To glove, or not to glove

[Mr Clean]

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

[ChryssyD]

We used to do everything bare-handed....Until blood-borne infection became a thing (with HIV), we didn't worry much about "normal" bodily fluids/waste: Wash your hands, that was what we did. And, since intact skin is still an effective barrier to blood-borne infection, we had it right way back when. Today we're just kind of paranoid. I know this isn't common wisdom, but we don't have to make people feel like germ factories--gloves aren't really necessary unless your skin barrier is infringed somehow. Although I do believe in protecting patients--if they are somehow immunocompromised, you should definitely glove up.

[All_night]

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.)

That made me feel guilty because that's what I tend to do at work. I feel like gloving and sanitizing takes less time than hand washing, when that's acceptable. Plus, I see many patients doing gross things, like never washing their hands even after having a bowel movement or putting their hands in their briefs. I'll work on toning it down, though.