To glove, or not to glove

We all want to protect ourselves and our patients against transmission of harmful hospital germs. Many times we are faced with situations when the question arises......To Glove, or Not to Glove Nurses Announcements Archive Article

To glove, or not to glove

New nurses and experienced nurses alike ponder this question. I know not you, you have the answer already, but let's explore the decision process since as nurses we love processes.

The short answer is to follow your policy and procedure guide.... blah, Blah, BLAH.

Ok, quick scenario illustrating the difference between "book world" and "real world".

After sitting through your yearly mandatory in services or videos about PPE personal protection equipment, Universal precautions, etc.

You being Nancy Nurse get the task of drawing blood. ooh yes, a skill that I may come in contact with "Blood and Body fluids". Quick memory call, about PPE and you do exactly what the PPE says you are entitled to use by OSHA. Can you name the PPE you will wear?

Okay, so you put on your equipment and step into the patient's room and announce you are there to draw their blood. Oh, this is how your patients see you. Your beady little eyes looking at them from behind your goggles, mask, a gown, and GLOVES.

Now before you say "No nurse would dress like that", let's logically evaluate this. A tip for those reading, it's a "catch 22" situation. For those that have not read the book, another saying might be "damned if you do, damned if you don't".

Ok, so you are dressed like an astronaut ready to walk on the moon. You are actually wearing all the PPE that is approved for coming in contact with the potential exposure of blood and body fluids.

There are couple problems. First, the patient is scared and going to complain no other nurse dresses like you, so you must be doing that for some racial/sexism/or other discriminatory reason.

The second reason is your employer is immediately going to ridicule you for wasting resources and utilizing unnecessary supplies.

Hence the catch 22 situation. You simply want to protect yourself and your family from possible blood borne diseases. So the employer is on you because of cost. The problem is if you ever draw blood and do not use the entire orificenal of PPE they will say that you are at fault for not protecting yourself as the employer willingly provides PPE for all employees.

In reality, most nurses use nonsterile gloves for this procedure. You will find in many policy and procedure manuals glasses or eye protection and masks are common standard PPE as well. It is up to the nurse to choose how safe do they want to be and still have a job. Again another example of the catch 22 situation where you put yourself at risk either health risk or employment risk.

Let me quickly finish by saying all of us nurses have learned what we know and practice from what we have been taught. Either from a professor, a book, video, co-worker, experience etc. Some brag about graduating top of their class from the oldest or world renowned school of nursing, etc.

The answer when to wear gloves is as simple as any time you think you "may" come in contact with blood, body, fluids or other contaminants.

The text book answer is to follow your employer policy and procedure book. Quick check where is that book? What chapter are gloves under? Better yet what page is your IV flush policy and procedure on? Yes, be honest you have absolutely no clue. Really bosses office, human resource office, nurses station. Okay, what color is the front cover? Yeah moving on.

Some may say I use the medical encyclopedia for reference, or x medical surgical nursing book, or y medical procedure book. All good answers but they vary by author and your employer will say we don't use that one.

Ever heard of WHO? That's right the global authority that so many bureaucrats love. They actually have a policy on when and where to use gloves from sterile to nonsterile to no gloves at all.

The 3rd page has a pyramid with useful information. Now you may have your employer in a catch 22 situation if they say they don't know or follow their guidelines. In the end, when your nursing judgment and actions are brought into question you will be facing a nursing board or a jury and I would like the weight of WHO on my side.

Below is a link to WHO glove leaflet.

http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf

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Mr Clean

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Specializes in Gerontology, Med surg, Home Health.

In all the years and all the times I've had blood drawn, not one nurse or phlebotomist has worn anything other than gloves....and I'm old!

Specializes in Oncology.

It airways amuses me when I go to Quest to get blood drawn and they're wearing their paper lab coats, gloves, and fluid face shields to draw blood.

Many of the older- wait, no, more experienced- nurses I work with don't wear gloves for blood draws, at least not difficult ones.

Specializes in Peds/outpatient FP,derm,allergy/private duty.

That pamphlet was very informative and easy to understand, Mr. Clean. In my experience there isn't a lot of confusion about when and where we gown, glove, etc.

Sometimes people will decide to go beyond recommendations from designated authorities such as WHO. because they believe there will be a measurable advantage or lower percentage of cross- contamination.

Many of us worked for decades without gloving up every time we were in the general vicinity of the patient.

It was considered at the time that wearing gloves had a negative implication, just as adult briefs were considered an affront to patient dignity.

Whether any of that is true could be up for discussion, but we're obliged to follow best practice guidelines regardless.

