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PubMedDate not supplied

Double or single gloves: which is safer in pediatric orthopedic surgery.

BACKGROUND AND AIM: Surgical gloves should form an efficient barrier between surgeons and patients to prevent cross infection. Single gloves (SGs) have long been reported unsafe, and usage of double gloves (DGs) is still not universal. No study has reported the usage of DGs in pediatric orthopedic operations. The aim of this study was to assess the efficacy of DGs versus SGs in prevention of body fluid contact between patients and surgeons during pediatric orthopedic surgery. METHODOLOGY: After 150 pediatric orthopedic operations, DGs and SGs were collected and tested for perforations. Gloves were tested for size, site, and number of perforations among principal surgeons, assistant surgeons, and scrub nurses. Gloves were not changed during long surgical procedures and were changed only if perforations were identified and recorded. The DGs used were Maxitex Duplex, powder-free indicator gloves and the SGs were of Gammex-Ansell. One hundred unused gloves of each group were tested as controls. Medical records of the patients were reviewed for age, sex, type of operation, duration of operation, and any postoperative wound infection. The data were entered in database and analyzed using SPSS package. The data were compared between double and SGs using t test with a level of statistical significance at P less than 0.05. RESULTS: Five hundred twenty-six DGs and 316 SGs were tested. Forty-three perforations were detected in DGs (8.1%). Outer gloves were breached in 7.8% and inner in 0.3% as compared with SGs in which 28 (8.7%) were perforated. In DGs, 4% had multiple perforations compared with 11.9% in SGs. There was a statistical significance (P<0.001) when the perforations of inner gloves were compared with the SGs. None of the inner perforations were recognized during surgery, but the outer gloves of the DGs were recognized in 71% as compared with 9% in SGs (P<0.001). The majority of perforations were seen in the nondominant hand in surgeons and assistants hands, whereas scrub nurses had 85% of perforations in the dominant hand. The index finger was the site of perforations in DGs (53.4%; SGs, 43%). The inner gloves were breached only when the outer glove was found to be perforated. The duration of surgery had a direct impact on the number of perforations. There were no perforations in DGs in less than 60 minutes as compared with 3 (10.7%) in SGs. Between 60 and 120 minutes, the perforations in the DGs were 11, and in SGs, 21. During the study period, 4 patients had surgical site infection. Three were superficial and one deep-seated infection. In 3 patients with infection, the gloves were found to be perforated, and 1 patient with infection had no perforations in the gloves. CONCLUSION: Our study confirms that DGs are safer than SGs during pediatric orthopedic operations. In the event of nonavailability of DGs, SGs should be changed on an hourly basis during long procedures. Lastly, there exists a relationship between surgical site infection and glove perforations.

Equipment Design↗
PubMed1998

Evaluating the effectiveness of gloves in reducing the hazards of hand-transmitted vibration.

OBJECTIVES: A method of evaluating the effectiveness of gloves in reducing the hazards of hand-transmitted vibration is proposed. METHOD: The glove isolation effectiveness was calculated from: (a) the measured transmissibility of a glove, (b) the vibration spectrum on the handle of a specific tool (or class of tools), and (c) the frequency weighting indicating the degree to which different frequencies of vibration cause injury. With previously reported tool vibration spectra and glove transmissibilities (from 10-1000 Hz), the method was used to test 10 gloves with 20 different powered tools. RESULTS: The frequency weighting for hand-transmitted vibration advocated in British standard 6842 (1987) and international standard 5349 (1986) greatly influences the apparent isolation effectiveness of gloves. With the frequency weighting, the gloves had little effect on the transmission of vibration to the hand from most of the tools. Only for two or three tools (those dominated by high frequency vibration) did any glove provide useful attenuation. Without the frequency weighting, some gloves showed useful attenuation of the vibration on most powered tools. CONCLUSIONS: In view of the uncertain effect of the vibration frequency in the causation of disorders from hand-transmitted vibration, it is provisionally suggested that the wearing of a glove by the user of a particular vibratory tool could be encouraged if the glove reduces the transmission of vibration when it is evaluated without the frequency weighting and does not increase the vibration when it is evaluated with the frequency weighting. A current international standard for the measurement and evaluation of the vibration transmitted by gloves can classify a glove as an antivibration glove when it provides no useful attenuation of vibration, whereas a glove providing useful attenuation of vibration on a specific tool can fail the test.

