Latex Glove
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Medical gloves are disposable
glove A glove is a garment covering the hand, with separate sheaths or openings for each finger including the thumb. Gloves protect and comfort hands against cold or heat, damage by friction, abrasion or chemicals, and disease; or in turn to provide a ...
s used during medical examinations and procedures to help prevent cross-contamination between caregivers and patients. Medical gloves are made of different polymers including
latex Latex is an emulsion (stable dispersion) of polymer microparticles in water. Latices are found in nature, but synthetic latices are common as well. In nature, latex is found as a wikt:milky, milky fluid, which is present in 10% of all floweri ...
,
nitrile rubber Nitrile rubber, also known as nitrile butadiene rubber, NBR, Buna-N, and acrylonitrile butadiene rubber, is a synthetic rubber derived from acrylonitrile (ACN) and butadiene. Trade names include Perbunan, Nipol, Krynac and Europrene. This rubber is ...
,
polyvinyl chloride Polyvinyl chloride (alternatively: poly(vinyl chloride), colloquial: vinyl or polyvinyl; abbreviated: PVC) is the world's third-most widely produced synthetic polymer of plastic (after polyethylene and polypropylene). About 40 million tons of ...
and
neoprene Neoprene (also polychloroprene) is a family of synthetic rubbers that are produced by polymerization of chloroprene.Werner Obrecht, Jean-Pierre Lambert, Michael Happ, Christiane Oppenheimer-Stix, John Dunn and Ralf Krüger "Rubber, 4. Emulsion Rub ...
; they come unpowdered, or powdered with
corn starch Cornflour, cornstarch, maize starch, or corn starch (American English) is the starch derived from corn (maize) grain. The starch is obtained from the endosperm of the seed, kernel. Corn starch is a common food ingredient, often used to thick ...
to lubricate the gloves, making them easier to put on the hands. Corn starch replaced tissue-irritating
lycopodium powder Lycopodium powder is a yellow-tan dust-like powder, consisting of the dry spores of clubmoss plants, or various fern relatives. When it is mixed with air, the spores are highly flammable and are used to create dust explosions as theatrical spe ...
and talc, but even corn starch can impede healing if it gets into tissues (as during surgery). As such, unpowdered gloves are used more often during surgery and other sensitive procedures. Special manufacturing processes are used to compensate for the lack of powder. There are two main types of medical gloves: examination and surgical. Surgical gloves have more precise sizing with a better precision and sensitivity and are made to a higher standard. Examination gloves are available either
sterile Sterile or sterility may refer to: *Asepsis, a state of being free from biological contaminants * Sterile (archaeology), a sediment deposit which contains no evidence of human activity *Sterilization (microbiology), any process that eliminates or ...
or non-sterile, while surgical gloves are generally sterile. Besides medicine, medical gloves are widely used in chemical and biochemical laboratories. Medical gloves offer some basic protection against corrosives and surface contamination. However, they are easily penetrated by solvents and various hazardous chemicals, and should not be used for dishwashing or otherwise when the task involves immersion of the gloved hand in the solvent. Medical gloves are recommended to be worn for two main reasons: # To reduce the risk of contamination of health-care workers hands with blood and other body fluids. # To reduce the risk of germ dissemination to the environment and of transmission from the health-care worker to the patient and vice versa, as well as from one patient to another.


