Wearing gloves with HIV positive patients

[Leekri]

(First time writing here)

Yesterday during my clinical, I was interviewing a HIV positive patient. Half way through, the primary nurse asked me to talk with her in the hall, and when we spoke she told me to wear gloves whenever I was with the patient or touching things in his environment.

The patient didnt have any open open cuts or bodily fluids out, and I didn't have any cuts and was just talking with the patient. There weren't any signs saying to use any special precautions either...

I personally don't think that situation neccesitated the need for gloves, but I was hoping to get someone else's opinion on this. :)

Also I'm a student, and the nurse was really adamant on the gloves so I didn't really ask questions.

[broughden]

(First time writing here)

Yesterday during my clinical, I was interviewing a HIV positive patient. Half way through, the primary nurse asked me to talk with her in the hall, and when we spoke she told me to wear gloves whenever I was with the patient or touching things in his environment.

The patient didnt have any open open cuts or bodily fluids out, and I didn't have any cuts and was just talking with the patient. There weren't any signs saying to use any special precautions either...

I personally don't think that situation neccesitated the need for gloves, but I was hoping to get someone else's opinion on this. :)

Also I'm a student, and the nurse was really adamant on the gloves so I didn't really ask questions.

Im also a student. Im presenting a presentation on ESKAPE (E for Enterococcus faecium, S for Staphylococcus aureus, K for Klebsiella pneumoniae, A for Acinetobacter baumannii, P for Pseudomonas aeruginosa, and E for Enterobacter species.) on Thursday of this week. Those are the six most troubling multi-drug resistant bacteria, with the possible seventh being C. diff, threats presently facing the US healthcare system.

In every single case they are primarily spread as nosocomial/HAI's (healthcare-associated infections). And in every single case (especially in regard to C. diff) the single biggest factor contributing to their spread through a hospital are staff NOT using gloves when coming into contact with patients, whether bodily fluids are present or not.

Many of these pathogens can survive for hours or even days outside of the body. Take C. diff which is a spore forming bacteria and can pass from one patient to another simply by lingering in the room of a former patient housed in that room with c. diff. It can resist desiccation for months. And make no mistake they kill tens of thousands of our patients every single year. And all we have to do to prevent most of them sweeping through our work place is wear gloves prior to any patient contact and then washing hands. That's it.

Now I know what some of you are going to say, "if the patient has C. diff of course we will glove up."

Two problems.

1. By the time you know the patient has C. diff they have been shedding the bacteria for days and you have been spreading it around the hospital

2. Some people are asymptomatic carriers of C. diff who can produce and shed the bacteria without ever showing symptoms of infection.

Measures to Control and Prevent Clostridium difficile Infection | Clinical Infectious Diseases | Oxford Academic

So yes, I agree with the nurse supervising you, ESPECIALLY when dealing with a patient who is immuno-compromised, like someone with HIV, you need to be gloved for THEIR safety in the hospital environment. Anyone who says other wise isn't paying attention to whats happening in healthcare right now and the CDC's Morbidity and Mortality Weekly Report.

[cayenne06, MSN, CNM]

Amazing how everyone here is so bent on attacking the nurse who gave her that instruction, where is the professional treatment towards one another/The name calling too ,was awful ..."ignorant,gets people so "angry,outdated practice," as if we are all so perfect here.

I think a lot of us (well, at least me) get a little defensive about this issue because of the crushing social shunning that HIV pos people have historically endured.

The way the story is presented by the OP, her instructor is telling her to take extra precautions with an HIV pos patient. It is not okay for new nurses to be taught that sort of behavior.

[broughden]

Gloves are unnecessary if you follow handwashing standards. Handwashing actually is more effective than gloving in prevention of disease. If a patient is on contact precautions, then you'd add gloving to your handwashing. No where is gloving ONLY a standard.

Wrong. I can provide peer reviewed study after peer reviewed study that hand washing is not as effective as glove wear, especially in the case of patients with virulent pathogens like C diff.

Given nursing is supposed to be a science based career some of you would do well to bone up on your microbiology.

[OldDude]

Im also a student. Im presenting a presentation on ESKAPE (E for Enterococcus faecium, S for Staphylococcus aureus, K for Klebsiella pneumoniae, A for Acinetobacter baumannii, P for Pseudomonas aeruginosa, and E for Enterobacter species.) on Thursday of this week. Those are the six most troubling multi-drug resistant bacteria, with the possible seventh being C. diff, threats presently facing the US healthcare system.

In every single case they are primarily spread as nosocomial/HAI's (healthcare-associated infections). And in every single case (especially in regard to C. diff) the single biggest factor contributing to their spread through a hospital are staff NOT using gloves when coming into contact with patients, whether bodily fluids are present or not.

Many of these pathogens can survive for hours or even days outside of the body. And make no mistake they kill tens of thousands of our patients every single year. And all we have to do to prevent most of them sweeping through our work place is wear gloves prior to any patient contact and then washing hands. That's it.

So yes, I agree with nurse supervising you, ESPECIALLY when dealing with a patient who is immuno-compromised, like someone with HIV, you need to be gloved for THEIR safety in the hospital environment. Anyone who says other wise isn't paying attention to whats happening in healthcare right now and the CDC's Morbidity and Mortality Weekly Report.