Evaluation Studies as Topic↗
PubMed2004

Hev b 5 and Hev b 13 as allergen markers to estimate the allergenic potency of latex gloves.

BACKGROUND: Sensitization to natural rubber latex has been linked to proteins from medical latex gloves. Various assays to estimate the amount of residual allergenic proteins extractable from latex gloves to assess their potential exposure hazard have inherent weaknesses. OBJECTIVE: This investigation was aimed at developing 2-site immunoenzymetric assays and identifying appropriate protein markers to assess the allergenic potential of latex gloves. METHODS: The presence of 6 latex allergens--Hev b 1, 2, 3, 5, 6, and 13--was measured in a cross-section of commercial latex medical gloves by using monoclonal and polyclonal antibody-based 2-site immunoenzymetric assays. The overall allergenic potential of these gloves was assessed by IgE-inhibition assay. Stepwise multiple regression analyses were performed to identify marker allergens that best explained the variation in latex glove allergenicity. RESULTS: All 6 latex allergens were detected in at least some of the glove samples. Hev b 5 and Hev b 13 were identified as the marker allergens that combined best to explain the variation in the glove allergenicity. The significant multiple correlation (R=0.855) between these 2 markers and glove allergenic potency forms the basis of an assay to gauge latex glove allergenicity. CONCLUSION: The overall allergenic potential of latex gloves can be estimated by using Hev b 5 and Hev b 13 as indicator allergens. The correlation between glove allergenicity and the level of these allergens was maintained for low-protein gloves (<200 microg/g). This estimation of glove allergenicity was superior to that obtained by using total protein readings.

Allergens↗
PubMed1997

Improving glove barrier effectiveness.

Perioperative staff members depend on surgical gloves to prevent disease transmission between themselves and patients, but these gloves frequently fail during use. Three approaches can make surgical gloves more effective barriers: preventing glove failures, monitoring glove integrity, and improving glove quality. Failure prevention includes modifying surgical techniques, improving instruments and equipment, streamlining teamwork, selecting the most appropriate gloves, double gloving, and performing preventive glove changes. Glove integrity monitoring can be performed visually or by feel, by wearing glove pairs with color-puncture indicators, or by using electronic monitoring devices. Glove quality improvements must be accompanied by testing methods that reflect in-use conditions. A glove rating system that is based on in-use performance may enhance glove safety substantially.

Equipment Failure↗
PubMedDate not supplied

Biomechanical performance of powder-free examination gloves.

Biomechanical performance studies were undertaken for powder-free, latex and nitrile examination gloves. Using standardized tests, examination glove performance was judged by measuring glove thickness, glove puncture force, glove tape adhesion force, glove donning force, glove stiffness, and immediate unrecovered stretch. Even though the nitrile examination gloves were thinner than the latex examination gloves, they exhibited a greater puncture resistance. In addition, tape adherence to the N-Dex nitrile glove was the lowest. Moreover, measurements of the handling characteristics of the nitrile examination gloves demonstrated that they are an acceptable alternative to latex examination gloves. While these biomechanical studies demonstrate the superiority of the nitrile examination gloves, clinical glove evaluation is still needed to determine their performance in the health care setting.

Biomechanical Phenomena↗
PubMed1997

Validation of the latex glove provocation procedure in latex-allergic subjects.

BACKGROUND: A latex provocation test is needed to clarify the allergic status of patients who present with a positive clinical history for latex allergy and a negative latex skin test and/or serologic test. OBJECTIVE: In the present study, we aimed to optimize and validate the performance and safety of a latex glove provocation protocol and to employ it to verify the barrier properties of the Dermapor expanded polytetrafluorethylene (ePTFE) glove liner (liner) for latex glove allergen. METHODS: Twenty-one skin test positive latex-allergic subjects donned goggles and a silicone mask, washed their hands and then put high allergen-containing latex gloves (mean = 15,072 AU/mL) on a moist, bare and liner-covered hand. Due to an absence of verifiable reactions on the bare hand in the first five subjects, the protocol was modified to puncture the skin in three sites on the hand prior to donning the liner/glove or latex glove alone. Subjects were observed for 30 minutes for localized allergic symptoms (pruritus and hives). Lined and unlined hands were compared for reactions. RESULTS: Application of highly allergenic latex gloves onto the bare hands of five skin test-positive, latex-allergic subjects produced some mild pruritus but no visually detectable dermatitis. In contrast, all 17 latex-allergic subjects who underwent the modified glove challenge protocol involving a puncture prior to glove application experienced intense pruritus with measurable wheals and erythema at sites where their skin was punctured. Equivalent wheal and erythema reactions were observed at a site where a puncture was performed directly through the glove. These same subjects experienced no pruritus or hives on their opposite hands that received a liner prior to latex glove application. CONCLUSIONS: Direct application of highly allergenic latex gloves onto the hands of skin test-positive, latex-allergic individuals does not commonly produce localized allergic symptoms after minutes, especially if the subject has successfully avoided latex and has no evidence of dermatitis. By puncturing the skin prior to latex glove donning, quantifiable hives are produced within 15 minutes following glove application. A Dermapor ePTFE liner prevents the transfer of allergen from gloves onto the skin and therefore can serve to minimize contact exposure as part of avoidance therapy.

