# Would You Tell



## CFRBryan347768 (Apr 24, 2008)

Is it wrong to go into a house with gloves allready on? What I mean is im not afraid of germs or anything but the second my hands get/clamy/sweaty gloves are not going on. So when we get toned out I put gloves on, and no one has ever really said anythingto me except this 1 person i just worked with me he literally demanded i take my gloves of after we got into the house. When he started telling me to take them i off i figured it was because i there was a latex allergy so i just pulled a pair of no-latex gloves on and thought i'd be good but once again he told me to take them off. I refused now even though there was no bodily fluids i still like to keep my gloves on? Am I so wrong? And can any one think of a reason why this guy wanted my gloves off?


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## Sapphyre (Apr 24, 2008)

Some providers (even into the textbooks) are advocating "selective BSI."  Meaning, if there's little to no chance of coming into contact with bodily fluids, don't even bother with gloves. Your choice on that.


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## Fire219man (Apr 24, 2008)

my gloves go on before I leave the squad.  You never know what your going to walk into.


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## skyemt (Apr 24, 2008)

well, i'll tell you about "selective BSI"....

do you need gloves on every call? of course not...
but, if you now have to figure out when you need them and when you don't, it adds one more thing for you to think about...

the only exposure incident we had in the recent past, was someone who employed selective BSI... this person became involved with the patient, when the nature of the call changed she forgot/too distracted to put on gloves...
then, found out there was an exposure issue with regards to fluids and a small cut on this emt's hand...

btw, that emt no longer uses "selective BSI"...

you never know exactly what you are dealing with right away, and it really is no inconvenience, to me anyway, to put on gloves before i get to the scene..

maybe it is overkill, but i won't forget them the time i need them most.


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## Sapphyre (Apr 24, 2008)

very true sky.  I was answering the last question.  Personally, I prefer gloves all the time.  What's it matter.  BTW, I prefer nitriles, really would not like to develop a latex allergy.


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## BossyCow (Apr 24, 2008)

All gloves all the time. If you wait until you enter the house or directly see the pt. the putting gloves on can be seen as a delay.  When my husband was in medic school, he walked in gloveless to a woman in labor. As he walked in the door, baby came out... he reached out and caught it, barehanded and had to fill out all the exposure forms since the mother was diagnosed with Chlamydia. He will never, ever go into a residence without gloves on first. 

I've seen some practice the selective BSI, but I've never figured out how that works with universal precautions.


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## Ops Paramedic (Apr 24, 2008)

Your are not wrong in wanting to wear gloves on every call or for any patient, no one can fault you, however they can fault you if you don't wear them and you are exposed.  Gloves are also not that expensive that you cannot use a pair for every call, and sometimes i would not even touch someone's door handle without gloves (Now if the door looks like that, can you imagine what the patient looks like).

  I understand the sweaty hands, and having to don a pair of gloves prior, but be careful of that as gloves tend to loose their efficacy after a period of time.  It is recommend that you don a new pair of gloves every 20 minutes or so.  Thus you can considder to don a second pair over the first.

To throw a stone in the bush: Does your personal General Practitioner wear golves every time he/she examines you??


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## MedicPrincess (Apr 24, 2008)

If we are going inside somewhere I am usually putting them on as we are walking up the place.  Outside calls....they are on as I am stepping out of the truck.

Shouldn't matter when you put them on, as long as they are on before you reach the patient.

I did have a "duh" moment the other day though.  On my lastest 48hr shift, at about hour 41 we had a diabetic call.  We initially tried PO efforts to raise the BS, and when they failed I turned around to get the IV bag.  Put the tourniquet on.  Cleaned my site.  Stripped off my gloves.  Pulled out the needle and when I turned to the patient it hit me what i had just done.


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## Jon (Apr 24, 2008)

I'm a practioner of "selective BSI". I've got a thigh pocket full of gloves, and I usually only put them on once I make patient contact. Intact skin is a VERY good barrier... and I try to make sure I've got no open cuts or sores on my hands (when I do, I wear gloves more often).

Think about the last time you visited YOUR physician. Did he put gloves on before he listened to lung sounds? NO! Did he put gloves on before he checked your prostate? YEP! SELECTIVE BSI... use what is needed.

Universal precautions are used SELECTIVELY! Do you wear a gown and facemask on EVERY call? NO! So why wear gloves?

Also... If I'm wearing gloves on a call, I often go through 2-3 or more PAIRS... I take off my gloves when I transition to touching something that should be "clean" (like my clipboard, radio, or cell phone)... EVEN IF I'VE NOT TOUCHED BLOOD OR OPIM WITH THE GLOVES.

One of my biggest pet peeves is the EMT who wears one pair of gloves from beginning of call to end... even when they make up the stretcher. Gloves, when worn, are ASSUMED to be dirty... I like my stretcher to be CLEAN when it is made for the next patient.


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## Ridryder911 (Apr 24, 2008)

Leave the unit with gloves on. Sorry, it is not just for the my sake, but the patients sake. Anyone that wants to expose the patient to what EMT's have touched is a foolish provider. Sorry, there are many autoimmune compromised patients out there, they do not need exposed or compromised, as we do not either. 

Patients expect gloves nowadays. It has been a norm for the past 25 years, and personally would not any of my caregivers to touch or perform any procedure without gloves on. 

Read the literature of what "clean" EMS units growing in them, MRSA, Staph, E-coli, etc.. and you want to touch?  Selective BSI is a gamble, and roll of the dice that the patient has full immunity, and that patient has not just went and had a B.M. and washed their hands. Sorry, not a germaphobic, but realistic...

