The benefits of latex-free gloves in the operating room environment.

Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.

A New Approach to Pathogen Containment in the Operating Room: Sheathing the Laryngoscope After Intubation.

BACKGROUND: Anesthesiologists may contribute to postoperative infections by means of the transmission of blood and pathogens to the patient and the environment in the operating room (OR). Our primary aims were to determine whether contamination of the IV hub, the anesthesia work area, and the patient could be reduced after induction of anesthesia by removing the risk associated with contaminants on the laryngoscope handle and blade. Therefore, we conducted a study in a simulated OR where some of the participants sheathed the laryngoscope handle and blade in a glove immediately after it was used to perform an endotracheal intubation. METHODS: Forty-five anesthesiology residents (postgraduate year 2-4) were enrolled in a study consisting of identical simulation sessions. On entry to the simulated OR, the residents were asked to perform an anesthetic, including induction and endotracheal intubation timed to approximately 6 minutes. Of the 45 simulation sessions, 15 were with a control group conducted with the intubating resident wearing single gloves, 15 with the intubating resident using double gloves with the outer pair removed and discarded after verified intubation, and 15 wearing double gloves and sheathing the laryngoscope in one of the outer gloves after intubation. Before the start of the scenario, the lips and inside of the mouth of the mannequin were coated with a fluorescent marking gel. After each of the 45 simulations, an observer examined the OR using an ultraviolet light to determine the presence of fluorescence on 25 sites: 7 on the patient and 18 in the anesthesia environment. RESULTS: Of the 7 sites on the patient, ultraviolet light detected contamination on an average of 5.7 (95% confidence interval, 4.4-7.2) sites under the single-glove condition, 2.1 (1.5-3.1) sites with double gloves, and 0.4 (0.2-1.0) sites with double gloves with sheathing. All 3 conditions were significantly different from one another at P < 0.001. Of the 18 environmental sites, ultraviolet light detected fluorescence on an average of 13.2 (95% confidence interval, 11.3-15.6) sites under the single-glove condition, 3.5 (2.6-4.7) with double gloves, and 0.5 (0.2-1.0) with double gloves with sheathing. Again, all 3 conditions were significantly different from one another at P < 0.001. CONCLUSIONS: The results of this study suggest that when an anesthesiologist in a simulated OR sheaths the laryngoscope immediately after endotracheal intubation, contamination of the IV hub, patient, and intraoperative environment is significantly reduced.

Comparison of compliance of glove use among anesthesia providers: a prospective blinded observational study.

Compliance of using gloves in the operating room (OR) is still poor amongst anesthesia providers. The practice of using gloves amongst OR anesthesia providers (attending anesthesiologists, anesthesia nurses, and trainees) in a tertiary care center was observed over 8 months. Observations were made during intravenous (IV) cannulations, laryngeal mask airway (LMA)/endotracheal tube (ETT) introductions, and ETT extubation/LMA removals, without alerting anesthesia personnel. Ten observations were made from each of the procedures for every provider involved. 1,240 observations were made involving 8 attending anesthesiologists, 9 trainees, and 14 nurses. A Chi-square test showed significant difference of glove utilization rates between the groups during all 4 procedures. The highest compliance was observed in trainees (50%), followed by nurses (39.64%), and attending anesthesiologists (10.93%). All groups had their highest compliance levels during IV cannulation. Additionally, attending anesthesiologists had the lowest compliance levels during all individual procedures. Anesthesia nurses had the highest compliance during LMA removals (39.29%), whereas trainees showed the highest compliance in all other procedures. Glove usage by anesthesia providers during routine OR procedures continues to be low. Educational programs highlighting the hazards of noncompliance and strict departmental protocols may help to eliminate irregularities in the use of gloves.

Factors that influence the selection of sterile glove brand: a randomized controlled trial evaluating the performance and cost of gloves.