History

Caroline Hampton became the chief nurse of the operating room when
Johns Hopkins Hospital Johns Hopkins Hospital (JHH) is the teaching hospital and biomedical research facility of Johns Hopkins School of Medicine in Baltimore, Maryland. Founded in 1889, Johns Hopkins Hospital and its school of medicine are considered to be the foundin ...
opened in 1889. When "in the winter of 1889 or 1890" she developed a skin reaction to
mercuric chloride Mercury(II) chloride (mercury bichloride, mercury dichloride, mercuric chloride), historically also sulema or corrosive sublimate, is the inorganic chemical compound of mercury and chlorine with the formula HgCl2, used as a laboratory reagent. ...
that was used for
asepsis Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
,
William Halsted William Stewart Halsted, M.D. (September 23, 1852 – September 7, 1922) was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced sever ...
, soon-to-be her husband, asked the Goodyear Rubber Company to produce thin rubber gloves for her protection. In 1894 Halsted implemented the use of sterilized medical gloves at Johns Hopkins. However, the first modern disposable glove was invented by Ansell Rubber Co. Pty. Ltd. in 1965. They based the production on the technique for making
condoms A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both external condoms, also called male condoms, and internal (female) ...
. These gloves have a range of clinical uses ranging from dealing with human excrement to dental applications. Criminals have also been known to wear medical gloves during commission of crimes. These gloves are often chosen because their thinness and tight fit allow for dexterity. However, because of the thinness of these gloves, fingerprints may actually pass through the material as glove prints, thus transferring the wearer's prints onto the surface touched or handled. The participants of the Watergate burglaries infamously wore rubber surgical gloves in an effort to hide their fingerprints.


Industry

In 2020, the market for medical gloves had a value of more than USD 10.17 billion and, with growing demand (especially in developing countries), is expected to grow by 9.2 per cent per year until 2028. The majority of medical gloves is manufactured in South East Asia with
Malaysia Malaysia is a country in Southeast Asia. Featuring the Tanjung Piai, southernmost point of continental Eurasia, it is a federation, federal constitutional monarchy consisting of States and federal territories of Malaysia, 13 states and thre ...
alone accounting for about three quarters of global production in 2020.


Labour rights violations

There have been several investigations in factories in Malaysia,
Thailand Thailand, officially the Kingdom of Thailand and historically known as Siam (the official name until 1939), is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. With a population of almost 66 million, it spa ...
and
Sri Lanka Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka, also known historically as Ceylon, is an island country in South Asia. It lies in the Indian Ocean, southwest of the Bay of Bengal, separated from the Indian subcontinent, ...
that documented severe violations of human and
labour rights Labor rights or workers' rights are both legal rights and human rights relating to labor relations between workers and employers. These rights are codified in national and international labor and employment law. In general, the ...
. Both in Malaysia and Thailand migrants represent the majority of workers in hard physical labour. They are frequently recruited by specialized agencies in their less affluent home countries such as
Nepal Nepal, officially the Federal Democratic Republic of Nepal, is a landlocked country in South Asia. It is mainly situated in the Himalayas, but also includes parts of the Indo-Gangetic Plain. It borders the Tibet Autonomous Region of China Ch ...
and are often charged with high recruitment fees forcing them into
debt bondage Debt bondage, also known as debt slavery, bonded labour, or peonage, is the pledge of a person's services as security for the repayment for a debt or other obligation. Where the terms of the repayment are not clearly or reasonably stated, or whe ...
. There are documented cases in which employees' passports were withheld by their employers leaving them especially vulnerable to exploitation. In 2010, for instance, Swedwatch, a Swedish labour right NGO examining a Malaysian factory, reported that most employees were working 12 hours per day seven days a week without overtime pay or payslip, harassment of workers by the management, safety deficits and poor hygienic conditions in employee housing. Reacting to these findings, from October 2019 to March 2020, the
US Department of Labor The United States Department of Labor (DOL) is one of the executive departments of the U.S. federal government. It is responsible for the administration of federal laws governing occupational safety and health, wage and hour standards, unemp ...
listed medical gloves produced in Malaysia on the
List of Goods Produced by Child Labor or Forced Labor The ''List of Goods Produced by Child Labor or Forced Labor'' is an annual publication issued by the United States Government's Bureau of International Labor Affairs at the U.S. Department of Labor. It has been published within the December 2014 ...
and temporarily banned the import of gloves produced by the Malaysian company Top Glove, the world's largest manufacturer at the time.