R/r 911


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## enjoynz (Apr 24, 2008)

I always put gloves on before leaving the ambulance.
They only come off if I'm driving to hospital.
If I'm doing the patient care, they stay on until the patient has been placed on a ED bed. 
I then remove them, wash my hands and get fresh linen to remake the stretcher.
A habit my manager has enforced in me.

Cheers Enjoynz


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## MSDeltaFlt (Apr 24, 2008)

Demand?!?  You never demand ANYONE to go against any BSI.  That makes absolutely no sense to me.

Also, what does your service's P&P say?  I'll bet they say something like, "Put the cotton-pickin' gloves on".


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## LucidResq (Apr 24, 2008)

Jon said:


> Think about the last time you visited YOUR physician. Did he put gloves on before he listened to lung sounds? NO! Did he put gloves on before he checked your prostate? YEP! SELECTIVE BSI... use what is needed.



Your doctor doesn't wear gloves because he knows you probably don't have tuberherpechlamydisyphilis or whatever. You've probably been seeing him for a while, he probably knows your history, and you're probably getting a routine check-up. You've come to see him and you've entered his space. 

In EMS you are walking into someone else's space, and who knows what will greet you when you open the door. Someone vomiting blood everywhere, placentas flying around, particularly explosive diarrhea... the nature of the business warrants being less than selective when it comes to wearing gloves, in my opinion. You have no idea who these people are, no idea what germs they're carrying, and no idea when they're going to shoot out some of their warm, wet sticky stuff right at you. 

In EMS, a situation that does not warrant the use of gloves can suddenly become a situation that absolutely warrants the use of gloves faster than you can get a pair on. That's the key reason why I think gloves should be put on prior to walking into a scene.


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## wexlerk13 (Apr 24, 2008)

seriously, your partner sounds like certifiable clown.  If he isn't your commander or boss or whatever you have, don't even listen to that non-sense


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## seanm028 (Apr 24, 2008)

Personally, I would not work with that partner anymore.  I guess we don't all have the luxury of picking and choosing partners, though.


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## Airwaygoddess (Apr 24, 2008)

Better to have them on, be ready to go!


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## EMT815 (Apr 24, 2008)

I used to not wear gloves on the "routine" medical calls, never had a second thought about it until I had one pt who had some incontinence issues that we didn't know about.I reached under her to help move her onto a stair chair and ended up covered in urine. I learned my lesson and now I always put on my gloves before leaving the rig.


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## AJemt (Apr 24, 2008)

gloves are on before i leave the truck (usually put on enroute to the call) or as i am walking in the door (if i have a hard time getting them on).  gloves come off before i hop in the truck if i am driving (load the pt, strip off gloves and toss in redbag trashcan, hop in front to drive) and go back on as i am walking towards the back door of the ambo to pull pt out to go into hospital.  if i have to decon/wipe down the litter gloves are on for that, otherwise after i strip the old linens off i remove my gloves to remake the litter.  depending on how sweaty my hands are and the pts condition/complaint i MIGHT take them off enroute to the hospital but usually not.  'selective bsi' only works if you know for absolutely sure and certain there is no risk of exposure - what happens when your pt who was fine and c/o just a bit of upset stomach/not quite feeling right codes?  time is of the essense....don't waste 45-60 seconds trying to put on a pair of gloves (that never seem to go on right when you need them to be on quickly!).
if the pt questions me i tell them that it is for their protection as well as mine - never had anybody ask questions beyond that (or i tell them it is company policy - that works too).
never EVER had a partner tell me to take them off.....i would tell that partner that it is your decision to wear gloves and unless the pt is allergic to latex you are not taking them off and if they are you will switch to nitrile/non-latex (though personally i like my company which is strictly non-latex gloves - never know when someone will be allergic).  if you have a problem with this person continueng to insist then speak wiht your supervisor about it.  good luck!


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## rmellish (Apr 24, 2008)

Gloves on when I enter the scene. Off once we unload the patient in the ER, or if I'm driving, off before I open the ambulance driver door. (Nothing says whacker like driving with gloves...)

Anyhow, I will remove them on long transports (1hr+) if I'm not doing anything with the patient. Always sanitize after they come off, and put on a fresh pair before resuming patient contact.


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## TheMowingMonk (Apr 24, 2008)

with my squad its mandatory protical that we wear gloves on every call, its the first thing i do when i arrive where ever the call is.


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## emtwacker710 (Apr 24, 2008)

I always put gloves on before entering the house or approaching the scene (because not everything happens at home lol) anyways I was told way back when I was a junior member "treat everyone as if they have everything" and I have always remembered that, and it has actually become almost automatic for me to put gloves on before I take a step near the pt.


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## Anomalous (Apr 27, 2008)

TheMowingMonk said:


> with my squad its mandatory protical that we wear gloves on every call, its the first thing i do when i arrive where ever the call is.



Us too.  It's hard to regulate "selective BSI".  If you just do it every call, it is no big deal.


