Knowledge Base
Learn about infection control practices and considerations.
Powdered and Powder-Free Gloves
Why is glove powder an issue?
Generally, glove powder may cause the following issues:
- Powder is an irritant that can dry hands and macerate the skin.
- Powder interferes with optimal wound healing and reduces resilience and strength of repaired tissue.
- Powder increases and prolongs inflammation by several mechanisms.
- Powder increases the risk of infection.
- Powder can irritate the respiratory mucosa and induce respiratory tract reactions.
- Powder can reduce resistance to infection by interfering with the body’s local defences.
- Powder may act as a carrier, aerosolising natural rubber latex proteins bound to its surface.
- Aerosolised natural rubber latex protein bound to powder can be inhaled and cause reactions in latex allergic individuals.
- Aerosolised glove powder may carry bacteria, viruses and fungi.
- Natural rubber latex proteins can bind to powder, be aerosolised, and contaminate surgical tissues, instrument trays, drapes, sponges, suture material, needles, instruments and equipment.
- Powder left behind in wound sites can cause inflammation, promote infection, increase scarring, induce adhesions, produce intestinal obstruction and cause pelvic pain and infertility.
- Powder can cause foreign body reactions resulting in granulomas (small areas of inflammation filled with immune cells) and adhesions after surgery.
- Powder has been implicated in the misdiagnosis of carcinoma (a type of cancer).
Is powder found only on the inside of powdered gloves?
No. Powder is added to facilitate glove donning and removal. The majority of powder in powdered gloves stays on the internal glove surface. However, some migrates to the outer surface during manufacturing, tumbling and packaging. Release of powder can also occur when gloves are torn or punctured and during donning, snapping in place and removal.
What kind of powder is generally used on gloves?
The powder used for surgical gloves is USP (United States Pharmacopeia) absorbable dusting powder (modified cornstarch) with less than 2% magnesium oxide added. Calcium carbonate and other chemicals may be added, depending on the manufacturer. Non-USP absorbable dusting powder may be used on examination gloves (e.g. oat starch).
At Hartalega, USP absorbable dusting powder (modified cornstarch) is being used in the production of powdered examination gloves.
Is this cornstarch the same as what I use at home for cooking?
No. The cornstarch used on gloves (USP absorbable dusting powder) is cross-linked with chemicals such as phosphorus oxychloride or epichlorhydrin. This alters the powder particles so they become more difficult to break down, enabling them to withstand steam sterilisation and hand sweat without degrading. To this chemically cross-linked powder is added a maximum of 2% magnesium oxide to help prevent caking.
Can I have allergies to cornstarch?
Though rare, allergies to cornstarch have been reported. However, USP (United States Pharmacopeia) absorbable dusting powder (modified cornstarch) present in standard gloves can bind with the chemicals (latex and synthetic gloves) and proteins (latex gloves) to which individuals are much more likely to be allergic. Powder can also absorb and transport infectious organisms such as bacteria, virus and fungi with which it comes in contact. A genetically predisposed individual could have an allergic reaction to the powder-bound chemical or protein allergens.
Are powdered gloves easier to don than powder-free gloves?
With the introduction of different glove surface treatment options, e.g. chlorination and polymer coating, powder-free gloves are designed to have similar ease of donning as powdered gloves, to facilitate dry and damp hand donning.
How much powder do powdered gloves contain?
Historically, powdered medical gloves were found to contain powder levels ranging from 50 to over 400 mg of powder per glove. Currently, powdered medical gloves should comply with the newly established ASTM limits on powder levels as specified in ASTM D3577 and ASTM D3578 for surgical and examination gloves respectively:
- Surgical gloves should have no more than 15mg/dm2. An average surgical glove has a surface area of about 11 dm2.
- Examination gloves should have no more than 10 mg/dm2. An average examination glove has a surface area of about 8 dm2.
How does powder enter into the surgical wound?
Powder may enter the surgical wound through several routes:
- Direct tissue contact during surgery.
- Surgical instruments prepared by individuals wearing powdered gloves.
- Falling into the wound from powder-contaminated air.
- Through puncture or glove rupture, which may release inner surface donning powder into the wound.
Does powder bind just chemicals, endotoxin and proteins?
No. Powder may act as a microbial-laden fomite, an object that can carry infectious organisms such as bacteria, yeasts, viruses and fungi from one host to another through inhalation, direct or indirect contact. These glove powder fomites can potentially contact patients during procedures such as routine examinations, emergency treatments, respiratory care, surgery and wound dressings, potentially contributing to increased inflammation and infection, adversely affecting length of hospital stay and associated costs of treatment.
Can powder have an adverse effect on laboratory test results?
Yes. Powder can be a factor contributing to inaccurate drug level and blood chemistry determinations.
In diagnostic laboratories powder interference has led to:
- Cancer misdiagnosis
- False negative HIV test results
- False positive pregnancy test results
- False readings in serologic tests for drug levels
- Artefacts on processed dental film
In research laboratories powder has:
- Interfered with PCR procedures (polymerase chain reaction – a procedure used to replicate DNA or RNA in a sample)
- Distorted X-ray films (auto-radiograph) readings
- Interfered with enzyme assays
Doesn’t wiping the gloves with a sterile wet sponge or towel remove the powder?
No. Such effort may lead to:
- Added clumping, creating even less absorbable aggregates.
- Reappearance of glove powder in 10 to 30 minutes even after careful rinsing. It is theorised that powder embedded in the glove is released after flexure of the glove material on the hands, and that the amount of powder increases with increased flexure.
It should also be emphasised that regardless of the amount of powder removed from gloves by wiping, the initial donning prior to wiping aerosolises surface powder, and that punctures or tears can allow powder from the inside of the glove to flow into the open wound.
In one study, gloves that were washed twice before surgery still left up to 4 million powder particles inside the surgical wound.
Why should I use powder-free gloves instead of powdered gloves?
Using powder-free gloves alleviates some of the concerns associated with glove powder. Advantages of using powder-free gloves include:
- Reduces the glove powder-associated transfer of natural rubber latex proteins, chemical contact sensitisers and endotoxins.
- Reduces the drying effect of glove powder on the skin.
- Reduces powder-induced irritation and abrasion to the skin.
- Reduces the risk of glove powder contamination of laboratory samples and assays.
- Reduces the aerosolisation of glove powder, potentially reducing the level of environmental contaminants to be inhaled.
- Reduces glove powder-associated post-surgical complications.
- Reduces latex aero-allergen levels in medical environments.
- Powder-free gloves are generally lower in chemicals, endotoxin, and proteins (for natural rubber latex) than powdered gloves.
The world is progressively moving away from using powdered latex gloves, especially in the medical setting. Why is that happening? I still prefer to use powdered latex gloves over nitrile gloves?
The U.S. FDA has banned the use of powdered surgical gloves and powdered examination gloves with effect from January 2017. The rationale for the ban is based on the multiple risks of illness or injury to both patients as well as healthcare workers. Other countries e.g. Germany, UK, Japan and Korea, have also banned or restricted the use of powdered medical gloves due to similar health concerns.
Are powder-free gloves completely free of particles?
Due to different manufacturing processes, a minimum amount of powder residues may still be found within powder-free gloves. If the residual powder content is less than or equal to 2mg per glove (as described in ASTM D3577, ASTM D3578, ASTM D6319 and EN 455-3), the glove is by definition considered as powder-free glove.