Sizing

Generally speaking, examination gloves are sized in XS, S, M and L. Some brands may offer size XL. Surgical gloves are usually sized more precisely since they are worn for a much longer period of time and require exceptional dexterity. The sizing of surgical gloves are based on the measured circumference around the palm (excluding the thumb) in
inch The inch (symbol: in or prime (symbol), ) is a Units of measurement, unit of length in the imperial units, British Imperial and the United States customary units, United States customary System of measurement, systems of measurement. It is eq ...
es, at a level slightly above the thumb's sewn. Typical sizing ranges from 5.5 to 9.0 at an increment of 0.5. Some brands may also offer size 5.0. First-time users of surgical gloves may take some time to find the right size and brand that suit their hand geometry the most. People with a thicker palm may need a size larger than the measurement and vice versa. Sizing should be one of the first thing to look for. Dexterity is essential for every worker and wearing the wrong size of glove can have a huge impact on someone's work. Wearing the right size of glove can also increase comfort, which can influence workers to wear their assigned PPE. Research on a group of American surgeons found that the most common surgical glove size for men is 7.0, followed by 6.5; and for women 6.0 followed by 5.5.


Powdered gloves

To facilitate donning of gloves, powders have been used as lubricants. Early powders derived from
pine A pine is any conifer tree or shrub in the genus ''Pinus'' () of the family Pinaceae. ''Pinus'' is the sole genus in the subfamily Pinoideae. ''World Flora Online'' accepts 134 species-rank taxa (119 species and 15 nothospecies) of pines as cu ...
s or club moss were found to be toxic.
Talcum powder Talc, or talcum, is a clay mineral composed of hydrated magnesium silicate, with the chemical formula . Talc in powdered form, often combined with corn starch, is used as baby powder. This mineral is used as a thickening agent and lubricant. ...
was used for decades but linked to postoperative
granuloma A granuloma is an aggregation of macrophages (along with other cells) that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such sub ...
and scar formation.
Corn starch Cornflour, cornstarch, maize starch, or corn starch (American English) is the starch derived from corn (maize) grain. The starch is obtained from the endosperm of the seed, kernel. Corn starch is a common food ingredient, often used to thick ...
, another agent used as lubricant, was also found to have potential side effects such as inflammatory reactions and granuloma and scar formation.


Elimination of powdered medical gloves

With the availability of non-powdered medical gloves that were easy to don, calls for the elimination of powdered gloves became louder. By 2016, healthcare systems in Germany and the United Kingdom had eliminated their use. In March 2016, the
United States Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...
(FDA) issued a proposal to ban their medical use and on December 19, 2016 passed a rule banning all powdered gloves intended for medical use. The rule became effective on January 18, 2017. Powder-free medical gloves are used in medical
cleanroom A cleanroom or clean room is an engineered space that maintains a very low concentration of airborne particulates. It is well-isolated, well-controlled from contamination, and actively cleansed. Such rooms are commonly needed for scientifi ...
environments, where the need for cleanliness is often similar to that in a sensitive medical environment.


Chlorination

To make them easier to don without the use of powder, gloves can be treated with
chlorine Chlorine is a chemical element; it has Symbol (chemistry), symbol Cl and atomic number 17. The second-lightest of the halogens, it appears between fluorine and bromine in the periodic table and its properties are mostly intermediate between ...
. Chlorination affects some of the beneficial properties of latex, but also reduces the quantity of allergenic latex proteins.


Polymer coating

On the market, it is a wide range of applications for polymer coatings in the market. Most of the current disposable gloves are powdered. These coatings include several polymers: silicone, acrylic resins, and gels that make gloves easier to wear. This process is currently used in nitrile gloves and latex gloves.


