409

44 Protective Gloves
Gunh A. Mellström, Anders Boman

Contents 44.1 Introduction

44.1 Introduction . . . 409 There are both an increased occupational use of pro-
44.2 Field of Application—Rules
tective gloves and increased interest in their protec-
and Regulations . . . 409
tive capacity against harmful chemicals as well as
44.2.1 Protective Gloves . . . 410
blood-borne infections (e.g., hepatitis, HIV), as the
44.2.2 Medical Gloves . . . 411
directives and regulations concerning the use and
44.3 Risk Evaluation—Glove Selection . . . 411
safety requirements for protective gloves have come
44.3.1 Selection Procedure for Gloves
Against Chemicals . . . 411
in to force in Europe.
44.3.1.1 Chemical Classification—Risk In order to select, purchase, or use protective
of Skin Injury . . . 411 gloves, it is necessary to obtain information on cur-
44.3.1.2 Working Activity—Degree of Exposure . . . 411 rent standards, on quality requirements, nature of
44.3.1.3 Glove Selection—Requirements . . . 411 hazard, performance data, acceptable level of expo-
44.3.2 Selection Procedure for Gloves sure to hazards, and the nature of dermatological
Against Microorganisms . . . 412 adverse effects caused by protective gloves of rubber
44.4 Protective Effect . . . 412 and plastics.
44.4.1 Protection Against Microorganisms . . . 412 The information on the performance of protective
44.4.2 Protection Against Some Chemical gloves and other protective clothing is found in an in-
Agents Hazardous to the Skin . . . 413 creasing amount of reports in the literature. Generally,
44.4.2.1 Disinfectants . . . 413 the choice of protective material may be obtained by
44.4.2.2 Pharmaceuticals . . . 413 reviewing the literature and deciding on the best suit-
44.4.2.3 Composite Materials (Bone Cement, able material.
Dental Filling Materials) . . . 413
44.4.2.4 Solvents . . . 414
44.4.2.5 Corrosive Agents . . . 414 44.2 Field of Application—
44.4.2.6 Detergents, Surfactants, Cleansers . . . 414
Rules and Regulations
44.4.2.7 Oils, Cutting Fluids, and Lubricant Oils . . . 414
44.5 Limitation of Use Due to Side Effects . . . 414
Gloves intended for protection of the user are in Eu-
44.5.1 Therapeutic Alternatives . . . 415
rope (EU), referred to as personal protective equip-
44.5.1.1 Gloves of Synthetic Materials . . . 415
ment and covered by the Personal Protective Equip-
44.5.1.2 Double Gloving . . . 415
44.5.1.3 Non-powder Gloves . . . 415
ment Directive 89/686/EEC. The gloves intended for
44.5.1.4 Creams and Gloves . . . 415
use in the medical field to protect patients and users
44.6 Glove Operating Instructions . . . 415 from cross-contamination, on the other hand, are re-
44.7 Testing of the Protective Glove Barrier . . . 415 ferred to as medical devices and are covered by the
44.7.1 Standard Test Methods . . . 415 Council Directive 93/42/EEC concerning medical
44.7.1.1 Physical Properties . . . 415 devices [29].
44.7.1.2 Penetration (Leakage) . . . 416 In the USA a committee within ASTM (American
44.7.1.3 Permeation . . . 416 Society of Testing and Materials), F-23 on Protective
44.7.1.4 Biocompatibility . . . 416 Clothing, has during the last 15 years been working
44.7.2 Other Tests . . . 417 with development of standards for items of protec-
44.8 Glove Materials and Manufacturing . . . 417 tive clothing, such as gloves. Another ASTM commit-
44.9 Conclusions . . . 417 tee, D-11 on Rubber, has been working with medical
References . . . 418 glove standard-setting activity since the mid-1970s. A
survey of the USA rules, regulations, and standards
concerning protective and medical glove use has re-
cently been presented by N. Henry III [15].
410 Gunh A. Mellström, Anders Boman

Table 1. Protection Index based on breakthrough Table 2. Examples of ASTM and EN Standards for protective
times determined during continuous contact with the gloves against chemicals
test chemical, describe in European Standard EN 374:3 EN, European Standard, European Committee for Standardisa-
tion; ASTM, American Society of Testing and Materials

Measured breakthrough time Protection Index Document number Title

>10 min Class 1 ASTM F 739 Standard test methods for resistance
>30 min Class 2 of protective clothing materials to
permeation by liquids and gases under
>60 min Class 3
conditions of continuous contact.
>120 min Class 4
ASTM F 1383 Standard test method for resistance
>240 min Class 5 of protective clothing materials to
>480 min Class 6 permeation by liquids and gases under
conditions of intermittent contact
Table 3. Examples of ASTM and EN Standards for medical ASTM F 1407 Standard test method for resistance of
gloves protective clothing materials to liquid
ASTM, American Society of Testing and Materials; EN, Euro- permeation—permeation cup method
pean Standard, European Committee for Standardisation ASTM F 903 Standard test method for resis-
Document number Title tance of protective clothing ma-
terials to penetration by liquids
EN 420 General requirements for gloves
ASTM D 3577 Standard specification for rub-
ber surgical gloves EN 374 Protective gloves against chemi-
cals and micro organisms:
ASTM D 3578 Standard specification for rub-
ber examination gloves Part 1 Terminology and perfor-
mance requirements
ASTM D 5151 Standard test method for detec-
tion of holes in medical gloves Part 2 Determination of resis-
tance to penetration
ASTM D 5250 Standard specification for polyvinyl
chloride gloves for medical application Part 3 Determination of resistance to
permeation by chemicals
ASTM D 5712 Standard test method for analy-
sis of protein in natural rub-
ber and its products.
EN 455 Medical gloves for single use:
Part 1 Requirements and test-
ing for freedom from holes
Part 2 Requirements and test-
ing for physical properties.
Part 3 Requirements and testing
for biological evaluation

