ARE "HYPOALLERGENIC" GLOVES WORTH THE COST?

B.A. Jolley*, C. Kennedy, G. Gillis and J. Conly.

The Toronto Hospital, Toronto, Ontario, Canada.

The Toronto Hospital (TTH) is a 2 site tertiary care institution, the General Division (TGH) with 800 beds, and the Western Division(TWD) with 430 bed. In January 1993, with increasing complaints from staff of possible skin reactions following glove use a survey was designed and implemented. Glove types used were 4 sterile latex, 1 sterile plastic, 1 unsterile latex and 1 unsterile vinyl. Clinical areas surveyed were the Intensive Care Units (6 ICU), Haemodialysis Units(2HDU), and Cardiac Investigation Unit(1 CIU). Information collected included work area, position, gender, age, glove type, type of skin reaction, and other allergies. Ninety-two percent of responses from both sites were from nursing staff. The overall percentage response from both sites was 16% ranging from 4%(Coronary Care Unit) to 50% (CIU) TGD; and 4.3%(Medical/Surgical ICU) to 45%(HDU) TWD. Skin reactions for all glove types per 100 pairs of gloves issued were as follows:

SITE	ITCHINESS	REDNESS	BURNING	VISIBLE RASH	OPEN SKIN LESION
TGD	1.4%	1.4%	0.9%	0.9%	0.7%
TWD	6.8%	4.75%	2.6%	3.6%	2.8%

There was no association with other allergies detected. One type of sterile latex glove at TGD had previously been identified as problematic at TWD HDU. The sterile latex glove labelled "hypoallergenic" in use at TGD was responsible for 69-74% of all types of skin reactions. This glove was also 6-10 times more expensive than the other 3 sterile latex gloves, and was the least commonly used at 100 pairs in 1 month. The other 3 sterile latex gloves had a mean usage of 1713 pairs in 1 month. As response percentage was low, this may be under-representation of this problem. No single glove was in use without complaints of skin reactions. Skin reactions range from types of contact dermatitis to latex allergy, and may be due to factors such as proteins, accelerators, chemicals and powders found in gloves, or inadequate processing such as poor leeching. Hand washing will remove most resident and transient micro-organisms from the hands as long as skin is intact. Stringent guidelines on quality control, and use of terms such as "hypoallergenic" are required. Health and Welfare Canada, in conjunction with various governmental and medical associations, is currently in the process of developing such guidelines.