The part that seems to get lost is that human skin is an excellent barrier against infection. Also, when i don't wear gloves after working with a patient I am much more likely to wash my hands with soap and water instead of foam in and out. The is a superior option to just foaming. Any EMS worker who has been doing the job for a while has got plenty of blood and other body fluids on their skin or clothes at one time or another without any negative consequence. Part of it just comes from experience with some "real world" knowledge. For me, getting something splashed in my eyes is far more of a concern than someone's blood on my skin. Safety glasses come in all different styles and can look very professional. Go to Grainger, Fastenal, any welding supply like Airgas, Prxair etc for an extensive selection of safety glasses you can try on that look good, are comfortable and provide protection. most are under 5 bucks with expensive versions in the $10-15 range.

Specializes in ambulant care.

I don´t know a gapless germ-screening.

So gloves are the fashionhit.

My pet peeve is, if some ... takes gloves with non-desinfected hands out of the box to leave his germs in there.

Mr. Clean - you chose one of my favorite things!

Or - unfavorite, I suppose.

To be honest, I am old enough (47 years of nursing practice!) to remember when body fluids were just an annoyance. I was a perinatal nurse for many years - and got everything on me - from amniotic fluid to saliva and everything in-between. We used gloves - sterile gloves - only for sterile procedures.

Once gloves became the norm, I started wearing them - and was taught that gloves should be used to protect against others' body fluids. So - that's what I do now.

I see healthcare providers (nurses, physicians, NP's, RT's, CNA's ..... the list goes on) wearing gloves every time they touch a patient for any reason. I mean ANY reason...... pushing a bed down the hallway, taking a blood pressure, listening to lung sounds....... any reason. Folks use them to touch a patient - and I don't understand that. (I'm sure that any situation can go from no fluid risk to high risk in a few seconds, but that isn't all the time - and if that were the main concern, then we should all wear complete protective gear every time a patient is touched.)

Nursing is about touching people. I learned a lot about the 'healing touch' that nurses have.

I had a patient with HIV - and I reached out to take his hand as he was going through an uncomfortable procedure -- and he said to me: 'You're the first nurse that has actually touched me in a long time.'

I firmly believe in protecting myself and that others should do the same. I just can't see that protection applying to every time a patient is touched. For me, touching a patient to comfort, support, console and care for a patient is just part of my practice - as it is for other providers.

There is not one of my own providers (NP's to MD's to PT's) who wear gloves to exam me - with the exception of pelvic and oral exams. None of them have caught anything yet!

Specializes in ER - trauma/cardiac/burns. IV start spec.

I was a new nurse during the height of the HIV/AIDS scare, new on nights and my first patient was a young man with AIDS. All I had to do was take vitals and call report to the floor. I went in to get his blood pressure without gloves on and he freaked out. I explained that it was safe, I was not drawing blood just taking blood pressure on an arm without any skin issues. He broke down in tears and told me that I was the first person that treated him like a human being. He got to where he would not come to the ER until night shift started and always asked for me. I was the last person that he recognized before he passed away. I guess he made the biggest impression on the way I treated all my patients.

Back in the day, we wouldn't use gloves to start IVs or draw blood on amazing vein-less babies/children because you couldn't "feel" what you were doing. I learned that wasn't always a good idea when I put an IV in a hard stick and got some of his blood on my thumb in the process (I bit my nails back then); Mom looked a little anxious, then said, "You know he has HIV, right?" Oops.

I'm still not neurotic about gloves, but if there's going to be blood involved I will wear them. But, yeah, the rest of the PPE--for a simple stick? Please.....

Specializes in Post Surgical.

My only question is - in the WHO pamphlet it states wearing gloves for bathing a patient is not necessary - but I believe I was taught that wearing gloves while bathing was necessary? Any input?

Not sure where you read the need to garb up to that degree to draw blood, but I've never seen anything that said to wear anything more than gloves to draw blood unless the patient is already on some type of infection precautions that require more personal protection for anything you do for that patient. Also, when was the last time you had to look through books to find policies and procedures. You get on the computer and go to policies and procedures. Easy. I've read articles on all nurses a few times and each and every time the article was so over dramatized and unrealistic, it was frustrating just reading them. Instead of being a site new nurses can turn to for assistance, it's more like the "Real World " of nursing sites.

Before gloves were the norm we cleaned people up bare-handed! We made a sort of mitt out of a washcloth, swiped once, got a new one, made a mitt, swiped again. Rinse and repeat. I know... the horror!!!! In fact, we did everything bare-handed. The gloves available were sterile and only for the doctors. I don't recall any nurse getting sick. Trust me we washed our hands very well.