Protective Value of Surgical Gloves
Protective Value of SurgicaI Gloves Including
the ''Cut Resistant Variety" Alexander A. Fisher, MD
Rubber gloves provide a relatively effective barrier against the human immunodeficiency virus and other viruses. However, it should be noted that the Food and Drug Administration and the American Society for Testing and Materials accept a current quality level of 1.5 percent for holes by a 1000-mL water test. Thus, some rubber gloves may have holes even before use. (1) Wearing two pair of rubber gloves is therefore usually advised.
Buxo(2) states that double latex gloves offer minimal resistance to punctures, cuts, and abrasions. Using double gloves seems to be ineffective in protecting the surgeon if unavoidable injuries occur. Multiple protective devices have been proposed, such as the use of thick vinyl gloves, chain-linked steel undergloves, continuous filament stainless steel fibers knitted with cotton, thicker cotton undergloves, use of dilute hypochlorite solution between layers of gloves, and protective shields in areas of the glove most likely to suffer trauma during surgical procedures.
None of these proposed solutions seem to satisfy the demand for protection, particularly against needle puncture, while retaining dexterity and comfort.
INJURIES TO DERMATOLOGIC SURGEONS
Kasper and Wagner(3) conducted an anonymous survey on
one hundred randomly selected fellows of the American So-
ciety for Dermatologic Surgery. Forty-one respondents
provided information about their expenence with percuta-
neous injury. Causes of injury during 6,278 invasive proce-
dures performed during a one-month period included suture
needlesticks (two injuries), injection needlestick (two), nee-
dle recapping (one), scalpel blade (one), skin hook (one),
and an injury during the transport of an instrunent (one).
Thus, of eight injuries reported, five were to derma-
tologic surgeons and three to other staff members. Two of
the injuries were incurred during suturing and three were
caused by injection needles. Thus, five of the eight injuries
were due to some form of needlestick. In addition, one scal-
pel blade injury and one skin hook injury occured. Five der-
matologic surgeons and two nurses reported injuries. A
dermatologic surgeon accounted for the one reported nee-
dle recapping injury. Four of the five injuries to dermatolog-
ic surgeons occurred to the dominant hand. Two of these
were due to suture needlesticks and two were due to injec-
tion needlesticks. One nurse was injured by a skin hook
while she was assisting in surgery. Another nurse was in-
jured when she was punctured by an injection needle that
was being transported by another nurse.
CUT RESISTANT GLOVES
Although the fibers used in cut resistant gloves are also
used in bulletproof vests, the manufacturers of these gloves
emphasize that the gloves are not needle puncture proof or
"cut proof," but are "cut resistant." It is suggested that
these gloves be used as liners between two rubber gloves.
FIBERS USED IN CUT RESISTANT GLOVES
Spectra PolyethyEene Fibers (Allied Signal)-This recently in-
troduced fiber is said to be highly resistant to cuts and abra-
sions. Such fibers are used in Paraderm and Perry liners.
Centurion (Biomet)--This combination of stainless
steel and polyethylene fibers is said to be "a breakthrough
in continuous filament knitting technology which allows
stainless steel to be encased in synthetic fibers, providing
the most cut resistant fabric available. Unlike thicker spun
bers, Centurion glove liners are thin enough to allow for
extraordinary tactile sensitivity".
Repel Cut Resistant De Puy (DuPont)--This prod-
uct contains Kevlar Aramid synthetic fibers and a poly-
methacrylate. It is not yet clear whether the polymethacry-
late in Kevlar will cause any reaction in orthopedic sur-
geons or dentists who may become sensitive to methyl
methacrylate.
SPECTRA FIBER COMPARED WITH KEVLAR
Spectra fiber is an extended chain polyethylene polymer.
Unlike Spectra, DuPont Kevlar is a type of polymer based
on chemicals with many benzene rings. Terephthalic acid
and paraphenylenediamine are the chemicals that DuPont
uses to make Kevlar aramid, which is registered with the
Federal Trade Commission.
CRITIQUE OF THE USE OF CUT RESISTANT GLOVES
Buxo (2) states that the results of his study suggests that the
Spectra-lOOO fiber offers protection against cuts and abra-
sions. It does not provide protection against punctures with
needles or other sharp instruments. The user question-
naires suggest that, in its present form, the liner is relative-
ly comfortable to most users and provides an adequate fit
with only a mild to moderate loss of dexterity.
Chain-linked steel gloves revealed superior cut re-
sistance using the slicing technique; however, upon impact
the resistance was similar to the Spectra glove. Buxo (2) finds
that steel gloves are significantly heavier and difficult to
slide over or under latex gloves and consequently have not
gained acceptance among users. The heavier Spectra glass
glove showed superior cut resistance during the slicing and
impact cutting trials.
THE PREVENTION OF NEEDLE PUNCTURES
Kasper and Wagner(3) found that 52 percent of one hundred
dermatologic surgeons allowed needles to be recapped by
hand although the Centers for Disease Control have recom-
mended against this practice.(4) Hussain, Latif, and Choud-
hary(5) also found needle punctures very common among
general surgeons.