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## Firesurfer75 (Apr 27, 2008)

MRSA is a rising problem, on its way to being the next plague if we're not careful. MRSA is easily transmitted topically or through respiratory, so just because there are no exposed fluids doesn't mean a thing against BSI. I work 911 full-time and private transport part-time.. I don't know how many times I've transported a patient with MRSA to the floor in a hospital and told the receiving nurse that the patient has MRSA and the arrogant nurse ignores me and starts grabbing at the patient without gloves. I've had MRSA 2 times both topically and by way of respiratory.. the :censored::censored::censored::censored:e clings on tight in the nares!! MRSA sucks! It is painful and isolates you from even having sex with your girly-friend because of risk of spread during the infected period. The meds will knock you on your hind end and make you sick. You can't :censored::censored::censored::censored:e for days because of the antibiotics in your system. You're terrified for weeks on end after it's gone that it will come back, and that you appropriately sanitized everything in your home. Ok so with that said, if you're not going to wear proper BSI.. gloves at a minimum... then do yourself a favor and stop wearing condoms during sex, even with those that swear they don't have ANY diseases. If some kook tells you to take your gloves off, drop your respect for that person. It was cool to get your hands soaked in blood back in the old days as it was cool for firefighters to eat a bar of smoke during a housefire back then. MRSA is alive and well due to us healthcare workers spreading it around, period. Damn I'm pissed right now to think anyone here or anywhere would ever suggest not wearing gloves during patient contact! I hope that none of the gloveless advocats EVER come in contact with a member of my family.


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## skyemt (Apr 27, 2008)

it only takes one bad call to bit you in the ..... hands.... lol

if you spoke to EMT's who have had exposure issues, many will sound just like those who don't wear gloves all the time now sound...

worth the risk? not for me... but.. at least, if you take a risk, you should get a reward, right? or what's the point in taking the risk?

to me, not much fun in "hey, guess what! i didn't wear gloves today!"

lol, just my humble opinion, of course...


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## Firesurfer75 (Apr 27, 2008)

Jon said:


> I'm a practioner of "selective BSI". I've got a thigh pocket full of gloves, and I usually only put them on once I make patient contact. Intact skin is a VERY good barrier... and I try to make sure I've got no open cuts or sores on my hands (when I do, I wear gloves more often).
> 
> Think about the last time you visited YOUR physician. Did he put gloves on before he listened to lung sounds? NO! Did he put gloves on before he checked your prostate? YEP! SELECTIVE BSI... use what is needed.
> 
> Universal precautions are used SELECTIVELY! Do you wear a gown and facemask on EVERY call? NO! So why wear gloves?




Just tell me exactly how you identify MRSA in its incipient phase prior to it's first appearance as a small whitehead? How do I identify MRSA on a handrail that may infect me? How do I identify MRSA on myself before it makes its appearance as so I don't pass it on to a patient when I am being selective about when I will don my gloves? Hey one more thing, do you think that I should do a "black light" test on a bathtub surface to see if there is any MRSA before I bathe? I know I sound like a diquehead here, but it is such a preventable thing that is extremely easy to pass on or contract. I don't have a bathtub at my house and prior to knowing that what I had was MRSA (the first time I contracted it) I soaked my "boil" at my mothers house in her bathtub... she contracted it from me when she took a bath, even AFTER she cleaned the tub.. apparently hadn't disinfected it enough! Just so you and the others understand, I had not even faintly had an open wound on myself during the times I contracted topical MRSA. In the past 3 months I have seen 2 patients on a vent because of respiratory MRSA that they claimed they contracted in hospitals. I saw a report of a teenager on a vent who contracted MRSA in the gym locker room at his high school. I honestly wouldn't care if anybody wore gloves who lived in a confined bubble, but I work the same streets as all of the other EMT's and am sick of MRSA so please spread the word around and chunk the practice of "selective" bsi.


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## Jon (Apr 27, 2008)

Gloves don't stop MRSA... the problem is that we don't CLEAN equipment.

The #1 way to prevent the spread of MRSA is to properly wash our hands and disinfect our equipment... even the Mayo Clinic says so: http://www.mayoclinic.com/health/mrsa/DS00735/DSECTION=8

If we wear gloves, and scratch our noses... we've contaminated ourselves... if we wear gloves and open a compartment door on the rig, then touch the SAME door handle with an ungloved hand... we've just contaminated ourselves.

Too many people in EMS wear gloves ALL THE TIME. I've seen a partner TAKE OFF A PAIR OF GLOVES TO RE-USE THEM "because I didn't really use them" 
	

	
	
		
		

		
			





I am at work, so I don't have my IC/EC train-the-trainer book... (Kathrine West's Infection Control Class) in fact, I'm not sure where it went. When I took the class a few years ago, MRSA wasn't as known to the public as it is now... but it was still a problem in health care.

This blog posting sums up some of what I'm trying to say:
http://phillydan.spaces.live.com/blog/cns!B2AD15EED4F62B2B!106.entry
(If you look at some of the postings, the poster works for one of the EMS supply companies).


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## rsdemt (Apr 27, 2008)

Every crew I have ever ridden with has put on gkoves before entering the house of any call.
I guess I can see the reasoning behind "selective bsi" but I would never enter any scene, without gloves on.
For my safety. more than anyone elses.


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## Firesurfer75 (Apr 28, 2008)

Jon said:


> Gloves don't stop MRSA... the problem is that we don't CLEAN equipment.
> 
> The #1 way to prevent the spread of MRSA is to properly wash our hands and disinfect our equipment... even the Mayo Clinic says so: http://www.mayoclinic.com/health/mrsa/DS00735/DSECTION=8
> 
> ...



You just made the statement yourself that MRSA can get on gloves.. if you scratch your nose after touching an infected surface with gloves on... What professional under any circumstance scratches their nose with gloves on? Defeats the whole purpose of bsi. Absolutely clean and disinfect all equipment and wash your hands, and also wear gloves. Dispose of gloves even if you don't use them after wearing them. IMO selective bsi is about as crazy as selective condom wearing. Prevention Prevention Prevention.


