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.

[Sour Lemon]

We agree to disagree.

Of course! Just offering a different perspective on over-glovers. I still wouldn't put on gloves to TALK to a patient, though.

[Guest219794]

I do. And then I glove up. But my patient doesn't know I hit the hand hygiene before entering.

You know what bothers me more than anything on this post? Is the OP, who is a student, is insuinuating that somehow gloving up can be viewed as discriminatory.

What in the actual .......???

Are you kidding me???

The student asked a reasonable question about a practice that is not evidence based. That practice is to use one set of gloves on Pt's with unknown HIV status, and a different practice on those with known HIV.

"the OP, who is a student, is insuinuating that somehow gloving up can be viewed as discriminatory."

You don't think that gloving up selectively could be seen as discriminatory?

How about this:

An ER triage nurse who, like most ER triage nurse, does not glove up for every encounter. A history and set of vitals is all that is usually needed- more detailed exams are done in a pt care room. Now, if, in the course of triage, he has to risk actual exposure, by controlling bleeding, removing a dressing, or that sort of thing, he dons gloves as appropriate. He uses evidence based practices in when he chooses to wear gloves, and does a good job protecting himself. With white people.

He dons gloves for all African American patients, and some others, depending on how dark their skin is. Because, well, better safe than sorry.

What do you think? Discriminatory?

[LiveFit99]

I could care less if it hurts a patients feelings when I put on gloves. It's for my safety. I often glove just to take blood pressure. And what about the mouse and keyboard at the computer? Ain't no way that things getting cleaned!

Patients are in the hospital dying. Lots of bugs floating around. What might they carry that hasn't been diagnosed? What may be left in the room from the previous 37 patients? Plus, many are covered in feces, incontinent, fungus growing in skin folds, egg and soup spilled down their chest. They haven't taken good care of themselves for over 20 years which is why they have a diabetic amputation and CHF in the first place.

What about that deserves risking my health to not hurt their feelings? This isn't shaking hands with your coworker at the business meeting.

[LiveFit99]

What about gloving when somebody comes in who's obese unkempt unshowered looks methed out and missing a few teeth? But not gloving for a clean cut suburban mom?

Discriminatory? Yes. Good critical thinking? Yes!

[psu_213, BSN, RN]

What about gloving when somebody comes in who's obese unkempt unshowered looks methed out and missing a few teeth?

True, I would glove up before touching someone who was unkempt (although I'm not sure what the 'missing teeth' thing has to do with it)--in the ED anyway--and I would wear gloves while trying to make them kempt.

It seems you might be confusing things here. We were not talking about the unkempt individual in you example, and there is a big difference between that pt and a put together individual who happens to be HIV+. Who's to say that the soccer mom is not HIV+?

And let's not forget, we are talking about conducting an interview, not getting elbow deep with the pt's whatever.

While were at it--who says that your coworkers hands are all that clean?

[Kratoswife]

I don't wear gloves for injections, either. Applying counter-pressure to the injection site with the alcohol swab before removing the needle seals it up fairly well. I think gloves are over-used and often used as substitutes for handwashing, which they shouldn't be.

I'm sorry but not using gloves while puncturing skin isn't wise to me.

Anything can happen.

I use gloves more now since I've caught multiple patients pleasing themselves and not washing their hands afterwards. Not because of HIV. I'm more afraid of catching C. Diff than HIV Tbh. Since it's more likely to catch.

[LiveFit99]

True, I would glove up before touching someone who was unkempt (although I'm not sure what the 'missing teeth' thing has to do with it)--in the ED anyway--and I would wear gloves while trying to make them kempt.

It seems you might be confusing things here. We were not talking about the unkempt individual in you example, and there is a big difference between that pt and a put together individual who happens to be HIV+. Who's to say that the soccer mom is not HIV+?

And let's not forget, we are talking about conducting an interview, not getting elbow deep with the pt's whatever.

While were at it--who says that your coworkers hands are all that clean?

Missing teeth, well that's part of the assessment. If it doesn't matter then why would I assess it? It tells you something about the health, or past care of the individual.

My previous post was in response to the person who tried to make a point about gloving for a white vs black person, which is a silly comparison. Instead, I wanted to point out reasons I might use visual information to "discriminate" in regards to my personal safety.

To the OP. Of course it's ridiculous to wear gloves to conduct an interview. Just like it's ridiculous to want nurses to foam everytime in and out of a room, even if they touch absolutely nothing.

[klone, MSN, RN]

Just like it's ridiculous to want nurses to foam everytime in and out of a room, even if they touch absolutely nothing.

You touched to doorknob to get in and out of the room. Reason enough right there.

[LiveFit99]

You touched to doorknob to get in and out of the room. Reason enough right there.

Which part of "touch absolutely nothing" did you not understand?

[Guest219794]

Missing teeth, well that's part of the assessment. If it doesn't matter then why would I assess it? It tells you something about the health, or past care of the individual.

My previous post was in response to the person who tried to make a point about gloving for a white vs black person, which is a silly comparison. Instead, I wanted to point out reasons I might use visual information to "discriminate" in regards to my personal safety.

To the OP. Of course it's ridiculous to wear gloves to conduct an interview. Just like it's ridiculous to want nurses to foam everytime in and out of a room, even if they touch absolutely nothing.

I made the silly comparison.

I am an ER nurse, and also use discretion when to wear gloves based on my assessment and observational skills, just like you. And any decent nurse.

If I had to go into the pockets of a retired nun (I have), I probably would not glove up. OTOH, if I was going through the pockets of a Bath Salts poisoning (I have. A lot.), Of course I would glove up.

That is not what the OP was about.

I sand by my comparison- Donning gloves simply because of HIV status displays as much ignorance as deciding based on race.

This is completely unrelated to using good assessment skills and nursing judgement skills to determine that one is in a higher risk situation.

This has nothing to do with the decisions you described.

[klone, MSN, RN]

Which part of "touch absolutely nothing" did you not understand?

How did you get into and out of the room? Patient doors do not swing in both directions; you would have had to touch a doorknob at some point.

And in reality, how often does a nurse go into a patient's room and touch absolutely nothing?

[Penelope_Pitstop, BSN, RN]

I'm 33, so AIDS has been a reality my entire life, and I first worked in an inner city hospital with a very HIV-affected population due to the IVDA in the area. I just assumed everyone had HIV or Hep C (which is what universal precautions' intent is).

Anyway, I later very briefly worked in a hospital about 50 miles away, in a more conservative, affluent area, in 2006. One day, a patient was ambulating in the halls, looking at the paintings on the walls, family member at this side, nice as you please. Well, most of the staff members ended up having a cow because THAT PATIENT HAD HIV! AND WAS OUT OF HIS ROOM! This was 2006, this was a group of educated people! (Also at this facility, patients' requests to not have nurses based on race, gender, ethnicity, etc. were HONORED by management. I didn't work there very long, don't worry).

The nurse described by the OP needs to realize that she doesn't know everyone's HIV status - in fact; a lot of people living with it are unaware of their status. That's the point of universal precautions!