clinical at hosp telling me NOT to use BSI. NEED HELP NOW

[bstone]

I can't believe there is even a debate as to the "appropriate" use of PPE and universal precautions.

 

[Sasha]

I think you're missing the part where it says she is an EMT student. She thus has to follow each and every single rule of her EMT program. If the hospital says she can do open heart surgery but her program say she can't then she cannot.

One of the main rules of doing clinicals when I went to school was do what was reasonably asked of you. Not wearing gloves is reasonable unless you're working with fluids.

Why do you need gloves to do vitals when you would not glove up to shake someone's hand on the street?

Sent from LuLu using Tapatalk

 

[usafmedic45]

This is a good resource: http://www.jstor.org/pss/30148309

:rofl:

 

[usafmedic45]

I can't believe there is even a debate as to the "appropriate" use of PPE and universal precautions.

I can't believe you're having a knee jerk response to this. I thought you were more intelligent than that.

The reason there is discussion about this is because the situation the OP describes is stated flat out by the CDC as not requiring any BSI other than handwashing. She was mistaken about her state's policies and thus the beginning of the discussion. There is no white paper, no regulation and no policy I have ever seen that says wearing gloves for every last patient contact is part of universal precautions.

 

[bstone]

I can't believe you're having a knee jerk response to this. I thought you were more intelligent than that.

http://dictionary.reference.com/browse/ad+hominem

And with that I sign off until Sat night. Good Shabbos.

 

[Sasha]

I can't believe you're having a knee jerk response to this. I thought you were more intelligent than that.

The reason there is discussion about this is because the situation the OP describes is stated flat out by the CDC as not requiring any BSI other than handwashing. She was mistaken about her state's policies and thus the beginning of the discussion. There is no white paper, no regulation and no policy I have ever seen that says wearing gloves for every last patient contact is part of universal precautions.

Where is your disclaimer banner? You're forgetting it.

I always tell students they don't have to wear gloves with clean unbroken skin and fly off the handle if they're one of THOSE who put on one pair of gloves and wear them for the whole call.

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[JPINFV]

I can't believe there is even a debate as to the "appropriate" use of PPE and universal precautions.

You're right. I can't believe there's a debate on universal precautions. Therefore, I shall quote a paper from the CDC regarding universal precautions.

III.A. Standard Precautions Standard Precautions combine the major features of Universal Precautions (UP) 780, 896 and Body Substance Isolation (BSI) 640 and are based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents. Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered (Table 4). These include: hand hygiene; use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure; and safe injection practices.

Page 66

IV.B.2. Gloves
IV.B.2.a. Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur

Page 79
http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf


Why does the CDC hate health care providers?

 

[medichopeful]

stated flat out by the CDC as not requiring any BSI other than handwashing.

Hey usaf do you have a link to this? I want to print it out and give it to a few people, including the instructor who teaches the EMT-B class here so he can hand it out!

Edit: Nevermind! :rofl:

 

[Veneficus]

This is a good resource: http://www.jstor.org/pss/30148309

First off, that is a nursing study, which are notoriously known to be biased towards justifying nursing practices and given almost no scientific credibility. (just like studies that originate out of places like China)

Secondly,

part 1 speaks directly to sterile surfaces of the patients body. Skin is not a sterile area, nor are genitals, nor any part of the gut tube, nor nares, nor ears.

part 2 specifically states:

"all humans are likely to have potentially infectious microorganisms, in all parts of thier moist body sites and substances "

Part 3, further talks about moist body sites and substances including blood.


From Merriam-Webster


Definition of MOIST



1: slightly or moderately wet : damp


2: tearful


3: characterized by high humidity

— moist·lyadverb

— moist·ness noun

FInally, I will see your nursing study and raise you one from NEJM (one of, if not, the most respected medical journals in the world.)

N Engl J Med. 2011 Apr 14;364(15):1407-18.

Intervention to reduce transmission of resistant bacteria in intensive care.

Huskins WC, Huckabee CM, O'Grady NP, Murray P, Kopetskie H, Zimmer L, Walker ME, Sinkowitz-Cochran RL, Jernigan JA, Samore M, Wallace D, Goldmann DA; STAR*ICU Trial Investigators.

Abstract

BACKGROUND:

Intensive care units (ICUs) are high-risk settings for the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE).

METHODS:

In a cluster-randomized trial, we evaluated the effect of surveillance for MRSA and VRE colonization and of the expanded use of barrier precautions (intervention) as compared with existing practice (control) on the incidence of MRSA or VRE colonization or infection in adult ICUs. Surveillance cultures were obtained from patients in all participating ICUs; the results were reported only to ICUs assigned to the intervention. In intervention ICUs, patients who were colonized or infected with MRSA or VRE were assigned to care with contact precautions; all the other patients were assigned to care with universal gloving until their discharge or until surveillance cultures obtained at admission were reported to be negative.

