Latex Surgical Gloves Research Articles

Natural rubber latex allergy: Spectrum, diagnostic approach, and therapy

Latex allergy has reached epidemic proportions in the United States and is increasingly recognized as a significant contributor to morbidity and mortality during medical and surgical procedures. Ultimately, many of the affected patients with recognized latex sensitivity and those who are not yet diagnosed will receive treatment for their allergic reactions to latex in emergency departments. Consequently, emergency physicians must have a comprehensive understanding of the etiology, epidemiology, pathogenesis, treatment, and management of these challenging patients. Groups at high risk include spina bifida cystica patients, health care workers, latex industry workers, specific food-allergy patients, and patients with a history of atopy or multiple surgical procedures. Sensitization to latex antigens is commonly encountered in health care workers wearing latex gloves with high latex allergen concentrations and in workers using powdered latex surgical gloves. Exposure to air-borne allergens and water-soluble IgE reactive latex antigens from natural rubber latex products in sensitized individuals can result in type I (immediate) hypersensitivity reactions. Clinical manifestations include contact urticaria, dermatitis, allergic rhinitis, conjunctivitis, asthma, angioedema, and anaphylaxis. Diagnostic tools include serological assays and skin prick testing. At present, latex avoidance is the only available treatment and is the key to preventing allergic reactions in latex-sensitized individuals. Health care worker sensitization to latex antigens in natural rubber products is becoming an increasing contributor to workers' liability and disability claims. Specific action can be taken to reduce occupational and patient exposure to latex antigens.

Two methods of testing surgical gloves for perforations: Perceived and unperceived glove perforations during vascular surgery

Abstract The purpose of this study was to evaluate perceived versus unperceived glove perforations during vascular surgery using the FDA water test procedure and a newer more sensitive fluorescent dye technique. The two techniques were also compared to determine the degree of sensitivity of the fluorescent dye technique with the FDA water test. Three hundred five (305) gloves from a vascular surgery team were analyzed post‐surgically for perforations. One hundred fifty‐five (155) sterile surgical latex gloves and 150 non‐sterile latex gloves were collected and evaluated first using the FDA water leakage method then using a fluorescent dye technique. The fluorescent dye technique employs the use of a black light to examine the gloves following the addition of fluorescing dye to the original water in the glove. This technique makes it possible to detect even smaller perforations than detected by the FDA method. The dye technique was more sensitive in detecting perforations than the water technique approved ...

Effect of puncture resistant surgical gloves, finger guards, and glove liners on cutaneous sensibility and surgical psychomotor skills

New puncture and cut resistant hand protection systems have been developed to enhance the barrier to cuts and needle puncture injuries during surgical procedures. It is important, however, that these new hand protection systems do not reduce tactile sensitivity or dexterity during surgery. Consequently, it was the purpose of this report to compare the cutaneous sensibility and dexterity of physicians' hands covered by these new puncture and cut resistant hand protection systems to that of the standard surgical latex glove. The hide (Medak) portion of the Life Liner and the polyethylene (Spectra) portion of the FingGuard, which offered the greatest resistance to needle puncture, were associated with the greatest reduction in cutaneous sensibility, as determined by moving and static two-point discrimination, aesthesiometer pressure sensation, and discrimination of suture size and configuration. In addition, the physicians believed that the puncture and cut resistant Life Liner glove liner markedly interfered with their handling of surgical instruments. The ultimate benefit of these puncture and cut resistant hand protection systems must be determined in well-controlled clinical trials.

A new powder-free glove with a textured surface to improve handling of surgical instruments

A latex surgical glove has been designed to have a textured surface that simulates the surface of intact skin. This textured surface enhances security of grasp of surgical instruments under wet and dry conditions without altering tactile discrimination. The unique hydrogel polymer of this glove allows the glove to be donned with either wet or dry hands without the use of cornstarch lubricants.

Bronchial provocation testing in the diagnosis of occupational asthma due to latex surgical gloves.

