Ever forget to put on your gloves?

[PapaBear434]

Do you change your gloves during the call at all, or is it the same pair of gloves from start to finish?

Depends. If they are a "clean" patient, no, I just keep them on just in case they squirt some fluid out of someplace. I take them off after I clean up the stretcher. If they are bloody, I change after all the bleeding is controlled. If I just get a little blood on my glove via a glucose check or something, I just use the remaining alcohol left on the pad to clean it off.

But one way or another, I rarely if ever touch the patient with an ungloved hand, and I never touch anything else like my pen or something with a glove that has been exposed to a fluid.

Then, of course, my pen is covered with alcohol cleaner when the call is done anyway.

 

[JPINFV]

What's the point of wearing gloves if you're paperwork, clipboard, and pen (even if you clean the pen afterwards) has been cross contaminated? When I wear gloves (essentially every patient, but there are a few exceptions) I tend to change them after every patient contact. Take a set of V/S, do an exam, etc. Change gloves so I'm wearing a clean set. Document what I need to document. I'm still wearing gloves in case I need to do something immediately, but I'm also controlling the cross contamination.

 

[PapaBear434]

What's the point of wearing gloves if you're paperwork, clipboard, and pen (even if you clean the pen afterwards) has been cross contaminated? When I wear gloves (essentially every patient, but there are a few exceptions) I tend to change them after every patient contact. Take a set of V/S, do an exam, etc. Change gloves so I'm wearing a clean set. Document what I need to document. I'm still wearing gloves in case I need to do something immediately, but I'm also controlling the cross contamination.

As I said, if they are "clean," I'm not that worried. The gloves are just in case they START to bleed, urinate, or otherwise start oozing something gross. I won't have to waste time on grabbing a new set of gloves to start helping them. After I"m done, THEN I change out before touching my stuff or the report again.

 

[VentMedic]

As I said, if they are "clean," I'm not that worried.

Define clean.

The microbes you can not see are the ones that will make you or another patient the sickest.

 

[PapaBear434]

Define clean.

The microbes you can not see are the ones that will make you or another patient the sickest.

That's why I was putting quotation marks around the word. Obviously, I can't see everything. But I am most concerned with bodily fluids, wounds, sweaty parts of the body... Anywhere the cooties are most likely to be. I'm only terribly worried about the most obvious nastiness.

I get what you're saying, I do, but as I said I am only worried about major exposures.

 

[VentMedic]

Anywhere the cooties are most likely to be. I'm only terribly worried about the most obvious nastiness.

I get what you're saying, I do, but as I said I am only worried about major exposures.

MRSA, VRE, C-Diff etc are of no concern to YOU? But, what about your patients who don't have healthy immune systems?

 

[medicdan]

How do you define a clean patient, not worthy of different gloves between tasks? What is "clean" on your ambulance?

I change my gloves fairly often between patient contacts, but everytime it is a different set of gloves.

MRSA is spread by staff (most often CNAs), not chaning their gloves between tasks and patients.

I just got into the habit of keeping two pens-- one for myself, one for patients. When I do my paperwork, I dont wear gloves, but when I get signatures, I don one glove, and use a piece of cardboard for my patient to sign, then put the pen back with my gloved hand... weird, right?

On non-emergencies, it goes something like this:
Go in meet patient, while donning gloves, transfer to stair chair, stretcher, whatever, then gloves OFF (usually hand sanitizer at the elevator or on the way out of the room). At my company, it is assumed that straps are always handled without gloves. Get the patient out to the truck no gloves, etc. When I get vitals, gloves go on, then off for paperwork, and back on for signatures, off when out of the truck, and finally back on to transfer back to bed. Lastly I wash my hands (or, in some facilities, use hand sanitizer).

 

[VentMedic]

MRSA is spread by staff (most often CNAs), not chaning their gloves between tasks and patients.

And you know this how?

Read this post by PapaBear434

That's why I was putting quotation marks around the word. Obviously, I can't see everything. But I am most concerned with bodily fluids, wounds, sweaty parts of the body... Anywhere the cooties are most likely to be. I'm only terribly worried about the most obvious nastiness.

I get what you're saying, I do, but as I said I am only worried about major exposures.

 

[PapaBear434]

MRSA, VRE, C-Diff etc are of no concern to YOU? But, what about your patients who don't have healthy immune systems?

Aren't we picking nits here? If they are obviously ill in some way or I suspect that they might be thanks to their appearance or apparent lack of hygiene, yes, gloves are on and changed frequently. If they are a perfectly healthy 20 year old male and fell during a hockey game and busted their arm, I'm not terribly worried about touching their other wrist for a pulse and then going to my paperwork.

Common sense sometimes prevails.

 

[VentMedic]

Aren't we picking nits here? If they are obviously ill in some way or I suspect that they might be thanks to their appearance or apparent lack of hygiene, yes, gloves are on and changed frequently. If they are a perfectly healthy 20 year old male and fell during a hockey game and busted their arm, I'm not terribly worried about touching their other wrist for a pulse and then going to my paperwork.

Common sense sometimes prevails.

I hope commonsense will prevail here which is why I have some good reading for you especially with the example you just mentioned. Also, how would this young person feel if you passed on MRSA from your hands to a break in his skin from the fall?

http://www3.niaid.nih.gov/topics/antimicrobialResistance/Examples/mrsa/default.htm

Here's an exert but you definitely should read the ENTIRE article.


