Do you wear gloves - page 8

Sorry I have so many questions but you guys are so helpful. I was woundering do you wear gloves most of the time, like when taking blood, giving injections etc. I remeber being in a hospital and... Read More

  1. by   abrenrn
    Oh, regarding bone marrow transplantations. They are done two ways: completely sterile (put in bubbles, all contact through sterile technique, laminar air flow etc.) and very clean (private rooms, laminar air flow, gowns to protect patients from microbes on uniforms, etc. - tecniques vary). I have worked both.

    Completely sterile is very hard on patients, for a number of reasons - bubble isolation, need to "sterilize" gut, skin, etc.. Very clean also hard but not as bad in terms of isolation, no "gut meds" - may need more antibiotics.

    It's been a few years since I worked in this setting so I am not completely up to date with the directions it is taking though I've heard many places seem to be moving toward very clean.
    Last edit by abrenrn on Nov 12, '02
  2. by   Youda
    This is right out of my "Fundamental of Nursing" book, Mario:
    "Gloves are Personal Protective Equipment. Gloves are worn for three reasons: first they protect the hands when the nurse is likely to handle any body substance . . . Second, gloves reduce the likelihood of nurses transmitting their own endogenous microorganisms to individuals receiving care. Third, gloves reduce the chance that the nurses' hands will transmit microorganism from one client or a fomite to another client."

    Clean gloves (like sold in bulk in boxes) do NOT protect the patient. They can help reduce, but not protect the patient from pathogens. To protect the patient, you have to consider the 6 steps of the Chain of Infection:
    1. the microorganism (pathogenicity, characteristics of the bacteria, etc.)
    2. source of the microorganism
    3. portal of exit (urinary tract, nose, skin, etc.)
    4. method of transmission (airborne, contact, etc.)
    5. portal of entry to the susceptible host
    6. host.

    Mario, any of the above steps in the Chain of Infection are can expose the patient (or the nurse) to nosocominal pathogens. Gloves just don't do it. They are there to protect the nurse and help reduce the chances that the nurse becomes a fomite. To believe that gloves alone protect the patient is really oversimplifying how infections are spread and the varieties and transmission of these nosocominal pathogens.

    And yes, MRSA can colonize in your nose or anywhere else for that matter. But remember that colonization protects the colony. There will always be individual cells that will break away from the colony and can reinfect the host or be spread to another host.
  3. by   abrenrn
    Just to add to what Youda said, handwashing remains the most effective means of protecting patients from caregivers (done immediately before putting on gloves) and caregivers from patients (done immediately after removing gloves). A caregiver so protected will be less likely to spread microbes from patient to patient or from work to home.

    Specific techinques for "clean" handwashing (vs sterile scrubbing) are included in all basic nursing texts along with other infection control techniques.

    What is now termed "standard precautions" was first called "universal precautions" which were implemented during early HIV days. The idea was to treat all patients as potentially infected - if not with HIV than something else. Before then only disease specific precautions were used.
  4. by   mario_ragucci
    Im not afraid to ask a stupid question. What is the significance of washing your hands after you take the gloves off? Is it to wash off any fomite that existed within the latex glove you took off? And I never claimed to have all the answers, nor am I saying it's okay not to wear gloves. I am interested in this because I always "go there."
    Surprised and concerned am I about specific examples of actual points vectors transmit from. I know about c-diff and mrsa and TB from the hospital, but what else,>(escherichia coli, enterococus, pseudomonas eruginosa, coagulase-negative staphlococcus aureus)

    mario shut his fat mouth and opened fundamentals of nursing. it goes into it all. But after todays knock down intro-lecture on antibiotics, these new words are but a blur. I love to read abut infections now, but memorizing pharmocological names for antibiotics is killing me.

    Anxiety r/t forced memorization AEB crying

    I'm sorry :-(
  5. by   Youda
    Mario, it's great that you do ask questions!

    Washing hands after gloves are removed for two major reasons:
    1. The gloves may have imperfections or have been damaged during use so that your hands have been exposed to allow microorganism entry.
    2. Your hands may become contaminated as you remove the gloves.

    Washing your hands before putting on gloves is for similar reasons. If the gloves have imperfections or are damaged during use, washing your hands before putting them on helps prevent microorganisms from transferring. Also, you can contaminate the gloves when you put them on.

