Latex Medical Emergency at Hand : Fear of AIDS Grows, Creating a Shortage of Disposable Gloves

Terry Gibson, vice president of Professional Hospital Supply in San Marcos, says that if he has to go to a hospital for surgery, he will take some disposable gloves along “so the operation doesn’t get canceled.”

His concern is exaggerated, but only slightly.

Gibson, whose firm stocks the supply rooms of many California hospitals, is acutely aware that gloves are vanishing from the shelves as medical personnel--from doctors to dentists, nurses to hospital janitors--grow increasingly fearful of being infected with the virus that causes acquired immune deficiency syndrome.

Demand is soaring for surgical, examination and other disposable medical gloves, which are worn once by those who come in contact with patients’ blood or other body fluids and then thrown away. Gloves deter AIDS transmission by covering cuts or skin openings on the hands of those who handle infected bodily fluids.

Orders are outstripping supply as manufacturers scramble to add production capacity and suppliers strive to fill the gap by importing gloves made in Taiwan, China, Thailand and Malaysia, home of the rubber trees that are the world’s major source of latex.

“If you are a small (distribution) company, you can make a lot of money now because hospitals will take gloves from just about anywhere. It is a panic state,” said Susan Ross, who is employed by a subsidiary of the Hospital Council of Southern California to arrange purchases for groups of hospitals.

To adjust to tight market conditions, hospitals and medical and dental offices are being forced in some cases to pay hefty premiums for gloves from new suppliers or to accept gloves of lesser quality.

Purchasers are placing multiple orders months in advance, realizing they will be put on waiting lists and possibly will receive only a portion of the quantity requested.

Sharon Hilgren, a dental assistant who tries to keep an Irvine dental office stocked with gloves, said she tells suppliers: “I will take anything and everything they can get me.” She said the last batch of gloves she received were peppermint flavored.

Not all the gloves can be counted on as effective barriers to the blood and other body fluids that may carry the viruses that cause AIDS, hepatitis B and other contagious diseases.

“If they fall apart, we put others on,” Hilgren said. “You can’t be choosy anymore, because we’d rather work with something on our hands than nothing.”

Throughout Southern California, medical personnel and suppliers voice similar concerns:

- Gary Wood said Long Beach Community Hospital was down to one day’s supply of surgical gloves when he became the hospital’s director of material management two months ago. Wood said he convinced the hospital’s surgeons that it was essential to add more suppliers and to order types of gloves other than the style they preferred.

- Beverly Pliska, who orders supplies for five doctors and a walk-in clinic in Irvine, was down to her last four or five boxes of exam gloves in late November. “If I don’t get any next week, I won’t have any more,” she said.

- Steven Haynes, assistant director of purchasing at St. Mary’s Medical Center in Long Beach, said he can’t count on having an adequate supply of latex gloves for more than a day at a time. He said he has turned down pleas from local doctors and dentists who want the hospital to share gloves with them.

- UCLA Medical Center can’t obtain latex examination gloves at any price, said Blaine Leffer, manager of the storehouse that supplies the hospital. The center’s policy-makers had decided to switch from vinyl to latex gloves because they believe latex offers greater protection.

“We have been told to get them (latex gloves) at any cost, and we can’t,” Leffer said. Nurses and other hospital personnel are continuing to wear vinyl gloves, he said, although not always of the correct size. For a month, the medical center was out of medium gloves, and personnel had to wear large or small sizes.

H. W. (Smitty) Smith, manager of merchandise for Pearson Dental Supply of San Fernando, said American manufacturers are attempting to ration gloves by typically filling only “10% of what you order” and delivering products three to four months after orders are submitted.

The prospect of going gloveless is scary, medical supply officials said. “There is a tremendous amount of apprehension and fear,” about the possibility of contacting AIDS, said Bruce Schuetz, director of materials management at Huntington Memorial Hospital. “We have an obligation legally and also morally to provide gloves to anybody who deals with patients.”

While gloves have been in tremendous demand for at least a year, most industry experts trace the current supply crunch to recommendations issued in August by the Centers for Disease Control urging health-care workers “to treat blood and other body fluids from all patients as potentially infective.”

