PONE-D-24-03435Nitrile Glove Composition and Performance – Substandard Properties and Inaccurate Packaging InformationPLOS ONE

Dear Dr. Cornish,

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript entitled "Nitrile Glove Composition and Performance – Substandard Properties and Inaccurate Packaging Information" by Cornish et al is very interesting and significant But the following concerns needed to be addressed before it can be published in PLOS ONE.

1. Is there any allergic reactions performed for this gloves? If not needed please give explanations

2. What about the flexibility of these gloves? As I have observed Nitrile Gloves are sometimes less flexible

3. What are the cost analysis off these gloves?

4. These gloves are biodegradable?

5. Is there any exceptional chemical present which could be penetrate these gloves?

6. Is these gloves are temperature sensitive?

Reviewer #2: This study evaluates the composition, durability, and mechanical properties of various nitrile glove brands. The authors found significant variability in glove performance, with some brands failing to meet ASTM standards despite being marketed as nitrile. NMR analysis revealed that one brand, Vglove, had a spectral signature consistent with PVC rather than nitrile. Thinner gloves like Restore Touch showed poor durability despite being composed of nitrile. The authors make a compelling case that glove quality should be prioritized to ensure healthcare worker and patient safety. The manuscript is well-organized and the methods are sound, but some areas need further clarification or development. Expanding the sample size and variety of glove brands tested would strengthen the conclusions. With some revisions to address the comments below, this paper has the potential to make a valuable contribution to our understanding of medical glove performance and composition.

Comments:

1. The introduction provides good context on the importance of glove integrity for healthcare worker safety. However, it would be helpful to include more background information on the specific chemical and physical properties of nitrile that make it a preferred material for medical gloves.

2. In the methods section, please clarify how the glove thickness measurements were taken. Were multiple spots measured on each glove to account for potential variations in thickness?

3. The FTIR results showed a high degree of spectral overlap between the glove samples, even those made of different materials. What are some potential reasons for this similarity, and how might it impact the utility of FTIR for glove composition analysis?

4. The NMR data provide compelling evidence that the Vglove brand is primarily composed of PVC rather than nitrile. Are there any other analytical techniques that could be used to further validate this finding?

5. How do the tensile strength and elongation values for the EMT gloves compare to the ASTM D6319 requirements for nitrile examination gloves? It would be informative to include this context even though there is not a specific EMT glove standard.

6. The authors note that future studies will analyze a wider variety of nitrile glove brands. Will these studies also include gloves marketed as latex or vinyl to assess their composition and performance relative to nitrile?

7. In the conclusion, the authors emphasize that gloves failing to meet minimum ASTM requirements should not be used for medical purposes. How can healthcare facilities and practitioners ensure they are purchasing high-quality gloves that meet these standards?

8. The durability testing used 120-grit sandpaper to create a rough contact surface. Is this grit size representative of the abrasive surfaces gloves might encounter in a clinical setting?

9. Table 1 compares the lowest mechanical property values to ASTM standards. Would it also be valuable to report the average values to give a more complete picture of each glove's performance?

10. The cost and mechanical properties comparison in Figure 8 is informative. Have the authors considered normalizing the cost per glove to account for variations in glove thickness?

11. In the introduction, the authors mention that low inspection rates during the pandemic allowed poorly made gloves to enter the US market. Do they have any recommendations for improving glove quality control and regulation going forward?

12. The Vglove brand did not provide any manufacturing information on their packaging or website. Is this lack of transparency a potential red flag that healthcare purchasers should be aware of?

13. Could variations in glove storage conditions or age impact their mechanical properties or durability? If so, how was this accounted for in the study design?

14. The discussion notes that PVC gloves have been found to be less durable and strong than high-quality nitrile gloves. What are some of the specific risks associated with using PVC exam gloves in clinical settings?

15. Beyond tensile strength and durability, what other glove properties might be important to assess in future studies to get a more complete picture of their overall quality and performance?

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Reviewer #1: Yes: Ihtisham Ul Haq

Reviewer #2: No

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Nitrile Glove Composition and Performance – Substandard Properties and Inaccurate Packaging Information

PONE-D-24-03435R1

Dear Dr. Cornish,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Mohamed Moafak Arbili

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The manuscript titled "Nitrile Glove Composition and Performance – Substandard Properties and Inaccurate Packaging Information" has been well revised. It is now ready to proceed to the next stage of publication.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript is significantly improved, Authors addresses all the comments seriously, thus i recommend accept

Reviewer #2: Well revised. "Nitrile Glove Composition and Performance – Substandard Properties and Inaccurate Packaging Information" Can be processed for the next stage of publication.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Ihtisham Ul Haq

Reviewer #2: Yes: Mahmoud H. Akeed

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