Accommodating latex allergy concerns in surgical settings

AORN Journal, Oct, 2003 by Esah S. Yip

* One study concluded that primary prevention of occupational natural rubber latex allergies can be achieved if a change to powder-free latex gloves with reduced protein levels is properly carried out and maintained. (14) Another study similarly concluded that latex sensitization can be controlled by exclusive use of powder-free latex or synthetic gloves. (15)

These research studies indicate that the development of low-protein, low-allergen natural rubber latex gloves has provided a solution for alleviating the latex allergy problem.

BARRIER PROTECTION

Although it is necessary to accommodate the specific needs of individuals who are latex sensitive, it is vital that the most important criteria for wearing gloves--to protect all health care personnel and their patients against viral transmission and infectious diseases--is not overlooked. In addition to one's skin, gloves function as a defense barrier for patients and health care providers. This is particularly critical during surgical procedures, when contamination by microorganisms must be minimized to avoid infection. The effectiveness of the barrier is directly related to the appropriate selection and use of gloves.

The majority of examination and surgical gloves used in health care facilities are made of natural rubber latex, because they offer a less expensive means of providing the needed barrier protection and other qualities essential for safe and effective performance (eg, comfort, fit, good grip, tactility, durability, ease of donning). Concerns about latex protein allergy, however, have caused a number of health care facilities to seek alternatives. Polyvinyl chloride (PVC) and nitrile synthetic examination gloves are available today; however, because of the inferior properties of PVC gloves in strength, fit, tactility and in-use barrier performance, (16-27) no surgical gloves are made of this material.

Synthetic surgical gloves made of neoprene, nitrile, polyurethane, thermoplastic co-polymer, and the newly developed polyisoprene also have been introduced into the marketplace. As properties of gloves vary depending on the materials from which they are made, it is important to make an informed choice when selecting gloves for safe use, especially with reference to their in-use barrier performance.

Information on the barrier integrity of medical gloves now is available, especially for the three common types of examination gloves--latex, PVC, and nitrile. Numerous studies have compared in-use barrier performance of medical gloves made from synthetic materials, particularly PVC, and natural rubber latex. Ten studies by various clinical researchers show that PVC examination gloves consistently leaked significantly more than natural rubber latex gloves. (16-25) In one report, 63% of PVC gloves leaked compared to 7% of natural rubber latex gloves. (17) Inferior barrier property also has been reported for polyethylene gloves. (18) On the other hand, nitrile gloves, made of a synthetic that more closely approximates the properties of latex, display better barrier performance than PVC. (23,24)