In sensitized subjects, provocation tests to latex may induce severe systemic reactions and even anaphylactic shock. It is probable that part of the risk is due to the difficulty in grading the stimulating dose and in starting from very low levels of exposure. To identify the aetiological agent of work-related asthma in four nurses with previous allergic contact urticaria to latex surgical gloves dusted with cornstarch powder, we performed a specific bronchial provocation test study, based on exposure on three different days to nonpowdered latex surgical glove extract, powdered latex surgical glove extract and cornstarch powder extract, respectively. Extracts were nebulized in increasing concentrations in a 7 m3 challenge room, in the absence of the patients. The initial extract concentration was a tenfold dilution of the predetermined skin test end-point in the individual undergoing challenge, and the highest concentration was the undiluted extract. After exposure, the patients' forced expiratory volume in one second (FEV1) was monitored for 2 h. If FEV1 decreased by at least 15%, the next scheduled exposure was not carried out and FEV1 was monitored over a period of 24 h. Whereas nebulization of cornstarch powder extract caused no bronchial reaction in the patients, nebulization of nonpowdered latex surgical glove extract induced immediate bronchoconstriction in two subjects as an undiluted solution, and nebulization of powdered latex surgical glove extract induced immediate bronchoconstriction in all subjects at the 1:10 dilution. No systemic reaction was elicited by the bronchial provocation challenges. Our results demonstrate that airborne powder from latex gloves can be an inhalative occupational hazard.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of methyl methacrylate monomer on latex gloves

Medical personnel require protection from chemical and biological hazards during clinical procedures. Methyl methacrylate monomer (MMA), used in orthopaedic and dental surgery, is capable of permeating latex gloves and can cause painful skin irritation. In this study, scanning electron microscopy has been used to demonstrate degradation of surgical latex gloves by immersion in methyl methacrylate monomer, with and without extension of the gloves. A considerable quantity of monomer was absorbed into the latex samples (7–12% of the original weight), which slowly evaporated over 10 days. A 2–3% weight loss was determined for the two types of gloves tested. Fissuring of one type of latex glove was observed after 30 min immersion in MMA.

Toxicity and immediate allergenicity of latex gloves

Surgical latex gloves and a natural rubber latex (NRL) catheter were evaluated for biocompatibility by cell culture methods and Type I allergic reactions in operating room personnel using latex gloves. The prevalence of relevant immediate allergy to NRL was 5.2% when using eluates made from different latex gloves as allergens and the skin-prick test methodology. The reliability of a questionnaire in detecting the sensitized persons was limited. Weak positive skin test reactions to surgical latex glove eluates were found to be unreliable as compared with challenging with the corresponding glove. Latex gloves exhibited more toxicity in cell culture than non latex gloves, but, inversely, the toxic catheter gave weak positive skin-prick test reaction in only one sensitized person, confirming that the allergenicity and toxicity of natural rubber products do not refer to the same properties of the products. Catheters exhibiting toxicity in cell culture have earlier been found to cause significant clinical symptoms in operated patients, but in the case of surgical gloves this relationship is not clear. One glove brand with a low content of known sensitizing rubber chemicals caused clear toxicity in cell culture but was well tolerated by the hospital personnel.

Natural Rubber Latex Surgical Gloves

Natural Rubber Latex Surgical Gloves

Unsuspected glove perforation during ophthalmic surgery.

To determine the rate of perforation of surgical gloves after ophthalmic surgery and to identify factors that contribute to the development of perforations. Case-control study of used and unused surgical gloves collected during a 7-month period. The ophthalmology surgical suites of a major teaching hospital. Development of glove perforations as measured by five different techniques. We tested 103 pairs of latex surgical gloves before use and 454 pairs of gloves after use. Of five techniques used to test for pinholes, air inflation with water submersion and compression was found to be the most sensitive, yielding a 6.80% prevalence in control glove pairs and a 21.81% prevalence in study glove pairs (P = .0005). When examined by subspecialty area, the lowest perforation rate (11.39%; P = .00009) occurred in cataract and intraocular lens surgery and the highest rate (41.67%; P = .003) occurred in oculoplastic surgery. Factors that correlated significantly with the development of perforations as determined by multiple logistic regression analysis included pediatric ophthalmology and strabismus surgeries, oculoplastic surgeries, level of training of the surgeon, duration of operation, and larger glove size. The thumb and index fingers of the nondominant hand contained the largest numbers of pinholes. The rate of surgical glove perforation after ophthalmic surgery is relatively high. Recommendations for reducing the rate of glove perforation are discussed.

Surgical glove perforations in otolaryngology: prevention with cut-resistant gloves.