Community –associated MRSA (CA-MRSA)

CA-MRSA is caused by newly emerging strains unlike those responsible for HA-MRSA and can cause infections in otherwise healthy persons with no links to healthcare systems. CA-MRSA infections typically occur as skin or soft tissue infections, but can develop into more invasive, life-threatening infections. CA-MRSA is occurring with increasing frequency in the United States and around the world and tends to occur in conditions where people are in close physical contact, such as athletes involved in football and wrestling, soldiers kept in close quarters, inmates, childcare workers, and residents of long-term care facilities.

 

[daedalus]

Actually, labcoats and ties have been implicated in MSRA so be sure you throw MDs in there too, however I am sure that CNAs also contribute. We all do (MRSA). EMTs and Paramedics wear the same jacket for three shifts a week at my company. I too have seen CNAs walk room to room with the same gloves and gown. Actually, I see it all the time.

 

[VentMedic]

Actually, labcoats and ties have been implicated in MSRA so be sure you throw MDs in there too, however I am sure that CNAs also contribute. We all do (MRSA). EMTs and Paramedics wear the same jacket for three shifts a week at my company. I too have seen CNAs walk room to room with the same gloves and gown. Actually, I see it all the time.

Trying to say "they" do it also does NOT excuse EMTs who believe their hands are not dirty if they don't have icky stuff on them. However, I will say most CNAs do know better since they do get more education on infection control than EMTs. If they work in a hospital, they must review this at least yearly and will be frequently monitored by the infection control staff. If they work in a surgical area, they may also be subject to period hand inspections/cultures or even nasal swabs just like the other staff members.

I, too, will touch a patient on rare occasions without gloves. But, I am no more than 3 feet away from hand cleaner or 8 feet from a place to wash my hands. I know that I have touched a patient and must clean my hands before moving out of this patient's immediate area. I also know that if I have touched charts or other common areas, I must wash my hands before going near another patient even if I am going to wear gloves. I also know myself to be relatively disease free but still feel that I should wash my hands after eating before I go to the bedside of a patient regardless of the fact that I will be wearing gloves.

 

[Fragger]

PPEs are always on before we head out!

 

[medicdan]

i cannot dig up the study I informally quoted about CNAs-- I do remember seeing it a few months ago, though. I have no doubt hospital CNAs are subjected to many controls and much education, but I worry about the staff at some of the nursing homes I frequent. In fact, I worry about most of them.
I agree, EMTs are just as guilty. I wash my outer coat every week, but that is barely enough for the contamination I encouter. I acknowledge the nastiness of most of what I touch, that is why I "pump in, pump out" with hand sanitizer, and wash my hands as often as possible. I keep a bottle of sanitizer taped to the suction in the back of the truck and in the central console in the front, and clean my hands as I come in. I dont eat in the truck, and when i do eat, I wash my hands before and after.

Take a microbiology course, it will scare you into conforming.

 

[swindlman]

I did once, the first call ive was ever on and remembered so had to run back to the rig looking stupid. so since then i always have some in a pocket

 

[PapaBear434]

i cannot dig up the study I informally quoted about CNAs-- I do remember seeing it a few months ago, though. I have no doubt hospital CNAs are subjected to many controls and much education, but I worry about the staff at some of the nursing homes I frequent. In fact, I worry about most of them.
I agree, EMTs are just as guilty. I wash my outer coat every week, but that is barely enough for the contamination I encouter. I acknowledge the nastiness of most of what I touch, that is why I "pump in, pump out" with hand sanitizer, and wash my hands as often as possible. I keep a bottle of sanitizer taped to the suction in the back of the truck and in the central console in the front, and clean my hands as I come in. I dont eat in the truck, and when i do eat, I wash my hands before and after.

Take a microbiology course, it will scare you into conforming.

Funny thing is, I wash all of my gear after every shift. Though, I don't actually wear a coat. I just have a pullover thing, so it's like wearing an over shirt over my polo. I get home, everything goes in the washer.

I guess I figure that in the course of moving a patient, helping them up, whatever... I am getting covered in stuff already by everything that the gloves don't cover. If they have MSRA, well, I'm probably gonna get it too. I don't take unnecessary risks (like licking them or something), but I'm also not going to change my gloves every time I touch them during a 10 minute transport.

Also, I myself keep hand sanitizer in my pocket in addition to the two on the walls of the rig and every couple feet in the ER.

 

[medicdan]

I'm with you, I understand...
I am trying to point out that you want to eliminate any chance that if you have nasties on your gloves, they arent transmitted to everything you touch, from straps on the cot to door handles to elevator buttons, to switches in the ambulance, etc. They are still going to get cleaned, but reduce the chance of the transmission as much as possible.

 

[rhan101277]

I did once, the first call ive was ever on and remembered so had to run back to the rig looking stupid. so since then i always have some in a pocket

Yeah it makes you look super stupid, especially when the person needs some quick help.

 

[EmsPrincess*]

I wash everything everytime I wear it for infection control. As mentioned above I wouldn't use the same gloves for a "clean" patient and thank goodness have never witnessed it being done.
I do recall a dental assistant walking out of the examination room with her gloves on after hitting the xray button for my daughter's xrays and then returning STILL GLOVED! Needless to say she was reported for leaving the room and returning with the same gloves on and AS MY SEVEN - YEAR - OLD pointed out Mommy, she needed clean gloves anyway after hitting the xray button!
It never ceases to amaze...

 

[AJ Hidell]

Funny thing is, I wash all of my gear after every shift. Though, I don't actually wear a coat. I just have a pullover thing, so it's like wearing an over shirt over my polo. I get home, everything goes in the washer.

That's why I don't understand people who whine about white shirts showing dirt, grime, and blood. Dude, if you have that stuff on you, you need to change shirts! If I have that nasty stuff on me, I want to know about it, not just remain blissfully ignorant for the next 24 hours because the dark blue hides it well.