44.2.1 Protective Gloves

The EEC-Directive gives general requirements for all
personal protective equipment, and requirements de-
pend on the type of gloves have been described [29].
Protective gloves are classified in three categories
due to intended use and attestation procedures:
Category II: Gloves of intermediate design—for inter-
mediate risk
Category III: Gloves of complex design—for irrevers-
ible/mortal risks

Category I: Gloves of simple design—for minimal The requirements for EC-type certification are a
risk application declaration of conformity and a technical documen-

tation file for all categories of gloves. For categories II
and III there are additional requirements on EC-type
examination testing by approved laboratories, certi-
fied by approved notified bodies, and manufacturing
under a formal EC quality assurance system.
The European Standard EN 420, for protective
gloves, defines general requirements for most kinds
of protective gloves. Key points are fitness of purpose,
innocuousness, sound construction, storage, sizing,
measure of glove–hand dexterity, product informa-
tion, and labeling.
Some of the EN and ASTM Standards for protec-
tive gloves against chemicals are given in Table 2
44.2.2 Medical Gloves
Medical gloves for single use are gloves intended for
use in the medical field to protect patients and users
from cross-contamination. They are classified in cat-
egories: surgical gloves, examination and/or proce-
dure gloves (sterile or nonsterile), and foil film gloves.
Examples of EN and ASTM Standards for medical
gloves for single use are given in Table 3
44.3 Risk Evaluation—
Glove Selection
44.3.1 Selection Procedure for Gloves
Against Chemicals
Several factors need to be taken into account when
selecting a glove for a particular application. One
of the first guidelines for the selection of protective
clothing, gloves included, was presented by Schwope
et al. [38].
Leinster [23] has described the selection and use
of gloves against chemical in a matrix model based
on working activity and chemical classification. The
selection procedure adapted to the EN standards for
protective gloves are presented below.
44.3.1.1 Chemical Classification—
Risk of Skin Injury
A. Mainly contact with chemicals less harmful and
not classified as hazardous substances and requir-
ing labeling. Minimal risk only for slight injuries.
44 Protective Gloves 411
B. Mainly contact with chemicals classified as toxic,
harmful, or irritant. Intermediate risk for moder-
ate, reversible injuries.
C. Mainly contact with chemicals classified as highly
toxic, highly corrosive, corrosive and agents
causing cancer, sensitization, or those absorbed
through the skin. High risk for severe or irrevers-
ible injuries.
44.3.1.2 Working Activity—Degree of Exposure
1. Risk of exposure, possible splashing
2. Occasional, repeated (intermittent), and expected
exposure
3. Continuous exposure during certain time, ex-
pected or by accident
44.3.1.3 Glove Selection—Requirements
Chemical class/ Working activity/exposure time
Risk of skin injury
1 2 3
A (Category I) Category I Category II
B Category I Category II Category II
C Category I Category II Category III
(Category I): Gloves not essential
Category I: Gloves of simple design should be used
when the risk for skin injuries is minimal and can
be identified beforehand. For example, disposable
and/or reusable gloves for wet work to protect against
cleaning agents and surfactants at home and in the
workplace. For CE- mark, the gloves and the package
should have the text: “For minimal risk only.” No test-
ing of the protective effect required.
Category II: Gloves of all kind with intermediate de-
sign. These gloves have neither simple nor complex
designs and should be used when there is an identi-
fied risk which is neither minimal nor high. For CE-
marking the protective effect has to be tested and ap-
proved by a certified laboratory. Breakthrough time
(BT) and/or permeation rates (PR) are required. The
gloves /packages should be labeled with CE-mark and
a pictogram (symbol) showing the protective perfor-
mance for a certain risk, e.g., chemicals and microor-
ganisms, heat, cold, mechanical risks.
412 Gunh A. Mellström, Anders Boman
Category III: Gloves usually have a more complex de-
sign for use in high-risk situations (emergency). They
are often used as a complement to protective clothing
(suit). The gloves should be tested for the intended
use by a certified laboratory. BT and/or PR are re-
quired and also test results relevant to the glove task.
The gloves /packages should be labeled with CE-mark
and a pictogram (symbol) showing the protective per-
formance for a certain risk and a four digit code for
the certified laboratory that performed the testing.
The Protection Index is based on BT determined
during continuous contact with the tested chemical,
measured with a standard method. The protection in-
dex is only and always valid for the specific chemical
tested (see Table 1).
Because of the diversity and numbers of chemicals
used in industry there was a need for test method
strategy. A list of a standard battery of test chemicals
was developed (ASTM/F 1001–89: Guide for the Se-
lection of Chemical to Evaluate Clothing Materials)
and most glove manufacturers publish their perme-
ation results with reference to this list.
44.3.2 Selection Procedure for Gloves
Against Microorganisms
A scheme for the selection and use of gloves by health
care personnel in different situations based on pur-
pose, working procedure, type of glove (medical
gloves or protective gloves), and risk of exposure to
infection or micro-organism has been suggested by
Burman and Fryklund [6].
• Protection of personnel from Hepatitis (A, B, C),
HIV, HTLV
• Surgical glove: surgery
• Examination gloves, nonsterile: dentistry, risk
of contact with blood
• Protective gloves (e.g., domestic gloves): risk
of contact with blood
• Protection of personnel and patients from various
viruses and bacteria
• Protective gloves: handling of feces, urine,
vomit, etc.
• Protection of patients from Hepatitis, HIV, and
other viruses and bacteria
• Surgical glove: surgery
• Examination gloves, sterile: other invasive
procedures
• Examination gloves, nonsterile: dentistry, iso-
lation, barrier nursing
• Protective gloves: isolation, barrier nursing,
handling of feces, urine, vomit, etc.
•
Fay [11] has presented a similar schedule with
clinical selection criteria for the gloves in health care
treatment.
44.4 Protective Effect
For most of the agents that can cause irritant derma-
titis there are few investigations and studies of the
glove barrier effect. In several occupations it is also
more the than one specific agent that is the cause of
the dermatitis, for example, in wet work of differ-
ent kinds, food handling and processing, and plant
maintenance. In these working situations good hand
hygiene together with rubber and plastic gloves of
simple or intermediate design will in most cases give
satisfactory protection. The investigations of gloves'
protective effect against microorganisms and some
hazardous chemicals are described below.
44.4.1 Protection Against
Microorganisms
Hamann and Nelson [14] reviewed a number of glove
barrier studies against microorganisms performed
with different kinds of test methods during the pe-
riod 1976–1993. They also compared the protective
barriers provided by latex and thermoplastic elasto-
mer (TPE) sterile surgical gloves against penetration
of the bacteriophage phi X174 as surrogate for blood-
borne pathogens. They found that the TPE gloves
had a mechanical barrier effect that was equal or bet-
ter than that offered by the latex gloves tested. Their
conclusions from the review of investigations of glove
barrier properties and their own results were that the
barrier effect of the gloves depends on a complex in-
teraction of several factors such as:
• Type and brand of glove (latex or plastic materi-
als)
• Condition of use (unused, stimulated use, or in
actual clinical situations)
• Sensitivity of the assay (water-, air-, dye-leak tests,
bacterial or viral penetration)
They also concluded that some trends could be seen
from the data such as:

