Removing Latex Gloves from the Hospital: A Rationale Decision?
Non-latex sterile surgical gloves have been introduced into the operating room as a solution to increased reports among healthcare workers (HCWs) and patients who describe allergies associated with latex.
On the one hand, this reminds me of the pulling of all peanuts from the school system because 1% of kids have allergies. Especially due to the fact that non-latex sterile surgical gloves have not been used routinely for surgical procedures – neither have peanuts for that matter - and little has been documented about their barrier effectiveness with surgical use.
Nonetheless, and a fortunate first step since the horse is out of the barn and non-latex gloves are already in use – studies report that non- latex nitrile medical gloves are comparable to latex when used for basic patient care.
Similar findings related to the barrier quality of non-latex surgical gloves during routine surgical use were also reported. However, there are several advantages and disadvantages that have been reported consistently with the use of non-latex surgical gloves during routine surgery. As a result, HCWs remain concerned about risks associated with the barrier quality and overall safety of non-latex surgical glove use. Let’s have a closer look, shall we?
Advantages of Non-latex Surgical Gloves
Although non-latex surgical gloves have been available for years, it is only recently that they have been used exclusively in some healthcare institutions that have changed to a totally latex-free surgical environment.
There are three documented advantages for their use. First, one of the most widely recognised advantages of non-latex surgical gloves is their ability to provide an alternative hand protection for HCWs who are allergic to latex, or who provide care to patients with a known latex allergy.
Second, many of these synthetic materials (nitrile, neoprene and polyisoprene) have provided satisfactory hand protection and there has been limited evidence of problems with clinical use. Third, non-latex surgical gloves may be safer during surgery because they can readily alert the surgeon when they become breached.
The majority of reports have demonstrated that when surgeons use non-latex surgical gloves they are easily able to see a hole produced from a surgical instrument or a sharp. The tensile strength of non-latex surgical gloves is less than surgical gloves, so when holes appear the material tends to tear, allowing the surgeon to immediately change the glove.
However, latex surgical gloves have more flexibility and often reseal – thus surgeons are not aware when a hole appears. The inability of the surgeon to recognise a break in the barrier protection provided by the non- latex surgical glove limits the ability to change them in a timely manner and reduce the risk of infection transfer between the surgeon and patient.
This indirect advantage of non-latex surgical glove use may eventually impact on the decisions made in the selection of surgical gloves to ensure patient and healthcare employee safety.
Disadvantages of Non-latex Surgical Gloves
In addition, theree are several reported disadvantages of non- latex surgical glove use. First, non-latex surgical gloves appear to be more sensitive to conditions of use, with certain surgeries and types of HCWs at greater risk from glove failures. In a federally funded study to compare the failure rates of latex and non-latex surgical gloves following surgical procedures, non-latex gloves were found to have a significantly higher failure rate than latex surgical gloves.
Furthmore, the location on the defect on the glove was found to be different for non-latex
and latex gloves. In latex gloves, the defects were found primarily in the fingers (43.8%) while in non-latex gloves the most frequent location was the top of the gloves (36.9%). This may purport to be initial data, supporting research into the durability of specific gloves and the testing of both formulation and glove design.
Secondly, specific types of HCWs are also associated with increased non-latex glove failure.
Surgical technicians have a higher glove failure rate than any other surgical worker – including surgeons, despite wearing their gloves for shorter lengths of time during procedures and also changing their gloves more frequently. This finding is surprising and is not consistent with findings for other members of the surgical team.
Surgical residents were found to have the second highest defect rate and wore their gloves longer than surgical technicians.
Third, the type of surgical speciality is also related to the glove failure rate. Non-latex surgical gloves have been reported to have higher defect rates among surgeons who specialise in orthopaedic, plastics and cardiac services. Additionally, time or duration of use (length of time for operative procedure) has been a factor that has inhibited their widespread use. Latex gloves fail primarily due to length of use, whereas non-latex gloves are more sensitive to conditions of use (e.g. type of healthcare worker and surgery). Khoo noted that human factors such as skill of surgical personnel, operative difficulty, sharp exposure and types of surgical instruments that require fine hand motor movements inadvertently impact the incidence of glove defects.
Patient and HCW Safety
Since surgical gloves undergo a series of physical stresses such as twisting, pulling, stretching, exposure to bodily fluids or chemicals, it is not unusual for the barrier to become compromised. Surgical gloves act as a barrier to infection, therefore frequent changing of gloves and monitoring glove breaches from sharps or surgical instruments is imperative.
