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In 2007, AORN's Recommended Practices Task Force revised the "Recommended practices on prevention of transmissible infections in the perioperative practice setting" to recommend that health care practitioners double-glove during invasive procedures. Previously, AORN had suggested that wearing two pairs of gloves might be indicated for some procedures. Research on the protective effects of double gloving provides compelling evidence that surgical personnel should double-glove during all surgical procedures. Statistics on unreported injuries and conversion rates of HIV and hepatitis B indicate that change is difficult; however, research also suggests that objections to double-gloving can be overcome and a practice change implemented to ensure the safety of health care workers and patients alike.

CONCERN ABOUT ALLERGIC REACTIONS to natural rubber latex gloves has increased during the past 15 years. These reactions have been attributed mainly to an influx of high-powder, high-protein gloves in response to increasing concerns about AIDS transmission beginning in the late 1980s. THIS ARTICLE REPORTS ON AVAILABLE RESEARCH that details the types and prevalence of potential allergic reactions, supports the use of natural rubber latex gloves in the OR, and recommends strategies to enable health care who are not latex sensitive to continue wearing natural rubber latex gloves in the OR.

The inherent tear resistance and elasticity of latex and the touch sensitivity it provides has made it the traditional material of choice for surgical gloves, protecting both health care workers and patients from the transmission of bloodborne infections. Although increased incidence of latex allergy has led to increased use of nonlatex surgical gloves, the effectiveness of these gloves as a barrier to infection has not been examined thoroughly. This laboratory-based study compared the performance of latex and nonlatex surgical gloves in a simulated stress protocol. The propensity of surgical gloves to fail was dependent on glove material, manufacturer, and stress. Nonlatex neoprene and nitrile gloves were comparable to latex and can provide a good alternative to latex for allergic patients and health care workers. In this study, isoprene was found to be inferior to latex and other nonlatex materials. The presence or absence of glove powder had no significant influence on the probability of glove failure.

Adverse reactions to medical gloves represent an important public health issue. Accordingly, there is increasing interest in understanding the information reported to the US Food and Drug Administration (FDA) describing health effects associated with the use of medical gloves. This article provides a retrospective analysis and summary of health effects associated with medical glove use reported to the FDA. The FDA's medical device adverse event databases were searched via computer using keywords to identify reports of reactions associated with any type of medical glove. Demographic and clinical information abstracted from these reports was used to perform frequency and trend analyses. The reported medical glove-related events, including the noted trends in reporting, suggest the need for further study and continued monitoring of such reports.

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.

The relationship between infection control standards and surgical gloving practices is an important issue in combating infectious disease. For their own and their patients' protection, health care personnel must rely on the barrier qualities of gloves more than ever before. Both surgical and examination gloves fail frequently, which puts health care providers and patients at risk of acquiring fluid-borne pathogens. This paper discusses current guidelines, the risk of infection by viral and bacterial pathogens, controversial issues involving gloving practices, and recommendations to improve infection control practices.

Health care personnel often pay little attention to the barrier effectiveness of the surgical gloves they use in clinical settings. They may assume that all surgical gloves provide adequate protection against the transfer of bloodborne pathogens, chemicals, or mutagenic substances. Perioperative staff members frequently are unaware that their surgical gloves have failed until they find blood on their hands after operative procedures are completed. In this first article of a three-part series, the authors review current surgical glove testing standards, define surgical glove failure, and describe the reasons that surgical glove failure occurs in clinical practice settings.

Latex continues to be the material of choice for surgical gloves because it is resealable and flexible, and it maintains the wearer's tactile sensitivity. The use of latex gloves for barrier protection may need to be reevaluated in light of the increasing number of individuals who are sensitive to latex. Hospital personnel can use low-allergen gloves or nonlatex gloves when caring for patients with known sensitivity to latex; however, only nonlatex gloves may be effectives at reducing or preventing anaphylactic reaction. Health care facilities must develop policies and procedures for dealing with latex-sensitive patients and health care workers.

To estimate the prevalence, risk factors, and clinical spectrum of adverse reactions to natural rubber latex-containing products among a national sample of perioperative nurses, the investigators administered a self-reporting questionnaire to a convenience sample of 2,200 members of the Association of Operating Room Nurses, Inc. Of the 1,738 nurses who responded, 369 (21%) reported latex reactions. Multivariate analysis identified a history of allergies to cosmetic powders, other allergies, chronic illnesses, and regular use of latex gloves as independent risk factors for reactions to latex-containing products. Localized reactions, such as contact dermatitis, were the reactions reported most commonly, although severe systemic reactions also were described.