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## Ridryder911 (Apr 28, 2008)

There is NO such thing as selective BSI. I had never heard of such until I read it here. Any fool that describes such is awaiting to get Hep B, C, and non A-B, C, HIV, and on and on..and then possible be a fomite and transfer something to another patient. 

Sorry, patients do not come with placards around their neck describing their history and we do not wear infra-red glasses to see MRSA and E-Coli and all the ten million little germs and viruses. 

Sorry, patients lie, they also do not wash their hands after using the restroom, they cough, sneeze, place their fingers into orifices and then .... shake your hand, then grab ahold onto your equipment, stretchers, straps, bench-seats, clipboards, all that you will probably touch during the course of the day.. Are you really sure, you cleaned *every* spot of that EMS truck?.. I can guarantee you did not Of course... now, you are going to touch that immunosuppressed patient with a a hand that just touched your equipment? How many EMT's know what diseases causes immunosuppression or procedures? Do your patient's tell you that they are immunodeficient? Mine don't & like I stated .. "they lie"... as well. Don' believe me, await tell the physician asks them questions and they are totally opposite of what they told you. 

So, treat each patient that they have a potential problem. It is for *their* protection as well as ours! 

R/r 911


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## WuLabsWuTecH (Apr 28, 2008)

Ops Paramedic said:


> Your are not wrong in wanting to wear gloves on every call or for any patient, no one can fault you, however they can fault you if you don't wear them and you are exposed.  Gloves are also not that expensive that you cannot use a pair for every call, and sometimes i would not even touch someone's door handle without gloves (Now if the door looks like that, can you imagine what the patient looks like).
> 
> I understand the sweaty hands, and having to don a pair of gloves prior, but be careful of that as gloves tend to loose their efficacy after a period of time.  It is recommend that you don a new pair of gloves every 20 minutes or so.  Thus you can considder to don a second pair over the first.
> 
> To throw a stone in the bush: Does your personal General Practitioner wear golves every time he/she examines you??


Is it ok to wear two pairs of gloves?  Won't the rubbing of the gloves between each other compromise them in some manner?


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## WuLabsWuTecH (Apr 28, 2008)

Ridryder911 said:


> There is NO such thing as selective BSI. I had never heard of such until I read it here. Any fool that describes such is awaiting to get Hep B, C, and non A-B, C, HIV, and on and on..and then possible be a fomite and transfer something to another patient.
> 
> Sorry, patients do not come with placards around their neck describing their history and we do not wear infra-red glasses to see MRSA and E-Coli and all the ten million little germs and viruses.
> 
> ...


So are you suggesting that we also wear gloves when handling the compartmenst in the rig?  What about the steering wheel?

And I apologize double posting, but I have no idea how to quote two messages that are on different pages of the thread!


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## Jon (Apr 28, 2008)

Firesurfer75 said:


> ...What professional under any circumstance scratches their nose with gloves on?...


That was my point. But, as Rid and others continually point out... EMT Class isn't long enough to teach decent A&P or anything else... There ISN'T a lot of 

From an infection control standpoint, though... getting blood on intact skin is a "non-exposure" so long as there are no other mitigating conditions (broken skin, LOTS of blood, mucous membrane contact, etc.).

I'll have to find my book at home. I can't find a decent article online that discusses the pros/cons of wearing gloves all the time.


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## skyemt (Apr 28, 2008)

i assure you,

even most who try to clean the rig, miss very important spots...

equipment is the obvious stuff, that many emt's still do not clean thoroughly...

but, when you stand up, do you grab a handrail?

how many times have you touched a patient, then written something down on the PCR... do you clean the pen? the clipboard?

next time on a call, just watch the emt treating the patient, and observe how many things and surfaces get touched... it is likely more than you think...


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## Firesurfer75 (Apr 28, 2008)

Ridryder911 said:


> There is NO such thing as selective BSI. I had never heard of such until I read it here.



LOL Rid, I was thinking the same thing.. I was just giving them the benefit of the dougt... I have NEVER heard of selective bsi either!


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## Amill (Apr 28, 2008)

Yea it's a pain in the rear for me to put on gloves once I'm already doing something and my hands get sweaty.  I put gloves on as I'm getting out of the truck.

No clue why that guy freaked out on ya for having gloves on.


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## CFRBryan347768 (Apr 28, 2008)

This turned out to be a very interesting thread! hehe


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## ErinCooley (Apr 28, 2008)

I'm a huge believer in "better safe than sorry...."

That being said, my VERY FIRST call as an EMT student, I got on the scene bare handed.  I got REAMED by the first responders (the EMT and medic laughed, they had both done it) and will never do that again!!


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## MAC4NH (Apr 28, 2008)

If and when you put on the gloves is your business based on your own beliefs and risk assessments.  However the only thing your partner can request is that you remove your gloves before driving the unit so you don't contaminate the cab.  While they should correct incorrect use of BSI, He/she has no right to tell you not to use BSI.  That person is a jacka** and if this is their opinion on BSI, what other aspects of patient care are they messing up?  Unless that person is a supervisor or some other high muckey-muck, either get a new partner or tell them where to go.  If they are in management, start looking for a new job because who knows what else they're doing wrong.  It's your certification and livelihood on the line.


