By Lori Jensen, R.N., Clinical Consultant, Ansell Healthcare Products LLC
Glove selection is serious business. The two primary considerations should always be barrier protection and allergen content. It is vital to examine available data on different materials to determine the type of exam glove that will be the most-proficient and meet the barrier protection needs of each healthcare worker. Most patient care activities require the use of a single pair of nonsterile gloves made of latex, nitrile or vinyl. However, because of allergy concerns, some facilities have eliminated or limited latex products, including gloves. For healthcare workers allergic to latex, the preferred recommendation as an alternative for medical examination gloves would be a latex-free material. Unfortunately, healthcare workers often presume that any gloving material is a proper barrier against blood-borne pathogen exposure. Frequently, this is not the case. When selecting a medical glove, an important consideration should be the barrier requirement related to the procedure or task at hand.
Years ago, there was only one non-latex medical glove material – vinyl. Today, there are three different type of synthetic materials used for exam gloves. When choosing an exam glove, it is necessary to be aware of the level of exposure risk the patient-care activities will require. Procedures that involve exposure to infectious material require a glove that provides appropriate barrier protection. It is important that the glove also fit well around the wrist. The Centers for Disease Control (CDC) recommends that gloves fit the user’s hand comfortably and should not be too loose or too tight. The glove should not rip, tear or damage easily, and it should be a glove that does not roll down. With this in mind, here is a review of the strengths and weaknesses of each latex-free material:
LATEX-FREE MEDICAL GLOVES
Nitrile is a petroleum-based, cross-linked film. It is extremely strong with puncture resistance that is superior to all glove films. Nitrile’s tensile strength is also typically better than other glove material. Nitrile’s elasticity is extremely high, and the gloves tend to conform to the shape of the wearer’s hands, providing good comfort and fit. The modulus (the force required to stretch the glove) of nitrile gloves is higher than other gloves, the material can feel a bit tighter, and you may have to go up a size. There are no latex proteins in nitrile, so there is no chance of Type 1 Latex allergy with use. Nitrile exhibits excellent chemical resistance and is recommended where high strength and/or chemical protection is required. Nitrile gloves are recommended as an alternative to NRL product and for conditions where high strength and chemical protection are required and for individuals with latex allergies. Although nitrile does not have latex proteins to cause Type 1 Latex allergy, they are made with accelerators and these accelerators could cause type IV allergies.
Neoprene is a generic name for polymers of chloroprene (2-chloro-l, 3-butadiene), which form a petroleum-based, cross-linked film that offers a similar fit, feel and barrier protection to latex. Available without chemical accelerators, neoprene contains no latex proteins, making it a great choice for anyone with Type IV chemical allergy. It is a strong material, and provides resistance to many chemicals (acids, alcohols, caustics, detergents, and ketones.) With a modulus very similar to NRL, it is comfortable to wear for long periods. Neoprene’s elasticity is close to that of latex with very high memory. The film is able to retain its original shape and is somewhat puncture-resistant. The work of some researchers has demonstrated that neoprene is the preferred barrier when handling the lypophilic form of some hazardous drugs. Neoprene gloves are recommended for individuals with latex allergies.
Polyvinyl Chloride (PVC)
Vinyl gloves are also frequently available and work well for appropriate tasks involving limited patient contact. Vinyl gloves may not provide a snug fit on the hand, especially around the wrist. Vinyl is a non-cross linked synthetic rubber called thermoplastic elastomer. Thermo means “heat” and plastic means “moldable”. Elastomer is simply an elaborate word that means “rubber”. So, a thermoplastic elastomer is a rubber that can be molded when heated. Vinyl is the least expensive glove of all of the synthetic gloves. However, vinyl should be chosen with caution because it lacks cross-linking, and the individual molecules of vinyl have a propensity to separate when the film is stretched or flexed. This causes small holes and breaches during glove donning and normal use. So even though the glove can stretch, it cannot recover, since the polymer chains are not connected. Since much weaker forces are binding the chains together, breaking them apart is much easier.
Vinyl may start to separate during a stretching process and initiate pinhole formation. Polyvinyl chloride (PVC), or vinyl, is prepared by the polymerization of vinyl chloride monomer. Plasticizers such as phthalate esters, phosphates and epoxidized oils are added to PVC to provide flexibility to the rigid polymer for use as gloves and other products. The quality of vinyl gloves can be measured by the barrier effectiveness, which involves assessment of leakage properties, in-use testing, permeability, bacterial transmission, and viral penetration. Vinyl has poor resistance to degradation by chemicals such as the alcohols used in swabbing down the work.
Vinyl gloves should not be used when handling chemotherapy drugs. Although vinyl does not have accelerators that could cause type IV allergies, skin irritations can develop due to different types of plasticisers used. Even though plasticizers are utilized in the creation of vinyl to give it better elasticity, providing a good fit, vinyl lacks elasticity and can only be stretched with difficulty; therefore the cuffs are often baggy, compromising barrier integrity and fit. Vinyl use should be limited to short procedures in low-risk situations that do not involve exposure to blood, body fluids or chemicals.
Strength and Durability
This is simply additional measures of barrier protection. Durability, including resistance to abrasion, punctures, and tears, is related to the tensile strength of the glove material.
Tensile strength is a measure of how much force is required to break the glove, measured in pounds per square inch (psi). Tensile strength is an important measure of barrier protection, in that a glove that breaks easily does not provide very good barrier protection.
Elasticity is the ability of a material to spring back to its original size, shape, or position after being stretched, squeezed, flexed, or expanded.
Crosslinking refers to the chemical bonding structure of the glove film. Crosslinked films tend to be stronger than films that are not crosslinked, because the individual molecules are linked to one another and therefore provide continuous interlocked structure with excellent elasticity and strength.
Puncture Resistance is the resistance of the barrier to cross-contamination that medical gloves are intended to provide.
Modulus refers to the amount of pressure that the stretched film exerts on the hand. In other words, it reflects the force required to reach a certain elongation, the stiffness of the material, or the amount of force required to move the hand in the glove.
Although chemical resistance is not the primary purpose of medical gloves, clinicians handle harsh chemicals in many situations. The chemical resistance of various glove films ranges from poor to excellent. Before handling dangerous chemicals, be sure to select a suitable glove.
It is important to recognize, however, that the least expensive glove is not always the most economical; conversely, the most expensive glove is not always the highest quality. The key to cost effectiveness in glove purchasing is to match the glove material to the task at hand.
The Health and Safety Act requires that employers provide appropriate personal protective equipment. Employers should provide suitable gloves that are available to prevent transmission of infection to healthcare professionals and prevent the transmission of infection to residents, clients and patients. Again, it is vital to remember that when selecting a medical glove, the two primary considerations should be barrier protection and allergen content. If a glove does not provide an intact barrier, it is not doing its job. It is important to remember disposable good quality gloves made of vinyl, nitrile, or neoprene can serve as adequate barriers, particularly when latex allergies are a concern. Employees should assess the risk of each procedure, choosing gloves that are appropriate for the task, and recommend alternative gloves if the ones available are not adequate. The following is suggested as a guide; non-latex gloves should be available for individuals with latex sensitivity. Vinyl gloves should be used for short tasks in which there is minimal stress to glove material. For housekeeping activities, instrument cleaning and decontamination procedures, general purpose reusable household gloves (e.g. neoprene, rubber, and butyl) are recommended. Medical gloves are not durable enough for these activities. Choosing the proper glove, made with the appropriate material for the task at hand, is a vital step in protecting health care providers and their patients and one that requires a well-informed decision.
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