If the gloves fit, check them out

HCWs need voice in glove selection

 Are your gloves the right fit for your hospital? To answer that, you need to consider much more than just whether they contain latex or powder. Does the level of tear resistance match the tasks of the wearer? Is the manufacturer known for quality? Is there a method for monitoring breaks in barrier protection? Did health care workers help choose the gloves they prefer?

Those are just a few of the questions that hospitals need to ask before selecting gloves, advises Denise M. Korniewicz, DNSc, RN, FAAN, professor at the University of Maryland School of Nursing in Baltimore and an expert on glove quality.

In fact, she has one overriding question for those who make glove purchasing decisions at hospitals: "Do we always look at the bottom dollar amount or do we actually ask some questions about the quality of gloves?"

To follow federal guidelines, health care workers need to wear gloves when they have contact with patients or blood and bodily fluids. Although no mention is made of the type of glove, not every glove is equal to its task, Korniewicz notes.

For example, vinyl and copolymers are known to have the least resistance to tears and punctures. Neoprene and nitrile have stronger properties, and latex has the ability to reseal after a puncture. "There are many issues related to gloves that aren’t as simple as people make [them] out to be," she says.

Here are some issues to consider as you select gloves:

Allergenic properties

Latex allergy is a problem that affects an estimated 8% to 12% of health care workers. Some hospitals have switched to powder-free and low-protein products to reduce the risk of sensitization while offering alternatives to those with latex allergy. Others have chosen to replace all latex gloves with nonlatex synthetics. However, even the synthetic gloves, such as neoprene, may contain chemical accelerants that cause a reaction in some health care workers.

"A lot of institutions are worried about latex sensitization or latex allergy. They jump to a non-latex product that may or may not be powdered, and they’re still having problems," Korniewicz says.

She recommends using powder-free gloves, whether latex or latex-free, and taking into consideration other allergy issues. Some latex-sensitive employees may be able to tolerate low-protein gloves; others may need a protection against an irritating accelerant.

Barrier integrity

Barrier integrity is a criteria that is directly related to the use of the gloves. If a phlebotomist is wearing the gloves for 30 seconds while drawing blood, there is little opportunity for a tear or degradation to occur. (A needlestick could penetrate any of the glove types.) However, tear-resistance and monitoring of glove integrity becomes very important when the wearer is involved in hours of surgery, she notes.

In one study, Korniewicz tested 1,254 pairs of gloves used in emergency department procedures and found that about 10% of them leaked. Only 1% of the nonused control pairs leaked. The glove failure rate nearly doubled after 20 minutes of wear.1 Various rates of glove failure (as high as 60%) also have been reported among surgical personnel.2

A double-gloving system with different colored gloves can allow the health care worker to tell if the glove integrity has been breached. The worker can then remove the gloves, wash hands, and don a new pair.

Comfort and fit

It’s important to involve health care workers in the selection of gloves, says Korniewicz. "They know if the glove works or it doesn’t; if it feels good or it doesn’t," she says.

As with other protective products, new gloves will be accepted more readily if the end user has a voice in the process. "Any time they introduce a new glove into a new area, one suggestion could be to hand a survey to your employees," she says. "Give them the gloves for a month or two weeks and follow up with a short survey."

Manufacturing quality

There are clear differences between glove types: their fit, their feel, their resistance to tears. Yet gloves also vary in quality by manufacturer. "There are quality differences in every product one buys, not just gloves," Korniewicz notes.

While gloves must meet basic standards set by the Food and Drug Administration (FDA), their durability and resistance to tears may differ.

Korniewicz suggests asking manufacturers for studies that show the barrier effectiveness of their gloves. "The better manufacturers have [done studies], and they will actually have data related to that," she points out.

A proposed FDA rule that would provide labeling of protein and powder content has been long-delayed. Meanwhile, Korniewicz is working on a rating system that would provide an independent method for determining glove quality. "You know an A’ tire; if it has an A’ rating, it’s an excellent tire. If you have a C’ tire, it doesn’t get as many miles on it. It’s the same in the health care world, but I don’t think that’s realized," she says.

References

1. Hansen KN, Korniewicz DM, Hexter DA, et al. Loss of glove integrity during emergency department procedures. Ann Emerg Med 1998; 31:65-72.

2. Korniewicz DM, Rabussay D. Surgical glove failures in clinical practice settings. AORN J 1997; 66:660-673.