• The material is an important determinant of the
glove barrier.
• The brand of glove influences the out come of bar-
rier testing.
• The quality of a glove is more closely related to the
manufacturer than to the glove material.
• Leakage rates are related to the level of use a glove
receives.
• The efficacy of the glove barrier varies with the
sensitivity of the testing procedure.
44.4.2 Protection Against Some Chemical
Agents Hazardous to the Skin
44.4.2.1 Disinfectants
Quite a lot of disinfectants are generally used to clean
surfaces and objects and to sterilize instruments. At
skin disinfection and in working situations where
there is a risk of acquiring blood-borne infections
the use of different kinds of disinfectants is frequent.
In these circumstances it is important to use gloves,
both to protect the skin against infections and fre-
quent contact with disinfectants harmful to the skin.
Some of these agents are known to cause allergic and/
or irritant reactions after contact with the skin, for ex-
ample ethanol [41], isopropyl alcohol [18], chlorocre-
sol [12, 13], and glutaraldehyde [34].
The influence of four disinfectants on six differ-
ent brands of medical gloves by measuring the per-
meation and conducting SEM studies of the exposed
glove material surfaces has been described by Mell-
ström et al. [30]. They found that gloves of latex, PVC,
and polyethylene gave acceptable protection from
contact with p-chloro-m-cresol- (Blifacid) and glu-
taraldehyde- (Cidex) containing products for at least
60 min but gave only a short time of protection from
contact with isopropanol and ethanol.
For risk of splashes or very short contact time
(10–30 min) and for occasional but intentional expo-
sure (30–60 min), thin gloves made of natural rubber,
EMA, PE, and PVC can be useful. At intentional ex-
posure during extended periods (>60 min) domestic
gloves of natural rubber or PVC or double gloving;
natural rubber with EMA, PE, or PVC as inner gloves
should be used.
44.4.2.2 Pharmaceuticals
Pharmaceutical preparations of drugs, e.g., cytostatic
agents have a very heterogeneous mechanism of ac-
44 Protective Gloves 413
tion; they have potent pharmacological properties
and it is well known that they can cause acute skin in-
juries in cases of accidental exposure [21]. The extent
of health hazards due to chronic exposure to small
amounts of cytostatic drugs by personnel handling
these drugs is still not completely known and there-
fore it is necessary to minimize the exposure. In order
to minimize the exposure when preparing, dispens-
ing, and administrating these drugs, standard proce-
dures, appropriate techniques, and personal protec-
tive equipment, e.g., gloves, should be used. However,
there are no requirements or criteria for evaluating
medical glove quality for this purpose of use.
The permeability of gloves to several cytostatic
drugs was presented in an overview by Mellström et
al. [32]. However, the procedures used were not stan-
dardized methods; the analytical methods, equipment,
and sensitivity varied tremendously, and therefore the
test results were hard to evaluate and compare.
Three factors seem to have a crucial influence on
the permeation through the lipophilic natural latex
glove membrane: the pH-value (ionization), lipophi-
licity, and the molecular size. Both Mitoxantrone and
Carmustine (BCNU), the two drugs that permeated
in less than 15 min, have low molecular weight and
high lipophilicity [26]. The need for requirements
of barrier effect against hazardous drugs for medi-
cal gloves has been shown by Sessink et al. [40]. They
studied the occupational exposure to cyclophospha-
mide, 5-fluorouracil, and methotrexate in technicians
involved in drug preparation. Contamination and
permeation through latex gloves were found for each
of the three compounds. Today there are some medi-
cal gloves intended for use in handling cytostatic
drugs (protective gloves by definition) and should
then fulfill the requirements on permeation for pro-
tective gloves (Category II) and not only require-
ments on leakage for medical gloves. That means that
they should have a Protection Index for the specific
chemical/drug they are suppose to give protection
against (see Table 1).
44.4.2.3 Composite Materials (Bone Cement,
Dental Filling Materials)
The increased use of acrylic compounds as substitute
for amalgam by dentists, dental nurses, and dental
