I was nervous the day we made the big switch to all non-latex gloves in our operating rooms. We'd been planning and researching for some time, but on the Monday morning that the big changeover went into effect, I found myself waiting for the barbarians at the gate to explode out of the OR and hunt me down. Then something amazing happened: nothing. No complaints. No threats of mutiny. No one peeling off her gloves and throwing them at me. Nothing. I was shocked. It was so quiet that I got on the phone and started making calls. Is there any problem? Is there anything going on? No, everyone said. Everything went smoothly. That was 9 years ago, and here at Johns Hopkins, we've had no problems since.
Much has happened since then. Providers and the public have grown increasingly aware of and increasingly concerned about latex allergies, and many facilities have at least moved in the same direction. Meanwhile, the FDA is proposing an outright ban on powdered latex surgical gloves. But when I talk to colleagues around the country and around the world, what I usually hear is that they still haven't gone all the way. They haven't tried to make their facilities completely latex safe.
Sometimes I get calls, asking for advice: "How did you do it? I've got this surgeon who refuses," or "We have an administrator who says we can't afford it." I'm always happy to help, because I believe the time has come for all providers to go the distance for the sake of our patients and for us.
How did we do it? The most important thing we did was make it a team effort. We were able to achieve our goal by first getting all the key players in one room to discuss issues, goals and potential hurdles. Surgeons, nurses, administrators, purchasing agents, risk management all the stakeholders.
Next, we got everyone in the OR involved with helping to select the gloves we'd be using. We had trials, we had glove company reps helping people size them properly, we made comparisons and even then, we still had some pushback, some people who weren't completely comfortable.
But we kept at it, and didn't force the issue. The tipping point came when we determined that more than 80% of our people had found gloves from 2 of the manufacturers we were considering that they liked. That was when we felt we had enough buy-in including from the chairman of the surgical department, from the anesthesia department and from the nursing department to move forward. Keep in mind, this was 9 years ago. The quality of non-latex gloves has improved a great deal since then. If a doctor is your main obstacle, sometimes it's more effective when you can arrange a doctor-to-doctor discussion. They'll speak the same language and they'll hear each other better.
It's important to recognize that the challenges are at least as much cultural, as they are physical. When I went to medical school in the 1980s, nobody wore gloves, except when they were performing sterile procedures. Then came HIV. And people said, "I can't put in an IV with gloves, I can't feel the vein." Now, of course, nobody would even consider putting in an IV without having gloves on.
Cultures can change. Where latex is concerned, it's become such a non-issue at our institution that it almost feels like a historical footnote. But the culture hasn't changed, or hasn't changed enough, across the country. If we could do it then, there's nothing to prevent anyone from doing it now.
I'd argue that the quality of non-latex gloves has improved over the years to the point that it's equal or superior to that of latex gloves. They have the same tactile quality and the same elasticity. We've had no problem with non-latex gloves not fitting well. The gloves we use now are made from either of 2 materials: nitrile and polyisoprene. My preference is the latter. It's a superb material that provides the same if not better tactile quality, strength and flexibility as latex gloves. It does, however, cost a little more.
Those who double-glove for a time found that putting on the second glove without powder (which is a problem in itself) was very difficult. But now every manufacturer has moved to non-powder gloves, and they've all figured out how to make it work for doublegloving. Many of my colleagues double-glove, and they have no problem with non-latex gloves.
Similarly, our ophthalmologic and other surgeons performing microscopic surgeries face a challenge, since they need fine motor control and good tactile sensation. But all of our ophthalmologic surgeons use non-latex gloves and I've heard zero complaints.
Take time to learn
Will surgeons and others be completely comfortable the first time they put on non-latex gloves? Probably not. There is a learning curve for new gloves, because every glove is a little different. All muscles have motor memory, and it takes a little time to get familiar with new products. But when you use them for a while I'd say about 50 times you get back to your baseline ability.
As noted, the non-latex alternatives are also a little more expensive, but the difference has been decreasing over the years and is much smaller now than it was 10 years ago.
To make the switch more economical, we negotiated with the 2 suppliers we were using and got an even better deal by paring down to just one supplier. That was part of our motivation from the beginning, in fact. By reducing the number of glove suppliers we were using, we were able to reduce inventory and costs, and make it a win-win situation.
Always on guard
We made the switch long ago, but we remain vigilant. Once in a while, people bring in latex gloves from outside. In one instance, a colleague was doing brachytherapy and handling radioactive beads. He knew he needed special gloves that were billed as being safer, and they contained latex. I happened to notice and asked about it. I knew it was a low-risk situation, but I wanted to keep the policy constant, if possible. Purchasing got involved and sure enough, we were able to find radiation-safe gloves that were non-latex.
Unfortunately, there are still a handful of products for which we haven't found suitable latex-free substitutes. For example, there are a few specialized urinary catheters and rubber catheters that are used for suctioning fresh tracheostomy patients. Surgeons are concerned that stiffer catheters may traumatize the new tracheostomy opening. When situations like those arise, we don't want to inhibit the ability of people to do their jobs properly, so we try to compromise and do things that are safe for the patient but won't impede the provider. And we make sure people are aware when we're using a latex product. Meanwhile, we continue to search for substitutes.
The risks associated with latex may be relatively small compared with some other issues, but eliminating latex gloves was something we could do fairly easily to increase the safety of our patients and staff. It's always better to be proactive than reactive. If you aren't, and the unexpected happens, you may suddenly find yourself dealing with an anaphylactic reaction. And everyone says, oh my gosh, how did this happen? And then you're scrambling.
It's better to get ahead of the problem, and there's no better time to do it than now. OSM