PURPOSE: To determine whether glove use modifies tactile and psychomotor performance of health care providers when compared with no glove use and to evaluate factors that influence the selection of sterile glove brand. METHODS: Forty-two anesthesia providers (nine anesthesiologists, seven nurse anesthetists, 20 residents, six student nurse anesthetists) enrolled in and completed this cross-over randomized trial from May 2010 until August 2011. Participants underwent standardized psychomotor testing while wearing five different types of protective gloves. Assessments of psychomotor performance included tactile, fine motor/dexterity, and hand-eye coordination tests. Subjective ratings of glove comfort and performance were reported at the completion of each glove trial. The manufacturer's suggested retail price was collected for each glove tested. RESULTS: There were statistically significant differences in touch sensitivity for all nerve distributions, with all glove types resulting in less sensitivity than a bare hand. When compared with the non-sterile glove, only the thickest glove tested (Ansell Perry Orthopaedic) was found to have less touch sensitivity. Fine motor dexterity testing revealed no statistically significant differences in time to completion amongst glove types or bare handed performance. In hand-eye coordination testing across treatment conditions, the thickest glove tested (Ansell Perry(®) Orthopaedic) was the only glove to show a statistically significant difference from a bare hand. There were statistically significant differences in glove comfort ratings across glove types, with latex-free, powder-free (Cardinal Esteem(®)), and latex powder-free (Mölnlycke-Biogel(®)) rated highest; however, there were no statistically significant differences in subjective performance ratings across glove types. CONCLUSIONS: Given the observed similarities in touch sensitivity and psychomotor performance associated with five different glove types, our results suggest that subjective provider preferences, such as glove comfort, should be balanced against material costs.

Primary prevention of latex allergy in healthcare-spectrum of strategies including the European glove standardization.

IgE-mediated allergy to natural rubber latex was first noted from rubber gloves in 1979. The initial reports in dermatological journals described contact urticarial reactions; later, severe generalized allergic reactions and asthma were documented. A considerable proportion of the people involved in medical and dental care were found to be sensitized to latex. This article describes and surveys a broad range of primary prevention measures at the local and national levels. Examples are given from paediatrics, dental education, and medical care. National strategies and position papers on latex allergy are presented in which medical professionals, manufacturers and public authorities have cooperated. Special reference is paid to the European work to standardize medical gloves, which led to document EN 455:3.

Disinfection of gloved hands during the COVID-19 pandemic.

BACKGROUND: Disinfection of gloves can be used during a pandemic situation when performing various procedures on the same patient or when removing personal protective equipment. If performing glove disinfection, there is a need to check the compatibility of gloves with the disinfectant product used. AIM: To test the resistance of nitrile gloves to various disinfectant solutions. METHODS: One hundred percent powder-free nitrile gloves, composed of nitrile butadiene rubber compounds, were exposed to various disinfectants to analyse resistance. The seven most commonly used disinfectant solutions in the healthcare field were selected for testing. The effects of each disinfectant were analysed in comparison with the control group (untreated glove). For tensile testing, the thickness of each test specimen was measured with a micrometer. FINDINGS: Bleach solution decreased the breaking load of gloves, although to a lesser extent than disinfectants that contained ethanol. CONCLUSION: Disinfectants that contain alcohol decrease the breaking load of nitrile gloves.

[What is the appropriate time-interval for changing gloves during surgical procedures]. / Wann sollte in Operationsräumen ein Wechsel chirurgischer Handschuhe erfolgen?

BACKGROUND: Surgical gloves are an important phys-ical barrier between surgical staff and the pa-tient. They enable prevention of transmission of microorganisms in both directions, from the sur-geons' hands to the patient and vice versa. Besides the duration of wearing and the role within the surgical team, the integrity of gloves depends on the type of surgery performed. Therefore indicator systems and specific material enforcements of gloves at predilection sites are under discussion and furthermore, recommendations have been made for double-gloving during trauma surgical procedures. Because of varying recommendations regarding the changing interval of gloves, changes are often performed rather late or even not at all. The consequence is an increasing rate of glove perforations and an incalculable risk of infections. MATERIAL AND METHODS: To elaborate an objective recommendation for the time-interval of glove change, the medical literature was searched in the data bases MEDLINE and PubMed. RESULTS: Various imprecise recommendations were expressed for the time point of glove changing rang-ing from 30 min to 180 min. Only in visceral surgery perforation rates had been correlated with the glove wearing time and the following recommendations of glove changing time points had been made: for the surgeon and first assistant at 90 min and for scrub nurses and second assistants at 150 min from the start of the operation. CONCLUSION: Because the perforation rate and thus the time for glove changing depend on the type of the surgery, the results found in visceral surgery can not be transferred to other surgical special-ties without additional scientific evidence. Further studies are needed that correlate the types of surgical procedures with specific perforation rates in order to provide basis for solid -recommendations helping to improve patients' and medical staff's safety.

At what point during total knee arthroplasty operations are gloves most frequently torn?

