Hi!
I think alot of us forget about the principle underlying the task. I teach infection control basics: PPE, is personal, to protect the individual, and nurse practice guidelines mandate that whenever there is the POSSIBLITY of exposure to blood or body fluids, we MUST wear the appropriate personal protective equipment, or be subject to serious LEGAL consequences, think OSHA and the Office of the Professions, (where our nurse license comes from). However, here is the rub, and where I think JACAHO and the State Health Depts. are coming from. PPE must be appropriate to the task at hand. #1 point, is that as soon as you put clean gloves on, they immediately become contaminated. But, they protect the wearer from exposure as they complete the current task, i.e. bagging biohazard waste. But recognizing clean to clean is clean, and clean to diry is dirty, and that we can never work from dirtier to something cleaner.......once you toss the bag into the cart.... you take your gloves off, WASH your hands, then push the handle of the cart, to where it needs to go, and don't therefore hit elevator buttons, or door handles, or touch a chart, with gloved hands that are more highly contaminated, (potentially infectious), or even smeared with unspeakables, when you move out into community areas. We get cited when we are seen to cross-contaminate. And it is up to each nurse to be able to identify to anyone who choses to ask, the reasons we are using the PPE our GOOD NURSING JUDGEMENT and LICENSURE requires us to use, and each circumstance might be different, but the rules don't change. And in a written Plan of Correction, like one I saw citing an aide who went from pericare to oral care to the hall linen cart to the next pt, and back again with the same contaminated gloves on and never washed hands, there are some serious reasons, like MRSA and VRE and C-diff why JCAHO deserves SOME credit!
A big problem with chronic glove use is the reality that the line between tasks becomes blurred, and staff, in part due to our overwhelming workload and urgency of multi-tasking, forget, neglect, don't find time to, oops meant to, wash their hands and change their gloves. So, do not hesitate to state, I am wearing my gloves because, and yes, I washed my hands. The big reality is that handwashing studies prove that indeed, nurses wash their hands more than everybody else, but who is seen by our patients and residents, and family members the most? We are, so we are held to higher scrutiny and I believe, higher standards. And I am proud of that. I wash my hands often and publicly, and my students joke they would rather die than be seen by me to be wearing two gloves in the hall. Do they wear gloves in the hall to bag the linen? Of course they do, but that is critical thinking, and another lesson in itself. Sue.
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