effective at reducing vibrations transmitted to the palm along the forearm direction. Gloves that are found to be superior at reducing vibrations in the forearm direction may not be more effective in the other directions when compared with other VR gloves. This casts doubts on the validity of the standardised glove screening test.

Practitioner Summary: This study used human subjects to measure three-dimensional vibration transmissibility of vibration-reducing gloves at the palm and identified their vibration attenuation characteristics. This study found the gloves to be most effective at reducing vibrations along the forearm direction. These gloves did not effectively attenuate vibration along the handle axial direction.     

The transmission of vibration through gloves: effects of push force, vibration magnitude and inter-subject variability

The extent to which a glove modifies the risks from hand-transmitted vibration is quantified in ISO 10819:1996 by a measure of glove transmissibility determined with one vibration magnitude, one contact force with a handle and only three subjects. This study was designed to investigate systematically the vibration transmissibility of four 'anti-vibration' gloves over the frequency range 16-1600 Hz with 12 subjects, at six magnitudes of vibration (0.25-8.0 ms(-2) r.m.s.) and with six push forces (5 N to 80 N). The four gloves showed different transmissibility characteristics that were not greatly affected by vibration magnitude but highly dependent on push force. In all conditions, the variability in transmissibility between subjects was as great as the variability between gloves. It is concluded that a standardised test of glove dynamic performance should include a wide range of hands and a range of forces representative of those occurring in work with vibratory tools. STATEMENT OF RELEVANCE: The transmission of vibration through anti-vibration gloves is highly dependent on the push force between the hand and a handle and also highly dependent on the hand that is inside the glove. The influence of neither factor is well reflected in ISO 10819:1996, the current standard for anti-vibration gloves.     

Nitrogen Narcosis and Performance Under Water

Abstract

Eighteen divers were tested four times under water, twice at a depth of 5 ft and twice at 100 ft. They performed three tests—digit copying, a sentence comprehension test and a manual dexterity test. All three showed a significant drop in efficiency at depth. This was small for digit copying (7-9 per cent) and manual dexterity (3 5 per cent), and somewhat larger for sentence comprehension (15-3 per cent). In all three cases the drop in efficiency was approximately the same as found at the equivalent pressure in a dry pressure chamber. This contrasts with previous results where impairment in the open sea has been considerably greater than in a dry chamber. Possible reasons for this discrepancy are discussed and it is suggested that level of anxiety may be a crucial factor.     

Preliminary study evaluating manual dexterity tests assessing gloves protecting against cuts and stabs by hand knives

The paper presents preliminary results on the research methodology of evaluating the ergonomic properties of gloves protecting against cuts and stabs by hand knives. Four manual dexterity tests were selected for the study: TEST 1: evaluation of fine finger movements pursuant to PN-EN 420; TEST 2: cylinder grip and pull test according to PN-EN 1082 evaluating gross movements of the arms and hands; TEST 3: Purdue Pegboard Test evaluating fine finger movements; TEST 4: evaluation of gross movements of the arms and hands while performing simulated occupational tasks. The tested gloves differed in terms of construction and material (metal mesh or knitwear incorporating a metal yarn) and were selected depending on the scope of work activities performed during meat cutting and boning. The tests were conducted on a homogeneous group of subjects. During the performance of the four dexterity tests, we monitored the loading of four groups of muscles of the upper limb (adductor pollicis, extensor carpi radialis, flexor carpi ulnaris, and biceps brachii) using surface electromyography (EMG). Additionally, subjective sensations concerning the strain on the upper limb were evaluated using a questionnaire survey.The objective of the study was to identify a group of tests that would be characterized by high sensitivity and ensure reliable assessment of gloves protecting against cuts and stabs by hand knives. The results showed that not all of the dexterity captured differences in the way the gloves affected dexterity. This was corroborated by electromyographic measurements, which revealed considerable differences in load of upper limb muscles when using various gloves and further supported by the subjective sensations of the participants, as reported in the questionnaire study. It was concluded that in order to reliably evaluate the ergonomic properties of gloves protecting against cuts and stabs by hand knives it is necessary to design new dexterity tests that would reflect actual workplace conditions, and could simulate occupational activities. Workplace observations helped to identify specific aspects of manual dexterity (fine, medium, gross), and types of hand movement associated with professional activities including different force configurations (finger flexion, wrist abduction, and pressing with the fingers and wrist). Based on those observations three new manual dexterity tests dedicated exclusively to evaluation of the ergonomic properties of gloves protecting against cuts and stabs by hand knives have been proposed.     

