Ready...Set...Gloves

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More than 100 years ago clinicians began using medical gloves for protection. In 1987, the Centers for Disease Control and Prevention (CDC) issued standar precautions, emphasizing glove protection when exposed to blood or other body fluids. As a result of the CDC’s recommendations, and the rise in HIV infections, healthcare workers have increasingly relied upon examination and surgical gloves.1

Today, clinicians should not only recognize the importance of donning gloves, but also understand the nature of the materials used in these gloves. Although gloves manufactured with different materials have comparable barrier properties when removed directly from the box and tested, their actual on-the-job barrier performance may be extremely different.2 Ineffective barriers or barriers that are easily breached have the potential to place clinicians and patients at risk.3

While the kinds of tasks, procedures, and hazards encountered at each facility will dictate the types of gloves required,4 the most common examination gloves include natural rubber latex (NRL), nitrile and vinyl. NRL gloves will continue to be the gold standard in barrier protection, although certain synthetic alternatives such as polyisoprene are available and offer similar performance characteristics, says Carolyn Twomey, RN, BSN, a clinical nurse consultant for Regent Medical. “As much as synthetics have improved, they have a long way to go to be comparable detail to detail with latex gloves,” she says.

Latex gloves are preferred for procedures and tasks considered moderate to high risk for exposure to blood and other potentially infectious materials and when nonsterile hand covering is indicated.5 With regard to chemicals, Toby Mathias, MD, staff dermatologist at Group Health Associates in Cincinnati, Ohio, warns, “When [nurses] use gloves [during the cleaning of instruments], they should not be latex gloves because glutaraldehyde can actually penetrate through latex and still cause problems.”

Wava Truscott, PhD, director of scientific affairs and clinical education at Kimberly-Clark Health Care, points out that nitrile is among the strongest materials available for gloves and is an excellent choice for most procedures. Nitrile gloves are ideal for clinicians who are allergic or sensitive to latex and who perform tasks or procedures involving prolonged exposure to blood, body fluids, chemotherapeutic agents, cleaning solutions and other chemicals.

Nitrile also has the benefit of being resistant to any breakdown from oilbased products,î Truscott says. ìNitrile would be an excellent product to use if you are working with a lubricant, milking tubing or performing various procedures requiring contact with an oil-based substance, Oils can breakdown latex where youíll notice your fingertips getting tacky or elongated whereas Nitrile does not.

“Nitrile gloves are more chemical resistant and more resistant to fats and oils and to certain cleaning chemicals such as glutaraldehyde and quaternary ammonium cleaners than natural rubber or vinyl,” says Don Groce, technical product specialist at Best Manufacturing Company. “Nitrile gloves do not contain natural rubber proteins. They do perform as well or maybe better than latex gloves for the protection from bloodborne pathogens. Most nitrile gloves do contain rubber accelerators which may cause some people to have an allergic reaction. Some contain accelerators such as carbamates, thiurams or benzothiazoles. These accelerators can cause a severe contact dermatitis in the area where the glove touches. These rubber processing chemicals have not been implicated in anaphylactic reactions and reactions to these chemicals do not involve the cardio-respiratory system. So, although these reactions can be severe, they are not life-threatening. A new accelerator-free nitrile glove has been developed by Best Manufacturing Company, so, now you can get a synthetic, non-latex, glove made with no rubber accelerators.”

Vinyl gloves are appropriate for shortterm tasks that involve minimal stress on the glove and low risk of exposure to blood and other potentially infectious materials.6 “There are a number of studies which show that vinyl has a higher failure rate than NRL,” Twomey says. “Another thing that you have to remember about vinyl is that it does not have the fit, feel or the performance characteristics of either latex or nitrile.” “Vinyl gloves do not contain accelerators or natural rubber proteins, but have been shown over and over again to fail viral penetration testing after a short time of usage,” Groce says. “The reason is that the vinyl film is not very stretchy and just the force of flexing them while wearing causes the film to fracture and allow fissures that viruses and bloodborne pathogens can penetrate and expose the worker.”

Surgical gloves are categorized into NRL and various synthetic materials, with further categorization into subsets of specialty gloves.7 “Natural rubber latex is made from polyisoprene,” says Deborah Davis, technical director of the Business Unit for Cardinal Health.

“Recently, they’ve been able to completely synthesize it. Chemically it is almost exactly the same as natural rubber latex, but you don’t have the proteins and allergens. It is a more consistent product. It is not based on a plant.”

Dusting powder used in both NRL and synthetic gloves is cause for concern, experts say. Besides increasing the risk of allergic reactions among patients and clinicians, the use of powdered gloves can lead to granulomas and adhesions in surgical patients.8 “There are pictures showing that powder is deposited on and attracted to the plastic materials used in endoscopy,” Truscott says.

Further, Truscott adds, “The powder can also absorb endotoxins, which are dead bacteria that can be acquired during the manufacturing process. Sterilization does not inactivate endotoxins. Thus, if you have a fever of unknown origin or inflammation that was unanticipated, endotoxins may be the cause.”

