Glove powders have a long history dating back to the late 19th century. The early
thick, gauntlet-style gloves that the Goodyear Rubber Company developed were reusable,
as they were capable of being sterilized by boiling, and the gloves were donned
over wet hands. As sterilization techniques were refined, wet glove over wet hand
donning could be abandoned. A dry method was needed in order to don gloves, and
powdered lubricants began to be used. Gloves continued to be reused, but were hand-powdered
in a powder box before being wrapped and steam-sterilized. By 1966, single-use gloves
became available, and continue to be the standard of care today.
POWDERED LUBRICANTS
There are three different points in the manufacturing process where powder is used:
1. Mold release agents make up the powder slurry that coats the glove former so
that the latex uniformly covers the former and the finished glove is able to be
removed from the former.
2. On the finished glove, a powder may be used to keep the gloves from sticking
together, also refered to as “blocking.”
3. On the finished glove, donning powder is applied to the inside of the glove so
that the wearer is able to put the glove on smoothly. The powder also acts to absorb
sweat from the hands of the wearer.
GLOVE MOLD RELEASING AGENTS
Talc and cornstarch have been used in the glove manufacturing process in order to
remove the finished product from the dipping mold. Today, a release agent such as
calcium carbonate may be used. Cornstarch is not usually used because it would dissolve
and disperse in the dipping solution. A powder-free coagulant can also be used.
Due to the continued reporting of talc complications, the ASTM specified in 1991
that the use of talc as a mold release agent was to be discontinued.
BLOCKING
To prevent blocking, some manufacturers use a powder to coat the glove so it does
not stick to itself. A cornstarch powder would be used for powdered gloves and a
post-process wash would be used for powder-free gloves.
DONNING LUBRICANT AGENTS
Lycopodium clavatum, or club moss, was one of the early lubricants in use
by approximately 1890. With its use came early reports of complications, including
masses and adhesions.
Talcum powder is a combination of magnesium silicate (chemically pure talc) and
calcium magnesium carbonate, calcium magnesium silicate, and possibly other substances.
It was an inexpensive donning powder. Talcum powder is not absorbed and behaves
like a foreign body, leading to an inflammatory response. A talc foreign body microscopically
appears flat and irregular in shape (Woods, 1997). Talc was implicated early in
its use for producing granulomas in tissue. Despite the reports in the literature
describing granuloma, adhesion, and inflammatory response to talc, it took a while
before a suitable substitute could be found. Various powders were experimented with,
but they could not withstand the time and pressure in the autoclave without clumping.
Additionally, removing glove powders was not a precaution practiced by the surgical
team.
The search for a suitable substitute to replace the above products ensued. Experiments
by Lee and Lehman (1947) led to the discovery of a mixture of cornstarch powder
treated with epichlorhydrin and other ingredients that was able to withstand the
autoclave and would be acceptable to the wearer. This cornstarch product replaced
the others. It was not without its problems, however, and further experiments by
Lee demonstrated that even this compound produced a foreign body-like reaction,
and adhesions were formed when the cornstarch was clumped together.
Today, gloving powders used for exam and surgical gloves must meet the USP monograph
for absorbable dusting powder or be shown to be equivalent in terms of safety and
effectiveness (Medical Glove Guidance Manual Draft, July 30, 1999). American Society
for Testing and Materials (ASTM) standards also apply.
POWDER ISSUES
Cornstarch powder has been determined to carry latex allergens (Hesse, 1997). It
has been suggested that the use of powdered gloves may be related to increases in
occupational asthma and latex allergies in healthcare workers. Skin breakdown from
the irritation caused by glove powder is also an issue with some healthcare workers.
In experiments by Newsom and Shaw, it was demonstrated that Methicillin-resistant
S. aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) may be able to use glove
powder as a vector and/or food source in a hospital environment (Newsom & Shaw,
1997).
In 1971 the FDA required manufacturers to label their glove packages with the following
warning:
“Caution: Powder should be removed from the gloves after donning by wiping gloves
thoroughly with a sterile wet sponge, sterile wet towel, or other effective method.”
Poor compliance with printed instructions has been cited in the literature, and
washing powder off gloves prior to surgery is not completed consistently. Some of
the reasons for poor compliance include the cost of materials and the time necessary
to complete the activity. Additionally, powdered gloves may be used in departments
that cannot wash them properly, as they do not have the materials readily available
to do so (i.e., ER, outpatient clinics, bedside, and interventional radiology).
A response to this situation has been to remove powdered gloves from the facility.
Several professional organizations have recommended the use of powder-free gloves
to reduce and/or eliminate the problems associated with powder use, such as:
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Early Dates
in Glove History
1917 – First reported talc granuloma (Shattock)
1933 – Post-op FB granuloma reported by Antopol found to contain Lycopodium (club
moss)
1935 – Erb reported 6 cases of Lycopodium granuloma
1936 – Owen described peritoneal nodules from use of glove powder containing talc
1943 – German reported 50 instances of talc granuloma
1947 – Roberts reported talc deposited in peritoneal cavity had migrated to fallopian
tubes, causing sterility in 5 women
1952 – Talc powder replaced by Bio-Sorb 1952 – Lehman and Wilder recommended washing
glove powder off gloves before use during surgery
1955 – Sneierson and Woo, cornstarch responsible for wound granuloma
1960 – Myers, “starch peritonitis” with replication of same in animal models
1960-1980 – Multiple reports from all over the world of cornstarch complications
involving larger studies series
1973 – Jagel and Ellis, adhesion formation
1976 – Cade and Ellis, peritoneal reaction
1978 – Walker, inflammatory reaction
Source: Woods et al., 1997
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