The Occupational Safety and Health Administration has endorsed the CDC guidelines, which call for the use of gloves and other “barrier precautions” such as masks and gowns.

In response, hospitals that once required personnel to wear examination gloves only when treating patients with diagnosed infectious diseases have made gloves part of the daily routine. In some hospitals, glove dispensers have been placed in each patient’s room.

Chemotherapy Gloves

“Practically everyone in the hospital is wearing gloves,” said Leffer, the UCLA Medical Center supply chief. He estimated that the hospital’s demand for gloves has increased 60% in the past year over what he called “the rampant paranoia about AIDS.”

So great is the concern in the emergency room, Leffer said, that some medical personnel are wearing extra-thick chemotherapy gloves intended as protection against radioactive materials.

Huntington Memorial’s Schuetz said the hospital’s use of examination gloves has increased tenfold in the last year, while its use of surgical gloves has doubled.

Richard Asa, spokesman for the American Dental Assn., said the organization advocated routine use of gloves to prevent transmission of diseases among patients, dentists and hygienists as early as 1976.

But glove usage in dentist offices didn’t really take off until 1986, he said, and it has grown “exponentially” since, propelled by an increased awareness of AIDS and the recommendations from the Centers for Disease Control.

According to medical supply industry officials, a shortage of latex examination gloves used for most nonsurgical procedures developed first, followed in more recent months by a shortage of less popular vinyl exam gloves.

Supplies of surgical gloves also have started to run short, partly because they are being used in place of examination gloves, purchasing agents said.

In addition, they said, many surgeons who worry that their gloves might rip have begun wearing two pair at a time in the operating room. Craig Reiff, marketing director for the operating room division of Baxter Healthcare Inc., said 20% to 30% of surgeons are “double gloving.”

In an effort to catch up with burgeoning demand, major American manufacturers are adding capacity both in the United States and Asia.

In Malaysia, for instance, Baxter is scheduled to complete construction of a new plant next year that will produce half a billion latex gloves annually. The company already produces a billion gloves a year. Ansell Inc., another large latex glove maker, recently built a manufacturing plant in Thailand.

Vinyl Market Boomed

Nonetheless, medical industry observers predict that the glove shortage will last at least another year and perhaps more than two years. Its duration will depend in part on how many other service workers, such as restaurant and cafeteria employees, grocers and police officers, opt to wear gloves to help reduce their risk of exposure to the AIDS virus.

Vinyl glove manufacturers, whose product is generally less preferred by doctors and nurses because it is considered less touch sensitive than latex, suddenly are swamped with orders.

Mike Mangano, regional vice president for Becton Dickinson & Co., a leading vinyl glove maker, acknowledged that a year ago, he was wondering how to drum up more business.

“All of a sudden, the market went nuts,” Mangano said. “The demand is unprecedented and higher than we can supply.” Part of the shortage, he said, has been caused by the “hoarding” of gloves by medical facilities that fear they will run short.

In September, following publication of the CDC guidelines, all 200 of the nurses who collect blood for the American Red Cross in Los Angeles and Orange Counties began wearing disposable gloves. “The providers have run out of the latex gloves, and we are using vinyl,” said Red Cross spokeswoman Gerry Slohle.

But she said some nurses have found it difficult to locate veins by touch through the vinyl, so they have clipped one finger from their gloves and covered the opening with a removable rubber shield.

Tracy Krutell, director of material management at St. Jude Hospital in Fullerton, said the hospital recently switched to vinyl gloves to cut costs. “You convert from latex to vinyl because suppliers tell you they can’t get latex gloves, or they charge you an arm and a leg” to get them, he said.

Importers Get in Act

Domestic glove manufacturers and distributors, struggling to fill at least a portion of the orders received from traditional customers, in some cases are refusing new business.

“We are not accepting new customers at this point since demand among our current customers has skyrocketed,” said Charlie Kirkpatrick, director of national purchasing for Bergen Brunswig, a leading medical supplier headquartered in Orange. “Last summer, we stopped taking new customers for exam gloves, and three months ago we stopped taking them for surgeon’s gloves.”