As a result of these concerns, several professional healthcare organizations have recommended that in addition to discontinuing unnecessary use of latex gloves, healthcare institutions implement low-allergen and powder-free gloves whenever possible.9 “All of our latex gloves are powder-free within our institution just to minimize the risk of exposing someone to latex, which would minimize their chances of developing a latex allergy,” says Collette Bird, RN, BSN, staff nurse in Digestive Disorders at St. Luke’s Health System in Sioux City, Iowa. “We like to designate our institution as latex safe because everything is powder free.”

Factors Affecting Barrier Protection

Experts agree that there are several factors that can degrade gloves, making it easier for them to rupture, split or disintegrate:

Storage Conditions.

Before gloves are even removed from the box, storage conditions can compromise the integrity of the glove. Heat, light, moisture and ozone can all degrade glove materials.10 “Latex gloves are an agricultural product,” Twomey says. “There are interesting things that affect latex gloves. Latex gloves are strongly affected by temperature. It is interesting too that if you and I were sitting in a room and put a latex glove on a table today, and there were fluorescent lights in there and we came back tomorrow, we would already start to see aging of the product. It starts to become yellow and hard and actually over a period of time will fail. So, ozone is a very significant issue for latex gloves. When you think about a lot of storage rooms and where your supplies are kept, often glove boxes are on the top shelf. They need to be brought down away from the ozone as much as possible.”

Glove Selection.

“It is important that a person grabbing a glove knows whether it is a latex or synthetic glove,” Truscott says. “Latex gloves should not be colored to look like synthetic gloves and vice versa. Healthcare workers need to be able to automatically recognize a synthetic versus a latex glove. This color differentiation will help lower the risk of accidentally pulling the wrong glove, which could result in barrier protection issues as well as latex allergy issues.

Davis adds, “When clinicians select gloves, they need to be sure they are putting on the correct size. For example, if they wear a glove that is too large and is baggy at the fingers or at the cuff, they can catch it on something and tear it. If it’s too tight, they’re not only going to have hand fatigue, but there is more of a tendency to rip it as they’re trying to put it on or minimally stress the glove at the cuff very badly and cause a weak spot that could later tear. They need to keep their fingernails short and change gloves frequently enough to avoid those sorts of issues as well.

Lotions.

“Another thing that can affect gloves is the type of lotion that clinicians may wear,” Davis says. “Obviously, there is a lot of focus on skin care and hygiene now with the CDC Hand Hygiene Guidelines. Often, clinicians resort to just bringing in some of these over-the-counter products. The danger there is that these lotions can contain petroleum-based substances like mineral oil or lanolin, which can break down latex. It’s not a particular issue with the synthetic gloves, but if you’re still wearing latex gloves, those kinds of lotions and creams can actually degrade the glove and you loose strength and barrier properties. What we always advise our customers to do is to work with employee health and infection control and make certain that they’re getting a clinically appropriate water-based lotion to use.”

Adhesives.

Truscott mentions that even trying to dislodge a piece of tape or label that has become attached to a glove can compromise a glove’s barrier properties.

Disinfectants.

Disinfectants can degrade gloves as well, reducing the product’s surface tension. Some common disinfectants found in healthcare settings include:
  • Alcohols
  • Phenolics
  • Quaternary Amines
  • Surfactants
  • Glutaraldehyde
  • Oxidizing Agents

“Because glove materials vary and perform differently in the presence of chemicals, it is important to know if your selected glove is a good barrier against chemicals you may encounter in the workplace. Some products may degrade in the presence of chemicals, so always consider your practice arena when choosing gloves to ensure proper performance and protection,” says Twomey.

“Glutaraldehyde has been shown to permeate through latex gloves. It is one of those chemicals that is a sensitizing chemical,” Groce says. “In other words, over a period of time of low exposure through glove permeation or through inhalation, workers can become sensitized to glutaraldehyde, so that they have a severe reaction and are unable to be around it at all. The recommended glove for glutaraldehyde is nitrile. You wouldn’t want to use latex or vinyl for glutaraldehyde or formaldehyde. If you look at other disinfectants like the quaternary ammonium compounds, which are used mainly as detergents for cleaning, they can cause severe reaction because they are corrosive.”

“There are a number of different products on the market that are affected by alcohol,” Twomey says. “Different alcohols will completely dissolve some gloves. It is important to realize that when you’re making decisions based on your practice arena that you chose one that’s going to play well with all that you do there.”


Glove Purchasing

For clinicians who may have to conduct trials of their own, here are some features to consider when evaluating gloves:11

Ease of donning.

Is this glove easy to put on with damp and dry hands?

Barrier protection.

Does it provide an intact barrier without holes?

Durability of the glove.

Is it resistant to tearing or puncture when in use?

Consistent fit over time.

How well does the glove fit when first donned and after extended use?

Tactile sensitivity.

Is the user able to fell small objects through the glove?

Grip.

Can the wearer grasp and hold slippery objects?

Comfort of the wearer.

Does the user complain of cramping or fatigue?

Non-irritating.

Does the wearer complain of skin irritations?

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