RESULTS:

During a 6-month intervention period, there were 5434 admissions to 10 intervention ICUs, and 3705 admissions to 8 control ICUs. Patients who were colonized or infected with MRSA or VRE were assigned to barrier precautions more frequently in intervention ICUs than in control ICUs (a median of 92% of ICU days with either contact precautions or universal gloving [51% with contact precautions and 43% with universal gloving] in intervention ICUs vs. a median of 38% of ICU days with contact precautions in control ICUs, P<0.001). In intervention ICUs, health care providers used clean gloves, gowns, and hand hygiene less frequently than required for contacts with patients assigned to barrier precautions; when contact precautions were specified, gloves were used for a median of 82% of contacts, gowns for 77% of contacts, and hand hygiene after 69% of contacts, and when universal gloving was specified, gloves were used for a median of 72% of contacts and hand hygiene after 62% of contacts. The mean (±SE) ICU-level incidence of events of colonization or infection with MRSA or VRE per 1000 patient-days at risk, adjusted for baseline incidence, did not differ significantly between the intervention and control ICUs (40.4±3.3 and 35.6±3.7 in the two groups, respectively; P=0.35).

CONCLUSIONS:

The intervention was not effective in reducing the transmission of MRSA or VRE, although the use of barrier precautions by providers was less than what was required. (Funded by the National Institute of Allergy and Infectious Diseases and others; STAR*ICU ClinicalTrials.gov number, NCT00100386.).

 

[WTEngel]

If you feel like you need to wear gloves, then wear gloves. I am not there so I can't speak to this for sure, but I am fairly certain they will not kick you out for choosing to wear gloves with each patient contact. If they do, and that is the ONLY reason, then I am sure your program will understand. However, if they say you had a bad attitude, were adversarial, etc. then that might be another story.

Coming to an online forum requesting help for this simple (or in reality a non) issue and not being able to stand up for what you "feel" is right does not bode well for your critical thinking skills. I know you are new and all, but try not to make a mountain out of a mole hill. If they ask you to assist in a surgery and tell you to enter the sterile field without scrubbing and wearing the proper PPE, then get back to me. Until then, figure this out and try not to feel compelled to consult an online forum for advice on solving simple issues that are really not problems at all.

No one is going to come in and yank your license. Let's not be ridiculous.

Sorry to be a little brash, but if you are having trouble like this while you are in school, imagine when you have to make "real" decision in the field after school, or are presented with "real" problems in the "real" world. Will you have time to consult a forum then?

 

[Remeber343]

So, to sum it up so you don't have to read everyone's argument. Once again, do what you would like. It's you're call.

 

[Veneficus]

So, to sum it up so you don't have to read everyone's argument. Once again, do what you would like. It's you're call.

But by reading the argument, you can make an informed decision from the information presented by multiple sources.

A good habbit to be in for a career in medicine.

"You could learn a lot from a dummy."

 

[medic417]

So, to sum it up so you don't have to read everyone's argument. Once again, do what you would like. It's you're call.

Says the guy with the misspelled name.:rofl:

 

[Veneficus]

Says the guy with the misspelled name.:rofl:

i like you

 

[BF2BC EMT]

OP listen the the hospital, there's a hospital in my home county(JPINFV you know this place) and their rules seem to outrank every company policy, we can't receive face sheets from this hospital chain so it's a fight to get pt info and they recently added a rule all ems must wash their hands when going into pts room and when leaving(how it should be), no gloves outside of pts room even if you havent gone in youre just outside waiting. But they have nurses watching and waiting to report you for the most minor infractions. So this hospital adds a lot of rules that you must follow even though they contradict company policy (no face sheet) or they aren't even in company policy mandatory hand washing and no gloves used or unused in the hospital hallway.

Long story short the contract the school/company hold with the hospital is more important then anything you feel is wrong. Sad, yes. So if they tell you keep glove wearing to a minimum do it.

 

[JPINFV]

(JPINFV you know this place) and their rules seem to outrank every company policy, we can't receive face sheets from this hospital chain so it's a fight to get pt info

Is this the one overlooking the ocean where the reason given was they found a face sheet in the ambulance bay?

and they recently added a rule all ems must wash their hands when going into pts room and when leaving(how it should be), no gloves outside of pts room even if you havent gone in youre just outside waiting. But they have nurses watching and waiting to report you for the most minor infractions.

Provided the nurses aren't acting like Satan himself, sounds reasonable. If they're stalking EMS crews like a hunter stalking a deer, then... <_<

 

[BF2BC EMT]

Is this the one overlooking the ocean where the reason given was they found a face sheet in the ambulance bay?



Provided the nurses aren't acting like Satan himself, sounds reasonable. If they're stalking EMS crews like a hunter stalking a deer, then... <_<

Haha yes sir, I think it's completely reasonable as well. The OP while on the hospital grounds should follow whatever protocols are in place. Not following rules and being a complete slap#### is the reason a lot of medic students have problems getting hospital rotations. The good old, well this is how it's done in the street argument.

 

[JPINFV]

Haha yes sir, I think it's completely reasonable as well. The OP while on the hospital grounds should follow whatever protocols are in place. Not following rules and being a complete slap#### is the reason a lot of medic students have problems getting hospital rotations. The good old, well this is how it's done in the street argument.

To be fair, I've never had a nurse there complain about me bringing an emergent patient in without paramedics. Yes, I'm glaring at you, Huntington Beach and St. Joseph's.

 

[jjesusfreak01]

Educate yourself about the risks of wearing/declining PPE for various conditions and types of patients. If your job/hospital has rules requiring PPE, wear at least the minimum they require. They CANNOT make you not wear PPE if you want to wear it.