technicians has caused an increasing frequency of
hand eczema for these groups. This is a serious and
increasing problem since today there are no gloves
available that allow the dexterity required and at the
same time give sufficient protection to the skin. Stan-
414 Gunh A. Mellström, Anders Boman
dard procedures, appropriate technique, and packag-
ing design together with adjusted personal protective
gloves are highly needed.
Acrylic compounds used in orthopedic and dental
surgery are well known to cause skin problems [20,
19, 35]. These compounds can also affect the barrier
capacity of the glove material after only a short time
of exposure.
The combined use of latex gloves with the 4H-
gloves as an inner glove can be useful in some work-
ing situations.
Double gloving and frequent exchange of gloves is
recommended if there is no Protection Index avail-
able for any glove.
44.4.2.4 Solvents
Alcohols and other aliphatic and aromatic organic
solvents have a degreasing and irritating effect on the
skin and can be absorbed through the skin into the
blood circulation. Category I gloves made of natural
rubber, PE, or PVC can be used when there is risk for
splashes or for very short contact times (10–30 min).
Category I or II gloves with a Protection Index for the
specific chemical should be considered for use dur-
ing occasional but intentional exposure (30–60 min)
and during intentional exposure for extended peri-
ods (>60 min). Gloves made of nitrile rubber, natural
rubber, neoprene rubber, 4H-glove, Viton, or butyl
rubber should be used.
44.4.2.5 Corrosive Agents
Corrosive substances such as oxidizing/reducing
agents, acids, bases, and concentrated salt solutions
can, after contact with small amounts but during
short, repeated exposure or extended exposure, cause
severe irritation to the skin.
Category I gloves made of natural rubber, PE, and
PVC are suitable for work with or at risk for exposure
to these kinds of hazardous chemicals only for a very
short contact time (10–30 min). Category II gloves
with a Protection Index should be considered for use
at occasional but intentional exposure (30–60 min)
and at intentional exposure during extended periods
(>60 min). Gloves made of neoprene, natural or ni-
trile rubber can be useful as well as butyl rubber, Vi-
ton, or the 4H glove.
44.4.2.6 Detergents, Surfactants, Cleansers
Washing up-liquids, cleaning agents, and soaps are
usually water based and when used in recommended
concentrations there are only mild effects on the skin;
however, used in too high a concentration they can
cause skin injuries. Sometimes organic solvents like
white spirit or isopropanol are added. Category I
gloves suitable for work at risk for splashes or with
very short contact time (10–30 min) can be made
of EMA, PE, or PVC. Category I or II gloves with a
Protection Index should be considered for use at oc-
casional but intentional exposure (30–60 min) and
at intentional exposure during extended periods
(>60 min). Gloves made of natural rubber, neoprene,
or PVC can be useful. If organic solvent is an ingredi-
ent, then the use gloves made of nitrile rubber is an
alternative.
44.4.2.7 Oils, Cutting Fluids, and Lubricant Oils
These agents often contain anticorrosive agents, bacte-
ricides, and antioxidants. Used oils can contain small
amounts of chromium, nickel and cobalt. Category I
gloves suitable for work at risk for splashes or with
very short contact time (10–30 min) can be made of
natural rubber or PVC. Category I or II gloves with
a Protection Index should be considered for use at
occasional but intentional exposure (30–60 min)
and at intentional exposure during extended periods
(>60 min). Industrial gloves made of nitrile rubber,
natural rubber, or neoprene can be useful gloves as
well as 4H gloves or nitrile rubber gloves.
Warning! When working at machinery with rotat-
ing parts, gloves can imply a risk of tear injury.
44.5 Limitation of Use Due
to Side Effects
Some common causes of side effects by glove users:
• Allergic reactions to gloves can be caused by, e.g.,
rubber chemicals, organic pigments, latex pro-
teins, glove powder, chromate in leather gloves.
• Irritant reactions to gloves, e.g., mechanical stress,
occlusion, sweating, maceration, endotoxins, eth-
ylene dioxide, glove powder
• Side effects due to glove powder, e.g., starch-in-
duced adhesions, granulomas following surgery

