US_Infectious_Yip.qxp 14/5/08 5:23 pm Page 68
Infection Control and Prevention
alongside colleagues wearing low-protein-latex gloves. One of the
Glove Powder and Powder-free Gloves studies even found that latex-allergic individuals could wear natural
rubber latex gloves with very low allergenic protein content, although it
Powdered Gloves is generally recommended that such individuals continue to wear
Cornstarch powder is used in the manufacture of latex gloves to synthetic substitutes.
prevent the sides from sticking together and to make it easier to put
the gloves on. The powder has been shown to absorb soluble Some studies reported that replacing high-protein gloves with the low-
proteins from gloves with high protein content during processing. protein variety resulted in cost savings ranging from $10,000 to
When dry, the powder particles can become airborne, carrying latex $200,000 per year. In fact, ECRI, one of the world’s leading independent
proteins with them. Inhalation of these aeroallergens is thought to organizations committed to advancing the quality of healthcare,
cause sensitization among some individuals, as well as eliciting recommends the use of latex gloves with a low-protein label or those
allergic reactions in those who are already sensitized. Many reports that are SMG-certified, especially the powder-free variety.
25
SMG is a
of latex protein allergy have been associated with the use of heavily quality-certification program that guarantees latex glove users a low
powdered gloves with high residual extractable protein content. content of both protein and powder, among other requirements. See the
However, improved glove manufacturing technologies today box on p. 69 for more information on the SMG program.
produce powdered gloves with vastly reduced protein/allergen
content, which greatly reduces the aeroallergenic potential. The significant positive impact of low-protein gloves has recently been
acknowledged in the US, as shown by the following statements:
Powder-free Gloves
Latex gloves with very little or no powder lubricant can be • “Low-protein, powder-free gloves dominate the market and have
prepared by either chlorination or polymer-coating. Both processes reduced exposures in the healthcare setting.” Donald Beezhold,
help to eliminate tackiness and reduce the residual soluble protein NIOSH, and Gordon Sussman, University of Toronto, Business Briefing:
content, mostly through extensive washing. Global Surgery – Future Directions, 2005.
• “At that time [mid-1990s] latex allergy peaked, and 8% to 12% of
substances. The soluble proteins present in the latex serum phase are people who used latex were sensitized to it. Now, that number is
largely lost when latex is processed into gloves, often leaving behind only down to about 1%. This is mainly due to a change in the way latex
a small amount of residual extractable protein. Not all of these residual gloves are manufactured… [which] has led to a 1,000-fold drop in the
extractable proteins cause allergic reactions. allergen content of the gloves.” Kevin Kelly, Chair of the Latex Allergy
Committee for the American Academy of Asthma, Allergy, and
Product Improvement Immunology, Health Link, Medical College of Wisconsin, 2005.
Because they are water-soluble, many of these remaining proteins can
be removed from latex gloves by proper processing. Improved
• “A large number of healthcare workers are back to work now, with
manufacturing technologies can now effectively reduce the residual
no fear of allergic reactions or asthma… Hospitals are more familiar
extractable protein fraction via appropriate pre- and post-leaching
with latex allergy now, and patients don’t have to be afraid to go into
protocols and the chlorination and/or polymer-coating process.
14
These
the hospital. If you have a latex allergy, it’s important to remember
new manufacturing techniques are far superior to those that were in use
to wear a medical alert bracelet or necklace. If you suspect you might
at the dawn of the AIDS epidemic, when the demand for latex gloves
be allergic to latex, be sure to get tested, and avoid contact with latex
spiked and hurriedly manufactured gloves with high levels of protein
in the meantime.” Kevin Kelly, Chair of the Latex Allergy Committee
began to flood the market. This older generation of gloves contained
for the American Academy of Asthma, Allergy, and Immunology,
levels as high as 1,000–2,000µg of residual soluble protein per gram of
Health Link, Medical College of Wisconsin, August 2005.
glove—high enough to cause sensitization and trigger allergic reactions
in latex-sensitive individuals.
14
In contrast, the current generation of latex
• “Healthcare workers shown to be latex-sensitive were therefore
gloves manufactured using the new techniques listed above can have
provided with non-latex gloves, and their co-workers with low or non-
levels as low as 100µg or less; this is especially true for powder-free latex
powder latex gloves… These maneuvers have reduced the prevalence
gloves. Aeroallergenicity—the potential to cause airborne allergens—is
of new latex-sensitive patients to a minimal degree, and it appears
also greatly reduced. See the box above for more information about
that the epidemic has been eliminated.” Jordan N Fink, Professor of
powdered and power-free gloves.
Pediatrics, Allergy Division, Medical College of Wisconsin, Business
Briefing: Global Surgery – Future Directions, 2005.
Allergy Alleviation
Recent hospital studies
15–24
in the US, Canada, and Europe show that Chemical Toxicity
wearing low-protein non-powdered or powdered latex gloves greatly The manufacturing of medical gloves—both synthetic and latex—
diminishes both the risk of allergic reactions and the likelihood of invariably involves the use of some chemicals. The chemical that is of
healthcare workers developing latex sensitivity. Studies have also shown most concern is di-2-ethylhexyl phthalate (DEHP), which is highly
that the use of low-protein powdered or non-powdered gloves allowed toxic. This is a plasticizer often used in the manufacture of vinyl
latex-sensitive individuals wearing synthetic gloves to work safely products, including gloves and some medical devices. It is added to
68 US INFECTIOUS DISEASE
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