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## Katie (Apr 29, 2008)

i always put gloves on before i leave the ambulance like Rid said not just for myself but for the pt too.  it's the way we were taught in school and it's just become habit for me.  no one can demand that you not take the precautions you think are necessary.  if you want to put gloves on before you leave the unit that's your call.  i've been out on calls with people who wear gloves through the whole call and some who don't but i've never seen anyone comment on it.  the i always try and have at least one extra pair in my pocket, usually two in case someone else needs it and forgot.

one of my instructors taught me to wear gloves for cleaning the unit.  let's face it you never know what might be in that bag you're blindly sticking your hand into.  you might not be supposed to throw dirty stuff back in there but that doesn't stop people from doing it, or from it happening in a call.


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## Tincanfireman (Apr 29, 2008)

Katie said:


> one of my instructors taught me to wear gloves for cleaning the unit.


 
I don't like sharing my germs with the patient or unit, and I don't want them sharing with me. If I'm driving, I'll be putting them on as I approach the scene, and if I'm riding they go on during the response.  We never wear them up front after leaving the scene.  I can't imagine why a person/partner would insist on me removing them, but unless they could produce a reason in something under .03 seconds, mine would stay on. To sacrifice your personal safety for another's satisfaction is ludicrous.


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## BossyCow (Apr 29, 2008)

Jon said:


> That was my point. But, as Rid and others continually point out... EMT Class isn't long enough to teach decent A&P or anything else...



I don't know about your system, but ours includes continual training. We get yearly training on infection control plus I review our infection control policy on a yearly basis and go over all updates with our EMTs. In addition to that, once a year we have the infection control director of the local hospital come in and do a presentation.

BSI doesn't mean putting on the magical nitrile shields of protection and be forever clean. BSI means practicing safe behavior around pts and their ickies. This is a matter of setting a standard within your agency and then training your staff and holding them to that standard. Initial EMT training deficits cannot be held responsible for lax practice in the field if the field supervisors allow risky behavior to continue.


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## AnthonyM83 (Apr 30, 2008)

If first on-scene, my gloves come on as I exit the ambulance and walk to the back or sometimes as I pull out the gurney (that way not touching dirty ambulance outside door handles with gloves that will be touching a patient).

If FD is already there, I carry gloves in my hands, because 2 to 6 EMTs/Medics are already surrounding the patient. No surprise ambushes. Also, a lot of these calls will be canceled as we walk up.

If I know it's something I'm not going to need gloves for sure, I'll abandon the 2nd on-scene rule (CPR in progress, injury, etc).

Only times I put on gloves while en-route are traumas where there's potential of a bloody someone running up to me as I exit the ambulance or where I'd need to hurry (GSW's, auto versus pedestrian, stabbings, assaults, drownings, etc)


THERE IS NOTHING WRONG WITH WEARING GLOVES INSIDE SOMEONE'S HOUSE.
Patients don't even think twice about it. It's standard for EMTs to wear gloves.
IT'S LESS OFFENSIVE if you come in wearing them then suddenly put them on before you touch them.


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## firecoins (Apr 30, 2008)

I put them on when necessary. Its not hard to put on gloves without making a big deal about it in front of a patient.  I have yet to have a patinet be offended.  Don't run if your not being chased.


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## AnthonyM83 (Apr 30, 2008)

They're not going to say anything. I've had patients give facial expressions and even made a friendly comment or two. And I have actually been offended (I wouldn't be now that I'm working in EMS, but previously when in a car accident...even though it was reasonable for them to put on gloves because I had freaking blood on me).

But my point was that if the original poster's problem though gloves shouldn't be on inside the house perhaps because of offending them, I wanted to point out it would be less offensive then to put them on right before touching the patient...IF we were going that route of worrying that much about it.


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## para82frame (May 1, 2008)

WuLabsWuTecH said:


> Is it ok to wear two pairs of gloves?  Won't the rubbing of the gloves between each other compromise them in some manner?



My understanding is that wearing 2 pairs of gloves doee not cause failure like umm, wearing 2 "protective devices" as the activity done while wearing gloves is not as vigorus, so the friction doesn't brake the gloves down like it would a condom.


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## firemedic7982 (May 5, 2008)

I think you would be wise to make it practice to wear gloves on every call. Im all about pt. compassion, but my safety, and my partners safety supercede the pt's feelings. 

I have yet to have someone get offended by me wearing gloves on a call. It is my services policy that all personnell will wear not only gloves, but eye protection on every pt. contact. 

Im not one to make fun, or belittle someone but to the original poster ... Your partner who got mad at you for wearing gloves is an idiot, and I would have told them wear to put it. Thats rediculous to get angry over protecting yourself, you have no idea what condition that pt. is in. Remember... people often lie, stretch the truth, and conveniently omit facts. Is that pt. infact in as good of health as they say they are???


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## BossyCow (May 5, 2008)

The whole idea of a pt being offended at PPE is ridiculous! I use PPE to protect myself from getting something nasty. We see a lot of really sick people in our ambulance and I'm not going to assume that first they know everything they are infected with, and second that they will be willing to share that information with me. 

Universal precautions means just that! It doesn't mean being careful when you know there is something that can get you, but the assumption that every patient has everything that can infect you. Waiting until we see a need to use PPE is too late in many cases. Yes, the skin is a wonderful barrier device but there's another organ we have to use to its highest purpose as well, the brain. My brain tells me that we are creatures of habit, and the habit of wearing clean gloves for each patient and taking them off when they get icky, or before we touch something clean is the best way to avoid contamination of the clean, with the dirty.

No, my doctor doesn't put gloves on before he treats me for my annual asthma meds update. But then, I am not bleeding, puking, losing control of my bladder, bowels or other bodily functions in his office. I have had patients do all of the above in my ambulance. My dentist wears gloves and a mask, as does his dental hygenist and my optometrist washes his hands when he enters the exam room before examining me. I do not find this offensive, but rather proof that they are vigilant in their dedication to avoid the spread of disease from one patient to another.

