Latex Medical Gloves: Time for a Reappraisal

As is well known, NRL has been used as a material for the production of gloves for almost a century. Throughout the 1990s there were increasing concerns about transmittable diseases, particularly HIV infection and hepatitis, which resulted in a dramatic increase in the use of NRL gloves. Escalating glove use in the 1990s was associated with the rise in reports of allergic reactions to NRL gloves among healthcare workers [1,6,7,8,9,10]. The increased demand for gloves led to an upsurge in glove production, especially in Malaysia. Between 1987 and 1989 the Malaysian Rubber Development Board received over 400 applications to form glove companies where previously only 25 existed [11]. Early on in the history of NRL allergy, some authors [12,13] suggested that the increased production in response to the sudden upsurge for latex gloves often led to inadequate leaching to reduce protein levels.

Deproteinised latex, being composed of enzyme-treated NRL, has also been used as the source material for nitrile gloves. We are not aware of published reports in which gloves made of deproteinised NRL have been compared with conventional NRL gloves, especially with respect to their allergenic properties, although there are reports that NRL-allergic patients can tolerate condoms made from this material [26].

A study in the USA in 2004 performed post-usage examination and testing of surgeons’ gloves after routine surgical procedures. The results revealed higher after-use defects for non-latex compared with latex disposable gloves [32]. Compared with NRL gloves, the odds ratio for defects was 1.39 (95% confidence interval 1.12–1.73) for neoprene and 1.90 (95% confidence interval 1.15–3.13) for nitrile gloves. In addition, the surgeons reported significantly greater satisfaction with regard to factors such as quality, safety and durability for latex compared with latex examination gloves. These results should probably be treated with caution because the surgeons had never used non-latex gloves before for routine surgery (acknowledged by the authors as a possible bias) and only 215 nitrile gloves were used compared to 2,647 latex and 3,624 neoprene gloves. In addition, the main difference in the study was in visible leaks, with no significant difference in water leaks, which may be explained by the low tear propagation strength of nitrile/neoprene. Similar differences between neoprene and NRL have been demonstrated in another study [33] where it was noted that punctures in neoprene gloves were detected more readily by surgeons than punctures in NRL gloves.

According to the Scientific Committee on Medicinal Products and Medical Devices of the European Commission [35], nitrile gloves are usually of lower tensile strength than surgical gloves, but their elastic modulus, or stiffness, is somewhat higher. In addition, nitrile has a higher permanent set than latex, meaning that once stretched it does not fully recover. Thus, nitrile gloves tend to be designed to fit more loosely than latex, and the combination of these properties may affect the users’ tactile sensation and delicacy of touch. This has been confirmed by a study [36] where participants noted that nitrile gloves that fitted their fingers were too narrow for their hands and gloves that fitted their hands were too large for their fingers. During this research, it was confirmed that there are detectable differences between nitrile and latex, where a pegboard test demonstrated an 8.6% increase in fine finger dexterity for latex over nitrile, although no differences related to gross dexterity. Whilst it is not clear at present what the practical effects of this research mean, it does appear that the stiffness of nitrile may affect user dexterity. The study also questioned users about their preferred material, with 67% preferring latex and 21% preferring nitrile.