Gloving Risk Management: Latex vs. Non-Latex Quality Assessment
Latex and non-latex gloves fail under different conditions. Latex gloves fail primarily due to length of use, whereas non-latex gloves are more sensitive to conditions of us (e.g., type of health care worker and type of surgery). Facilities can help health care workers guard against glove defects by double gloving and by changing gloves often, especially when using non-latex gloves in higher-risk surgeries.
These are the conclusions of a clinical trial I led. The study demonstrated differences in the barrier quality of latex and non-latex sterile surgical gloves during routine surgery.
Latex gloves are most vulnerable to time of use, more likely to fail after 6 hours of use. Non-latex gloves appear to be more sensitive to conditions of use, with certain surgeries and personnel types being at a higher risk of having a glove failure (although duration of 6 or more hours did not predict failure among the non-latex gloves, time may still be a factor, because gloves with defects were used for a significantly longer time than gloves without defects).
Because surgical gloves undergo a series of physical stresses such as twisting, pulling, stretching, amid exposure to body fluids or chemicals, it is not unusual for the barrier to become compromised. In our analysis of gloves that had been used in surgery, we realized the great majority of glove defects are not visible to the naked eye and may inadvertently expose HCWs blood borne pathogens.
This is a legitimate concern. Non-visible glove failure rates create the risk of cross contamination of blood borne pathogens such as hepatitis or HIV among exposed HCWs or patients. Surgical gloves that are compromised by unnoticed visible defects may also be an indirect cause of surgical wound infection.
Our results are consistent with the results of other studies that reported that up to 83% of glove defects go unnoticed to the naked eye. It is important to note that the rate of surgical glove defects was associated with the HCW’s role (surgeon, resident, first assistant, scrub person). Scrub personnel had higher defect rates but
changed their gloves more frequently, whereas surgical residents wore their gloves longer but had the second highest defect rate.
Additionally, the data showed that the majority of the glove defects occurred on the fingers and top of hand, which may be associated how instruments are passed from one HCW to another. Additional human factors that contribute to defects include the skill of surgical personnel, operative difficulty, sharp exposure, and types of surgical instruments that require fine hand motor movements.
Furthermore, untrained surgical personnel require additional experience to become proficient using protective gear, such as in donning gloves which may have caused scrub and surgical resident personnel to have higher glove defect rates. These findings support those of others who have suggested that the risks associated with one’s role in the operating room may depend on training, acquisition of clinical skills, and years of surgical experience. Because surgical gloves act as a barrier to infection, frequent changing of gloves and monitoring glove breaches from sharps or surgical instruments is imperative.
Material Type
Non-latex surgical gloves had higher defect rates than latex gloves and defects were consistently higher among specialties such as orthopedic, plastics, and cardiac services. However, glove type was but one among many factors, and the data are consistent with others who suggest that the type of surgery, duration of operative event, hand dominance, and surgical skill are factors associated with surgical glove defect rate.
Based on the results of this study, I recommend the following: (1) surgical gloves, regardless of material (latex or non-latex) should be changed frequently (worn less than 2 hours); (2) HCWs with less surgical experience may be at greater risk for exposure to blood borne pathogens, and specific training in handling procedures may be required or need to be updated; (3) HCWs working in orthopedic, oral, plastics, and cardiac need to adhere to the blood borne pathogen regulations that require HCWs to frequently change their gloves, especially when the barrier becomes compromised; and (4) surgical personnel (surgeons, nurses) responsible for training surgical residents and scrub personnel need to emphasize frequent glove changes, especially among learners.
Better equipment decisions will protect worker and patient, and greatly reduce costs of accidents and accidental infection in the OR. Best of all, glove decisions are ones that HCWs and their managers have control over and so make a positive difference in their work environment.
Denise M. Korniewicz, DNSc, RN, FAAN, is a Professor & Senior Associate Dean for Research, and Interim Assistant Dean of Student Services, Univertity of Miami.
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