This study examines the role of cut-resistant, "orthopedic-type" gloves in prevention of exposure of surgical personnel to infectious body fluids through surgical glove perforation. The incidence of glove perforations in 12 consecutive cases of intermaxillary fixation (IMF) was studied. Surgeons were double-gloved with standard latex gloves and wore cut-resistant gloves between the outer and inner gloves. As controls, six cadaver heads were wired into IMF with surgeons double-gloving without the cut-resistant glove. The rates of latex glove perforation were then compared between the two groups. Fifty-three percent (32 of 60) of outer latex gloves, but no inner latex gloves (0 of 50) were perforated when surgeons wore cut-resistant gloves. In the control group, 45% of outer gloves (9 of 20) and 15% of inner gloves (3 of 20) were perforated. The difference of inner glove perforations--hence cutaneous exposure--between these two groups was statistically significant (p < 0.01). The use of cut-resistant gloves in addition to double-gloving with latex surgical gloves is recommended for facial plastic and reconstructive procedures with metal implants and major head and neck surgery, because these operations have a high rate of glove perforation. Because some loss of dexterity is noted when cut-resistant gloves are worn, the risk of glove perforation must be weighted against the need for optimal dexterity.

Surgical glove powders bind latex antigens.

Latex surgical gloves have recently been identified as a potential source of allergens. Much of the current information suggests that the soluble proteins in latex may cause significant reactions in sensitive individuals. The starch powders used as a lubricant on some latex gloves have also been identified as potential allergens in some patients. In this study, we determined these powders to act as potential carriers of latex allergens. We have produced a polyclonal antiserum to be used as a reagent to study latex proteins. By Western blot analysis, we identified a significant interaction between latex proteins and starch powders. The binding of latex proteins to starch particles results in a glove particle that may have an increased potential to act as an allergen. The latex protein-starch particles represent a potential mechanism for exposure and sensitization of health care workers to latex allergens. Elimination of these particles from the operating room should reduce the route of sensitization and the potential for adverse reactions to latex.

Characterization of latex antigens and allergens in surgical gloves and natural rubber by immunoelectrophoretic methods

Allergy to natural rubber (latex) products is increasingly frequent among both medical personnel and lay subjects. Although individual antigens and allergens in latex products have not been fully characterized, they are believed to derive from the sap of the rubber tree. Rabbit IgG and human IgE antibodies against rubber proteins were used to characterize antigens and allergens in surgical latex gloves and natural rubber by crossed immunoelectrophoresis and its modifications. The results from crossed-line immunoelectrophoresis demonstrated that the surgical latex gloves had at least 10 antigens in common with natural rubber sap and ammoniated latex. In crossed radioimmunoelectrophoresis, at least six of the 10 protein antigens in the surgical glove extract and natural rubber were allergens since they bound IgE antibodies from the latex-allergic patients' sera. The surgical glove extract also demonstrated one allergen not found in natural rubber, suggesting that rubber proteins may be altered during glove manufacture.

Immediate allergy to natural latex: clinical and immunological studies.

Since 1979 several reports of contact urticaria due to natural latex have been documented. In recent years cases of anaphylaxis, rhinitis, and asthma due to latex have appeared. Nine patients, studied in our clinic between 1986-1991, suffered immediate allergic reactions caused by rubber products. All showed an immediate skin reaction to latex extract. Rub testing with surgical gloves was positive in eight patients. Immunological techniques (RAST, ELISA, HRT) demonstrated specific IgE against latex. Specific bronchial provocation testing was performed in one patient who presented with asthma when she used latex surgical gloves. Patch testing to common rubber additives were negative in our patients. These results suggest that natural latex antigens present in rubber objects can cause hypersensitivity reactions probably due to IgE-mediated mechanisms.

Prick and use tests with 6 glove brands in patients with immediate allergy to rubber proteins.

20 patients with contact urticaria from rubber gloves were prick tested using eluates from 4 latex (Triflex, Ansell Gammex, Exona, Armi) and 2 non-latex (Tactylon, Elastyren) glove brands. All patients showed a positive prick test reaction to at least 2 latex glove eluates. A hypoallergenic glove (Ansell Gammex) gave a positive prick test reaction in 1 patient, but non-latex gloves were negative in all cases. All patients showed a positive result in the use test with a latex surgical glove (Triflex), whereas none did with a non-latex glove (Tactylon). Non-latex gloves and, in some cases, also hypoallergenic latex gloves, are a good alternative to rubber gloves for patients with immediate latex allergy.