The finding that the majority of injuries to dermato-
logic surgeons occurs to the index and middle fingers of the
dominant hand is consistent with the previous observation
of Gross et al(6) who found more perforations in the dominant
than nondominant handed gloves of dermatologic surgeons.
In their experience, they have discemed that many derma-
tologic surgeons pick up instruments off the surgical tray
themselves, possibly increasing their chances of self-injury.
Injury to the dominant hand seems to be emerging as a spe-
cial risk to those who practice dermatologic surgery.
COMMENTS
Prior to use, rubber gloves may contain holes that make it
advisable to use two pair of rubber gloves instead of one. It
is ironic that cut resistant gloves made of materials that are
used in the manufacture of "bulletproof' clothing do not
protect the surgeon from needle punctures, which are the
most common injuries they sustain. What is urgently need-
ed is a puncture proof thimble-like object in the finger ends
of rubber and cut resistant gloves that provides tactile satis-
faction.
REFERENCES
1. Beck WC: Glove tears and sharp injuries in surgical personnel.
JAMA 267: 934, 1992.
2. Diaz-Buxo JA: Cut resistant glove liner for medical use. Surg Gyne-
col Obstet 172: 312, 1991
3. Kaspar TA, Wagner Jr, R: Percutaneous injury during dermatologic
surgery. Injury to Surgeons. JAAD 25: 756, 1991.
4. Update: Universal precautions for prevention of transmission of hu-
man immunodeficiency virus, hepatitis B virus, and other bloodborne
pathogens in health-care settings. MMWB 37: 387, 1988.
5. Hussain SA, Latif ABA, Choudhary AA: Risks to surgeons: a survey
of accidental injuries during operations. Br J Surg 75: 314, 1988.
6. Gross DJ, Jamison Y, Martin K, et al: Surgical glove perforation in
dermatologic surgery. J Dermato Surg Oncol 15: 1226, 1989.
Cutis Vol 49, May 1992 Pages 310-312
DELASCO COMMENT: Since routine recapping of needles is now illegal
under OSHA rules, and substantial fines may be levied if an employee
is injured with a needlestick, as a result of violation of the
OSHA rules, it can be expected that needles will be or should be
handled in a safe manner (immediately discarded in a sharps container
after use) so that needlesticks injury should be close to eliminated.
Cut Resistent gloves will now protect from much of the balance of
injuries.
the ''Cut Resistant Variety" Alexander A. Fisher, MD
Rubber gloves provide a relatively effective barrier against the human immunodeficiency virus and other viruses. However, it should be noted that the Food and Drug Administration and the American Society for Testing and Materials accept a current quality level of 1.5 percent for holes by a 1000-mL water test. Thus, some rubber gloves may have holes even before use. (1) Wearing two pair of rubber gloves is therefore usually advised.
Buxo(2) states that double latex gloves offer minimal resistance to punctures, cuts, and abrasions. Using double gloves seems to be ineffective in protecting the surgeon if unavoidable injuries occur. Multiple protective devices have been proposed, such as the use of thick vinyl gloves, chain-linked steel undergloves, continuous filament stainless steel fibers knitted with cotton, thicker cotton undergloves, use of dilute hypochlorite solution between layers of gloves, and protective shields in areas of the glove most likely to suffer trauma during surgical procedures.
None of these proposed solutions seem to satisfy the demand for protection, particularly against needle puncture, while retaining dexterity and comfort.
INJURIES TO DERMATOLOGIC SURGEONS
Kasper and Wagner(3) conducted an anonymous survey on
one hundred randomly selected fellows of the American So-
ciety for Dermatologic Surgery. Forty-one respondents
provided information about their expenence with percuta-
neous injury. Causes of injury during 6,278 invasive proce-
dures performed during a one-month period included suture
needlesticks (two injuries), injection needlestick (two), nee-
dle recapping (one), scalpel blade (one), skin hook (one),
and an injury during the transport of an instrunent (one).
Thus, of eight injuries reported, five were to derma-
tologic surgeons and three to other staff members. Two of
the injuries were incurred during suturing and three were
caused by injection needles. Thus, five of the eight injuries
were due to some form of needlestick. In addition, one scal-
pel blade injury and one skin hook injury occured. Five der-
matologic surgeons and two nurses reported injuries. A
dermatologic surgeon accounted for the one reported nee-
dle recapping injury. Four of the five injuries to dermatolog-
ic surgeons occurred to the dominant hand. Two of these
were due to suture needlesticks and two were due to injec-
tion needlesticks. One nurse was injured by a skin hook
while she was assisting in surgery. Another nurse was in-
jured when she was punctured by an injection needle that
was being transported by another nurse.
