If at first you don't succeed with powder-free surgical gloves, try again. And, if needed, again. That's what Terry Crow, CST, the materials manager at the Surgical Pavilion in Little Rock, Ark., learned from her facility's experience going powder-free.

She found that one switch to a powder-free latex glove didn't settle the matter. Over the last 18 months, her freestanding surgery center selected a powder-free glove, ran a trial on another brand of powder-free glove, used that glove for a time, then switched back to the original powder-free choice after infection rates spiked and techs complained that they kept putting their hands through gloves while donning them.

One thing that didn't change was her facility's desire to go powder-free. How did she and her staff get from point A to point B? Here's a look at the lessons Ms. Crow learned about what staff need in a glove, as well as the new options that can fulfill those needs (see "Your Six Newest Safety Glove Choices" on page 66).

Trial and error
Like a growing number of surgical facilities, the Surgical Pavilion had decided it was time to get powder out of the OR.

"We were going in the powder-free direction. I had dermatitis allergies and some other staff members did, too. I could tell by the condition of my hands if I had worn powdered or powder-free gloves," says Ms. Crow.

They made the switch to powder-free early last year. The first selection was a powder-free glove with an inner layer of nitrile for easy donning. The staff was satisfied, she remembers, but one surgeon came back from a meeting with a sample of another brand of powder-free glove that seemed to offer more choices in thickness and sensitivity. Ms. Crow ran a glove trial, and found the glove was thinner and rated better among physicians for microsurgery. That manufacturer also offered a latex-free glove to use with latex-sensitive patients, as well as a per-glove price that was 30 cents better.

The facility made the switch, and at first was pleased with six or seven choices in powder-free and latex-free gloves from the same manufacturer. But after using the glove on long, more complicated cases, the staff began to complain about comfort. Ms. Crow noted another disturbing trend: Staff members were putting their hands through the gloves. Plus, infection rates went up.

"At first, I thought they were being too rough on them until I went to scrub a case and I put my hand through the gloves - they would separate at the palm," she says. "It took me three pairs of gloves to get the case started."

The facility went back and reconsidered the strengths of the original powder-free glove choice, a move made easier when the manufacturer matched its competitor's per-glove price. So far, reviews have been positive:

• infection rates returned to normal;
• comfort is good; and
• the gloves stay put when staff pull them down on their fingers.

Key qualities
At that point, Ms. Crow and her staff were able to put their collective finger on what they do - and don't - want in a powder-free glove.

"When we put [the original powder-free] glove on, it doesn't move around on the hand," says Ms. Crow. "There is a good memory to the material. Some gloves move around when the hand gets sweaty, and this may contribute to glove failure during the longer procedures."

She also found the manufacturer had introduced additional choices in the latex-free and powder-free categories. After consideration by the staff, the facility switched back, and it now has several choices in both powder-free gloves and latex-free gloves for latex-sensitive patients and staff members.

"At this point, none of our staff members use a powdered latex glove, although some surgeons do. This is by choice. The difference in cost between powder-free and powdered latex gloves is not an issue for us because there are important benefits with powder-free," says Ms. Crow.

She suggests these questions to help sort out the right glove for your facility:

• How well does it fit most hands?
• Does it stay in place?
• How does it hold up during long and very wet procedures?

She also notes that staff preference is extremely important regarding surgical gloves.

From the manufacturers
The increased interest in latex-free and powder-free latex gloves is motivating manufacturers to continue to improve and expand these products, giving you more options when doing your trial. Here's what manufacturers we spoke to told us.

• Many powder-free gloves have lower levels of proteins, as most manufacturers say they've improved their manufacturing capabilities.
• Powder-free gloves are getting easier to don thanks to improvements in polymer inner coatings. The challenge for manufacturers is creating effective coatings that allow both enhanced donnability and double-gloving (the industry seems to think there is a trend toward double-gloving).
• Polyisoprene continues to draw strong interest in the latex-free category, although a worldwide shortage in its raw material might stunt its growth. Note that the use of chemical accelerators in production of some polyisoprene gloves is causing concern about related Type IV allergies.
• You'll find neoprene, a material touted for its barrier protection properties, in more products.
• You'll find hand-friendly technology, such as emollients to soothe and protect skin, in more brands of surgical gloves.

Usage up, prices down
Latex-free and powder-free glove use is up 51 percent in 2004, according to industry source Healthcare Products Information Services (HPIS), a company that tracks market trends in the acute-care and alternate-care markets. Powdered latex glove usage declined in 2004; in the acute-care market, powdered gloves and powder-free gloves are tied at 45 percent market share each, says HPIS.

Compounding that is the fact latex glove prices are up; the price of raw latex nearly doubled from 2002 to the end of 2003, and remained at high levels during 2004. This has begun to affect the prices of all latex products, says Virginia James, a product manager for Regent Medical, and gives facilities some incentive to consider latex-free gloves at this time.

However, the price differential between latex surgical gloves and latex-free products is not expected to disappear. The overall raw material cost for a surgeon's glove accounts for 15 percent to 20 percent of the price you pay; sterilizing, manufacturing and packaging comprise the rest, says Paul Bottcher, a senior product manager for Medline Industries.

Try, try again
With so many glove options available, flexibility is the key in proceeding with your glove trial.

"You have to adjust as you go along. If your staff says there is a problem, you need to take that seriously. Listen to their concerns and preferences, and go from there," says Ms. Crow. "If they won't wear a glove, there's no use in having it around."