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Life after the FDA’s powdered glove ban

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In January 2017, the FDA banned the use of powdered gloves. As a result, physicians, nurses, dentists, kitchen workers, and veterinary professionals cannot buy them or use them.

More than a year later, professionals still are trying to understand the reason for this perplexing ban (See the sidebar, “What colleagues think”).

The first documented use of gloves for medical procedures dates back to the late 1800s when Caroline Hampton, a scrub nurse at John Hopkins Hospital, developed an allergic reaction to a chemical used
for asepsis. Her soon-to-be husband, famous surgeon William Halsted (of Halsted’s principles fame), contacted the Goodyear rubber company to create thin rubber gloves. The idea was to prevent his bride from suffering a skin reaction.

In 1964, Ansell manufactured the first disposable, sterile gloves. Fine powder was found to make getting gloves on (donning) and off (doffing) more easily. Glove powder evolved over time, until the FDA’s ban.

Why exactly were powdered gloves banned? The main benefit is that the powder simplifies the application and removal of gloves. The FDA decided this
sole benefit was overshadowed by the downsides.

What colleagues think
Surgeons

Georgia

  • “I’m not a fan. The feel is inferior and it is harder to palm instruments. I’ve gotten used to them though. I also have had more trouble finding a brand that fits my size. The fingers are usually too short.”
  • “I don’t really notice a difference in surgery gloves. My problem is when I am using patient examination gloves, where I maybe have to reglove multiple times in a short span. Your hands start sweating and it is hard to put the next set on.”

Illinois

  • “I think the gloves are fine. They make it a little more difficult to double glove during ortho procedures, but otherwise they do not bother me too much.”

Missouri

  • “It is more difficult to reglove in surgery when my first set is wet, but the slight inconvenience is worth eliminating potential health problems for my patients, staff, and me. It’s also nice not to have powder residue on my dark scrubs when I grab a pen out of my pocket after removing my exam gloves.”

North Carolina

  • “They are just horrible. We have difficulty telling when there are any perforations. When we have to change gloves, they are very difficult to put on when your hands are sweaty and it is virtually impossible to double glove. In short, we cannot stand them.”

Texas

  • “They are challenging to don and unfortunately don’t fit the same as the powdered version. They also are not very durable.”
  • “I didn’t like them that much when we first made the switch, but to be honest, it is not really that big of a deal.”

General practitioners

Pennsylvania

  • “I dislike them intensely. Another example of how our government is overstepping its boundaries.”

Wyoming

  • “I am not a fan. The touch is somewhat different and less sensitive. I do feel I am more used to them than I was originally and will likely think nothing of them in a year. The one aspect that still drives me up the wall is when regloving is required and there is any moisture (i.e. sweat) on your hands.
    I can’t tell you how many failed attempts have resulted in gloves being shot across the OR or dental suite, both accidentally and intentionally.”
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Glove powder adheres to latex protein, causing it to become aerosolized when gloves are manipulated. In turn, this increases the exposure to latex, which can cause various reactions ranging from sensitivity and airway inflammation to severe allergies. This can affect both patients and health-care workers.

In addition, the body reacts to the powder, which acts a foreign substance. This has been shown to potentiate wound infection, peritoneal adhesions, and granulomatous reactions. Most of the research was done primarily in humans and lab animal models. I could not find any official statement explaining why veterinarians also are affected, but the new law does apply to us.

According to the American Latex Allergy Association, less than one percent of the general population is “sensitized to natural rubber latex.” In addition, eight to 17 percent of (human) health-care workers are affected. I am unaware of any reliable statistics related to veterinary medicine.
I tried extremely hard to better understand the reasons for the ban and obtain statistics from industry professionals. I contacted every major manufacturer and supplier, nationwide. Incredibly, not a single one would answer our basic questions on record.

So if you still own a stash of old powdered gloves, “just in case,” what should you do with them? According to the FDA, “unused supplies… will need to be disposed of according to established procedures of the local community’s solid waste management system.” In plain English, the gloves can be disposed of in regular trash.

Bottom line: The ban affects veterinary practices and we are now obligated to use unpowered surgical and exam gloves.

Glove materials, powder
Medical gloves can be made of natural or synthetic polymers. Latex gloves are made of natural latex, which comes from the rubber tree. Nonlatex gloves are made of a variety of materials, including polyvinyl chloride, neoprene, and nitrile. Watch a short YouTube video on how gloves are made here.

Glove powder essentially acts as a lubricant. The first powder, used in the late 1800s, was made of spores (from Lycopodium, i.e. club moss) or pollen (from pine trees). These materials caused wound granulomas and adhesions. Talcum powder (i.e. magnesium silicate), used in the 1930s, also caused adhesions and granulomas. The year 1947 saw the first absorbable powder: modified cornstarch powder. Until recently, starch was the most commonly used type of glove powder.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified is a board-certified veterinary surgeon and serial entrepreneur. His traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. Visit his websites at DrPhilZeltzman.com and VeterinariansInParadise.com. AJ Debiasse, a technician in Stroudsburg, Pa., contributed to this article.

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