Impact of Gloves on User Performance and Comfort in the Semiconductor Industry

The potential impact of using single and double gloves on workers’ performance and comfort in the semiconductor industry was assessed in an experimental investigation. Four gloves configurations were included in the study: bare hands without gloves, single vinyl gloves, latex rubber gloves over vinyl gloves, and tripolymer gloves over vinyl gloves. Also, each gloves condition was examined under wet and dry configurations. Three basic tests were devised: 1) carrying out a test task, 2) using a testing rig to assess subjects’ abilities to exert pull‐down forces while using a power grip, and (3) using a pinch grip. The test rig included end effects that are identical in dimensions made of polypropylene, stainless steel, and Teflon. Sixteen male and 7 female workers participated in the study. Results indicated that, in comparison to using dry and bare hands, using double gloves increased the level of effort exerted, reduced comfort, and reduced the sense of security during the test task (p < .05). Also, it was concluded that wearing gloves may reduce workers’ capacity to perform material‐handling tasks. The ability to exert pull‐down forces using both power and pinch grips was reduced but by different degrees, depending on the gloves configurations and the material comprising the end effects. Other than the differences in reference to dry bare hands, differences between glove‐using study conditions were statistically insignificant.     

Physiological aspects of electrically heated garments

Abstract

Inactive man exposed to cold climates and dressed in conventional cold-weather clothing experiences difficulty in maintaining the temperature of the hands and feet. Comfort and performance, especially manual dexterity, are degraded as the temperature of the extremities falls with duration of exposure, and there is also the risk of cold injury. Electrical heating (EH) is a form of auxiliary heating which can offer a solution in some circumstances and is most useful when the wearer can conveniently connect to a power supply of a vehicle or some other type of military equipment. Physiological evaluations and user trials on various types of electrically heated (EH) items including coveralls, gloves, mitts, socks and insoles have been reviewed in this paper, using studies done by the Army Personnel Research Establishment (APRE) as the main source material. Cold-chamber trials showed the effectiveness of EH in maintaining hand temperatures and slowing the fall in foot temperatures even in the extremely cold climate of ?32^°C; however, impermeable outers worn over EH gloves, degraded the thermal protection available compared to leather outers. After user trials, whole-body heating in the form of coveralls was judged unnecessary provided that EH hand and foot protection and cold-weather clothing were available. A survey of a number of field trials has been undertaken with a view to extracting general advantages and disadvantages rather than those specific to a particular type of EH equipment. This survey indicated that the user perceived the advantages of EH clothing in terms of increased comfort and manual dexterity; however, users also pointed out disadvantages such as encumbrance, restriction to movement and durability problems. Clearly EH items need to be carefully tailored to the user's requirements and this may incur financial penalties.     

Design options for improving protective gloves for industrial assembly work

The study investigated the effects of wearing two new designs of cotton glove on several hand performance capabilities and compared them against the effects of barehanded, single-layered and double cotton glove conditions when working with hand tools (screwdriver and pliers). The new glove designs were based on the findings of subjective hand discomfort assessments for this type of work and aimed to match the glove thickness to the localised pressure and sensitivity in different areas of the hand as well as to provide adequate dexterity for fine manipulative tasks. The results showed that the first prototype glove and the barehanded condition were comparable and provided better dexterity and higher handgrip strength than double thickness gloves. The results support the hypothesis that selective thickness in different areas of the hand could be applied by glove manufacturers to improve the glove design, so that it can protect the hands from the environment and at the same time allow optimal hand performance capabilities.     

Task specificity of finger dexterity tests

Finger dexterity tests are generally used to assess performance decrease due to gloves, cold and pathology. It is generally assumed that the O’Connor and Purdue Pegboard test yield similar results. In this experiment we compared these two tests for dry conditions without gloves, and for dry and wet conditions with two types of Nytril gloves. In line with previous observations, wearing gloves caused a decrease in performance of about 12% for the O’Connor test and 9% for the Purdue test. Wetting the gloves prior to the test had no effect on the Purdue score. However, wetting the gloves increased the O’Connor performance significantly by 11%. The results show that the O’Connor and Purdue tests do not yield similar results and should be used selectively for specific tasks.     

Do mechanical tests of glove stiffness provide relevant information relative to their effects on the musculoskeletal system? A comparison with surface electromyography and psychophysical methods

The main purpose of the present study was to test the construct validity of two mechanical tests of glove stiffness using a surface electromyography (SEMG) methodology that would allow estimating the effect of glove stiffness on forearm muscle activation during a standardized grip contraction. The mechanical tests [free-deforming multidirectional test (FDMT) and Kawabata Evaluation System for Fabrics (KESF)] were applied on 27 gloves covering a wide range of stiffness. In 30 human subjects, a psychophysical assessment of these gloves was also carried on in addition to the SEMG test. The results showed that the sensitivity of the different tests to glove stiffness differences was slightly better for the FDMT (75% sensitivity) than for the psychophysical assessment (72%), while the SEMG test showed much lower sensitivity (13-31%, depending on the muscle). The SEMG test was highly correlated to the psychophysical assessment (0.88-0.95, depending on the muscle tested), and the FDMT (0.88-0.94) and KESF (0.77-0.86) mechanical tests, showing the construct validity of mechanical tests, particularly for the FDMT. It was concluded that mechanical tests provide relevant information relative to the effect of glove stiffness on the musculoskeletal system of the forearm.