Alternatives to latex

Due to the increasing rate of latex allergy among health professionals, and in the general population, gloves made of non-latex materials such as
polyvinyl chloride Polyvinyl chloride (alternatively: poly(vinyl chloride), colloquial: vinyl or polyvinyl; abbreviated: PVC) is the world's third-most widely produced synthetic polymer of plastic (after polyethylene and polypropylene). About 40 million tons of ...
,
nitrile rubber Nitrile rubber, also known as nitrile butadiene rubber, NBR, Buna-N, and acrylonitrile butadiene rubber, is a synthetic rubber derived from acrylonitrile (ACN) and butadiene. Trade names include Perbunan, Nipol, Krynac and Europrene. This rubber is ...
, or
neoprene Neoprene (also polychloroprene) is a family of synthetic rubbers that are produced by polymerization of chloroprene.Werner Obrecht, Jean-Pierre Lambert, Michael Happ, Christiane Oppenheimer-Stix, John Dunn and Ralf Krüger "Rubber, 4. Emulsion Rub ...
have become widely used. Chemical processes may be employed to reduce the amount of antigenic protein in
Hevea ''Hevea'' is a genus of flowering plants in the spurge family, Euphorbiaceae, with about ten members. It is also one of many names used commercially for the wood of the most economically important rubber tree, '' H. brasiliensis''. The genus is ...
latex, resulting in alternative natural-rubber-based materials such Vytex Natural Rubber Latex. However, non-latex gloves have not yet replaced latex gloves in surgical procedures, as gloves made of alternative materials generally do not fully match the fine control or greater sensitivity to touch available with latex surgical gloves. (High-grade
isoprene Isoprene, or 2-methyl-1,3-butadiene, is a common volatile organic compound with the formula CH2=C(CH3)−CH=CH2. In its pure form it is a colorless volatile liquid. It is produced by many plants and animals (including humans) and its polymers ar ...
gloves are the only exception to this rule, as they have the same chemical structure as natural latex rubber. However, fully artificial polyisoprene—rather than "
hypoallergenic Hypoallergenic, meaning "below average" or "slightly" allergenic, is a term meaning that something (usually cosmetics, pets, textiles, food, etc.) causes fewer allergic reactions. The term was first used in 1953 in an advertising campaign for co ...
" cleaned natural latex rubber—is also the most expensive natural latex substitute available.) Other high-grade non-latex gloves, such as nitrile gloves, can cost over twice the price of their latex counterparts, a fact that has often prevented switching to these alternative materials in cost-sensitive environments, such as many hospitals. Nitrile is more resistant to tearing than natural latex, and is more resistant to many chemicals. Sulfur compounds used as accelerants to cure nitrile can speed the tarnishing process in silver, so accelerant-free nitrile or other gloves must be used when handling objects made of these metals when this is not acceptable.


Double gloving

Double gloving is the practice of wearing two layers of medical gloves to reduce the danger of infection from glove failure or penetration of the gloves by sharp objects during medical procedures. Surgeons double glove when operating on individuals bearing infectious agents such as
HIV The human immunodeficiency viruses (HIV) are two species of '' Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the im ...
and
hepatitis Hepatitis is inflammation of the liver parenchyma, liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), Anorexia (symptom), poor appetite ...
, and to better protect patients against infections possibly transmitted by the surgeon. A systematic review of the literature has shown double gloving to offer significantly more protection against inner glove perforation in surgical procedures compared to the use of a single glove layer. But it was unclear if there was better protection against infections transmitted by the surgeon. Another systematic review studied if double gloving protected the surgeon better against infections transmitted by the patient. Pooled results of 12 studies (RCTs) with 3,437 participants showed that double gloving reduced the number of perforations in inner gloves with 71% compared to single gloving. On average ten surgeons/nurses involved in 100 operations sustain 172 single gloves perforations but with double gloves only 50 inner gloves would be perforated. This is a considerable reduction of the risk. In addition, cotton gloves can be worn under the single-use gloves to reduce the amount of sweat produced when wearing these gloves for a long period of time. These under gloves can be disinfected and used again.


See also

* Latex allergy *
Needlestick injury A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick ...


References

{{Laboratory equipment First aid Gloves Medical hygiene Safety clothing
glove A glove is a garment covering the hand, with separate sheaths or openings for each finger including the thumb. Gloves protect and comfort hands against cold or heat, damage by friction, abrasion or chemicals, and disease; or in turn to provide a ...
Occupational safety and health Protective gear