PURPOSE: The aim of this study was to determine the time points during a total knee arthroplasty operation when there is the greatest possibility of tearing a surgical glove and thus the stage of the operation at which there is the greatest risk of infection. METHODS: The study included 300 total knee arthroplasty cases performed by 10 orthopedic surgeons. Using a chronometer during the operation, the upper layer of each surgical glove was removed and inflated with sterile saline at 10-min intervals. When a tear was determined, a record was made of the time it occurred, the stage of the operation, the finger that was torn, and the side (right or left hand). RESULTS: The mean time of the glove perforation was 40.74 ± 10.69 min. Glove tears occurred at the rate of 28.9% (n = 39) in the thumb, 63.7% (n = 86) in the index finger, 2.2% (n = 3) in the middle finger, and 5.2% (n = 7) in the ring finger. The tears occurred after the femoral cut in 8.1% (n = 11), after the tibial cut in 14.8% (n = 20), at the stage of trial component reduction in 52.6% of cases (n = 71), after placement of the prosthesis in 7.4% (n = 10), and at the closure stage in 17% (n = 23) (p < 0.001). CONCLUSION: The fingers requiring the most care during total knee arthroplasty are the thumb and index finger. The stages of the operation with the greatest risk for glove tears are trial component reduction and wound closure. Changing gloves after these high-risk surgical stages would help to decrease the risk of periprosthetic infections. LEVEL OF EVIDENCE: Level IV/Case series.

A novel method to teach and assess the sterility of donning sterile gloves.

Sterility is of utmost importance during surgery, particularly orthopaedic surgery. The literature suggests sterility, when compromised, is frequently contaminated at the point of donning sterile gowns and gloves. We describe a novel method to assess the compliance of sterility whilst applying surgical gloves using an ultraviolet lightbox and an ultraviolet-sensitive 'Germ paint'. We carried out an audit of 'sterility' using this method with our surgical trainees. A subsequent educational programme described methods of glove-donning. Repeat assessment yielded significantly improved results. Educating staff using this method may improve sterility in theatre. We believe this is a novel method to teach and assess sterility during glove-donning. The equipment is readily accessible within each NHS hospital. Medical and theatre staff should use this as part of training and departmental induction programmes.

The final steps in converting a health care organization to a latex-safe environment.

BACKGROUND: In a follow-up to a previous article, which described the approach at The Johns Hopkins Medical Institutions to establishing a latex-safe environment, subsequent efforts to convert all the sterile gloves to nonlatex products and thereby complete the implementation of a latex-safe program are reported. Before the complete conversion to nonlatex sterile gloves, operating room use had increased to approximately one-third of our total sterile glove use during the preceding four years. NEW APPROACHES TO CONVERTING TO ALL NONLATEX STERILE GLOVES: The final stages of the conversion involved both consistent follow-through with education, training, and personnel involvement at all levels and a change in the culture of the medical facility. New and improved nonlatex glove products were coming to the market, and their costs were decreasing because of increased supply and competition. GLOVE TRIALS: Five synthetic neoprene or polyisoprene gloves-two from one manufacturer and three from the second manufacturer-were evaluated in glove trials. Overall, by manufacturer, a similar rate of acceptance among the various sterile nonlatex gloves (74.2% versus 78.1%) was found. However, to ensure that all users were satisfied, contracts were awarded to both vendors. The weekend before the conversion date of May 1, 2007, all old powdered sterile latex gloves were replaced with the new stock of nonlatex sterile gloves. THE CONVERSION PROCESS: Once financial and logistical concerns were addressed, conversion to a latex-safe environment entailed readying the organization for the change in organizational culture. Key factors were (1) general acceptance from all the chiefs of the surgical departments; (2) centralization for all purchases of medical supplies, including sterile gloves, through corporate purchasing; and (3) ongoing education and vigilance.

Do surgical personnel really need to double-glove?

In 2007, AORN's Recommended Practices Task Force revised the "Recommended practices on prevention of transmissible infections in the perioperative practice setting" to recommend that health care practitioners double-glove during invasive procedures. Previously, AORN had suggested that wearing two pairs of gloves might be indicated for some procedures. Research on the protective effects of double gloving provides compelling evidence that surgical personnel should double-glove during all surgical procedures. Statistics on unreported injuries and conversion rates of HIV and hepatitis B indicate that change is difficult; however, research also suggests that objections to double-gloving can be overcome and a practice change implemented to ensure the safety of health care workers and patients alike.

Hands-on defibrillation with a safety barrier: An analysis of potential risk to rescuers.