44.5.1 Therapeutic Alternatives
The occupational groups that most frequently are af-
fected by contact dermatitis and contact urticaria due
to rubber (latex) gloves are cleaning personnel, food
industry workers (manufacturing, cooking), and all
kinds of health care employees [9, 10, 27]. Utilizing
gloves of alternative materials will minimize the risk
of adverse effects in persons sensitive to latex rubber
proteins and is strongly recommended.
44.5.1.1 Gloves of Synthetic Materials
Gloves of plastic polymer materials are necessary to
use both in the treatment of patients and by those
employees with a known allergy to latex proteins.
They reduce the risk for contact dermatitis caused
by rubber additives as well as for contact urticaria by
latex proteins. Gloves of polymer materials are also
necessary for use by those employees with a known
allergy to chromate in leather gloves.
44.5.1.2 Double Gloving
• Natural rubber latex gloves and inner gloves of
plastic material, nylon, or cotton reduce the risk
of contact dermatitis and urticaria caused by latex
rubber gloves.
• Natural rubber latex gloves and synthetic fiber
gloves reduce the risk of cut and puncture inju-
ries.
• Natural rubber latex gloves and latex or plastic
gloves reduce the risk of blood-borne infections
and/or chemical permeation.
44.5.1.3 Non-powder Gloves
Powder-free gloves should be used to reduce the risk
of symptoms like rhinitis, conjunctivitis, and asthma
caused by glove powder contaminated by latex pro-
teins.
44.5.1.4 Creams and Gloves
Allmers [1] has recently shown that the combined use
of skin care cream and latex gloves may hamper the
uptake of allergens from latex gloves and reduces the
risk for side effects from latex gloves.
44 Protective Gloves 415
44.6 Glove Operating Instructions
• Reusable gloves should be for personal use only.
• Reusable gloves should be decontaminated before
they are removed.
• The decontamination procedure used will depend
on the chemical.
• Reusable gloves should not be left, when not being
used, where they are likely to be contaminated.
• Persons who experience hand sweating should
have several pairs of gloves available.
• Disposable/single-use gloves can be removed by
peeling the glove inside out.
• Gloves contaminated on the inside should be
thrown away.
• Gloves used in contact with solvents should be ex-
changed several times a week
44.7 Testing of the Protective Glove
Barrier
If protective gloves and medical gloves for single use
are to give an adequate level of protection, different
properties must be tested and evaluated.
44.7.1 Standard Test Methods
44.7.1.1 Physical Properties
In the EN and ASTM standard specifications, require-
ments and test methods are given, such as sampling
and selection of test pieces; physical dimensions with
length, strength, and thickness; and load for break
before and after accelerating aging. The barrier ef-
fect is also affected by storage conditions; this is most
important for medical gloves made of natural rubber
latex.
In the British Standard (BS 3574:1989) the fol-
lowing guidelines and requirements for storage are
given:
• The gloves should be kept in the original trans-
portation or ward package and the storage tem-
perature should be below 25C°.
• The relative humidity of the air may not be so high
that there is condensation.
• The gloves should be stored in the dark, protected
from the sun and the light from fluorescent tubes,
and not be stored near any source yielding ion-
ized radiation, e.g., an X-ray apparatus.
416 Gunh A. Mellström, Anders Boman
44.7.1.2 Penetration (Leakage)
The penetration of chemicals and/or microorganisms
is a process which can be defined as the flow through
closures, porous materials, seams, and pinholes or
other imperfections in a protective or medical glove
material and on a nonmolecular level. Leakage can
lead to uncontrolled contact to hazardous chemicals
or infectious materials, especially in the health care
field. Penetration test methods for protective gloves
and leakage testing for medical gloves has been de-
scribed by Mellström et al. [31]. Leakage tests as a
rule include a random sampling procedure where a
certain number of gloves are filled with a specified
volume of water or air. These are pass/fail tests and
the number of gloves that fail out of the number of
gloves tested depends on the batch or lot size. A sam-
pling procedure for inspection by attributes is defined
by the International Organisation for Standardisation
(ISO 2859) Examples of some ASTM and EN stan-
dard test methods for penetration/leakage testing are
presented in Tables 2 and 3.
There are several standardized leakage test meth-
ods designed for medical gloves that have been evalu-
ated; all test methods had inherent limitations [7].
Standard quality control testing and virus penetration
testing have recently been presented in an overview
by Lytle et al. [25]. The standard tests for glove in-
tegrity and the virus penetration testing (employing
used and intact gloves as well as penetration through
punctures in gloves) are discussed. The tests used for
evaluation of the barrier integrity fall into two catego-
ries:
• Those intended to assure quality during and after
manufacturing, and
• Those tests which imply challenging the barrier
with viral or chemical agents.
They concluded that viral challenges to gloves in-
dicated that latex gloves provided significant barrier
protection against very small viruses, and that appar-
ent barrier integrity cannot assure safety, but current
quality control protocols assure that medical gloves
provide significant protection.
44.7.1.3 Permeation
Permeation is usually described as the process by
which a chemical migrates through the protective
clothing material on a molecular level, including
sorption, diffusion, and desorption processes. Per-
meation test methods for protective gloves have been
described by Mellström et al. [31]. The principle of
permeation standard testing is a flow-through sys-
tem where a two-compartment permeation cell of
standard dimensions is used. The test specimen act
as an barrier between the first compartment which
contains the test chemical and the second compart-
ment through which a stream of the collecting me-
dium (gas or liquid) is passed for the collection of dif-
fused molecules of the test chemical or its component
chemicals for analysis. The key parameters measured
are usually:
• Breakthrough time (BT, min). Both in the ASTM
and EN standard test methods, BT is defined as
the time when a specified permeation rate is
reached.
• Permeation rate (PR), i.e., the mass of test chemi-
cal permeating the material per unit time per unit
area (µg/min cm2)
• Steady-state permeation (SP), i.e., a state that is
reached when the permeation rate becomes virtu-
ally constant.
In the European Standard for protective gloves
against chemicals and microorganisms, one of the
requirements is that the protective effect of a certain
combination of protective glove/test chemical should
be presented as a Protection Index.
• Protection Index is based on BT measure at con-
stant contact with the test chemical (European
Standard EN 374: part 1,1994; see Table 1).
44.7.1.4 Biocompatibility
In recent years there have been increased problems
with severe adverse reactions in health care workers
caused by latex products, e.g., latex proteins in gloves.
Also, adverse reactions due to rubber chemicals, pow-
der, lubricants, endotoxins, and pyrogens are well
known and more frequent than reactions to proteins.
To date there is not yet any complete agreement on
methods of measurements and control of these aller-
gens. However, in the European Standard the require-
ments and test methods for biological evaluation for
medical glove use have been recommended in the EN
455: Medical gloves for single use.
At the ASTM work is also in progress to develop
requirements and standardized test methods for
those chemicals that are clearly associated with
allergic reactions as well as for determination of
allergenically relevant natural rubber latex proteins
(see Table 3).
 44 Protective Gloves 417