Wrong. I can provide peer reviewed study after peer reviewed study that hand washing is not as effective as glove wear, especially in the case of patients with virulent pathogens like C diff.

Given nursing is supposed to be a science based career some of you would do well to bone up on your microbiology.

Yikes, Heads up broughden...you've opened up a can of worms...the responses should be varied and very interesting. Remember to keep it professional.

[broughden]

Yikes, Heads up broughden...you've opened up a can of worms...the responses should be varied and very interesting. Remember to keep it professional.

Thanks. Its a topic I take very serious. I am a former patient who ended up in isolation with an HAI raging through my body. I came very close to never seeing the birth of my daughter due to a necrotic infection of my colon.

And Im always professional!

[OldDude]

Thanks. Its a topic I take very serious. I am a former patient who ended up in isolation with an HAI raging through my body. I came very close to never seeing the birth of my daughter due to a necrotic infection of my colon.

And Im always professional!

Wow, I can certainly understand from where your passion about the subject arises! Glad you overcame and are here to talk about it and to hold your daughter!! Good luck with nursing school and beyond.

[CloverPark, RN]

Ugh.... this reminds me of a time back when I was a CNA in a small hospital and they were expecting a Hep C positive patient and the charge nurse was scrambling to figure out where to put her... because she didn't think she should be sharing a bathroom with a non-hep C patient.... and on another shift, I was assigned to do a 1:1 with her for safety reasons, because she was going through hepatic encephalopathy and was very dioriented... The nurse came in the room and said, "If I were you, I'd wear gloves at all times while I was in here... She has Hep C and there's probably Hep C all over this room." Mind you, she had no open wounds and was sleeping almost the entire time...

[CloverPark, RN]

If you're going to worry about catching something from a patient hepatitis is much easier to catch and thousand of people carry the hepatitis virus having no symptoms thus not even being aware they have it.

Even knowing that, it's not that easy to catch hepatitis

I just wanted to add that the chances of contracting Hep C are EXTREMELY unlikely as a healthcare worker, even when coming into contact with bodily fluids, more so blood, because the chances of contracting it through other bodily fluids is highly unlikely. I myself was Hep C positive, and didn't even know it until about 5 years after being infected. In that time I had unprotected sex with my husband (many many times) and shared razors with him, and gave birth to 2 children, one of which whose blood actually MIXED with mine in-utero.... and neither my husband or children ended up with Hep C...

By the way, thanks to modern medicine, I have since been "cured" of Hep C. There are excellent meds out there now, only 1 pill a day for 8 weeks, which have been proven to "cure" Hep C. I quote the word cure because I am always skeptical and personally cannot say for sure I am indeed "cured," although the virus has been undetectable in my blood for almost a year now.

[psu_213, BSN, RN]

Amazing how everyone here is so bent on attacking the nurse who gave her that instruction, where is the professional treatment towards one another/The name calling too ,was awful ..."ignorant,gets people so "angry,outdated practice," as if we are all so perfect here.

I used the term ignorant. It was not name calling, it was not judgemental--it was a statement of fact. I freely admit that I am ignorant (i.e., lacking knowledge) certain topics. I would hope that, if I were displaying such ignorance on a nursing related topic, a fellow nurse would educate me. If the education is presented in an appropriate way, I am certainly not going to feel that the fellow nurse is attacking me. I realize I am not perfect, and neither are fellow nurses.

[Injection]

Just talking = NO GLOVES!

[Orion81RN]

Wearing gloves will not make a patient "feel like crap" or feel bad about themselves. It is an everyday common practice in the hospital.

Standard precautions should be observed for every patient interaction necessitating touch, which includes wearing gloves.

Instructing a student to wear gloves does not make the nurse paranoid or ignorant.

I have not read through the posts, so I'm sure someone has already quoted the CDC on this. However, I will do it still.

"All health-care workers should routinely use appropriate barrier precautions to prevent skin and mucous-membrane exposure ******WHEN CONTACT WITH BLOOD OR OTHER BODY FLUIDS OF ANY PATIENT IS antici- ANTICIPATED.****** Gloves should be worn for touching blood and body fluids, mucous membranes, or non-intact skin of all patients, for handling items or surfaces soiled with blood or body fluids, and for performing venipuncture and other vascular access procedures. Gloves should be changed after contact with each patient. Masks and protective eyewear or face shields should be worn during procedures that are likely to generate droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes. Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids."

Do you wear gloves when simply walking in a room and touching objects, or even shaking hands, with EVERY patient?

If you do, then, yes, I would say you are either uneducated on transmission methods or....paranoid. I typically agree with your posts, but this one baffles me.

And wearing gloves can ABSOLUTELY have an impact on a patient's emotions. WHERE are you getting otherwise?

[jubu97rn]

I had an STNA angry because no one told her a resident was HIV+. My question is: what would she do differently if she knew? She said "Well he has a rash on his balls." I'm glad she is not working in our facility anymore because apparently she doesn't routinely wear gloves when touching scrotums and who knows what else.