Adult↗
PubMed2001

An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice.

OBJECTIVE: To investigate the puncture resistance of a recently introduced non-latex, nitrile dental glove in comparison with a latex glove worn during routine clinical dental procedures. SETTING: Dentists in general dental practice working within the UK during 1999. SUBJECTS AND METHODS: 2,020 gloves worn by five general dental practitioners were examined for punctures following standard clinical use by a water inflation method. Procedures undertaken during glove usage and length of time worn were recorded. RESULTS: Following clinical use, 1.9% of the latex gloves and 5.3% of the nitrile gloves had punctures, a statistically significant difference (P < 0.0001). The puncture resistance of the nitrile gloves was superior to the puncture resistance of previously tested worn non-latex (vinyl) gloves. There was no evidence of a statistically significant difference between operators for the percentage or incidence of punctured gloves (P = 0.787) after correcting for glove type. No statistically significant difference was noted between incidence of puncture in the control, unused gloves (n = 200 for each type) and the gloves examined following clinical use (P = 0.907 for nitrile, P = 0.613 for latex). CONCLUSION: No increase in the number of punctures was noted following clinical use for either glove type. This could be considered to indicate good puncture resistance of the gloves tested in clinical use.

Analysis of Variance↗
PubMed2004

Puncture resistance and stiffness of nitrile and latex dental examination gloves.

OBJECTIVE: The aim of the current study was to assess the puncture resistance and stiffness of nitrile and latex dental examination gloves. METHODS: Puncture resistance was measured by employing an adapted version of ASTM F1342-91 using both a 316 stainless steel puncture probe (0.8 mm diameter) and a dental injection needle (0.45 mm diameter) interfaced to a tensile testing apparatus. Glove specimens (12 cm length, 1.5 cm breadth) were removed for modulus (M100) evaluation by assessing the force required to elongate the specimen to 100% of the original length. Glove samples were also aged to investigate whether puncture resistance and M100 values varied with aging at 70 degrees C for 7 days in an air-circulating oven. RESULTS: The nitrile glove types were assessed to have significantly higher puncture resistance compared with the latex glove type when the steel puncture probe was the pentrometer when using the one way analysis of variance (ANOVA) at the 95% significance level. Interestingly the puncture resistance for the latex glove type was significantly higher (P < 0.001) when a dental injection needle was used as the pentrometer compared with the nitrile glove types. The M100 values were significantly higher for the nitrile glove types for which the stiffness increased when the gloves were aged (P < 0.001). CONCLUSIONS: The higher stiffness values resulted in increased puncture resistance when the nitrile glove specimens were aged irrespective of the pentrometer type. However, the ability of latex to re-seal itself on puncture may be beneficial when considering the protection potential of each glove type against breaches in cross infection. For clinicians that have experienced an adverse reaction to natural latex gloves, the results of the current study indicate that nitrile gloves are available at reasonable cost and offer the clinician comparable resistance to puncture with latex gloves.

Analysis of Variance↗
PubMed2004

Assessment of the durability of medical examination gloves.

This study determined the durability of various types of medical examination gloves using a laboratory test developed by the researchers. Results of this testing are compared with a simulated clinical method, also developed by the researchers, found to produce failures at rates similar to actual clinical use. Ten types of exam gloves were tested. One set of gloves was tested using a glove durability method. A second set was worn and conditioned using a simulated clinical method for comparison. The third set consisted of a control set of gloves that were not stressed. Samples consisted of 100 gloves combined from 2 or 4 manufacturers. All gloves were water-leak tested as the last step. The glove durability method created failures at similar rates to the simulated clinical method. The majority of the defects were located in the finger regions of the gloves. Durability of powdered and powder-free vinyl gloves was inferior to that of other glove types tested, with failure rates ranging from 24% to 42%, compared with 3% to 17% for the other glove types tested. Glove durability was also affected by the powdered state of the gloves and the user having long fingernails.