44.7.2 Other Tests • The resistance to penetration and permeation of

Additional information on protective efficacy of
gloves can be derived from in vivo testing in man or
in experimental animals [2, 3].
In work-related testing the concentration of the
chemical or its metabolites is measured in blood,
urine, or other body fluids after exposure in the ac-
tual working situation with and without protective
gloves [5, 16, 22, 40].
The protective effects as well as side effects of gloves
can be studied by patch testing, with the specific
chemical together with pieces of glove. The results are
read as the difference in reactivity between protected
and unprotected skin. The patch test method may be
used when no data on permeation are available [24].
All these tests are mainly used for testing the pro-
tective effect against allergens but can in exceptional
cases be used for testing with irritant chemicals.
hazardous chemicals and microorganisms
• Risk of adverse effects when using a specific glove
(allergic contact dermatitis, contact urticaria, ir-
ritation, itching, etc.)
• Mechanical quality of the glove material (tensile
strength; dexterity; cut, tear, and puncture resis-
tance)
• Function, the gloves must not imply another risk
or be a hindrance
• Comfort, the right size, pleasant to wear
• Quality uniformity, a moderate price
All these factors show that the selection procedure
can be complicated indeed.

Table 4. Survey of glove materials used for protective (PG)

44.8 Glove Materials and and medical gloves (MG)
Manufacturing PG, protective glove; MG, medical glove for single use

Material name/Trade Names Abbre- Intended

The materials used for manufacturing of protective viation use
gloves are natural rubber, synthetic rubber, textile
fibers, leather, and several polymeric materials (see Natural rubber (Latex) NR PG and MG
Table 4). Mellström and Boman [28] presented man- Synthetic rubber materials
ufacturing methods and glove types and a detailed Butyl rubber BR PG
description of the materials used for gloves. The pro-
Chloroprene/Neoprene NE PG and MG
tective effect of different glove materials against haz-
ardous chemicals depends on the following factors: Fluor rubber/Viton V PG
Nitrile rubber/Nitrilite, N-Dex NI PG
Thickness: Styrene-butadiene/Elastyren MG
• ΒΤ increases as the thickness of the glove material Styrene-ethylene-butadiene/Tactylon MG
increases but in a nonlinear fashion [17, 39].
Plastic polymeric materials

Material composition: EMA (ethylene-methylacrylate) EMA PG and MG

• The quality and protective effect of gloves of the Polyethylene, polythene PE PG and MG
same material can differ due to manufacturing Polyvinyl alcohol PVA PG
processes, variation in polymer formulation, ad- Polyvinyl chloride PVC PG and MG
ditives, and quality control procedure [28, 36].
PE/EVAL/PE, laminate/4H-glove 4H PG
• The barrier effect of different generic materials is
quite variable. Each combination of chemical and Leather PG
protective glove material has to be considered Textile: PG
[33, 37]. Cotton, nylon, jersey PG, inner
gloves
Special Fibre materials/Kev- Used in
44.9 Conclusions lar, Lycra and Spectra Fibre jersey, sur-
gical inner
Factors of importance that have to be considered in gloves, cut
the selection procedure are: resistant
418 Gunh A. Mellström, Anders Boman

Table 5. Examples of glove materials and the protective effect against some chemicals known as irritants
*Abbreviations see Table 4.

