The glove dilemma: why choice matters

Healthcare Purchasing News, Oct, 2008 by Kathleen B. Stoessel

There is a wide variety of medical gloves on the market today. Depending upon how they are manufactured, these gloves may be made from natural or synthetic materials, powdered or powder-free, colored or uncolored, and contain higher or lower residual substances such as Natural Rubber Latex [NRL] proteins and chemicals. NRL has been the gold standard for decades while synthetic alternatives such as nitrile and vinyl have become frequently used substitutes. The vast number of glove choices for healthcare personnel has created an interesting dilemma. The selection of inappropriate gloves can result in compromised barrier protection, glove-associated reactions and powder complications. The following review highlights critical considerations for the selection of medical gloves in the healthcare environment. These considerations for medical glove selection include their barrier integrity and associated complications.

Barrier integrity

A key consideration for the selection of medical gloves is barrier integrity.

Many healthcare personnel assume that all well manufactured gloves will maintain the same barrier protection throughout the course of their activities, but this is NOT an accurate assumption. Regardless of the quality of the manufacturing process, the material from which the glove is made will have its own strengths and limitations.

Base glove materials

The three primary materials from which examination gloves are made include natural rubber latex (NRL), and, two synthetic glove materials, acrylonitrile-butadiene (Nitrile), and polyvinyl chloride (Vinyl, PVC). Each of these materials will differ, sometimes dramatically, in strength and durability when subjected to various stresses under different conditions (See Image 1).

NRL gloves are made from a milk-like substance derived from the rubber tree, Hevea brasiliensis. Processed NRL has a molecular structure that allows for the properties of stretchability and elasticity that are ideal for tasks involving rigorous manipulation. These properties enable the glove to stretch when challenged and return rapidly to its original shape) NRL gloves are highly durable, (2) tear and puncture resistant and provide resistance to the penetration of many chemicals. They also provide excellent comfort, ease of movement and tactile sensitivity. (2,3) However, NRL gloves do have some limitations. The barrier properties of NRL may deteriorate when exposed to petroleum-based products, ozone, oxygen, or ultraviolet light. (2,4)

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Nitrile is a synthetic material comparable to NRL in maintaining its barrier protection during rigorous use. It is resistant to oil-based products, (5,6) glutaraldehydes, (3) and many other chemicals. (2) Nitrile gloves have excellent in-use durability and are highly resistant to abrasion and punctures. (7) They also provide excellent comfort, ease of movement and tactile sensitivity. (1,8) Nitrile does have some limitations. For instance, nitrile is susceptible to deterioration by ozone, oxygen, and ultraviolet light. Historically nitrile has not been as flexible as natural rubber latex.

Vinyl is a synthetic material that is resistant to oils and ozone and is generally less expensive than natural rubber latex or nitrile; however, vinyl has several limitations. Vinyl has a rigid and brittle molecular structure that can fracture or separate when the material is manipulated. Even with the addition of many chemicals used to enhance softness and stretchability, vinyl is still less capable than NRL and nitrile of maintaining its integrity when challenged during use? This material has limited elasticity and strength and does not withstand being snagged, repeatedly jabbed, or stretched. It has less durability and limited use with chemicals. It is not recommended for use with chemotherapeutic drugs, glutaraldehyde or alcohol. (9,10)

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In-use barrier performance studies

Table 1 is a summary of four published barrier studies performed on examination gloves over the last decade. In these studies, gloves were used for routine healthcare tasks [e.g., unscrewing caps off of irrigation fluid; manipulating sharp instruments, taping dressings in place and picking up different sized objects]. In all cases, the vinyl glove material had the highest percentage of barrier breach or leakage. The nitrile glove material did as well or better than the natural rubber latex material. Of particular Interest, the 2004 Kerr study noted that glove wearers are often not aware of a breach in their glove barrier protection. In fact, 78% of the barrier breaches were not recognized by the glove wearer, and the majority of these defects were located in the finger regions of the gloves. (8)

Associated complications

A second consideration when selecting gloves is their potential for eliciting reactions and powder complications.

Irritant and allergic potential

Medical gloves have been associated with irritant and allergic reactions. These glove-associated reactions have been divided into 3 types: Irritation, Type IV, Chemical Allergy, and Type I, Natural Rubber Latex (NRL) Protein Allergy.