BACKGROUND: Interruptions in compressions reducethe efficacy of cardiopulmonary resuscitation (CPR) and are inevitable during hands-off periods for shocks. Clinical exam gloves were found to facilitate safe contact with patients during shock delivery but the safety of this practice has been questioned. Polyethylene is of interest because of its safety record in the medical arena and its electrical insulation properties. METHODS: This study measured the current leak through 2 mil (0.002 inch) polyethylene drapes during shock delivery. The current leak was assessed by measurement of voltage changes in a circuit recommended by the International Electrotechnical Commission (IEC) for current leak safety testing. Current flowed off the drape, through the circuit and to electric ground in a manner consistent with standardized testing. Perceptibility was assessed in a subset with the investigator's bare hands pressed into the drape during shock delivery. RESULTS: Thirty-three patients undergoing elective cardioversion at Emory University Hospital underwent analysis (age 23-90, 36% female). Biphasic energies were 200-360 J. The root mean square (RMS) current leak averaged 0.072 ± 0.022 mA and peak current leak averaged 0.67 ± 0.21 which is well below IEC recommendations of 3.5 mA RMS and 5.0 mA peak. Finally, no instances of dielectric breakdown occurred and no shocks were perceptible. CONCLUSIONS: Polyethylene is a common medical material which may facilitate safe hands-on defibrillation. Our data illustrates that a thin, semitransparent layer of polyethylene is a safe and feasible adjunct to cardiac arrest kits to allow continued compressions and simplification of the CPR process.

Glove perforations during open surgery for gynaecological malignancies.

OBJECTIVE: To audit glove perforations at laparotomies for gynaecological cancers. SETTING: Gynaecological oncology unit, cancer centre, London. DESIGN: Prospective audit. SAMPLE: Twenty-nine laparotomies for gynaecological cancers over 3 months. METHODS: Gloves used during laparotomies for gynaecological cancer were tested for perforations by the air inflation and water immersion technique. Parameters recorded were: type of procedure, localisation of perforation, type of gloves, seniority of surgeon, operation time and awareness of perforations. MAIN OUTCOME MEASURE: Glove perforation rate. RESULTS: Perforations were found in gloves from 27/29 (93%) laparotomies. The perforation rate was 61/462 (13%) per glove. The perforation rate was three times higher when the duration of surgery was more than 5 hours. The perforation rate was 63% for primary surgeons, 54.5% for first assistant, 4.7% for second assistant and 40.5% for scrub nurses. Clinical fellows were at highest risk of injury (94%). Two-thirds of perforations were on the index finger or thumb. The glove on the nondominant hand had perforations in 54% of cases. In 50% of cases, the participants were not aware of the perforations. There were less inner glove perforations in double gloves compared with single gloves (5/139 versus 26/154; P = 0.0004, OR = 5.4, 95% CI 1.9-16.7). The indicator glove system failed to identify holes in 44% of cases. CONCLUSIONS: Glove perforations were found in most (93%) laparotomies for gynaecological malignancies. They are most common among clinical fellows, are often unnoticed and often not detected by the indicator glove system.

First clinical study of a new virus-inhibiting surgical glove.

QUESTION UNDER STUDY: Prospective clinical study to evaluate the tolerance, ergonomics and glove barrier value (mechanical resistance to breach) of a new surgical glove sandwiching droplets of a disinfecting agent between two layers of a synthetic elastomer (G-VIR) able to inactivate viruses when breached. METHODS: 100 surgical procedures were performed by six surgeons wearing G-VIR on 100 patients included after informed consent. Procedures were classified into laparoscopic (n = 28) or open surgery (n = 72); open surgery being subdivided either into superficial (n = 33) and deep (n = 39) or into hernia (n = 32) and non hernia (n = 40). The ergonomics and tolerance of the glove were evaluated by the surgeons using a questionnaire. Patients were clinically evaluated daily during hospitalization and once between the 4th to 6th postoperative week. All used gloves underwent a water leak test to detect any breach. RESULTS: 834 G-VIR gloves were used, 456 by the first surgeon and 378 by the assistant surgeon, resulting in 195 exposures, lasting 288 operator-hours (OH). No adverse effect on patients and/or surgeons linked to G-VIR could be observed. Ergonomics of G-VIR has been evaluated as equivalent as standard double gloving, excepted for donning which was more difficult (P <0.05). The breach rate per glove (BRpG) amounted to 1.8%. According to breach rate per operator-hour (BRpOH), surgical procedures could be categorized in low (laparoscopy), middle (non hernia and hernia superficial) and high (hernia deep) risk procedures. CONCLUSIONS: G-VIR gloving offers an excellent mechanical protection, is suitable for daily surgical practice and maybe recommended in high risk surgical procedures.

[Gloves as medical devices or individual protection devices: current regulations and correct use in hospital environments]. / Guanti come dispositivi medici o come DPI: normativa vigente e corretto impiego in ambito sanitario.