Equipment Failure↗
PubMed1998

Comparison of perforation between single and double-gloving in perineorrhaphy after vaginal delivery: a randomized controlled trial.

A prospective randomized controlled trial of single and double-gloving methods in perineorrhaphy after vaginal delivery was performed between August 1, and September 30, 1996 at Rajavithi Hospital to compare glove perforation between both methods. We examined 1,316 individual gloves in the double-gloving method and 742 individual gloves in the single-gloving method. These gloves were tested by immersing in water. The glove perforation rate was 5.2% (107 of 2,058). There was significant reduction in the glove perforation rate of double-inner gloves (2.7%) compared with the single-gloving group (6.7%). The perforation rate of the double outer-gloves group was 5.9%. The perforation rate in the matched outer and inner perforation was found only in 0.3% (2 of 658). The double-gloving method had a significant benefit in protection of the surgeon's hand from the exposure to blood compared with the single-gloving method.

Delivery, Obstetric↗
PubMed2006

Glove selection as personal protective equipment and occupational dermatitis among Japanese midwives.

This study was conducted to 1) evaluate the personal selection and use of protective gloves against bloodborne pathogens and management of glove selection in the workplace, 2) survey the experience with occupational dermatitis and other allergic symptoms, 3) explore the relationships between occupational dermatitis experience and glove use, and 4) determine the impact of glove selection upon occupational dermatitis among midwives. Subjects were 1,150 midwives working in Japan. Participants were selected from the members of Japanese Nursing Association and 835 responded to the survey. More than 30% of respondents wore gloves only when clients had an infectious disease, 41% reported experience of occupational dermatitis, 26% associated the dermatitis with medical glove use, and 2% had a diagnosis of latex allergy. Demographic variables that were significantly associated with occupational dermatitis included history of allergic symptoms other than due to occupational exposure, age, tenure and type of working institution. Using latex gloves during administering enema, shaving, changing pads, washing perineum, receiving newborns, suctioning, and handling waste significantly increased the risk of occupational dermatitis experience compared to not using gloves. Logistic regression analysis with backward stepwise elimination revealed glove selection management, such as availability of alternative glove types, using latex gloves for washing perineum, and using latex gloves for handling waste were significant predictors of occupational dermatitis. Occupational dermatitis is a significant issue and glove use as personal protective equipment is not standardized. Some occupational dermatitis may be preventable by managing appropriate glove selection.

Adult↗
PubMed2004

Scientific basis for selection of emergency medical examination gloves for emergency medical technicians, paramedics, firefighters, and emergency department personnel.

Dusting powders were first applied to gloves to facilitate donning. After 1980, manufacturers devised innovative techniques to manufacture gloves without dusting powders. It has been well documented that the powders on gloves present a health hazard to patients, as well as healthcare workers. First, these powders elicit tissue toxicity in every tissue in the body. Second, these powders serve as carriers of latex allergen and may precipitate a life-threatening allergic reaction in sensitized patients. These well-documented hazards of glove powders have caused a growing number of emergency medical technicians, paramedics, firelighters, and hospitals to abandon the use of powdered emergency medical examination gloves, using only powder-free gloves. Powder-free latex as well as non-latex gloves are now available to emergency medical technicians, paramedics, firefighters, and emergency department personnel. The use of powder-free natural rubber latex-free gloves is especially important to emergency medical technicians, paramedics, firefighters, as well as emergency department personnel to avoid eliciting an allergic reaction in the latex sensitized patient. The majority of our emergency medical technicians, paramedics and firefighters are now wearing powder-free emergency medical examination gloves that comply with the stringent Codes and Standards established by the National Fire Protection Association (NFPA), while very few hospital emergency department personnel have been provided with NFPA approved gloves. It is the purpose of this report to review the stringent regulations for emergency medical examination gloves that are outlined by the NFPA. This design and performance Standard was devised by the NFPA to address protective clothing for emergency medical operations. The design and performance requirement of the emergency medical examination gloves were described in the NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, 1997 Edition. In September 2003, the emergency medical examination glove must meet the new design and performance requirements of emergency medical examination gloves discussed

Certification↗
PubMed2001

Glove barriers to bacterial cross-contamination between hands to food.

