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Powdered latex gloves still rule the surgical-glove market, but latex-free and powder-free gloves are gaining ground quickly, today making up one-third of the $290 million U.S. surgical-glove market and posting 10 to 15 percent sales increases annually. What's more, the price advantage latex gloves have long held over latex alternatives is shrinking, thanks to improved technology and increased production of latex-free products. A dramatic increase in the price of raw, natural-rubber latex is expected to shrink that gap even further in 2004. To arm you with the information you'll need to consider switching gloves at your facility, we asked your colleagues and manufacturers for their advice.
Increased latex allergy awareness
More and more administrators and QI committees are aware of issues surrounding prolonged exposure to latex proteins and donning powder. Studies indicate that healthcare workers are the most at-risk group for latex sensitivity and allergy.
"I used to have to fight lots of battles and became an involuntary latex-allergy guru," says surgeon Peter M. Blecher, MD, who was diagnosed with latex allergy in 1991. "Now, many hospitals are latex-free, and more of my colleagues who are not latex sensitive use latex-free gloves."
The focus has also increased on the potential hazards of donning powder. The powder, which is used to counteract the tackiness of natural rubber latex, may provide a vehicle to aerosolize latex proteins, increasing exposure.
"It's critical that we work to limit the amount of glove powder exposure, as well as latex exposure," says Wava Truscott, PhD, the director of scientific affairs and clinical education for Kimberly-Clark. Dr. Truscott says that the powder increases risks for post-surgical complications, including increased inflammation, granuloma and infection potential.
Several administrators tell Outpatient Surgery that eliminating powder is a much easier sell to resistant surgeons than going latex-free. In general, surgeons still prefer the fit and feel of latex over synthetic gloves, and many do not want to make the switch if they are not latex-sensitive. However, most say they can live without the powder.
"We went to powder-free latex about 18 months ago, and it was not a difficult transition," says Debbie Stewart, the director of surgical services for McKee Medical Center in Loveland, Colo. "The powder starts the whole allergic chain. All the exam gloves and most surgical gloves we use are powder-free latex." They also use a latex-free glove for their latex-sensitive physicians.
Containing the cost
Ms. Stewart says glove costs increased when the facility went powder-free but it was not difficult to cost-justify the switch, because the changeover was backed by clinical research. "I had the infection control nurse and the surgeons on my side," she says.
Many consumers wonder why powder-free gloves cost more than powdered ones. Here's why, according to the manufacturers. Most latex glove manufacturers use powder in the manufacturing process to free the gloves from the mold and then, as a second step, remove the powder (as an alternative, some manufacturers chlorinate latex gloves to reduce their natural tackiness). Secondly, in lieu of powder, manufacturers use alternative donning agents. These days, it is most likely to be a polymer applied to the inside, and sometimes the outside, of the glove. Manufactur-ers pass on the higher cost of the polymers to the consumer.
Manufacturers say the price difference will shrink, though. "The average selling price has decreased in every glove segment. As sales volumes increase, we're achieving economies of scale. Secondly, we've noticed a significant movement away from consumers seeking only the cheapest gloves," says Dan Manley, vice president of marketing for Regent Medical.
Meanwhile, the price of raw natural latex may rise sharply - perhaps as much as 30 percent - in 2004. This is largely related to supply and demand, says to Jeannie Thomas of Cardinal Health. Some rubber plantations, particularly in Malaysia, have converted to palm plantations. A prolonged rainy season in Southeast Asia has also driven down latex harvesting.
Industry sources say the current situation will affect the price of powdered latex gloves more than powder-free gloves.
"The raw material is a higher percentage of the cost of powdered latex and exam gloves. We may have to raise prices in 2004 on those products. We'll wait and see with the powder-free surgical gloves," says Ansell's Diego Rodriguez.
Entering the comfort zone
As the demand for the technology grows, manufacturers have refined their powder- and latex-free gloves to be easier on the skin, more comfortable for longer procedures, and suited for various types of surgical use.
Arguably, the biggest buzz in latex-free technology centers around polyisoprene gloves. The technology was first introduced in 1998 but has only grown in popularity fairly recently. Proponents say they have a fit and feel comparable to natural rubber latex.
"I went through a variety of gloves before settling on [polyisoprene]. Until recently, we lacked synthetic gloves with the elastic properties of latex. Previously, synthetic gloves had to be very snug to fit well, which were less comfortable and fatigued the small muscles in my hand. These fit well and feel good even during long periods of use," says Dr. Blecher.
Ms. Stewart says surgeons really like the polyisoprene gloves they use. "They are very happy with how it feels. It dons easily, doesn't tear, and there are different thickness options," she says.
Decisions, decisions
Facilities find themselves with more and more latex- and powder-free choices than ever before. "There are now six or seven options - just in a single brand line," says Terry Crow, materials manager for The Surgical Pavilion in Little Rock, Ark. Her facility has been entirely powder-free for eight months.
While the front-end of the glove selection process is more complex than ever before, the end result may actually simplify your glove selections.
"We used to have five different kinds of gloves. Now we just have two - a powder-free latex glove and a latex-free," says Ms. Crow.
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