If a patient is 'offended' by my putting on gloves, tough beans! What are they going to think when I put on a face shield, hepa filter mask or get out a big red bio-hazard bag to put their stinky effects in?


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## medic8613 (May 6, 2008)

In my opinion if someone tells you to take your gloves off you can tell them to f*** off. The most important thing is your safety, and the absence of bodily fluids does not mean that there is nothing you need protection from. There is never a situation in which you can be faulted for wearing gloves (well...maybe if there is heat or fire involved that could cause them to melt.)

I put gloves into the same category as reflective jackets, Kevlar vests, and steel toe boots. You don't need an excuse to wear them. They exist only for your protection and are to be used at your discretion, however there are situations that require their use.


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## medic8613 (May 6, 2008)

I waited more than 15 minutes to edit, so I have to add this way:

As for sweaty hands, I carry a pair of large gloves and a pair of extra large. Once I take off the large ones and my hands are sweaty, the XLs are easier to put on.

The textbook answer is always wear gloves during any patient encounter. I have also never heard the term "selective BSI," but this is essentialy what I do. I put my gloves on some time during the scene survey and general impression part of my assessment. If the scene or general impression indicates that gloves are reccomended then I put them on. The exceptions are children, where I wait to make contact with them before putting on gloves, and when dispatch says things like GSW, MVC, arrest, or childbirth. Then they go on before I leave the bus. Just be smart about it. If dispatch suggests that bodily fluids may be involved then put gloves on.

Are there flaws in the way I do it? Of course there are. I never know what I'm walking into, but this is just the habit I have gotten into. As for those who say putting on gloves after you walk in is a "delay in care," I disagree. Until protocols or laws specificly state when to put gloves on, it is up to the individual. Putting gloves on once you reach the patient is not a delay of care. It is simply changing your approach to the call by adding a measure of safety, just like putting on a mask after you notice that your patient is coughing up blood. If the 10 seconds it takes a reasonably intelligent person to put on a pair of gloves causes an adverse effect on the outcome, then the patient was already in trouble and having gloves on probably wouldn't have made a difference.

One department had a rule saying that its your fault if you should have been wearing PPE and you get exposed (for example: You start an IV without gloves on and you get the patient's blood in a cut. The expense of all testing and medications is on you because you were not following SOPs. However if you start an IV and blood shoots into your mouth, thats different. A mask is not considered necessary when starting an IV.)


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## Jon (May 6, 2008)

As I said... I think my biggest problem is when a provider wears 1 set of gloves throughout the entire call... driving to the hospital/making a new stretcher, etc. Beyond that, I wouldn't tell someone else to take gloves off.

JOn


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## LE-EMT (May 7, 2008)

This is kind of an odd topic to me.  I guess I look at it like this.  I could give a flying monkey's bahookie if it offends you when I walk in with gloves on or if I put them on before I touch you.  YOU ARE DIRTY AND I AM DIRTY get over it.  It is for your safety and mine.  Hell I have been known to wear two or three pair when dealing with  particularly dirty individuals.  
When on scene would you NOT need gloves.  when you aren't dirrect contact with the PT over in the corner picking your nose????   
This is the way I look at all cases.  I just walked into a contaminated house.  Being as this is not my personal residence I do NOT know what is on the counter, the walls, the PT, hell in the air.  Not to mention YOU ARE EMS so you were called for a reason the PT is sick in some way shape or form.  I am  not saying run into a persons house with your Haz-mat gear on.  I am just saying better safe then sorry folks.


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## TNEMT06 (May 8, 2008)

I put them on before I get out of the unit.


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## Buzz (May 8, 2008)

One of my instructors brought this topic up for discussion one day. Our book said use gloves at a minimum every time. The discussion was based on when to put them on. For the example he used, he said if we were responding to someone in a call in the classroom, when would we put the gloves on? Most everyone said as they were getting out the ambulance. He and a few other people said they would have put them on at the patient's side because the multitude of door handles that needed to be touched to even get up to the patient. You'd run the risk of bringing germs from every door handle you touched up to the patient. 

I've personally gotten into the habit of wearing two pairs of gloves and removing the top set whenever it seems appropriate for the situation.


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## Res1cue (May 8, 2008)

Without reading the multitude of replies to this topic, I will say this: always put on your gloves BEFORE exiting the unit. If you don't need them, take them off. If you DO need them, they're already there and won't delay patient care.

Why don't you directly ask your partner why he was so upset by you having gloves on?


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## CFRBryan347768 (May 8, 2008)

Res1cue said:


> Without reading the multitude of replies to this topic, I will say this: always put on your gloves BEFORE exiting the unit. If you don't need them, take them off. If you DO need them, they're already there and won't delay patient care.
> 
> Why don't you directly ask your partner why he was so upset by you having gloves on?



After that i wanted nothing to do with him, since the original post he was asked to leave, didnt resign so he was fired.


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## mdkemt (May 8, 2008)

I always put gloves on as soon as we hop into car.  Just the way it is.  You never know what is going to happen or what you will encounter.  Better to be safe then sorry.


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## Hightoweruk (May 9, 2008)

i always put gloves on before arriving on scene, normally o it when sat nav says 2 mins away so you have time to ge them on or change one if it tears, while also not giving your hands too much time to start sweating in there.

