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By Carolyn L. Twomey
In 1890, Dr. William S. Halstead acquired rubber gloves for his nurse who hadhand issues related to carbolic acid use in the perioperative arena.1The adaptation of gloves as a component of surgical attire followed quickly asthe reduction in surgical infections was noted. Today surgical gloves are justthat--an item worn in every case when an aseptic environment is essential.Historically, practitioners took gloves off the shelf without much thought tothe material from which they are made, the impact to the patient and thepractitioner from the materials used in the glove manufacturing process, theglove performance characteristics, or the quality of the protective barrier.
Today, more and more practitioners are educated on the issues of dermatitis,chemical allergy and latex protein allergy associated with the use of latexgloves.2 Nevertheless, the ongoing education of healthcarepractitioners remains an essential component of risk reduction for bothpractitioners and patients alike. In a recent paper published in The AmericanJournal of Infection Control, researchers found that although education wasprovided regarding latex allergies and powder, and alternative products wereoffered, practitioners failed to make the "right choice."3Today, as in 1997 when the National Institute of Occupational Safety and Health(NIOSH) Alert4 was released, many experts in the field of allergy andimmunology continue to stress the importance of choosing low protein powder-freegloves.5
Latex glove manufacturers have made significant strides in addressing theseissues. Latex protein levels have dropped across the board and the powder-freelatex glove has made its presence known.6 Today, the market has anumber of powder-free latex gloves, made donnable either through the use of analternative donning agent, such as a polymer coating, or through a finishingprocess which creates a surface that allows for ease of donning.7
It is helpful to understand what is happening in the glove market overall. Asawareness and understanding of the latex allergy and powder associated issueshave increased, the shift in the market has become quite clear. As of thirdquarter 2002, approximately one-third of the surgical glove market is powderfree. The powder-free sector of the surgical glove market is growing at adouble-digit pace while the surgical glove market overall is growing at asingle-digit pace.8 In addition, while synthetic gloves becameavailable when an alternative to latex was needed, in the last two years therehas also been an explosion in the synthetic (latex-free) market, not only involume growth (33 percent) but also in technology available.9 Today anumber of synthetic compounds from which the gloves are manufactured areavailable with a broad spectrum of performance characteristics. There has alsobeen the introduction of a synthetic double gloving system and a syntheticpuncture indication system--two key risk management tools. Some believe thatwithin a few years, powder-free and synthetic gloves will be the predominanttechnologies.10 The significance of this market shift makes itimperative that those involved in product selection or value analysis committeesunderstand the performance characteristics of both powder-free latex products aswell as the plethora of synthetic technologies. Keep in mind that gloveselection at the practitioner level is dependent upon:
At the committee level, the key to a successful glove selection process isthe determination of glove selection criteria to include such items as:
To complicate decision making, it is also important to understand theinterplay between the surgical glove selected and hand hygiene products as wellas surgical gowns, because indeed there are differences. The majority of gownsused today are manufactured with special coatings or proprietary fabrics toprevent strikethrough. However, these barrier characteristics of gowns may leadto a more slippery outer surface. Couple this with a glove that has a smoothinner surface to facilitate donning, and you may have an interface issue (oftenconsidered the most vulnerable area of our surgical attire11). Thisinterface issue and the potential for cuff slide down leads to the potential forcontamination and quality practice issues. Another interesting issue, addressedin a study by Dr. Kenneth Meyers and William Beck, found that the design of thegown sleeve (fullness gathered at the stockinette cuff) can compromise thesterile barrier. This design creates channels in the gathers of the gown thatallow blood and body fluids to run into the glove, soaking the stockinette--thecritical interface in the gown-glove interface.
Myers and Beck reported: "From these studies, we conclude thatprevention of liquid penetration of gown and glove requires sealing theirinterface. The exact nature of the sealant, specifics of manufacture, andmaintenance of sterility will need to be developed by industry, but it shouldnot be technically difficult once the two industries work in concert."12
Interestingly enough, anecdotal reports have also included the running ofsweat from inside the glove out through these same channels, soaking thestockinette cuff leading to barrier compromise.
Today, hand hygiene products for use as a surgical scrub include those thatare brushless and/or waterless. Anecdotally, some practitioners have reportedgreater drag on the hands and arms from some emollients or other components ofthe surgical scrub that remain on the hands and arms. Yet practitioners workingin sync with the industry have been able to overcome many of these difficulties.
It is critical that those involved in the purchase of surgical attirecomponents consider the relationship between the elements and explore theseissues with the vendors involved. Some glove manufacturers are responding toissues such as cuff slide down with changes in glove design so the cuff remainsmore securely on the gown. It is important to work with your manufacturers toaddress these issues because in all of the above mentioned situations,practitioners and manufacturers working together have been able to work throughthe issues.
As we go forward in healthcare, it is important to realize that our knowledgemust encompass the understanding of new technologies, not only in our areas ofexpertise, but also clearly understanding products that we evaluate and use. Weneed to ask about and understand product features, benefits, performancecharacteristics, challenges (issues) as they relate to product interaction withother medical devices or products, and solutions
Manufacturers that truly want to partner with you for the long term will bejust as interested in assuring your in-depth knowledge about their products asthey are in responding to your needs long after the product is implemented.
Carolyn L. Twomey is a clinical nurse consultant for Regent Medical.