BACKGROUND: Hospital work consists of the care and assistance of patients, who therefore constitute another group of individuals besides the workers, which is a completely different situation compared to other workplaces in manufacturing industries. OBJECTIVES: Health professionals must know how to use the right devices to protect both the patients and themselves. In the case of protection of the hands, health professionals must also know when to use gloves as "individual protection gloves" and when to use gloves as "medical devices", and comply with both Italian and European Community regulations. METHODS AND RESULTS: The Hospital of Vimercate (Milan) has drawn up technicalprocedures regarding the various types of gloves used in hospitals, which provide health care workers with accurate information on regulations and protocols, prevention guidelines, safety management recommendations, purchasing specifications, quality controls, correct uses of gloves and devices.

[Criteria for choice and purchase of gloves: quality or cheapness? The role of the Occupational Health Physician]. / Criteri per l'acquisto e la scelta dei guanti: qualità o economicità? II ruolo del medico competente.

BACKGROUND: The choice of gloves in the healthcare settings is very important because of the high biological and chemical risks present in these workplaces. In order to rationalize and optimize this choice we must balance cost, quality, security and comfort. OBJECTIVES: The aim of this study was to analyse the rules in force and to point out the relevant role of the Occupational Health Physician in the right choice and purchase of sanitary gloves. METHODS: We reviewed the rules in force and the most relevant studies on these topics. RESULTS AND CONCLUSIONS: The regulations in force provide that the manufacturers must perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results are reported in the technical sheets. Thus the manufacturers have only to declare to be "in accordance with the rules". Therefore purchasers should require the manufacturing companies to give detailed information and verify their reliability. Moreover rules could be adapted to higher quality standards. The Occupational Health Physician should suggest the purchase of gloves with high biocompatibility, assuring the protection from the risks of specific tasks and suitable for preventing the onset of new glove-related diseases and the relapses in workers with already diagnosed occupational diseases.

[Latex and synthetic polymers gloves: protective effectiveness against biological risk]. / Guanti di latice e guanti di polimeri sintetici: efficacia protettiva nei confronti di agenti biologici.

BACKGROUND: The quick evolution of knowledge about latex and, especially, its effectiveness as protection against biological risks on one hand, and, on the other hand, as trigger of cutaneous, respiratory and sistemic allergic diseases, required a marked distinction between conditions in which latex is necessary and conditions in which latex could be substituted by syntetic polymers. OBJECTIVES: The aim of this study is to verify protective effectiveness of gloves made of syntetic polymers against biological risks compared with latex gloves which until now have been considered as the best protection. METHODS: Literature review. RESULTS: The most recent studies seem to consider neoprene gloves as the safest protection to replace latex in working activities with high biological risk exposure. CONCLUSION: The literature review marked the lack of studies exclusively focused on glove permeability towards biological agents. It seems therefore necessary to investigate this topic to validate results and to guarantee a suitable protection to workers daily exposed to biological risk.

[Old and new types of sanitary gloves: what has improved?]. / Vecchie e nuove tipologie di guanti in commercio e possibili implicazioni clinico-preventive: materiali e patologie, qualcosa è migliorato?

BACKGROUND: During the eighties a large increase in latex gloves production was observed because of the high demand of gloves in health care settings. In this period a low compliance to minimal quality standard was detected and the poor glove quality was associated with an increase of both irritant and allergic glove-related diseases. Since the second half of nineties health care workers and manufacturers paid more attention to these problems and a trend to a gradual, even if slow, quality improvement was observed. Most frequently powder-free gloves and synthetic gloves were offered on the market. OBJECTIVES: The aim of this study was to highlight what has improved about materials and types of sanitary gloves during the last ten years. METHODS: The information are based on a review of the scientific literature and practical experiences. RESULTS AND CONCLUSIONS: Today a large selection of gloves made of different materials are available and they should be addressed to specific tasks. The review of the scientific literature and the analysis of many technical sheets provided by the manufacturers pointed out a trend to a better latex gloves quality (less chemical additives and generally a lower total protein content); sometimes data about a lower extractable latex allergens content are also available. Unfortunately detailed information on glove composition are not usually provided by the manufacturers; purchasers should require the manufacturing company to give comprehensive information and verify their reliability. Moreover the regulation in force should be adapted to higher quality standards. Powder-free and synthetic gloves consumption has improved but the use of synthetic rubber gloves should be further enhanced since some materials (e.g. neoprene and nitrile rubber) have a good biocompatibility and seem to have physical properties and protective efficacy similar to latex. Moreover allergic reactions to synthetic gloves (some chemical additives) are only occasional.

[Consensus Document. Update on latex exposure and use of gloves in Italian health care settings]. / Documento di Consenso. Aggiornamenti in tema di esposizione a latice e impiego di guanti in ambito sanitario.

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.