Importers are scrambling to fill the void. Gibson, the Professional Hospital Supply vice president, said 75% of the gloves that his company supplies to about 200 California hospitals are made by foreign manufacturers. Only six months ago, he said, “there weren’t any imports,” except for those gloves made overseas by American manufacturers.

American Consolidated Products, a Santa Ana importer, began importing exam gloves from Taiwan in August and now supplies at least 5% of the national market, said Ed Skonezny, president.

Skonezny estimates that the United States is consuming 5 billion pairs of disposable gloves a year, up from about 3 billion a year ago. It’s big business, he said, noting that American Consolidated alone has about $20 million of gloves on order.

Some purchasers of medical gloves are reluctant to buy imports, fearing the quality standards are less stringent and the gloves may prove less dependable.

“I will not commit to any imports,” said Mike McElaney, manager of the Tustin regional office of Healthco International, a large dental industry supplier.

Carolyn Satterthwaite, assistant director of an Orange County medical supply agency, said she stopped ordering imported gloves because they tended to tear. “A doctor would slip on the gloves, and the fingers popped out,” she said.

Production Checks

Many buyers, however, have no such qualms. “The gloves coming from Taiwan are probably as good or better than the domestic gloves,” Gibson contends.

Skonezny said American Consolidated has 150 field inspectors who check production lines at overseas factories to make sure the gloves it buys are of acceptable quality.

Memorial Medical Center of Long Beach had run out of American-made exam gloves and had begun issuing surgical gloves to nurses when its first shipment of imported exam gloves arrived recently.

“The (imported) gloves came through, and they are excellent,” said Ron Denton, the hospital’s director of materials services. Denton noted, though, that the imports cost 20% more than he was accustomed to paying.

Some American glove manufacturers and distributors claim that they are trying to keep prices down to avoid alienating longtime customers.

Eugene Freed, senior vice president of marketing for Ansell Inc., said the company is raising prices only enough to reflect added production expenses, including added plant capacity and rising prices for latex, which is in demand for both gloves and condoms.

“The manufacturers we deal with are trying to be very responsible,” said Bergen Brunswig’s Kirkpatrick, who anticipates near-term price increases of 6% to 8% for latex exam gloves.

Some buyers said the shortage is making gloves much more expensive.

A broker for a group of Southern California hospitals said most American glove manufacturers have told her that they will no longer sign contracts guaranteeing prices for several years.

The broker, who asked to remain anonymous, said she has been told that when her current contracts expire next year, the manufacturers she deals with intend to increase the price of surgical gloves to 39 cents from 33 cents a pair, an 18% increase, and to boost the price of latex exam gloves to 7 cents a glove from 5 cents, a 40% hike.

Gibson said a manufacturer of surgical gloves told him that it will increase its prices by 17% when his purchase contract expires Jan. 1. He said he will have to pass on the price increase to Professional Hospital Supply’s clients.

Some overseas manufacturers clearly are capitalizing on the supply-demand imbalance by boosting prices, said importer Skonezny. “Prices on imported gloves have gone up at least 40% in the last four months,” he said.

Gail Carpenter, purchasing manager for St. Joseph Hospital and the affiliated Childrens Hospital in Orange, said she sends packing “off-the-wall” glove suppliers who are asking four times the customary price, even though she is having difficulty keeping her shelves stocked.

Despite the hassles, it is doubtful whether hospitals will allow their personnel to go gloveless. “I don’t think anybody will take that chance,” Gibson said.

Even if a cure for AIDS is found, most medical industry observers believe that gloves--possibly along with eye goggles and gowns--have become a permanent part of hospital garb to guard against the spread of disease.

Pearl Jemison-Smith, a nurse epidemiologist at the University of California Irvine Medical Center in Orange, said the hospital is drafting a letter to patients explaining why personnel now wear gloves routinely. She said the use of gloves has caused consternation among some patients who resent the implication that they may carriers of deadly diseases.