CUT RESISTANT GLOVES
Although the fibers used in cut resistant gloves are also
used in bulletproof vests, the manufacturers of these gloves
emphasize that the gloves are not needle puncture proof or
"cut proof," but are "cut resistant." It is suggested that
these gloves be used as liners between two rubber gloves.
FIBERS USED IN CUT RESISTANT GLOVES
Spectra PolyethyEene Fibers (Allied Signal)-This recently in-
troduced fiber is said to be highly resistant to cuts and abra-
sions. Such fibers are used in Paraderm and Perry liners.
Centurion (Biomet)--This combination of stainless
steel and polyethylene fibers is said to be "a breakthrough
in continuous filament knitting technology which allows
stainless steel to be encased in synthetic fibers, providing
the most cut resistant fabric available. Unlike thicker spun
bers, Centurion glove liners are thin enough to allow for
extraordinary tactile sensitivity".
Repel Cut Resistant De Puy (DuPont)--This prod-
uct contains Kevlar Aramid synthetic fibers and a poly-
methacrylate. It is not yet clear whether the polymethacry-
late in Kevlar will cause any reaction in orthopedic sur-
geons or dentists who may become sensitive to methyl
methacrylate.
SPECTRA FIBER COMPARED WITH KEVLAR
Spectra fiber is an extended chain polyethylene polymer.
Unlike Spectra, DuPont Kevlar is a type of polymer based
on chemicals with many benzene rings. Terephthalic acid
and paraphenylenediamine are the chemicals that DuPont
uses to make Kevlar aramid, which is registered with the
Federal Trade Commission.
CRITIQUE OF THE USE OF CUT RESISTANT GLOVES
Buxo (2) states that the results of his study suggests that the
Spectra-lOOO fiber offers protection against cuts and abra-
sions. It does not provide protection against punctures with
needles or other sharp instruments. The user question-
naires suggest that, in its present form, the liner is relative-
ly comfortable to most users and provides an adequate fit
with only a mild to moderate loss of dexterity.
Chain-linked steel gloves revealed superior cut re-
sistance using the slicing technique; however, upon impact
the resistance was similar to the Spectra glove. Buxo (2) finds
that steel gloves are significantly heavier and difficult to
slide over or under latex gloves and consequently have not
gained acceptance among users. The heavier Spectra glass
glove showed superior cut resistance during the slicing and
impact cutting trials.
THE PREVENTION OF NEEDLE PUNCTURES
Kasper and Wagner(3) found that 52 percent of one hundred
dermatologic surgeons allowed needles to be recapped by
hand although the Centers for Disease Control have recom-
mended against this practice.(4) Hussain, Latif, and Choud-
hary(5) also found needle punctures very common among
general surgeons.
The finding that the majority of injuries to dermato-
logic surgeons occurs to the index and middle fingers of the
dominant hand is consistent with the previous observation
of Gross et al(6) who found more perforations in the dominant
than nondominant handed gloves of dermatologic surgeons.
In their experience, they have discemed that many derma-
tologic surgeons pick up instruments off the surgical tray
themselves, possibly increasing their chances of self-injury.
Injury to the dominant hand seems to be emerging as a spe-
cial risk to those who practice dermatologic surgery.
COMMENTS
Prior to use, rubber gloves may contain holes that make it
advisable to use two pair of rubber gloves instead of one. It
is ironic that cut resistant gloves made of materials that are
used in the manufacture of "bulletproof' clothing do not
protect the surgeon from needle punctures, which are the
most common injuries they sustain. What is urgently need-
ed is a puncture proof thimble-like object in the finger ends
of rubber and cut resistant gloves that provides tactile satis-
faction.
REFERENCES
1. Beck WC: Glove tears and sharp injuries in surgical personnel.
JAMA 267: 934, 1992.
2. Diaz-Buxo JA: Cut resistant glove liner for medical use. Surg Gyne-
col Obstet 172: 312, 1991
3. Kaspar TA, Wagner Jr, R: Percutaneous injury during dermatologic
surgery. Injury to Surgeons. JAAD 25: 756, 1991.
4. Update: Universal precautions for prevention of transmission of hu-
man immunodeficiency virus, hepatitis B virus, and other bloodborne
pathogens in health-care settings. MMWB 37: 387, 1988.
5. Hussain SA, Latif ABA, Choudhary AA: Risks to surgeons: a survey
of accidental injuries during operations. Br J Surg 75: 314, 1988.
6. Gross DJ, Jamison Y, Martin K, et al: Surgical glove perforation in
dermatologic surgery. J Dermato Surg Oncol 15: 1226, 1989.
Cutis Vol 49, May 1992 Pages 310-312
DELASCO COMMENT: Since routine recapping of needles is now illegal
under OSHA rules, and substantial fines may be levied if an employee
is injured with a needlestick, as a result of violation of the
OSHA rules, it can be expected that needles will be or should be
handled in a safe manner (immediately discarded in a sharps container
after use) so that needlesticks injury should be close to eliminated.
Cut Resistent gloves will now protect from much of the balance of
injuries.