Medical glove

Medical gloves are disposable gloves used during medical examinations and procedures to help prevent cross-contamination between caregivers and patients.[1] Medical gloves are made of different polymers including latex, nitrile rubber, polyvinyl chloride and neoprene; they come unpowdered, or powdered with cornstarch to lubricate the gloves, making them easier to put on the hands.[2]

Dentist wearing nitrile gloves.

Cornstarch replaced tissue-irritating Lycopodium powder and talc, but even cornstarch can impede healing if it gets into tissues (as during surgery). As such, unpowdered gloves are used more often during surgery and other sensitive procedures. Special manufacturing processes are used to compensate for the lack of powder.

There are two main types of medical gloves: examination and surgical. Surgical gloves have more precise sizing with a better precision and sensitivity and are made to a higher standard. Examination gloves are available as either sterile or non-sterile, while surgical gloves are generally sterile.[3]

Besides medicine, medical gloves are widely used in chemical and biochemical laboratories. Medical gloves offer some basic protection against corrosives and surface contamination. However, they are easily penetrated by solvents and various hazardous chemicals, and should not be used for dishwashing or otherwise when the task involves immersion of the gloved hand in the solvent.

History

Caroline Hampton became the chief nurse of the operating room when Johns Hopkins Hospital opened in 1889.[4] When "(i)n the winter of 1889 or 1890" she developed a skin reaction to mercuric chloride that was used for asepsis, William Halsted, soon-to-be her husband, asked the Goodyear Rubber Company to produce thin rubber gloves for her protection.[4] In 1894 Halsted implemented the use of sterilized medical gloves at Johns Hopkins.[5][6]

Glove materials
Latex
Neoprene

The first disposable latex medical gloves were manufactured in 1964 by Ansell. They based the production on the technique for making condoms.[7] These gloves have a range of clinical uses ranging from dealing with human excrement to dental applications.

Criminals have also been known to wear medical gloves during commission of crimes. These gloves are often chosen because their thinness and tight fit allow for dexterity. However because of the thinness of these gloves, fingerprints may actually pass through the material as glove prints, thus transferring the wearer's prints onto the surface touched or handled.[8]

The participants of the Watergate burglaries infamously wore rubber surgical gloves in an effort to hide their fingerprints.[9]

Sizing

Generally speaking, examination gloves are sized in XS, S, M and L. Some brands may offer size XL. Surgical gloves are usually sized more precisely since they are worn for a much longer period of time and require exceptional dexterity. The sizing of surgical gloves are based on the measured circumference around the palm in inches, at a level slightly above the thumb's sewn. Typical sizing ranges from 5.5 to 9.0 at an increment of 0.5. Some brands may also offer size 5.0 which is particularly relevant to women practitioners. First-time users of surgical gloves may take some time to find the right size and brand that suit their hand geometry the most[10]. People with a thicker palm may need a size larger than the measurement and vice versa.

Research on a group of American surgeons found that the most common surgical glove size for men is 7.0, followed by 6.5; and for women 6.0 followed by 5.5[11].

Powdered gloves

To facilitate donning of gloves, powders have been used as lubricants. Early powders derived from pines or club moss were found to be toxic.[12] Talcum powder was used for decades but linked to postoperative granuloma and scar formation. Corn starch, another agent used as lubricant, was also found to have potential side effects such as inflammatory reactions and granuloma and scar formation.[12]

Elimination of powdered medical gloves

With the availability of non-powdered medical gloves that were easy to don, calls for the elimination of powdered gloves became louder. By 2016, healthcare systems in Germany and the United Kingdom had eliminated their use.[12] In March 2016, the United States Food and Drug Administration (FDA) issued a proposal to ban their medical use[13] and on December 19, 2016 passed a rule banning all powdered gloves intended for medical use.[14] The rule became effective on January 18, 2017.[15]

Powder-free medical gloves are used in medical cleanroom environments, where the need for cleanliness is often similar to that in a sensitive medical environment.

Chlorination

To make them easier to don without the use of powder, gloves can be treated with chlorine. Chlorination affects some of the beneficial properties of latex, but also reduces[16] the quantity of allergenic latex proteins.[17]

Alternatives to latex
Main article: Latex allergy
Nitrile powder free gloves

Due to the increasing rate of latex allergy among health professionals, and in the general population, gloves made of non-latex materials such as polyvinyl chloride, nitrile rubber, or neoprene have become widely used. Chemical processes may be employed to reduce the amount of antigenic protein in Hevea latex, resulting in alternative natural-rubber-based materials such Vytex Natural Rubber Latex. However, non-latex gloves have not yet replaced latex gloves in surgical procedures, as gloves made of alternative materials generally do not fully match the fine control or greater sensitivity to touch available with latex surgical gloves. (High-grade isoprene gloves are the only exception to this rule, as they have the same chemical structure as natural latex rubber. However, fully artificial polyisoprene—rather than "hypoallergenic" cleaned natural latex rubber[18]—is also the most expensive natural latex substitute available.[19]) Other high-grade non-latex gloves, such as nitrile gloves, can cost over twice the price of their latex counterparts, a fact that has often prevented switching to these alternative materials in cost-sensitive environments, such as many hospitals.[20] Nitrile is a synthetic rubber. It has no latex protein content and is more resistant to tearing. Also it is very resistant to many chemicals and is very safe for people who are allergic to latex protein.[21] Nitrile gloves are the most durable type of disposable gloves.[22] Although nitrile gloves are known for their durability, extra care should be taken while handling silver and other highly reactive metals because those substances can react with sulfur, an accelerant in nitrile gloves.[21]

