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Glove Powder Complications.

Because of the general concern over surgical and medical asepsis, along with the obvious precautionary standards practiced by most health care professionals, the routine use of surgical and medical exam gloves is commonplace.

Much has been written regarding the consequences of an impending Latex allergy with continuing use of latex gloves by health care workers. Unfortunately, latex allergy is still very misunderstood, and more often than not inappropriately self: diagnosed by health care professionals. Often, the glove powder itself is blamed as the primary causative agent for hand skin irritation, rather than a true latex-induced allergic condition.

Most glove powders are nothing more than common cornstarch (ie, baby powder) and are rarely the primary, cause of hand skin irritation while wearing latex gloves. However, cornstarch glove powder is in tact directly responsible for an array of patient complications and occupational illnesses.

Surgeons first began using surgical rubber gloves at the turn of the century. These early rubber gloves were extremely difficult to put on, leading to very severe skin irritations. Early surgeons used water as a lubricant to facilitate putting them on.[1]

By the early 1900s a new, dry lubricant was introduced that made the gloves easier to put on and caused less skin irritation to surgeons' hands. This new lubricant was lycopodium spores, commonly known as club moss.[1] Unfortunately, club moss was found to cause adhesions and granulomas in postoperative patients because it behaved like a foreign body.[1] Club moss was quickly superseded by hydrous magnesium silicate, otherwise known as talcum powder or talc.[1]

In 1947, approximately 35 years after talcum powder was first implemented as a dry lubricant, researchers at the University of Virginia concluded on the basis of overwhelming evidence that talcum powder was a formidable fomite in human surgery. It promoted disease and infection, long with excessive inflammation and exaggerated scarring in patients.[1,2]

In 1947 the government ordered talcum powder replaced with a newer lubricant known as maize starch, or more commonly, cornstarch. The complications associated with talcum powder diminished but were never eradicated.[1-3]

At the time, cornstarch glove powder was thought to be totally absorbed by the body, but it became apparent that cornstarch was not as inert as originally thought. In fact, it is considered a highly reactive substance both in vitro and in vivo. Unfortunately, cornstarch powder remains the dry lubricant on most surgical and medical exam gloves today.[1,4,5]

Glove powder has been proven to cause disease. Any time powdered gloves are used, wound contamination with cornstarch particles is likely to occur. These particles can fall from gloves into an open wound or enter a body cavity.[4,5]

In an open wound or body cavity, cornstarch glove powder behaves like a true foreign body, causing an exaggerated inflammatory response, frustrating the body's defense systems. This in turn allows for opportunistic pathogens and microbes to thrive, enhancing the possibility for various infections to take root.[1,6] This could be disastrous for immunocompromised or immunosuppressed patients.[6]

Researchers from Brigham Hospital in Boston discovered that when powdered gloves were put on or removed, especially when inappropriately snapped off, cornstarch particles became airborne.[1] They also discovered that this aerosolized powder eventually settled and thinly covered the entire surface of the operating room suite, later to be reaerosolized and make its way into the hospital's ventilation system.[1]

Aerosolized glove powder can transport bacteria and microbes from the contaminated gloves themselves or from other sources, potentially inducing a nosocomial infection or occupational illness.[1,6] Glove powder also can transport chemicals used in manufacturing the gloves themselves into the air, along with other chemicals found in health care facilities such as formaldehyde or gluteraldehyde.

Aerosolized glove powder carries aeroallergen concentrations of latex proteins, which easily cling to the glove powder particles. The unrecognized and often chronic inhalation of latex proteins by staff members can lead to an occupationally induced latex allergy that worsens with each exposure. Symptoms can include, but are not limited to, conjunctivitis, rhinitis or asthma,[7] all of which irritate ocular and pulmonary membranes.[8]

Glove powder can act as a fomite, carrying infectious organisms such as VRE (vancomycin-resistant enterococcus) or MRSA (methicillin-resistant Staphylococcus aureus). Glove powder also can be a food source for microorganisms.[9] As a fomite, contaminated glove powder can be transported easily to another host (ie, a patient or staff member) through inhalation, direct contact or indirect contact. Contamination with microorganisms also can occur from 1 anatomical site to another on the same patient from powder-borne crosscontamination.[1,6,9]

The average amount of cornstarch granules on surgical or medical exam gloves can be as much as 80 to 120 mg per pair on some brands, with an approximate average of about 2720 cornstarch granules per square millimeter of glove area. Cornstarch granules can range from 7 to 30 [micro] m in diameter, allowing much smaller microorganisms and latex proteins to attach easily and be carried elsewhere. For comparison, the polio virus measures 0.04 [micro] m, HIV measures 0.12 [micro] m, staphylococci measure 1 [micro] m and Mycobacterium tuberculosis measures 3 [micro] m.