Chemical name Breakthrough time (min)/Glove material*

60<BT 60 ≥ BT ≤ 240 240 ≥ BT ≤ 480

Glutaraldehyde PVA PVC BR, NE, V

Diethanolamine NR BR, NE, NI, PVC, V, 4H
Ethanolamine NR, PVA, PVC BR, NE, NI, V,4H
Isopropylamine NR, NE, NI, PVC, V
Triethanolamine BR, NE, NI, PVA, PVC, V
Heamethyldisilazane (HMDZ) NR, NE, PVC
Di-n-butylphtalate NR, PVC NE BR, NI, PVA, V
Diethylphtalate 4H
1,4-Butanediol diglycidyl ether 4H
Benzyl alcohol NR, NI, PVC BR V, 4H
Ethylene glycol PVA BR, NR, NE, NI,
PE, PVC,V,4H
Furan BR, NR, NE, NI, PVC PVA, V
N-Methyl 2-pyrrolidone (NPM) NE, NI, PVA, PVC, V NR BR, 4H
Tetrafluorethylene BR, NE, PVA, V
Tetramethylenediamine (TMEDA) BR, NR, NE, NR, PVC, V

References 8. Douglas AA, Neufeld PD, Wong RKW. An inter laboratory

1. Allmers H. Wearing test with 2 different type of latex
gloves with and without the use of a skin protection cream.
Contact Dermatitis 2001; 44:30–33
2. Boman AS, Mellström GA. Percutaneous absorption of
three organic solvents in the guinea pig. IV. Effect of pro-
tective gloves. Contact Dermatitis 1989; 21:260–266
3. Boman AS, Mellström GA. Percutaneous absorption stud-
ies in animals. In: Mellström GA, Wahlberg JE, Maibach
HI (eds) Protective gloves for occupational use. CRC Press,
Boca Raton, FL, 1994; pp 91–107
4. British Standard (BS 3574:1989), Her Majesty’s Stationery
Office, London (Storage conditions for medical gloves)
5. Brooks SM, Anderson L, Emmet E, Carson A, Tsay JY, Elia
V, et al. The effects of protective equipment on styrene ex-
posure in workers in the reinforced plastics industry. Arch
Environ Health 1980; 35:287–294
6. Burman LG, Fryklund B. The selection and use of gloves by
health care professionals. In: Mellström GA, Wahlberg JE,
Maibach HI (eds) Protective gloves for occupational use.
CRC Press, Boca Raton, FL, 1994; pp 283–292
7. Carey R, Herman W, Herman B, Casamento J. A laboratory
evaluation of standard leakage tests for surgical and exami-
nation gloves. J Clin Engineer 1989; 14:133–143
comparison of standard test methods for medical gloves.
In: McBriarty JP, Henry N (eds) Performance of protective
clothing, Vol. 4. ASTM STP 1133, American Society for
Testing and Materials, Philadelphia, 1992; pp 99–113
9. Estlander T. Occupational skin diseases in Finland, 1974–
1988, (Academic dissertation), Acta Derm-Venereol 1990;
(Suppl):155
10. Estlander T, Jolanki R. Allergic contact dermatitis from
rubber and plastic gloves. In: Boman A, Estlander T,
Wahlberg JE, Maibach HI (eds) Protective gloves for occu-
pational use. 2nd ed. CRC Press, Boca Raton, FL, 2005;
pp 127–144
11. Fay MF. Risk analysis as the base for surgical glove selec-
tion. J Long Term Eff Med Implants 1994; 4:141–155
12. Freitas JP, Brandão FM. Contact urticaria to chlorocresol.
Contact Dermatitis 1986; 15:252–252
13. Gonçalo M, Gonçalo S, Moreno A. Immediate and de-
layed sensitivity to chlorocresol. Contact Dermatitis 1987;
17:46–47
14. Hamann CP, Nelson JR. Permeability of latex and thermo-
plastic elastomer gloves to the bacteriophage Phi X 174.
Am J Infect Control 1993; 21:289–296

