What you really need to know about gloves

Rubber gloves have been protecting the lives of patients and healthcare workers since Sir William Halstead first introduced them to a Johns Hopkins operating theatre over 110 years ago [ 1 ] . No accurate estimates exist to tell us how many lives have been saved by gloves since that time but it must be numbered in the hundreds of thousands, if not millions.

Given the importance of preventing infection within the hospital environment it is essential that some of the knowledge that has been gathered in the past one-hundred years be passed on to today’s healthcare workers. This article presents five key points that aim to provide a basic foundation upon which to build that education.

• When to wear gloves.
  The purpose of wearing gloves is not solely to protect healthcare workers from infection. An equally important role is to reduce or prevent infection of the patient by the healthcare worker. With this in mind gloves should be worn whenever contact with bodily fluids or other infected materials is expected and should be changed between each patient to prevent the spread of hospital acquired infections. The use of alcohol gels to clean the outside surface of gloves is not recommended as this may lead to a degradation of the rubber.

• When to change gloves.
  When you perform any strenuous task whilst wearing a surgical or examination glove you run the risk of damaging the glove and being exposed to infection. [ 2 ] To safeguard yourself you should consider the duration and strain involved with the task and change your gloves at appropriate intervals. Remember, not all glove materials offer the same protection; vinyl gloves fail earlier than latex which in turn tend to fail earlier than nitrile.

• No guarantee of safety.
  Even with today’s modern technologies it is impossible to manufacture an affordable surgical or examination glove that is guaranteed to be free of holes. The permitted level for pinholes in medical gloves is AQL 1.5 [ 3 ] . Simplistically, this means that up to 1½ percent of examination or surgical gloves can have a hole; over one glove in every dispenser. Therefore, the glove helps to protect you but does not guarantee your safety. You can reduce your risk of infection by washing thoroughly after each glove change and by using a moisturiser to help maintain a healthy and intact skin.

• Allergy to natural rubber.
  Many articles have been written about the rise of latex allergy amongst hospital staff and patients [ 4 ] . This Type I hypersensitivity is caused by a number of proteins present in rubber taken from the Hevea Brasiliensis tree (the source of all commercial natural rubber in the NHS). The number of new allergy cases has decreased rapidly since the NHS ceased the use of powdered gloves but continues to be a disabling and potentially fatal complication for a number of patients and staff [ 5 ] . You can protect yourself by only wearing natural rubber gloves when they are required and by reporting any potential allergic reactions to Occupational Health who will investigate and may provide synthetic rubber alternatives.

• Allergy to process chemicals.
  Many natural and synthetic rubbers are manufactured using chemicals known as accelerators. These accelerators are often thiurams or dithiocarbamates, chemicals known to cause Type IV hypersensitivities (typically manifesting as itching, redness or dermatitis) [ 6 ] . Although reactions of this kind are never life threatening they can be debilitating and may severely affect an individual’s ability to perform their job. As with latex protein, protection comes from only wearing gloves when they are necessary and reporting any sign of allergy to the Occupational Health department. Occupational Health will provide further investigation and may be able to issue alternatives such as accelerator free gloves that have recently come onto the marketplace.

To find the correct balance the healthcare worker must understand the advantages and limitations of the gloves they use and must make informed decisions about when gloves are required and how often they should be changed. Buyers should seek out gloves that are low in proteins and accelerators to minimise the risk of potentially expensive and debilitating allergic reactions in patients and staff and Occupational Health Departments should inform themselves of the best practice for glove use and of the danger signs of allergy so that exposure can be halted before a serious reaction occurs.

John Spashett, Technical Manager - Medical, BM Polyco Limited