Surgical gloves that are compromised by unnoticed visible defects may be an indirect cause of surgical wound infection. Research demonstrated that a majority of non-latex glove defects were not always visible to the naked eye and may inadvertently expose HCW to bloodborne pathogens. Eighty-three per cent of glove defects pass unnoticed, which may contribute to the risk of cross- contamination of bloodborne pathogens such as hepatitis or HIV among exposed HCWs or patients.
Non-latex or latex surgical gloves that have unnoticed visible defects may be an indirect cause of surgical wound infection, especially non-latex surgical gloves that are coloured (pink, green and blue) and make it difficult for surgeons to distinguish a barrier breach.
Economic Considerations
Healthcare administrators prefer non-latex products; however, the demand and supply of these products remain inconsistent. The availability of non-latex gloves is dependent on the ability of synthetic manu-facturers to supply the raw materials for production. The costs for non-latex gloves passed along to the healthcare industry can be two to three times that of latex surgical gloves.
The demand for non-latex products and non- latex surgical gloves will need to increase tremendously before the price can be stabilised, therefore institutions may want to evaluate the costs associated with a commitment to an all-non-latex environment.
General Surgical Practice Guidelines When Using Non-latex Surgical Gloves
Non-latex surgical gloves can be safely used as an alternate hand barrier even though they remain inferior to latex surgical gloves. Based on the advantages and disadvantages that have been reported, it is recommended that:
• non-latex surgical gloves should be changed immediately when the barrier is breached;
• HCWs with less surgical experience may be at greater risk from exposure to bloodborne pathogens and therefore may require additional training when using non-latex surgical gloves, since they tend to break easily with use;
• HCWs in orthopaedic, oral, plastics and cardiac surgical suites need to adhere to the bloodborne pathogen regulations that require HCWs to frequently change their gloves, particularly when the barrier becomes compromised; and
• surgical personnel (surgeons and nurses) responsible for training surgical residents and scrub personnel need to emphasise frequent glove changes, particularly amongst trainees.
Future Trends in Non-latex Surgical Glove Use
The quality of non-latex surgical gloves is dependent on the type of material (nitrile, neoprene
or isoprene), glove manufacturer and stress during clinical use. Non-latex neoprene intact gloves are comparable to latex and can provide a safe alternative to latex among latex allergic patients and HCWs.
Nitrile continues to be too rigid as a surgical glove and is poorly rated amongst surgical personnel. Other features – such as powder – continue to be omitted as a donning agent for non-latex gloves, since recent data supports the discontinuation of powder as it enhances allergic symptoms. New non-latex gloves are continuously being developed to provide cost-effective quality barrier protection.
Renewed emphasis about patient and HCW safety poses new challenges for manufacturers. Innovative methods are needed to develop new gloves with anti-microbial properties to reduce cross-contamination between and among HCWs. Gloves in the future may provide added needle stick or sharp protection with the use of puncture-free materials. These challenges will force the provision of strict standards for glove manufacturers and will move the market towards the survival of quality non-latex gloves.
Denise M. Korniewicz, DNSc, RN, FAAN, is a Professor & Senior Associate Dean for Research, and Interim Assistant Dean of Student Services, Univertity of Miami.
Most latex allergies occur amongst repeat patients of the hospital, specifically those who are immune-compromised or are children. Health care workers, who wear gloves repeatedly and with regularity, do not seem to develop latex allergies in as great a proportion as do those who confront the same products as patients.
That being said, given my own development of dermatitis after several years of scrubbed, bacteria-free hands being submerged in powdered gloves, I can appreciate the cumulative affects (and effects) of chemicals to the skin.
“An estimated 1% to 6.5% of the general population is hypersensitive to NRL. Among health care professionals, the incidence increases to between 3% and 17%.7″
Vol. 15 •Issue 2 • Page 69
More Than a Workplace Danger
An Update on Latex Sensitivity
By Kara L. Scanlan, NP
I must add this to Tina’s comment. I am confused by her statement. The percentage of HCW’s with this allergy is higher than that of routine patients, it’s in all the stats published. I was an ER nurse for 17 years. When I switched in to the OR I began anaphylaxing every day and we didn’t know why. Turns out that the dermatitis that I had for years in the ER was early latex allergy. Going to the OR, where the powder with latex proteins in it, was much higher, pushed me over the edge. I am disabled from this now and my health has been compromised to a level of no recovery. The skin is the largest organ impacted by latex allergy. All those open cracks, etc allowed the latex protein to enter my system and go from a local reaction to systemic. Type 4 is the chemical reaction to the gloves, Type I is the systemic reaction to the latex protein.
Just my 2 cents since Tina says HCW’s have a lower chance of getting this.