Ade


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## KB1MZR (May 11, 2008)

Department Policy = Gloves on Every Call for Every pt.  That means as soon as I get in the ambulance the gloves go on.  They come off after the stretcher is disinfected in the ED and I'm ready to put new sheets on.  If you want to wear gloves WEAR GLVOES


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## CFRBryan347768 (May 11, 2008)

KB1MZR said:


> Department Policy = Gloves on Every Call for Every pt.  That means as soon as I get in the ambulance the gloves go on.  They come off after the stretcher is disinfected in the ED and I'm ready to put new sheets on.  If you want to wear gloves WEAR GLVOES



I Hope You Change Gloves In Between Settings, Load Strecher New Gloves, New Gloves When Taking PT Out And New Gloves When Moving Strecher To Re-Make


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## KB1MZR (May 11, 2008)

CFRBryan347768 said:


> I Hope You Change Gloves In Between Settings, Load Strecher New Gloves, New Gloves When Taking PT Out And New Gloves When Moving Strecher To Re-Make



Well, not being a driver (volly jr.) I am with the pt. from the initial contact until they are handed over to the ED.  Then i pull the sheets off the stretcher throw em in the bin, wipe it down and then gloves off until the next call - and then another pair of gloves to go clean the pt. compartment before the stretcher goes back in - stretcher needs to be made first for purposes of a busy volly town with only 1 scheduled crew (scatter for 2nd calls) so we respond from the ED a lot.


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## daedalus (May 11, 2008)

CFRBryan347768 said:


> Is it wrong to go into a house with gloves allready on? What I mean is im not afraid of germs or anything but the second my hands get/clamy/sweaty gloves are not going on. So when we get toned out I put gloves on, and no one has ever really said anythingto me except this 1 person i just worked with me he literally demanded i take my gloves of after we got into the house. When he started telling me to take them i off i figured it was because i there was a latex allergy so i just pulled a pair of no-latex gloves on and thought i'd be good but once again he told me to take them off. I refused now even though there was no bodily fluids i still like to keep my gloves on? Am I so wrong? And can any one think of a reason why this guy wanted my gloves off?


Whoever told you to take off your gloves is an arrogant idiot. Never let someone tell you when you can and cannot protect yourself. Also, this person must have never had to clean a gurney after a patient who was constipated for 6 days became incontinent of the gurney. The smell wont come off. No amount of cavacide and scrubbing will change that. If you want your hands to smell like that too, dont wear gloves.


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## CFRBryan347768 (May 12, 2008)

KB1MZR said:


> Well, not being a driver (volly jr.) I am with the pt. from the initial contact until they are handed over to the ED.  Then i pull the sheets off the stretcher throw em in the bin, wipe it down and then gloves off until the next call - and then another pair of gloves to go clean the pt. compartment before the stretcher goes back in - stretcher needs to be made first for purposes of a busy volly town with only 1 scheduled crew (scatter for 2nd calls) so we respond from the ED a lot.



Eh, you should still change your gloves.


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## JPINFV (May 12, 2008)

KB1MZR said:


> Well, not being a driver (volly jr.) I am with the pt. from the initial contact until they are handed over to the ED.  Then i pull the sheets off the stretcher throw em in the bin, wipe it down and then gloves off until the next call - and then another pair of gloves to go clean the pt. compartment before the stretcher goes back in - stretcher needs to be made first for purposes of a busy volly town with only 1 scheduled crew (scatter for 2nd calls) so we respond from the ED a lot.



It doesn't matter if you're providing care or not. If you use the same pair of gloves you are going to be tracking your ambulance's (it's dirty regardless of how well anyone cleans it) and your patient's germs all over the place, including your clipboard and pen. You definitely shouldn't be touching things like door handles or walking through the ER with gloves on due to infection control practices.

Now if this means going through 5-6 pairs of gloves, then go through 5-6 pairs of gloves. I got into the habit of changing gloves when ever I worked on my paperwork during a transport. This way I had a clean pair of gloves on so I wasn't cross contaminating anything, but I could still render any care without taking a second to put gloves on.


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## TheMowingMonk (May 26, 2008)

i always keep about 6 pairs of gloves in one of my cargo pockets


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## MikeRi24 (May 26, 2008)

gloves always on. When I am with my fire dept, even if I'm the officer on the rig just doing the PCR, I still have a pair on. Is this overkill? Maybe, but it's a habbit that I have gotten into. Like others have said, better to be safe than sorry. I personally also tend to suffer from extremely dry skin on my fingers and hads, and the skin is always flaking off and i have a lot of cracks in there, so I really don't want to take any chances if you can see where I'm coming from.


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## mikeylikesit (May 26, 2008)

so maybe your partner just figured that you like to "waste" gloves...you know with how expensive they are and everything. i always wear gloves before i see the patient. if i don't need them hey no harm no foul. but since i don't have superman vision i can tell if or what kind of germs and diseases the patient has on them. better safe then sorry.


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## BossyCow (May 27, 2008)

mikeylikesit said:


> so maybe your partner just figured that you like to "waste" gloves...you know with how expensive they are and everything. i always wear gloves before i see the patient. if i don't need them hey no harm no foul. but since i don't have superman vision i can tell if or what kind of germs and diseases the patient has on them. better safe then sorry.



Exactly, the technical term for that is Universal Precautions


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## emtashleyb (May 27, 2008)

Ridryder911 said:


> There is NO such thing as selective BSI. I had never heard of such until I read it here. Any fool that describes such is awaiting to get Hep B, C, and non A-B, C, HIV, and on and on..and then possible be a fomite and transfer something to another patient.
> 
> Sorry, patients do not come with placards around their neck describing their history and we do not wear infra-red glasses to see MRSA and E-Coli and all the ten million little germs and viruses.
> 
> ...



again I am going to have to agree. I put my gloves on before I m out of the medic. I also learned from my dad's mistake he let the older guys pressure him into not wearing gloved back in the 80s and he now has hepitius c because of it. Im not trying to keep it going in the family or even catch something worse. I also feel like its for the paitents safety too. They might be too embarassed to tell you they have an immune problem wouldnt you feel like crap if because  your carelessness caused them to get very ill?