Double gloving

Double gloving is the practice of wearing two layers of medical gloves to reduce the danger of infection from glove failure or penetration of the gloves by sharp objects during medical procedures (For people with HIV and Hepatitis, surgeons use antivirus glove). This should better protect the patient against infections transmitted by the surgeon. A systematic review of the literature has shown double gloving to offer significantly more protection against inner glove perforation in surgical procedures compared to the use of a single glove layer. But it was unclear if there was better protection against infections transmitted by the surgeon.[23] Another systematic review studied if double gloving protected the surgeon better against infections transmitted by the patient. Pooled results of 12 studies (RCTs) with 3,437 participants showed that double gloving reduced the number of perforations in inner gloves with 71% compared to single gloving. On average ten surgeons/nurses involved in 100 operations sustain 172 single gloves perforations but with double gloves only 50 inner gloves would be perforated. This is a considerable reduction of the risk.[24]

References
  1. "Medical Gloves and Gowns". FDA. Retrieved 2010-03-10. Medical gloves are disposable gloves used during medical procedures. Medical gloves help prevent contamination between caregivers and patients. Some are designed to prevent contact with certain chemotherapy drugs. Medical gloves include examination gloves, surgical gloves, and medical gloves for handling chemotherapy agents (chemotherapy gloves). These gloves are regulated by the Food and Drug Administration (FDA). FDA makes sure that manufacturers of these devices meet performance criteria such as leak resistance, tear resistance, etc.
  2. "Glove manufacturing". Ansell.eu. Archived from the original on 2011-10-04. Retrieved 2012-12-14.
  3. "Personal Protective Equipment FAQ". Centers for Disease Control and Prevention. Retrieved 2013-06-08.
  4. S. Robert Lathan (2010). "Caroline Hampton Halsted: the first to use rubber gloves in the operating room". Proc (Bayl Univ Med Cent). 23 (4): 389–92. doi:10.1080/08998280.2010.11928658. PMC 2943454. PMID 20944762.
  5. "Hopkins Ceases Use Of Latex Gloves During Surgery". WJZ-TV. January 15, 2008. Archived from the original on October 11, 2008. Retrieved 2010-03-03. A surgeon at Johns Hopkins Hospital is credited with being the first to introduce the rubber surgical glove back in 1894.
  6. "Rubber Gloves". Johns Hopkins Hospital. January 14, 2008. Retrieved 2010-03-03. William Stewart Halsted, The Johns Hopkins Hospital’s first surgeon in chief, is credited as the first to develop and introduce rubber surgical gloves in the United States. That was in 1894, five years after the institution opened.
  7. "100 Years of Australian Innovation - latex gloves". Retrieved 2010-03-07. In 1945, Ansell designed and built the first automatic dipping machine, which produced 300 dozen pairs of synthetic gloves in eight hours. Ansell introduced disposable surgical gloves in 1964, which won the company an Export Award in 1967. International expansion over the next two decades saw Ansell become the world's largest producer of latex gloves for household and medical use.
  8. Robert Ramotowski (2012-10-18). Lee and Gaensslen's Advances in Fingerprint Technology, Third Edition. CRC Press. pp. 171–. ISBN 978-1-4200-8837-3.
  9. "Watergate". Spartacus.Schoolnet.co.uk. Archived from the original on 2012-12-03. Retrieved 2012-12-14.
  10. "Surgical Gloves Size Chart". Retrieved 2017-05-21.
  11. Berguer R, R; Hreljac, A (2004). "The relationship between hand size and difficulty using surgical instruments: a survey of 726 laparoscopic surgeons". Surgical Endoscopy. 18 (3): 508–512. doi:10.1007/s00464-003-8824-3. PMID 15100896.
  12. Robert Lowes (March 21, 2016). "FDA Proposes Ban of Powdered Medical Gloves". Medscape. Retrieved March 22, 2016.
  13. "FDA proposes ban on most powdered medical gloves". FDA. March 21, 2016.
  14. http://www.ada.org/en/publications/ada-news/2016-archive/december/fda-bans-most-powdered-gloves RET. JAN 10, 2017.
  15. https://www.federalregister.gov/documents/2016/12/19/2016-30382/banned-devices-powdered-surgeons-gloves-powdered-patient-examination-gloves-and-absorbable-powder RET. JAN 10, 2017.
  16. https://www.fda.gov/RegulatoryInformation/Guidances/ucm070925.htm
  17. Medical Glove Powder Report (Report). U.S. Food and Drug Administration. September 1997. Retrieved June 2, 2016.
  18. "User Labeling for Devices that Contain Natural Rubber (21 CFR 801.437); Small Entity Compliance Guide". Food and Drug Administration. Retrieved 2012-12-14.
  19. "Polyisoprene Surgical Gloves". SurgicalGlove.net. Retrieved 2012-12-14.
  20. "Advantages and Disadvantages of Non-latex Surgical Gloves" (PDF). touchbriefings.com. Retrieved 2012-12-14.
  21. "www.nps.gov/museum/publications/conserveogram/01-12.pdf" (PDF). www.nps.gov. Retrieved 2015-06-17.
  22. "What Are Nitrile Gloves? (with pictures)". Retrieved 2015-06-17.
  23. Tanner, J; Parkinson, H (2006). "Double gloving to reduce surgical cross-infection". The Cochrane Library (3): CD003087. doi:10.1002/14651858.CD003087.pub2. PMID 16855997.
  24. Mischke, C; Verbeek, J (2014). "Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel". The Cochrane Library (3): CD009573. doi:10.1002/14651858.CD009573.pub2. PMID 24610769.
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