    As Anne said, the boxes of "clean gloves" must be considered contaminated as soon as the box is opened. Just a tiny speck of dust is enough to contaminate a box of gloves with pathogens. Many bacteria actually thrive and enjoy these environments. When a pathogen like pseudomonas can metabolize soaps, you need the friction of handwashing to remove these kinds of pathogens.

    So why care? Because gloves protect YOU. Everytime a nurse doesn't do this, they take those pathogens to clean utility rooms, into surgical suites, to the nurses' station, to the phone! Ever wondered why everyone gets the flu or a cold at work about the same time? Because someone isn't wearing gloves and washing their hands.
  6. by   abrenrn
    If I seemed a bit sharp to some when I responded to a post, it was because I had not been asked a question, I had been told I dropped a bomb. After that, many questions were posed and I responded, appreciating the "sorry" at the end of the post.

    I may have taken the statement that "I dropped a bomb" wrong. I took it as criticism. I did provide useful information in any case, all based on the authority of nursing texts, medical articles, CDC information as well as my experience in:

    1 - As a student, in Brooklyn, in 1985, I saw AIDS patients in almost every clinical setting I was in. The first one I cared for was a non-IVDU young woman married to an IVDU. The second one I cared for was four.
    When I started as a student, people were putting on space suits to walk into an AIDS patients room and say hello. In the meantime, blood would be drawn from a non-AIDS patient without gloves. Given that AIDS was being seen as "the tip of an iceburg" people started thinking, "how do I know who has this incurable infection?" The CDC responded by saying that since you don't know, assume everyone can and protect yourself appropriately, take "universal precautions".
    When students, first, then practitioners started wearing gloves for any potential exposure to blood and body fluids, patients would get upset. They would say, "what, you think I have AIDS?" It really did happen, just as Mario thought it might. As the glove wearer I had to explain, no, I don't think you have AIDS, but I've been told I should wear gloves with every patient, even someone as obviously uninfected as you, or I will fail. We did a good job in the mid eighties and now people expect you to wear gloves. So, the CDC has started calling this standard precautions.

    2 - I worked for about a year in a sterile bone marrow transplant unit. This meant sterilizing everything in the patients environment, including the patient (skin, mouth, gut, vagina, etc.) and using strict sterile technique (including full surgical scrub) to go into room. We had to learn the difference between sterile "clean" gloves and sterile "sterile" gloves as anything that went into the room had to be sterilized first - even boxes of clean gloves. We put clean gloves over sterile gloves to make beds, empty potties, etc. to prevent our sterile gloves from being contaminated.
    As such, learning "rules" was too hard. It was easier to learn the difference between sterile and clean, what is considered non-sterile (anything below your waste or above your shoulders is considered non sterile, BTW), and then pay attention so I would know if I was "clean" or "sterile".

    3 - Finally, the most important concept to remember in infection control I think is "barrier" - something placed between a possibly infectious source and a possibly susceptible host. Exactly who is protected by the barrier depends - who may have an infection, who may get it? Gloves, gowns, masks, eye shields all follow from that understanding.
    For susceptible hosts (in this case, nurses) there are barriers provided by nature. One of the most important is the skin. It is rare to get an infection through the skin when there are no breaks. Of course if a microbe is on your hands, you eat a piece of cake, say, the microbe will likely pass into your gut. Most microbes are passed through the gut without causing infections (the GI tract has barriers of its own). Even aerosolized microbes generally meet some barriers before they get into the lungs and the rest of the system.

    That is why handwashing - frequent and especially before and after patient contact; before and after eating; anytime you even think there was a chance of touching a germ is the number one method for preventing the transmission of infections.

    *****Correct handwashing using appropriate techniques, appropriate soaps is more effective than any other infection control method. *****

    Check your books, check infection control manuals, check with the CDC. If anyone discovers that this information is incorrect from any of these sources, please let me know.

    One more thing - all of this is tied very closely to the use of the antibiotics being studied. Overuse of antibiotics has led to the overabundance of resistant organisms (non-resistant ones are killed). Fewer antiobiotics are needed when appropriate infection control methods are used - especially handwashing.

    Sorry for the lecture, folks. I'll probably stop posting now. I'll check back though. I may have missed some new information about infection control. If someone posts credible information, I will apologize for my errors.
  7. by   mario_ragucci
    Originally posted by abrenrn
    I may have taken the statement that "I dropped a bomb" wrong. I took it as criticism. I did provide useful information
    And thats what the bomb in this case is: useful information. A bomb shakes everything, and my word imadgry is often way out there on Pluto so I apologize.

