THICKNESS OF BUTYL GLOVES SIGNIFICANTLY IMPACTS GROSS AND FINE DEXTERITY – A RANDOMIZED CONTROLLES CROSSOVER TRIAL

Results: Results showed that medics were the most dexterous when using their bare hands. Wearing of 0.  mm-thick gloves resulted in 52.7 % decrease in gross dexterity and 59.3 % decrease in fine dexterity. However, the wearing of 0.3 mm thick butyl gloves resulted in a lower reduction in gross dexterity by 25.1 % and a reduction in fine dexterity by 36.4 % compared to bare hands. Wearing 0.3 mm thick butyl gloves results in a 58.4 % improvement in gross dexterity and a 56.2 % improvement in fine dexterity from wearing 0.6 mm thick butyl gloves.

Conclusion: This study provides level 1 scientific evidence that wearing thinner 0.3 mm thick butyl gloves gives medics superior gross and fine dexterity compared to the 0.6 mm thick gloves.

Keywords: Fine and Gross Dexterity, Thickness of Butyl Gloves, Randomised Controlled Crossover Trial

Introduction

The Medical Response Force (MRF) provides mass casualty Chemical, Biological and Radiological (CBR) first aid while donning Mission-Oriented Protective Posture (MOPP) suits. This includes the wearing of thick butyl gloves.
These medics are required to perform emergency life-saving procedures such as endotracheal tube insertions, cardiopulmonary resuscitations, and setting up of intravenous infusions while wearing butyl gloves. The speed and success of these procedures are critical in determining the chances of survival for casualties.
Medics currently wear 0.6 mm thick butyl gloves as part of their MOPP suits. Additional training sessions are specially catered for these medics to ensure that the loss of the medics’ dexterity in using their gloves does not compromise their operational effectiveness and readiness, especially in rendering adequate and timely medical care to injured or afflicted personnel.
We have indented new gloves with reduced thickness (0.3 mm) in 2013. These were introduced with aims to improve the manual dexterity (defined as the “manual ability that requires rapid coordination of gross or fine voluntary movements, based on certain number of capacities, which are developed through learning, training and experience” [1]) of the MRF medics when performing treatment procedures in deployment exercises. We detail, in this article, our study to compare the differences in dexterity between the two types of gloves.

Methods

The Purdue Pegboard Test was used to compare the differences in dexterity between the 0.3 mm thick butyl gloves and 0.6 mm thick butyl gloves. The Purdue Pegboard Test (model 32020 manufactured by Lafayette Instrument Company) was used in this study because it measured gross (in terms of arms, hands, fingers) and fine (in terms of fingertip movement) motor dexterity and coordination [1, 2, 3]. The tasks in the test reflect some of the important tasks MRF medics carry out during casualty management in deployments. In addition, the Purdue Pegboard Test is highly reliable as a standard test for dexterity and has been extensively used since its development in 1948 for testing the dexterity of industrial and assembly workers [3, 4]. The test is now being used in clinical settings such as in testing patients with Parkinson’s and multiple sclerosis [4, 5].

Standardized Procedures
The standardized procedure for administering the Purdue Pegboard Test by Tiffin [2] was followed. Each participant was seated at a table with the Purdue Pegboard directly in front of them. The evaluator was seated opposite the table, facing the participant. The evaluator explained the purpose and procedure of the study. Each proceeding of the test was recorded on a video camera. The test subjects were asked their dominant hand (the hand which they write with) before the practice test began. Participants were given the opportunity to practice each test before the timed test to ensure understanding [2]. The gloves were also fitted to the hands of the participants.

Participant Size
61 medics from MRF took part in this test. The medics were each given five lessons and five attempts to try out each of the tests before the commencement of the study. All 61 medics were between the age of 19 to 25, and all have received at least 10­ years of formal education.

Randomisation
All 61 medics were first randomized to 3 different groups, either performing the dexterity test using bare hands, the 0.3 mm thick butyl gloves or the 0.6 mm thick butyl gloves. After performing the test in the first group, the medics were randomized and cross-overed to the other two groups. All 61 MRF medics participated in and completed the Purdue Pegboard dexterity tests. A standardised mandatory 5 minute rest was given to each participant in between the three test groups.

The Purdue Pegboard Test
The Purdue Pegboard measures the gross and fine dexterity of both hands through a series of 4 sub-tests: the right hand, left hand, both hands and assembly test [2, 3]. The conformation of the Pegboard during the test was as follows: the right and left cups in the extreme corners of the board each contained 25 pegs. The cup second from the left held 40 washers, and the cup second from the right held 20 collars for the right handed participants and vice versa for the left-handed participants [2, 3].
The participant has 30 seconds to complete each of the first three sub-tests: the right hand, left hand, and the both hands test. The scores recorded on these sub-tests are the number of pegs (for the right and left hand test), or pairs of pegs (for the both hands test) placed on the columns of the pegboard within 30 seconds. The last sub-test (i. e. the assembly test) involves assembling sets of pegs, washers, and collars using both hands simultaneously. The score recorded for the assembly test is represented by the number of sets assembled (i. e. consisting of pin, washer, collar, second washer) in 1 minute. Participants are required to place or assemble as many pegs or sets as possible in the given time limits for each sub-test.