Cornstarch powder has been proven to cause granulomas and adhesion formations in postoperative patients, which could lead to peritonitis, most commonly granulomatosis peritonitis 4 weeks post laporotomy[1,10] Cornstarch adhesions have been documented to cause postoperative intestinal obstructions and can mimic carcinoma.[1,9]

Cornstarch glove powder has been mistaken for some microorganisms because it stains Gram positive. It can be mistaken for yeasts as well. Glove powder has been proven to induce false-negative results on HIV blood tests (ELISA) by contaminating the serum wells.[3]

Cornstarch powder has been found to contaminate perfused donor kidneys.[10] It also binds to skin tape, interfering with the tape's ability to adhere to skin.[1] It also can cause artifacts on processed dental film.

Researchers at St. George's Hospital in London, England, have discovered that cornstarch powder contaminates catheters during normal handling. Through the simple act of drawing a nylon catheter out of a plastic envelope, a small electrostatic charge is generated that strongly attracts cornstarch granules to adhere to the catheter.[6] The implications of this should be considered during all types of catheterizations, including epidural, venous, arterial, cardia and even urinary.

Other documented adverse reactions to cornstarch glove powder include: postoperative synovial inflammation, retroperitoneal fibrosis, meningismus post-craniotomy, post-thoracotomy syndrome, endophthalmitis, pseudotumors, pericardial fibrosis, intra-abdominal granulomas in postoperative heart surgery patients, corneal inflammation postophthalmic surgery, adhesions to the Fallopian tubes, pelvic pain, infertility and myocardial contamination following catheterization.[1, 4, 10, 13]

The FDA has placed warnings on all powdered gloves, advising physicians to wash the powder from the surface of the gloves with sterile water before any patient contact. Unfortunately, this is now known to be highly ineffective, leaving large amounts of powder on the surface of the glove in the form of clumps, enhancing a delayed foreign body reaction.[1, 5] The most effective way to remove glove powder is to wash the outside of the glove with a 10 ml of povidone-iodine solution for 60 seconds, followed by a 30-second rinse with sterile water. Unfortunately, this method is very costly, time consuming and not 100% certain.[1]

In 1982 the first powder-free glove was introduced to the medical profession. Unfortunately, powder-free gloves have not been universally accepted by surgeons or medical institutions, despite the increased prevalence of latex allergies among health care professionals and patients and despite the fact that patients and staff members continue to experience complications associated with corn starchglove powder.

Switching to powder-free gloves, or better yet powder-free nonlatex gloves, would be in the best interest of all patients and staff. Although the initial cost of conversion may be high, the cost-effectiveness in the long run would be well worth it. The nosocomial infection rate, occupational illnesses, disability claims and latex allergies all would be minimized.

References

[1.] Edlich RF, Watkins FM. Glove powder facts and fiction. Surgical Services Management. 1997;3(2):47-50.

[2.] Lampe A, Pietersen-Bruins H. Wearing gloves as a cause of false negative HIV tests. Lancet. 1988;12:1140-1141.

[3.] Truscott W. Glove powder and nosocomial infections: is there a connection? Infection Control and Sterilization Technology. 1996;2(1).

[4.] Hunt T, Salvin JP, Goodson WH. Starch powder contamination of surgical wounds. Arch Surg. 1994;129:825-828.

[5.] Giercksky EK. Misdiagnosis of cancer due to multiple glove granulomas. Eur J Surg. 1997;579 (Suppl):11-14.

[6.] Green M. Powder contamination of extradural catheters and implications for infection control. Eur J Surg. 1997;163:39-40.

[7.] Newsom SWB, Shaw P. Airborne particles from latex gloves in the hospital environment. Eur J Surg. 1997;163:31-33.

[8.] Ruhl C, Urbanic JH, Foresman PA, et al. A new hazard of cornstarch, an absorbable dusting powder. J Emerg Med. 1994;12:11-13.

[9.] Rae T, McCormick-Thomson LA, Murray DW, Rushyon N. The effect of starch glove powder on joints and other tissues. Ann R Coll Surg Engl. 1989;71:361-365.

[10.] Moriber-Katz S, Goldstein S, Ferluga D, et al. Contamination of perfused donor kidneys by starch from surgical gloves. AJCP. 1988:81-84.

[11.] Hubar JS, Etzel KR, Dietrich CB. Effects of glove powder on radiographic quality. Journal of the Canadian Dental Association. 1991;57:790-792.

[12.] Truscott W, Roley L. Glove associated reactions: addressing an increasing concern. Dermatol Nurs. 1995;7:283-292,303.

[13.] Baur X, Chen Z, Allmers H. Can a threshold limit value for natural rubber latex allergens be defined. Journal of Allergy Clinical Immunology. 1988; 101.

Michael Shymko, A.S., R. T. (R), is a staff technologist at Bay Shore Community Hospital in Holmdel, NJ.

Radiologic technologists are invited to share their work experiences and technical advice with other readers through this column. For details on how to submit a paper to the "On the Job" column, write to Managing Editor Katie Racette, c/o ASRT, 15000 Central Ave. SE, Albuquerque, NM 87123-3917.
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Author:Shymko, Michael
Publication:Radiologic Technology
Geographic Code:1USA
Date:Jul 1, 1999
Words:1660
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