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## scottmcleod (May 27, 2008)

Think back to your training, long long ago...

S - STOP (Collaborate and listen... ice is back with a brand new invention... )
E - Yada
T - Yada
U - Yada
*P - Personal Protective Equipment!  Put it on.*

No gloves = fail in your exam, so why should you get away with it in real life?

On that note, I think my personal kit that lives in my backpack is down to one pair... thanks for reminding me to stock up again!


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## JPINFV (May 27, 2008)

scottmcleod said:


> No gloves = fail in your exam, so why should you get away with it in real life?



Poor argument. Should every patient get high flow O2 because that's the way the practical station is written (US NREMT exam)?


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## scottmcleod (May 27, 2008)

JPINFV said:


> Poor argument. Should every patient get high flow O2 because that's the way the practical station is written?



How did I know that was going to be the first response to my post...

Touché. That on the other hand, might be a mistake in the way we're trained.

Still. Oxygen isn't part of your "do this before you even enter the scene."

(Whatever. I opened my mouth, and you promptly closed it.)

My work is done here.


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## JPINFV (May 27, 2008)

I hate it when I have an argument that I want to post, but I can think of a counter right off the bat. I feel your pain.


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## REMSI Medic 10 (May 29, 2008)

yeah, I don't agree with selective BSI because of MRSA running rampant, I'm never too careful. Even if you fell and need help getting up you're see me with my gloves on.


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## REMSI Medic 10 (May 29, 2008)

also, if I know a call will be REALLY messy, I'll put on 2 pairs, that way I less on the risk of contaminating the jumpkit or something else.


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## mikeylikesit (May 29, 2008)

2 pairs is a bad idea though, the friction or rubber on rubber can easily tear itself.


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## Jeremy89 (May 29, 2008)

REMSI Medic 10 said:


> yeah, I don't agree with selective BSI because of MRSA running rampant, I'm never too careful. Even if you fell and need help getting up you're see me with my gloves on.



Actually my grandma just found out she has MRSA.  she made us wash our hands even after being within feet of her.  It was weird to see it first hand.


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## LIFESAVER4U (Jun 3, 2008)

My gloves are on as soon as I reach the door.


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## karaya (Jun 3, 2008)

I never wear gloves; it is difficult for me to use my cameras with gloves.  The only time I don any gloves is if the crew wants me to hold something yucky. :unsure:


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## Medic9 (Jun 3, 2008)

Ops Paramedic said:


> Your are not wrong in wanting to wear gloves on every call or for any patient, no one can fault you, however they can fault you if you don't wear them and you are exposed.  Gloves are also not that expensive that you cannot use a pair for every call, and sometimes i would not even touch someone's door handle without gloves (Now if the door looks like that, can you imagine what the patient looks like).
> 
> I understand the sweaty hands, and having to don a pair of gloves prior, but be careful of that as gloves tend to loose their efficacy after a period of time.  It is recommend that you don a new pair of gloves every 20 minutes or so.  Thus you can considder to don a second pair over the first.
> 
> To throw a stone in the bush: Does your personal General Practitioner wear golves every time he/she examines you??



Nope, but he washes his hands as soon as he comes in the room. 
On emergency calls I wear gloves. If I am doing an interfacility transport I usually ditch the gloves once the pt is loaded into the rig and everything is set for the trip. If they are nasty then I keep the gloves on and smear a little Vicks on the back of my glove. That way I can rub my "itchy" chin and smell the Vicks.


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## mikeylikesit (Jun 4, 2008)

Medic9 said:


> If they are nasty then I keep the gloves on and smear a little Vicks on the back of my glove. That way I can rub my "itchy" chin and smell the Vicks.


yeah, i usually do that when I'm in the morgue. never bring it around on the bus though. good idea with the itchy chin thing, I'll remember that one.


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## EMERG2011 (Jun 5, 2008)

Honestly, I'd rather be safe than sorry. Granted, most of the calls recieved on my service are drunken college students who are usually covered in whats affectionately known as "vodka-vom," but I've always been a person who believes in Murphy's laws -  so the one day you dont go right in with the gloves will be the day that you have the PT with AIDS or MRSA or some other equally nasty disease.




mikeylikesit said:


> 2 pairs is a bad idea though, the friction or rubber on rubber can easily tear itself.



Not really - surgeons double glove themselves before all procedures, including 10, 12, and 15 hour procedures, using either nitrile or latex gloves, and rarely if ever have gloves wear off from the friction of the gloves on each other. Just a cool tidbit I wanted to add in.


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## mikeylikesit (Jun 5, 2008)

EMERG2011 said:


> Honestly, I'd rather be safe than sorry. Granted, most of the calls recieved on my service are drunken college students who are usually covered in whats affectionately known as "vodka-vom," but I've always been a person who believes in Murphy's laws - so the one day you dont go right in with the gloves will be the day that you have the PT with AIDS or MRSA or some other equally nasty disease.
> 
> 
> 
> ...


Yes but suregeons rarely touch completely dry surfaces. trust me when i have had two pairs on and they rip for me all the time, granted i have never tried it with nitrile, i still don't trust it myself.


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