15. Henry III NW. US rules, regulations, and standards for
protective gloves for occupational use. In: Boman A, Est-
lander T, Wahlberg JE, Maibach HI (eds) Protective gloves
for occupational use. 2nd ed. CRC Press, Boca Raton, FL,
2005; pp 35–41
16. Hogstedt C, Ståhl R. Skin absorption and protective
gloves in dynamite work. Am Ind Hyg Assoc J 1980;
41(5):367–372
17. Jencen DA, Hardy JK. Effect of glove material thickness
on permeation characteristics. Am Ind Hyg Assoc J 1989;
50:623–626
18. Jensen O. Contact allergy to propylene oxide and isopropyl
alcohol. Contact Dermatitis 1981; 7:148–150
19. Kanerva L, Estlander T, Jolanki R. Allergic contact derma-
titis from dental composite resins due to aromatic epoxy
acrylate and aliphatic acrylates. Contact Dermatitis 1989;
20:201–211
20. Kassis V, Vedel P, Darre E. Contact dermatitis to methyl
methacrylate. Contact Dermatitis 1984; 11:26–28
21. Knowles RS, Virden JE. Occasional review. Handling of in-
jectable antineoplastic agents. Br Med J 1980; 30:589–591
22. Lauwerys RR, Kivits A, Lhoir M, Rigolet P, Houbeau D,
Buchet J-P, et al. A biological surveillance of workers ex-
posed to methylformamide and influence of skin protec-
tion on its percutaneous absorption. Int Arch Occup Envi-
ron Health 1980; 45:189–203
23. Leinster P. The selection and use of gloves against chemi-
cals. In: Mellström GA, Wahlberg JE, Maibach HI (eds)
Protective gloves for occupational use. CRC Press, Boca
Raton, FL, 1994; pp 269–281
24. Lidén C, Wrangsjö K. Protective effect of gloves illustrated
by patch test testing–practical aspects. In: Mellström
GA, Wahlberg JE, Maibach HI (eds) Protective gloves
for occupational use. CRC Press, Boca Raton, FL, 1994;
pp 207–212
25. Lytle CD, Cyr WH, Carey RF, Shombert DG, Herman BA,
Dillon JG, et al. Standard quality testing and virus penetra-
tion. In: Mellström GA, Wahlberg JE, Maibach HI (eds)
Protective gloves for occupational use. CRC Press, Boca
Raton, FL, 1994; pp 109–127
26. Mader RM, Rizovski B, Steger GG, Moser K, Rainer H,
Dittrich. Permeability of latex membranes to anti-cancer
drugs. Int J Pharm 1991; 68:151–156
27. Maso MJ, Goldberg DJ. Contact dermatitis from disposable
gloves. A Review. J Am Acad Dermatol 1990; 23:733–737
28. Mellström GA, Boman AS. Gloves: types, materials, and
manufacturing. In: Mellström GA, Wahlberg JE, Maibach
HI (eds) Protective gloves for occupational use. CRC Press,
Boca Raton, FL, 1994; pp 21–35
44 Protective Gloves 419
29. Mellström GA, Carlsson B. European Standards on protec-
tive gloves. In: Mellström GA, Wahlberg JE, Maibach HI
(eds) Protective gloves for occupational use. CRC Press,
Boca Raton, FL, 1994; pp 39–43
30. Mellström GA, Lindberg M, Boman A. Permeation and de-
structive effects of disinfectants on protective gloves. Con-
tact Dermatitis 1992; 26:163–170
31. Mellström GA, Carlsson B, Boman AS. Testing of pro-
tective effect against liquid chemicals. In: Mellström GA,
Wahlberg JE, Maibach HI (eds) Protective gloves for occu-
pational use. CRC Press, Boca Raton, FL, 1994; pp 53–77
32. Mellström GA, Wrangsjö K, Wahlberg JE, Fryklund B. The
value and limitation on gloves in medical health service:
Part II. 1996; 8(4):287–295
33. Mickelsen RL, Hall RC. A breakthrough time comparison
of nitrile and neoprene glove materials produced by dif-
ferent glove manufacturers. Am Ind Hyg Assoc J 1987;
48:941–947
34. Nethercott JR, Holness DL, Page E. Occupational contact
dermatitis due to glutaraldehyde in health care workers.
Contact Dermatitis 1988; 18:93–197
35. Pegum JS, Medhurst FA. Contact dermatitis from perme-
ation of rubber gloves by acrylic monomer. Br Med J 1971;
2:141–143
36. Perkins JL, Pool B. Batch lot variability in perme-
ation trough nitrile gloves. Am Ind Hyg Assoc J 1997;
58:474–479
37. Sansone EB, Tewari YB. Differences in the extent of solvent
penetration through natural rubber and nitrile gloves from
various manufacturers. Am Ind Hyg Assoc J 1980; 41:527–
528
38. Schwope AD, Costas PP, Jackson JO, Weitzman JO. Guide-
lines for the selection of protective clothing. American
Conference of Governmental Industrial Hygienists, Inc.
(2nd) Cincinnati, 1985
39. Schwope AD, Costas PP, Mond CR, Nolen RL, Conoley
M, Garcia DB, et al. Gloves for protection from aqueous
formaldehyde: Permeation resistance and human factors
analysis. Appl Ind Hyg 1988; 3:167–176
40. Sessink PJM, van de Kerkhof MCA, Anzion RB, Bos RP.
Environmental contamination and assessment of exposure
to antineoplastic agents by determination of Cyclophos-
phamide in urine of exposed pharmacy technicians: Is skin
absorption an important exposure route? Arch Environ
Health 1994; 4:165–169
41. van Ketel WG, Tan-Lim HN. Contact dermatitis from eth-
anol. Contact Dermatitis 1975; 1:7–10