Surgical and Exam Gloves
While there are several latex alternatives for disposable gloves, the advantages and disadvantages of each mean it is important to choose the right glove for the situation. Gloves are classed as Exam Grade or General Purpose. Exam gloves are regulated by the FDA, general purpose gloves are not. Exam gloves are regulated by the U.S. Food and Drug Administration’s (FDA) Center for Devices and Radiological Health and tested using standards provided by ASTM International (www.astm.org) in the United States and in Europe by the Personal Protective Equipment Directive for the European Community (ec.europa.eu).
The following considerations should be taken into account when selecting medical gloves:
1. Allergies: will the gloves cause an allergic reaction in staff or patients.
2. Blood borne pathogen barrier protection: medical gloves should provide protection in compliance with ASTM F 1671 (ASTM F1671 - 07 Standard Test Method for Resistance of Materials Used in Protective Clothing to Penetration by Blood-Borne Pathogens Using Phi-X174 Bacteriophage Penetration as a Test System, information provided with glove manufacturer.) Additionally, it is recommended that gloves comply with ASTM F1671-97a (Resistance of Materials to Penetration by Blood-Borne Pathogens) to ensure barrier protection against certain viral elements.
3. Chemical barrier protection: medical gloves should provide protection against chemicals including, but not limited to, chemotherapy drugs, and sterilants. This protection is measured using ASTM F 739 (Standard Test Method for Resistance of Protective Clothing Materials to Permeation by Liquids or Gases Under Conditions of Continuous Contact) and ASTM F 1383-96 (Standard Test Method for Resistance of Protective Clothing Materials to Permeation by Liquids or Gases Under Conditions of Intermittent Contact).
4. Elasticity and Tensile Strength: how far will a glove stretch without breaking and how much force it takes.
5. Cut resistance
6. Abrasion resistance
7. Tear resistance
8. Puncture resistance
9. Dexterity
10. Contamination: powdered gloves can lead to complications in surgical patients and increase allergy risk. Airborne powder can carry high levels of both latex and bacteria, increasing risk for infection and latex allergy reactions. Other contaminants, like silicone, can leave residue behind, either airborne or through direct contact.
Denise M. Korniewicz, PhD, RN, FAAN, Professor and Senior Associate Dean for Research at the University of Miami School of Nursing and Health Studies and School of Medicine, Department of Epidemiology has published the following guidelines for comparative medical gloves (Dr. Denise M. Korniewicz. Advantages and Disadvantages of Non-latex Surgical Gloves.):
| Table 1: Selection Guide for Gloves Used in Healthcare Settings | ||||||
|---|---|---|---|---|---|---|
Barrier Protection |
Strength & Durability |
Puncture Resistance |
Fit & Comfort |
Elasticity |
Allergenicity |
|
Latex |
Long-standing barrier qualities |
Strong, natural rubber is durable |
Has re-seal qualities |
Provides comfortable fit |
Natural ability due to elastic quality rubber |
Contains protein & chemical allergens low powder is preferred |
Neoprene (Chloroprene) |
Good but tear resistance is marginal |
Strong |
Has some puncture resistant qualities |
Provides a good fit, has some elastic ability that enhances fit |
Close to latex and allows for flexibility |
Contains no latex proteins but has some accelerator chemicals |
Nitrile |
Resistant to punctures & tears, flexes and does not develop holes |
Strong has puncture resistant qualities |
Has puncture resistant qualities |
Slightly tighter fit |
Less than latex over time tends to shape to wearer's hand |
Contains no proteins but contains some accelerator chemicals |
Vinyl |
Easily breaks during use, baggy |
Weak, breaks easily & punctures easily in use |
Punctures with sharps |
Fit limited baggy |
Dexterity compromised |
Contains no proteins but chemical accelerators |
Polyurethane |
Durable and high puncture resistance |
Excellent tear puncture and abrasion resistance |
Superior to latex for puncture resistance; mimics nitrile in performance |
Good comfort and fit; has latex-like qualities |
Elasticity is apparent |
Contains no latex proteins & no chemical accelerators |
Copolymer (Block Polymers) |
Good resistance to tears |
Stronger than vinyl; puncture resistance is fair |
Easy to puncture |
Latex like fit and comfortable |
Elasticity superior to vinyl but below latex |
Contains no latex proteins but some chemical accelerators |
Julie's Story Continued
Julie asked her doctor about her symptoms and he referred her to an allergist. The allergist suspected latex allergy based on her history and did a scratch test. Within minutes of the latex solution application, her arm became swollen, red, and itchy. Spirometry indicated that Julie has asthma, and since it had not been previously documented in her medical record, the allergist diagnosed latex allergy-induced asthma. Julie can no longer work in the ICU, so the employee health nurse is helping her find another job within the hospital that will be safe for her.
