William Stewart Halsted, The Johns Hopkins Hospital's first
surgeon in chief, is widely credited
as the first to develop and introduce rubber surgical gloves in
the United States. That was in 1894,
five years after the institution opened.
Now, in an effort to make medical care safer for patients
and health care workers, the hospital
has become the first major medical institution to become "latex
safe" by ending all use of latex gloves
and almost all medical latex products.
"Latex hospital gloves were invented here, so it's only
fitting that Johns Hopkins takes the
initiative to promoting alternatives," said anesthesiologist
Robert H. Brown, chair of the Johns
Hopkins Hospital Latex Task Force and one of many Johns Hopkins
faculty and staff members who
have contributed to making the hospital latex-safe.
It was at Johns Hopkins that immunologists Robert Hamilton
and Franklin Adkinson conducted
early key research related to the problems of natural rubber
latex as an allergen. Furthermore, Brown
points out, the nurses and other frontline hospital workers have
been instrumental in implementing the
latex-safe policy and educating the staff.
Studies show that roughly 6 percent of the general
population and up to 15 percent of health
care workers are allergic to latex, with the higher rate among
medical personnel due to longer periods
of contact with natural rubber. In addition to surgical gloves,
latex is used in numerous medical
devices such as tourniquets, blood pressure cuffs and stethoscope
tubes. The anaphylactic reactions,
similar to those caused by foods such as peanuts or by bee sting
allergies, can include a drop in blood
pressure, an irregular heartbeat, swelling in the hands and feet
and constriction of the airways. In
extreme cases, anaphylactic shock, which can occur minutes after
the exposure, can lead to death.
Allergic reactions generally result from exposure to natural
proteins, in this case proteins
specific to natural rubber latex, a product from rubber trees.
Currently available replacement gloves are made of one of
three synthetic products — neoprene,
polyisoprene or vinyl, none of which contains natural plant
Johns Hopkins is now using sterile neoprene and polyisoprene
gloves in the operating room
because they have a more sensitive feel.
Julie Freischlag, professor and chair of surgery, said, "The
sensitivity and fit of the new gloves
are the same as what you get with latex gloves. Unless someone
told you, you wouldn't know the
difference. The only downside is that they are a little more
Sterile neoprene and polyisoprene gloves cost 30 percent to
50 percent more than latex gloves.
Nonsterile neoprene and vinyl examine gloves cost approximately
the same as those made from latex.
Johns Hopkins uses mostly neoprene gloves for all nonsterile
procedures that require glove protection.
Brown says the risk of developing an allergic reaction to
latex is higher if contact is made with
broken skin or mucous membranes, such as when hands are raw from
multiple scrubbings or when
health care workers breathe in the powder that makes the gloves
easier to put on. Patients for whom
latex medical products are commonly used for treatment, such as
children with conditions like bladder
exstrophy or spinal bifida, can have as high as an 80 percent
chance of developing an allergic reaction
to the natural rubber latex.
Halsted is reported to have developed the latex glove to
protect the hands of his scrub nurse
from the harsh antiseptics in widespread use as disinfectants. By
1966, disposable latex gloves were
the norm in operating rooms nationwide, and in the 1980s, the
need for "universal precautions,"
prompted by the AIDS epidemic, increased their use outside the
operating room and among health
care workers everywhere. As glove use proliferated, so did the
rate of allergic reactions, and by the
mid-1990s, latex allergies were considered a major health issue.
Brown says he prefers the term
"latex safe" to "latex free" because removing all sources of
natural rubber remains a bit of a
"We are still searching the hospital for the few remaining
medical latex products that we might
have overlooked, although we can safely say that all major latex
products that are a clear risk to
health care workers and patients have been eliminated," he
To hear Robert Brown and Julie Freischlag talk about the
transition to latex-free surgical
gloves and a latex-safe environment at Johns Hopkins, go to