Anatomy of a defective barrier

a) To determine the frequency of perforations in latex surgical gloves before, during, and after surgical and dental procedures; b) to evaluate the topographical distribution of perforations in latex surgical gloves after surgical and dental procedures; and c) to validate methods of testing for latex surgical glove patency. Multitrial tests under in vitro conditions and a prospective sequential patient study using consecutive testing. An outpatient dental clinic at a university dental school, the operating suite in a medical school affiliated with the Veteran's Hospital, and a biomechanics laboratory. Surgeons, scrub nurses, and dental technicians participating in 50 surgical and 50 dental procedures. We collected 679 latex surgical gloves after surgical procedures and tested them for patency by using a water pressure test. We also employed an electronic glove leak detector before donning, after sequential time intervals, and upon termination of 47 surgical (sequential surgical), 50 dental (sequential dental), and in three orthopedic cases where double gloving was used. The electronic glove leak detector was validated by using electronic point-by-point surface probing, fluorescein dye diffusion, as well as detecting glove punctures made with a 27-gauge needle. The random study indicated a leak rate of 33.0% (224 out of 679) in latex surgical gloves; the sequential surgical study demonstrated patency in 203 out of 347 gloves (58.5%); the sequential dental study showed 34 leaks in the 106 gloves used (32.1%); and with double gloving, the leak rate decreased to 25.0% (13 of 52 gloves tested). While the allowable FDA defect rate for unused latex surgical gloves is 1.5%, we noted defect rates in unused gloves of 5.5% in the sequential surgical, 1.9% in the sequential dental, and 4.0% in our electronic glove leak detector validating study. In the sequential surgical study, 52% of the leaks had occurred by 75 mins, and in the sequential dental study, 75% of the leaks developed by 30 mins. In terms of the anatomical localization, the thumb and forefinger accounted for more than 60% of the defects. There were no differences in the frequency of glove leaks between the left and right hand. Leak rates were highest for the surgeon (52%), followed by the first assistant (29%) and the scrub nurse (25%). No false negatives were noted using the electronic glove leak detector; one false positive was seen out of 225 gloves tested (0.44%), as noted in our validation studies. Significantly high glove leak rates were noted after surgical and dental procedures, indicating that the present day latex surgical gloves can become an incompetent barrier once they are used. Unused latex surgical gloves demonstrated a higher rate of defects than allowed by the Food and Drug Administration standards, indicating substantial noncompliance of quality control standards by manufacturers as well as inadequate governmental oversight. Double gloving, or the use of thicker latex surgical gloves, would probably reduce the frequency of glove leaks. Latex surgical gloves should be tested for patency before use and during surgical and dental procedures.

Allergenicity suppression in natural latex surgical gloves

By a revised manufacturing process we aimed to obtain latex surgical gloves without immediate allergenicity, and also to determine a simple physical technique by which to estimate this allergenicity. Five glove samples were evaluated for allergenicity by physical and biochemical methods and by skin tests at the University Allergy Centre. Three groups of allergic patients with documented anaphylaxis to surgical gloves, positive skin tests to latex extract and specific IgE to latex (RAST Pharmacia greater than or equal to class II), volunteered for the study. The protein content, the in vitro allergenic potency of glove supernatants (RAST inhibition) and the skin test results with glove supernatants were lower in washed gloves than in non-washed samples (P less than 0.02 to P less than 0.009). The supplementary effect of glove sterilization at 120 degrees C (for 1 h in saturated steam) was obvious. The protein content became undetectable in four of the five glove supernatants, and skin tests results with sample supernatants were decreased (M +/- SEM = 0.68 +/- 0.29 mm vs 3.06 +/- 0.61 mm with non-sterilized gloves), P less than 0.009 by Wilcoxon test. With the Spearman test there was a significant correlation (P = 0.029) between the mean wheal size, obtained with supernatants (Groups 1 and 2) and electrical conductivity. Skin tests through pieces of gloves randomly distributed and coded were decreased by sterilization: 0.66 +/- 0.25 mm vs 2.86 +/- 0.45 mm, P less than 0.0001. Thus, it is possible to decrease glove allergenicity by washing them after mould forming and then sterilizing with steam. Electrical conductivity may be a simple parameter for revealing allergenicity.