 

Results

Data were expressed as mean ± SEM based on independent experiments. Statistical analysis was performed by one-way analysis of variance (ANOVA) for multiple testing using Bonferroni post-hoc analysis (SPSS/Windows; SPSS Inc., Chicago, IL). Probability values were considered significant at p < 0.05.
The results showed that troopers were the most dexterous (both fine and gross) when using their bare hands (Gross Dexterity Score: 46.13 ± 0.93; Fine: 9.31 ± 0.23), (Table 1, Figure 1).

Bare hands vs 0.3 mm thick and 0.6 mm thick butyl gloves
Wearing of 0.6 mm thick butyl gloves resulted in 52.7 % decrease in gross dexterity (46.13 ± 0.93 vs. 21.82 ± 0.78; p < 0.0001) and 59.3 % decrease in fine dexterity (9.31 ± 0.23 vs. 3.79 ± 0.22; p < 0.0001), (Table 1, Figure 1).
After wearing 0.3 mm thick butyl gloves, medics had a lower reduction in dexterity compared to bare hands. The wearing of 0.3 mm thick butyl gloves resulted in a reduction in their gross dexterity by 25.1 % (46.13 ± 0.93 vs. 34.56 ± 0.98; p < 0.0001) and a reduction in fine dexterity by 36.4 % (9.31 ± 0.23 vs. 5.92 ± 0.25; p < 0.0001), (Table 1, Figure 1).

0.6 mm thick vs. 0.3 mm thick butyl gloves
Medics performed better in 0.3 mm thick gloves than in 0.6 mm thick gloves in all tests, across comparison between dominant hands, non-dominant hands, and using both hands.
Medics who wore the 0.3 mm thick butyl gloves experienced a 58.4 % improvement in gross dexterity (0.6 mm: 21.82 ± 0.78 vs. 0.3 mm: 34.56 ± 0.98; p < 0.0001) and a 56.2 % improvement in fine dexterity (0.6 mm: 3.79 ± 0.22 vs. 0.3 mm: 5.92 ± 0.25; p < 0.0001) compared to wearing 0.6 mm thick butyl gloves, (Table 1, Figure 1).

Discussion

To our knowledge, there has not been a randomized controlled trial to provide Level 1 evidence that the thinner 0.3 mm thick butyl gloves provide improved dexterity compared to the 0.6 mm thick butyl gloves.
For maximum gross and fine dexterity, medics should be allowed to operate in MOPP 2 posture (without gloves). However, this should not compromise the safety of any medics in any operational domains.
However, in the event of possible contamination, MRF medics are required to MOPP up and wear gloves. The 0.3 mm thick butyl gloves has been proven to be superior in terms of dexterity compared to the 0.6mm-thick butyl gloves with an improvement in both gross and fine dexterity by more than 1.5 times.
In the event that gloves are required to be worn, this study recommends the use of 0.3 mm thick butyl gloves over 0.6 mm thick butyl gloves because of its superiority in dexterity.
Similar studies conducted have found that performance on the dexterity tests was best with bare hands, and thereafter deteriorated with increasing thickness of the gloves [6, 7]. However, Bensel [6] noted that the occurrence of damage to the gloves in the form of punctures and tears is inversely proportional to the thickness of the gloves [7, 8, 9], and that the thinnest glove material that offers sufficient protection from a chemical environment would result in efficient manual performance, without compromising on permeation [5, 6, 9].
Wearing 0.3 mm thick butyl gloves gives the medics a more than 50 % increase in both gross and fine dexterity compared to 0.6 mm thick butyl gloves, in both dominant and non-dominant hands.

Conclusion

The study clearly demonstrates that the medics wearing 0.3 mm thick butyl gloves have superior gross and fine dexterity compared to the medics wearing 0.6 mm thick butyl gloves. This highlights the need to don the thinner 0.3 mm thick butyl gloves to improve the medics’ dexterity. This is even more important for medics attending to patients in the treatment area, where improved dexterity is crucial to the success of life-saving procedures.
However when compared to bare hands, medics wearing the 0.3 mm thick butyl gloves have significantly poorer gross and fine dexterity.

References

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Date: 03/30/2014

Source: Wehrmedizinische Monatsschrift 2014/2