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   Source To Surgery - February 1997, Vol. 5 Issue I

Glove Powders: What You Need to Know
Patricia Fleming, RN, Ansell Perry, Massillon, Ohio

Glove powders, used as both a donning lubricant and a mold-release agent, have been the subject of FDA regulation and much discussion in literature. Although talc was once commonly used as a donning agent, its use was discouraged by the FDA in 1972 due to its inability to be absorbed by the body. Today, virtually all manufacturers of powdered surgical gloves use a cornstarch derivative, USP Absorbable Dusting Powder, as a donning agent. However, clinical evidence regarding the hazards of glove powders for both healthcare professionals and their patients continues to mount.

Absorbable cornstarch powders have been found to cause adhesions, granulomas, fibrosis, contamination of donor organs, peritonitis, fistula formation and bowel obstruction.1 In 1971, the U.S. FDA issued a regulation requiring that a caution statement be printed on every surgical glove package, stating "Caution: After donning, remove powder by wiping gloves thoroughly with a sterile wet sponge, sterile wet towel, or another effective method." Tests have shown that common methods of glove washing are not only time consuming and ineffective, but can cause aggregation of the starch powder, making it resistant to absorption in the body.2

Not only are glove powders potentially hazardous to the patient, they can cause problems for the healthcare professional as well. Approximately 35% of healthcare professionals who wear medical gloves experience skin problems at sometime or another.3

Skin reactions may be:
Irritant Contact Dermatitis - Dry, crusty, hard bumps and horizontal cracks on the skin which may manifest as itchy dermatitis on the back of the hands under the gloves. Frequent hand washing, strong surgical scrubbing agents, soaps, detergents, glove powders and the occlusion caused by glove wear are many of the causes associated with irritant contact dermatitis.

Allergic Contact Dermatitis (Chemical Allergy, Type IV Reaction) - Allergic Contact Dermatitis, also known as Type IV reaction, is increasingly common among latex glove users. These reactions are typically caused by essential chemicals added during manufacturing to accelerate the vulcanization process, increase the elasticity, strength and durability of latex gloves, and to prolong shelf life.

Unfortunately, residual chemicals can be extracted onto the skin during use, resulting in allergic reaction. Symptoms include a red rash and palpable areas with bumps, sores and horizontal cracks. Reactions occur within several hours to several days after contact with offending chemicals. The affected area may extend beyond the glove and up to the forearm.

Immediate Contact Urticaria (Latex Allergy, Type I Reaction) - Serious concerns have emerged recently regarding Type I allergic reactions to natural rubber latex. Clinical research has shown that water-soluble proteins in the latex itself appear to be the primary cause, leaching out of the latex glove film and migrating onto the skin either directly or indirectly, through their adsorption on to glove powders. Symptoms range in severity from immediate contact urticaria (wheal and flare reaction, hives and eczema) to respiratory problems and occasional life threatening anaphylaxis.3

Although glove powders are not allergens themselves, they are an environmental contaminant which, through adsorption and binding of extract latex proteins, carry latex protein allergens through the medial environment.4 When airborne, inhalation of glove powders can cause a variety of respiratory problems.5

However, studies have shown that not all powdered gloves exhibit the same allergy levels. In order to reduce personnel exposure to latex allergies, Dr. Yunginger and his colleagues at the Mayo Clinic measured allergy levels in over 70 different pairs of exam and surgical gloves from a wide variety of manufacturers. In this study, Dr. Yunginger described a 3,000-fold difference in allergenicity among different glove brands. As a result of this study, the Mayo Medical Center and associated hospitals now purchase only gloves (powdered and powder-free) with the lowest amount of allergens. 6

Glove powders may also cause interference with laboratory diagnostic testing. Such interference has led to specimen contamination, misdiagnosis, false negatives and inappropriate treatment. This is clinically significant as it has been reported that the presence of starch glove powder contamination is capable of producing false negative results in enzyme-based assay for HIV virus in biological fluid.7

Costs associated with skin irritations due to glove powders may include; interruption in the quality of an employee's performance, reduced productivity, temporary employee replacement retraining, Workers' Compensation and potential loss of employment. The financial implications of glove powder contamination, such as extended hospital stay, repeated medical, surgical and laboratory procedures, costly glove washing procedures, increased liability, are substantial.

There are many factors to consider when making the choice of which glove to use. Not only must healthcare professionals consider fit, feel, comfort and price, they must also now consider the effects of glove powders.

There are two ways of effectively combating the problems associated with starch glove powder:

  1. Replace starch with an alternative powder, which is an effective lubricant to aid donning but which is truly inert and fully absorbable in body tissue.
  2. Replace powdered gloves with powder-free gloves.
The advantages of powder-free gloves over powdered gloves are obviously being recognized as statistics indicate the usage of powder-free surgical and examination gloves is increasing approximately 30% yearly.

REFERENCES

  1. Hunt, T.K., et al., Starch Powder Contamination of Surgical Wounds. Arch. Surg., 1994, 129, 825-826.
  2. A Closer Look at Perry Natural, Smith & Nephew Perry, May, 1992.
  3. Thompson, R., Clinical Manifestations: A Review, Source To Surgery, 1995 3, 5.
  4. Tomazic, V.J. et al. Cornstarch Powder on Latex Products is an Allergen Carrier. J. Allergy Clin. Immunol, 1994, 93, 751-758.
  5. Bauer, X. Jaeger, D. Airborne Antigens from Latex Gloves. Lancet, 1990, 1, 912.
  6. Mayo Medical Center Leads the Way in Stopping Sensitization of Patients & Healthcare Workers, Source to Surgery, Feb. '95, Vol. 3, Issue 1.
  7. Lampe A.S. et al., Wearing Gloves as Cause of False Negative HIV Tests. Lancet 1988, 2 (8620), 1140-1141.

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