Hand Dermatitis: The Role of Gloves

The wide range of problems that occur in association with occupational skin exposure has brought into focus the need to understand the role of allergens in skin disease. Their impact on health, their role in the causation of skin disease, and the measures that can be instituted to regulate, control, and prevent skin problems are receiving increased attention by OR managers because of the associated costs of skin reactions in OR nurses and the inherent dangers associated with latex allergy. Latex gloves have become a standard part of OR attire, and even though they serve as the primary form of hand protection in the OR, gloves also may serve as one of the key causes of contact or allergic dermatitis in OR personnel. The high frequency of latex glove allergy, especially in OR nurses and surgeons, focuses attention on the need to evaluate the type and quality of surgical latex gloves selected for use. When instances of new skin reactions appear in nursing personnel. OR managers should look for recent changes in glove brands, scrub products, or antimicrobial agents as possible trigger allergens. In such circumstances, managers may wish to use hypoallergenic products as a solution. Although hypoallergenic and/or powder-free gloves or scrub products may be more costly on a unit basis, when compared to the time lost from work, physical discomfort of the worker, and the expense of treatment, they are really quite a bargain.

Efficacy of glove combinations in reducing cell culture infection after glove puncture with needles contaminated with human immunodeficiency virus type 1.

To study the effect of various latex and treated glove combinations in reducing the frequency of human immunodeficiency virus (HIV) infection of tissue culture cells after puncture by surgical needles contaminated with infectious human immunodeficiency virus type 1 (HIV-1). One, two, or three layers of sterile latex glove material, or two latex layers with intermediate cotton or Kevlar (with or without the virucidal compound nonoxynol-9) were used to cover 24-well cell culture dishes containing MT2 cells in cell culture medium. Surgical needles wet with cell culture medium containing HIV-1 (HTLV IIIA strain) were passed through the glove materials into the culture medium in the wells of the culture dishes. The culture medium in each well was then assayed biweekly for HIV-1 p24 antigen as a test for infection of cells in the well. The rate of HIV-1 infection of cell cultures after glove puncture was greater than 90% with a single latex surgical glove barrier, 23% to 60% with double or triple layers of latex gloves, less than 8% with an intermediate cotton glove impregnated with 4% nonoxynol-9, 6% with an intermediate Kevlar glove, and 0% with an intermediate Kevlar glove impregnated with nonoxynol-9. An intermediate glove of Kevlar or of Kevlar or cotton impregnated with virucidal compound nonoxynol-9 between standard latex gloves may improve surgical glove safety, compared with latex gloves alone with respect to needlestick transmission of HIV-1. The experimental model used may permit rapid investigation of other glove systems as barriers to the transfer of infectious agents through gloves by needlestick.

Surgical Latex Glove Allergy: Characterization of Rubber Protein Allergens by Immunoblotting

Immunoblot analysis employing IgE antibodies derived from sera of 3 physicians and 2 nurses allergic to surgical latex gloves, disclosed 10 allergens in natural rubber sap. Nine of the 10 allergens were detected in ammoniated natural rubber latex, but only 4 allergens in a latex glove extract. The allergenic proteins had apparent molecular weights ranging from 14 to 70 kD. Allergens with molecular weights of 14 and 21 kD showed the most intense immunoblot reactions suggesting that these proteins could be the major allergens in the natural rubber. An 11-kD protein and a 26-kD protein were only seen in the glove extract, indicating that they could be modified rubber proteins formed during glove manufacture.

Permeation of Cancer Chemotherapeutic Drugs Through Glove Materials under Static and Flexed Conditions

Abstract Gloves are the most common protective measure against contamination with antineoplastics. However, there is no consensus about which glove material offers the best protection. There are few data on the permeability of gloves to this group of potential carcinogens. All studies have been conducted under static conditions, with no attempt at simulating the flexing and stretching that may be present in the occupational setting. Flexing has been shown to increase the permeability of glove materials to certain chemicals. To investigate the effects of flexing on permeation by antineoplastics, a permeation cell apparatus was modified so that glove materials could be flexed during testing. Surgical latex, exam latex, and polyvinyl chloride (PVC) gloves were tested with four drugs: cyclophosphamide, doxirubicin, methotrexate, and 5-fluorouracil. Utilizing radiolabeled compounds and liquid scintillation counting for a direct and sensitive analytical technique, gloves were tested at times representative of o...