Human hands are an important source of microbial contamination of foods. However, published data on the effectiveness of handwashing and glove use in a foodservice setting are limited. Bacterial transfer through foodservice quality gloves was quantified using nalidixic acid-resistant Enterobacter aerogenes (a nonpathogenic surrogate with attachment characteristics similar to Salmonella). Five transfer rates were determined: chicken to bare hand, chicken to hand through gloves, bare hand to lettuce, hand to lettuce through gloves (with low inoculum on hands), and hand to lettuce through gloves (with high inoculum on hands). At least 30 observations were made for each percent transfer rate using 30 individual volunteers. The logarithm of percent transfer data were then fit to distributions: chicken to bare hand, normal (0.71, 0.42); chicken to hand through gloves, gamma (5.91, 0.40, -5.00); bare hand to lettuce, logistic (1.16, 0.30); hand to lettuce through gloves (low inoculum), normal (0.35, 0.88); hand to lettuce through gloves (high inoculum), normal (-2.52, 0.61). A 0.01% transfer was observed from food to hands and from hands to food when subjects wore gloves and a 10% transfer was observed without a glove barrier. These results indicate that gloves are permeable to bacteria although transfer from hands to food through a glove barrier was less than without a glove barrier. Our results indicate that gloves may reduce both bacterial transfer from food to the hands of foodservice workers and in subsequent transfer from hands back to food.

Colony Count, Microbial↗
PubMed2004

Lower-protein latex gloves. A way to reduce allergic reactions in hospital staff.

It has long been accepted that the proteins in natural rubber latex (NRL) medical gloves can cause sensitivity reactions in some healthcare workers. What hasn't been clear is whether the amount of protein in the gloves relates to the number of people who react to NRL gloves. Recent studies, however, clearly demonstrate that it does. By using lower-protein gloves, hospitals can help address NRL-allergy issues among glove users. Recent standards from the American Society for Testing and Materials (ASTM) have recommended using gloves with aqueous soluble protein content no higher than 200 micrograms per square decimeter (microgram/dm2) of glove material. But some gloves are available with protein levels as low as 50 micrograms/dm2. ECRI believes that hospitals should use NRL gloves with the lowest possible protein levels. Hospitals wishing to buy low-protein gloves should look for labeling that lists the protein content of the gloves, that identifies them as conforming with the latest ASTM standards, or that lists a new type of certification--the Standard Malaysian Glove (SMG) certification. The SMG program sets glove requirements that include barrier strength and protein content. Gloves bearing the SMG label conform to published standards and are routinely inspected for quality.

Gloves, Surgical↗
PubMed1990

Outer gloves in orthopaedic procedures. Cloth compared with latex.

A randomized prospective study was undertaken to determine the rate of punctures of the inner glove when techniques of double-gloving were employed for orthopaedic operations. Group I consisted of twenty-five procedures in which double latex gloves were used, and Group II comprised another twenty-five in which latex inner gloves and cloth outer gloves were worn. As the outer glove was expected to act as a barrier against puncture of the inner glove, only inner gloves were tested. All glove exchanges done intraoperatively for presumed tears of the inner glove were noted, as were punctures of the skin. The type and length of the procedure were also documented. Group I (double latex gloves) had a significantly higher rate of total inner-glove perforations per procedure (p less than 0.0001) than Group II (cloth and latex gloves). Furthermore, unrecognized perforations were significantly higher in Group I than in Group II (p less than 0.01). In Group I, the number of punctures increased with the duration of the operation; a puncture was found in all procedures in which the operation lasted longer than three hours (p less than 0.01). In Group II, only two tears of the inner glove occurred. Both were unrecognized and were independent of the duration of the operation.

Gloves, Surgical↗
PubMed1993

Glove perforations and blood contact associated with manipulation of the fetal scalp electrode.

