Powdered gloves increase surgical complication risk

Adhesions, granulomas, decreased resistance linked

Same-day surgery managers and infection control experts have long been aware of the risk of latex gloves to patients with latex allergies, but the risks posed by the powder in gloves to all patients now is being addressed by surgery programs.

"There is substantial data and compelling evidence of the risks to surgical patients from powdered gloves, so our entire facility, including same-day surgery, went powder-free several years ago," says Victoria Steelman, RN, PhD, CNOR, advanced practice nurse at the University of Iowa Hospital and Clinics in Iowa City. "We’ve known that powder increased the exposure of employees to latex proteins, so protection of employees and patients of latex allergies is one reason to go powder free."

Reduction of the risk for post-surgical complications for patients is another good reason, she adds. These risks include adhesions, granulomas, aggravated inflammation, cytotoxic complications, clots, delayed healing, and fever, says Wava Truscott, PhD, director of scientific affairs and clinical education for Kimberly-Clark in Roswell, GA.

While patients undergoing lengthy, complicated procedures that are typically inpatient procedures are at highest risk, research does show that same-day surgery patients are at risk as well, she says. (For access to research summaries and names of specific articles, see resource at the end of this article.)

The use of trocars in minimally invasive surgeries for gynecological patients can deposit granules of powder from gloves into the incision just as ophthalmologic instruments can deposit powder into eyes during procedures, says Truscott.

It’s not just powder particles left on instruments or gloves that can cause problems, either, points out Steelman. Before going powder free, Steelman’s facility conducted air-sampling studies in different areas to determine the level of powder particles.

"Even in areas outside the surgical suite, we found particles that exposed people not wearing gloves to latex proteins," she says. Although staff members were rinsing gloves and washing hands after taking gloves off, the powder particles were escaping into the air and contaminating the environment, she adds.

Powder-free gloves are more expensive than traditional gloves, with the additional expense varying according to volume ordered and discount programs in which a same-day surgery program participates.

Prices for powder-free surgical gloves range from 75 cents to $1.20 on average per pair, as compared to traditional surgical gloves with powder that range from 30 cents to 50 cents on average per pair, according to a Kimberly-Clark spokesperson.

The extra cost is attributed to the process through which a glove undergoes to become powder free, says Truscott.

"All gloves start with powder on them in the manufacturing process," she says. The powder is necessary to remove the gloves from the forms on which they are made. "Once made, powder-free gloves go through multiple rinsing cycles then are turned inside out, and the rinsing process is repeated," Truscott explains.

Although the gloves may cost more than traditional gloves, the switch to powder-free gloves at Steelman’s facility was a break-even proposition.

"Once we looked at the time and supplies required for our staff to rinse their hands and gloves every time they donned or removed gloves, the cost difference was minimal," she points out.

Nancy Flannagan, RN, CNOR, quality improvement coordinator for surgical services at Piedmont Hospital in Atlanta, says, "When you reduce the risk of expenses associated with adhesions or allergic reactions in post-surgical patients, as well as employee health costs associated with employees’ allergic reactions, it just makes sense in both financial and patient care concerns to go powder free."

Staff health problems minimized

While concerned about the risk of post-surgical complications, Flannagan points out that reduction of the spread of latex protein through the powder is a great benefit of going powder free.

"We have a number of surgeons and staff members with latex allergies, and we realized that even if they had the option of latex-free gloves, the powder from latex gloves was in the air and the areas in which they worked," says Flannagan. "It’s not practical to think that a same-day surgery program can go completely latex free, but we can minimize the exposure to latex protein by going powder free."

Asking staff members and surgeons to switch to a glove that they traditionally have not used is not easy, admits Steelman. Before you switch to powder-free gloves, be sure you have administrative support for the move, she suggests.

Use evidence-based practices that are supported by research, and collect relevant information on your own same-day surgery program, such as post-surgical complications that are related to powder and numbers of staff members, patients, and surgeons allergic to latex, to make your case, she recommends.

"We standardized the glove we used throughout the entire hospital, not just the surgical areas," Steelman points out. "By using one vendor, we were able to choose a high-quality glove at a reasonable price," she says.

Be ready, however, to offer an alternative choice to surgeons or staff members, Steelman suggests. "At the beginning of our conversion to powder free, we also choose another glove that would serve as our optional glove," she says. "It, too, was powder-free but did have a different feel from our standard glove.

"The second glove made it possible for the same-day surgery manager to give surgeons some choices without compromising the facility’s commitment to powder free," Steelman explains.

Staff education prior to the switch to powder free included posters produced in-house and placed in locker rooms and other employee areas, she says.

"The posters explained that the switch to powder-free gloves improved patient and employee safety and were part of the hospital’s overall commitment to high-quality care," Steelman says.

Sources and Resource

For more information, contact:

  • Nancy Flannagan, RN, CNOR, QI Coordinator, Surgical Services, Piedmont Hospital, 1968 Peachtree Road N.W., Atlanta, GA 30309.
  • Victoria Steelman, RN, PhD, CNOR, Advanced Practice Nurse, University of Iowa Hospital and Clinics, 200 Hawkins Drive, Iowa City, IA 52242. Phone: (319) 356-4751. Fax: (319) 357-8234. E-mail: Victoria-steelman@uiowa.edu.
  • Wava Truscott, PhD, Director, Scientific Affairs and Clinical Education, Professional Health Care, Kimberly-Clark, 1400 Holcomb Bridge Road, Roswell, GA 30076. Phone: (770) 587-8447. Fax: (770) 587-7764. E-mail: wtruscott@kcc.com.

For more information about the risks associated with powdered gloves and current research on the topic, go to www.kchealthcare.com, click on "Knowledge Network," then choose "Article Reprints." Volumes 1, 2, and 3 of FirstHAND address issues surrounding powder and powder-free gloves. Free copies of FirstHAND also are available by calling (800) 524-3577.