    I concur with everything that is said, because it is all making sense to me. And I always am in your debt for the knowledge you/yall provide. The only experience I have haad with bacteria is what I grew on petri dishes; the rest is all imaginary and conceptual. 'd love to get some samples to look at under the microscope from an actual room, or to see live c-diff. Yall know alot about this subject and I am honored to talk to you. When I get to work they ask me right away if i am clean, or if I am dirty. If I am clean, I go to transplant room. If I am dirty, I go to isolation rooms. Big deal, right? It's all really interesting stuff to me. I'd love to play this board game with you, with some sterile wine and kosher cheeze :-(:kiss
  8. by   abrenrn
    Too bad we can't play the game. In any case I don't drink wine for the most part (even thoughthe alcohol, a great disinfectant, tends to sterilize it - safer with vodka I think), and those I generally like kosher (old Hebrew National commercial, "we answer to a higher power"), I only like melted cheese.

    Thanks, though.
  9. by   Youda
    Can I be the hat?

    What really blew my mind several years ago is when I naively volunteered to be part of an infection control team. We were having a high rate of UTIs and other infections, usually of the same Genus. So, we went around doing environmental cultures.

    E.coil in the ice machine. Pseudomonas on water fountains. C.diff on silverware. And you don't even want the list of bacteria on door knobs, the telephone, in the clean utility room, on hand rails in the halls, at the nurses station . . .

    Wearing gloves to protect ME is essential !!
  10. by   abrenrn
    Just want to add that I almost always wear gloves. There are times I choose to take the risk of not wearing gloves. This occurs only when a - my hands have no visible openings and b - only latex is available.

    If I wash my hands well, there is minimal if any risk to the patient. If my skin is intact there is a low degree of risk to me (if I wash my hands immediately after, using paper towels on faucets, the whole nine yards). If I wear latex, though, I itch. I get tears in my skin. My own personal barrier has been breached. I am now at much higher risk of infection from any source than I was before I put on the latex gloves.

    I try my best to have vinyl at all times and not have to choose one thing over the other. But my intact skin protects me all the time, I don't wear gloves all the time. If I have to choose between the intact skin and gloves that will cause breaks, I choose the intact skin as the greater form of protection. Since I wash my hands, I do not put my patient at greater risk.

    And I do always worry about the hands in the glove box before me. Were they washed?

    My final two cents.
  11. by   patsue53
    I think this subject has been handled very well. The reasons for wearing gloves and hand-washing have been thoroughly explaned and defended. Why any nurse in this day and age would expose themselves and risk their co-workers and patients by not gloving-up is beyond me. It's irresponsible and dangerous. To those who are afraid of contracting a latex allergy (or already have) I say this: There has been a great deal of research and experimentation to come up with a good latex free glove. The hospital where I'm employed is attempting to remove as much latex as possible. Latex-free gloves are now the standard glove in every patient room and every procedure room. They're purple and gaudy but they're comfortable, fairly stretchy, and actually great educational opportunities when patients questions our purple gloves.) If your facility is not forward-facing enough to be following the trend toward latex free then it's up to you to demand a latex free glove for your own safety. While you're at it you might also go to your administration and ask why your facility is not protecting patients and staff by removing latex from as many areas as possible.

    There's no valid excuse for not wearing gloves in situation with the potential for exposure to body fluids. Has anybody NEVER grabbed what they thought was a dry sheet only to realize they're handling someone's urine? :uhoh21:

    Protect yourselves and protect others. Wear GLOVES!
  12. by   SmilingBluEyes
    well-said Pat...
    There really IS NO EXCUSE not to wear gloves in the face of what is known today about pathgens and the dangers involved.
  13. by   TeenyBabyRN
    a large University affiliated hospital I used to work for still has latex gloves on all the units and in all the rooms. It practically takes acts of both God and congress to get them to provide nonlatex gloves - they require testing in their lab documenting a positive Ag-Ab response to latex. Then, heaven help you if you go thru your supply too fast...

    My take on this is shame on them and they should know better Latex allergies can develop over time. The allergic response can also worsen without warning.

    By the way, I also put on gloves for any kind of patient contact. With the babies - well we all know where they just came from and some of the micropreemies are not stable enough for a thorough bath for a while after birth (not to mention that their skin has the consistency of Jello)
    As far as working with adults, I put gloves on as soon as I enter the room. Some people are just not clean and would not think twice about wiping their noses with their hands (or picking at a wound, etc.) and then touching something in the room. EWW! Makes me want to grab some alcohol foam just thinking about it.