OBJECTIVE: To assess prospectively the frequency of glove injury associated with insertion of the fetal scalp electrode and subsequent examination of the cervix with the electrode in place. METHODS: Over a 7-month period, sterile gloves were collected after use for insertion of the fetal scalp electrode or cervical examination with the electrode in place. Attendants indicated their level of training, time, date and purpose of glove use, and cervical examination. They also noted whether they were aware of a glove perforation or observed blood, amniotic fluid, or genital tract secretions on their hand. Glove patency was assessed by filling the glove with water to 1.5-2.0 times its normal volume and observing for leaks. One hundred unused gloves were tested for patency and served as controls. RESULTS: Five hundred one gloves were evaluated, of which 13 (2.6%, 95% confidence interval [Cl] 1-4%) had perforations. Seven of 277 gloves (2.5%) used only for examinations had perforations, compared with six of 244 (2.5%) used only for insertion of the electrode. Two percent (95% CI 0-5%) of the unused control gloves had perforations. These observed differences were not statistically significant. Nineteen attendants (3.8%, 95% CI 2.1-5.5%) noted blood or genital tract secretions on their hand after insertion of the electrode (N = 4) or subsequent cervical examination (N = 15). Only one point of contract resulted from a glove perforation; the other 18 were on the wrist and apparently resulted from leakage of fluid around the open cuff of the glove. CONCLUSIONS: The risk of glove perforation during insertion of the fetal scalp electrode or subsequent cervical examination is low if proper technique is observed. Blood or fluid contact is more likely to result from leakage of fluid around the open cuff of the glove during a vaginal examination.

Amniotic Fluid↗
PubMed1989

Latex and vinyl examination gloves. Quality control procedures and implications for health care workers.

In December 1987, we investigated an increased number of cases of herpetic whitlow in medical intensive care unit nurses who routinely gloved for secretion contact. One particular brand of vinyl examination glove had been used in the medical intensive care unit. Restriction endonuclease mapping established the similarity of employee isolates with one patient isolate of herpes simplex virus type I. When initial viral assay demonstrated 2.5% to 10% penetration of herpes simplex virus type I across unused gloves, an evaluation of glove quality was undertaken. In a 300-mL watertightness test, seven brands of vinyl gloves failed 4% to 28% (average, 11.1%; 132/1200), while seven brands of latex gloves failed 0% to 2.6% (average, 1.4%; 24/1750). The brand of vinyl glove that had been in use in the medical intensive care unit failed 28% of the time. Watertight gloves were then tested for permeability to herpes simplex virus type I. None of the latex gloves failed (n = 1726), while only 10 of the vinyl gloves failed (n = 1068, 0.95%). Extreme variability in glove quality was observed. However, gloves made from intact vinyl may provide similar protectiveness as those made from intact latex. As the demand for gloves increases, emphasis should be placed on the production of plentiful, better quality latex and vinyl gloves.

Disease Outbreaks↗
PubMed1997

Endotoxin as a factor in adverse reactions to latex gloves.

BACKGROUND: Endotoxin is an inflammatory made by gram negative bacteria that can irritate the skin, induce respiratory problems, fever, and shock. It is an adjuvant for both delayed hypersensitivity and IgE production and has been shown to magnify antigen specific mediator release. Since many of the clinical problems associated with natural latex products involve similar clinical sequelae, we investigated the possibility that latex gloves might be contaminated with endotoxin. OBJECTIVE: To measure the endotoxin content of a variety of natural latex gloves, investigate the its distribution and origin, associated with latex proteins, and determine the particle sizes associated with its release. METHODS: Endotoxin, protein, and allergen were measured using a quantitative kinetic Limulus assay, modified Lowry, and RAST inhibition, respectively. Particle size and density were determined using an Anderson multistage air sampler and CsCl2 gradient. RESULTS: Endotoxin was found to be a highly significant contaminant of some latex gloves. Levels ranged from 0.09 ng to 2.8 micrograms/g of glove. Protein levels ranged from < 25 to 1150 micrograms/g of glove while allergen levels ranged from < 1 to 837 micrograms/g of glove. Endotoxin and protein eluted rapidly from the interior of the gloves tested. Greater than 70% of the endotoxin was found to be associated with particles in the < 7 microns aerodynamic diameter range. The highest levels of endotoxin were found in nonsterile examination gloves with a tendency towards powdered gloves containing more endotoxin and protein. A slurry containing cross-linked dextran through which gloves were dipped revealed very high endotoxin contamination (64 micrograms/mL) while unused cross-linked dextran has very little associated endotoxin. CONCLUSIONS: These data demonstrate that some natural rubber latex gloves, particularly nonsterile examination gloves, are contaminated with high amounts of endotoxin and proteins. These were found mostly on the inside of gloves and were released as very small respirable particles that were not physically associated with the powder. These findings support the hypothesis that endotoxin may be responsible for some of the tissue irritation associated with latex glove use. In addition, this material may be responsible for the enhancement of delayed and immediate hypersensitivity reactions to chemicals and proteins found in these products and offers a possible explanation for the disproportionate severity of these reactions.

Allergens↗