In-use barrier integrity of gloves: Latex and nitrile superior to vinyl

Background: Although gloves manufactured with different materials have comp arable barrier properties when removed directly from the box and tested, th eir actual on-the-job barrier performance may be extremely different. Altho ugh effective in static, pre-use conditions, barrier properties may be comp romised once challenged by the rigorous hand and finger movements associate d with many health care procedures. Gloves are meant to act as barriers, pr otecting persons by reducing the risk of exposure to bloodborne pathogens. Ineffective barriers or barriers that are easily breached during risk-assoc iated procedures have the potential to place health care professionals at r isk. Multiple studies attesting to the barrier attributes of vinyl and late x gloves during varied controlled clinical situations are available. Studie s are available that address the permeation characteristics of nitrile, but no studies document the effectiveness of nitrile as a barrier to bloodborn e pathogens or compare the barrier effectiveness of nitrile to gloves made of other materials during simulated use or clinical situations. Objective: This study was undertaken to compare the barrier integrity of la tex, vinyl, and nitrile gloves during controlled, simulated clinical use co nditions that were specifically designed to mimic patient care activities. This study compares the performance of gloves made of natural rubber latex, long considered the gold standard; polyvinyl chloride (vinyl), a synthetic copolymer; and nitrile (acrylonitrile butadiene), a recently available syn thetic for use in the health care environment. Methods: A total of 2000 gloves (800 latex gloves, 800 vinyl gloves, and 40 0 nitrile gloves) were evaluated for baseline determinations in unused glov es and for failure rates after specific simulated use conditions. Potential bias was avoided through strict control of all actions and manipulations. Gloves were graded on a pass or fail system for leaks as defined by America n Society for Testing and Materials D5151, Standard Test Method for Detecti on of Holes in Medical Gloves. To more fully characterize the gloves evalua ted, individual products were also tested for physical dimensions (finger a nd palm thickness), powder levels, total protein (Modified Lowry), and anti genic protein (Latex ELISA [enzyme-linked immunosorbent assay] for Antigeni c Proteins). Results: With the exception of one vinyl glove brand with a 12% failure rat e, no significant differences in failure rates were detected among the 3 ty pes of gloves when tested directly out of the box with no manipulation. How ever, after manipulation intended to simulate in-use conditions, vinyl glov es failed 12% to 61% of the time. Latex and nitrile performed significantly better, with failure rates of only 0% to 4% and 1% to 3%, respectively. Al l latex gloves, with one exception, tested at less than 50 mu g/g of total water extractable protein. The antigenic protein levels, with one exception , tested from less than 0.2 mu g/g to 5.5 mu g/g. The one latex product tha t fell outside these values had 154 mu g/g of total protein and 105.7 mu g/ g of antigenic protein. Conclusions: This study indicates that the latex and nitrile gloves evaluat ed were comparable in terms of barrier performance characteristics both unu sed and during manipulations mimicking patient care procedures. Whereas str etch vinyl exhibited lower failure rates than standard vinyl, the higher in -use leakage rates associated with ail vinyl gloves tested indicate decreas ed durability and, potentially, compromised barrier protection when this sy nthetic is used. Careful consideration to the degree of barrier effectivene ss should be given before glove selection when the potential exposure to bl oodborne pathogens or biohazard risks is a concern.