Didn't Wear PPE - Should I worry ?

[Aidey]

I stopped reading after the bolded comment above. If you do contract any communicable diseases it's nobodies fault but your own.

Always wear PPE, every call, every time. No excuses.

Observe the PPE habits of the ED staff the next time you are in the hospital. They do not wear gloves every time they get near a patient. Unless you wear PPE to go out in public it is a bit hypocritical to say that gloves are mandatory on every call, period.

 

[NomadicMedic]

Observe the PPE habits of the ED staff the next time you are in the hospital. They do not wear gloves every time they get near a patient. Unless you wear PPE to go out in public it is a bit hypocritical to say that gloves are mandatory on every call, period.

Great point. There's a big difference between "icky" and infectious. I don't like to touch either, but I could place my hand in a fresh bucket of urine and not really worry about exposure.

I also don't put gloves on just shake someone's hand, feel their pulse and skin temp or put EKG electrodes on.

 

[Aidey]

Great point. There's a big difference between "icky" and infectious. I don't like to touch either, but I could place my hand in a fresh bucket of urine and not really worry about exposure.

I also don't put gloves on just shake someone's hand, feel their pulse and skin temp or put EKG electrodes on.

Exactly. We're probably exposed to nastier bugs on shopping cart handles and gym equipment than we get exposed to from our pts.

 

[NomadicMedic]

Exactly. We're probably exposed to nastier bugs on shopping cart handles and gym equipment than we get exposed to from our pts.

That's not to say I don't practice almost obsessive hand washing, but I usually don't wear gloves unless its messy or I'm doing something invasive with the potential for contamination.

But, YMMV and your service may have specific rules about when to don PPE.

 

[Aidey]

That's not to say I don't practice almost obsessive hand washing, but I usually don't wear gloves unless its messy or I'm doing something invasive with the potential for contamination.
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I'm basically the same way. Personally I think the OP will be fine, didn't do anything outrageous and people need to take off their tinfoil gloves.

 

[Mariemt]

Personally, I wear gloves to every call, on every patient until I see there is no body fluids present.
You can be dispatched to a syncope patient where it isn't mentioned they have a head wound or GI bleed. Etc.
On long transfers with no fluids present I don't want the patient to feel they are some freak or anything, I don't mind removing them without any obvious blood or other fluids present. I still always wash my hands before and after touching my patients though

 

[Kevinf]

Observe the PPE habits of the ED staff the next time you are in the hospital. They do not wear gloves every time they get near a patient. Unless you wear PPE to go out in public it is a bit hypocritical to say that gloves are mandatory on every call, period.

The ED staff also has easy access to sinks with running water and soap, which they'll use after contact with a patient. We don't always have that luxury.

 

[RocketMedic]

Yesterday, I held an old lady's hand bare-handed! OOOOHHHHH!

 

[Clipper1]

Exactly. We're probably exposed to nastier bugs on shopping cart handles and gym equipment than we get exposed to from our pts.

The public is now becoming more aware of that which is why grocery stores and gyms have hand wipes available in plain view to wipe off the unknown nasties you might be touching. This is all about educating the public. As someone being involved in health care you should already know the importance of protecting not only yourself but also the patient from all the nasty things you touched before getting to them. But then I bet you might even go into a grocery store wearing the same uniform you were all shift after seeing many patients.

Hospital staff may not always wear gloves but all of them know the consequences not only for their own protection and that of the patient but also from an administrative action when they are viewed as lacking good judgment. We don't always know who is infectious which is why people are screened now prior to being admitted into the hospital for MRSA and the flu. Health care workers are to wash or gel prior to touching a patient (ANY PATIENT) and immediately after before leaving that patient's space. This does minimalize the risk to others if they did touch the patient or the equipment with bare hands.

Hospitals have taken a lot of steps to minimalize risk for both the providers and the patients. It is sad to read where some throw caution out. Think about how many things you touch after the patient is your are using your bare hands and not washing or using gel right away. Also, remember there are things the gel is ineffective against like C. Diff.

I've also heard some EMS providers will not wear gloves with kids because it would frighten them. Or, when talking about RSV some will just say "it's just a bad cold" and nothing to worry about. Or, kids don't have old people's diseases.

Think about all the patients you come into contact with as well as yourself.

Definitely a need for more and continuous education on the topic.

 

[Clipper1]

Yesterday, I held an old lady's hand bare-handed! OOOOHHHHH!

Did you wash or gel immediately afterwards? Or did your hands touch your uniform which your child might also touch to hug daddy?

 

[Kevinf]

Why are we ridiculing best practices to safeguard ourselves and other patients from possible contaminants/contagions? ED staff have clean sinks and policies in place to wash before and after patient contact. We generally don't have that luxury, and gloves are the easiest way to replicate that.

 

[shyandroid]

Observe the PPE habits of the ED staff the next time you are in the hospital. They do not wear gloves every time they get near a patient. Unless you wear PPE to go out in public it is a bit hypocritical to say that gloves are mandatory on every call, period.

In the contexts of the OP, this was a call out in public and I was not referring to those who work directly in ED. EMS deals with too many unknown variables when working out in the field to not wear PPE during medical/trauma calls. I would assume because the close access to a sink & antimicrobial soap ED staff are less stringent on PPE.

I have witnessed an internist was his hands prior and after contact with a pt in an outpatient care facility. Granted this is was not in an emergency setting but to your point - I took no issue with what he did.

 

[Rialaigh]

I wear gloves when I take care of acutely sick patients

I generally don't wear gloves when I take care of injured patients or patients that are chronically sick.

There is a major difference between sick and injured, and acute and chronic.

 

[VFlutter]

I wear gloves when I take care of acutely sick patients

I generally don't wear gloves when I take care of injured patients or patients that are chronically sick.

There is a major difference between sick and injured, and acute and chronic.

So chronic and injured patients do not have communicable diseases?

Have you, or a coworker, ever picked up a MRSA infection from a chronic patient? We have had Nurses get all kinds of crazy infections from patients.

 

[medicsb]

Are there services that do not supply ambulances/response vehicles with hand wipes?

I'm pretty obsessive about "gelling" and hand-washing whether I'm in hospital or working as a medic. I've never not had access to hand wipes on an ambulance. So, even if I touch something nasty (like the moist candida infection on the underside of a boob), I have something close by to clean myself with. The times when I've gotten blood on my hand/s, I've had wipes nearby to clean myself with until I could use soap and water.

Anyhow, there is no recommendation that gloves be worn on every patient encounter. But, hand washing or using water-less hand-sanitizers are recommended before and after every patient contact. If you want to wear gloves always, fine. But, realistically, it's not needed always.

 

[Rialaigh]

So chronic and injured patients do not have communicable diseases?

Have you, or a coworker, ever picked up a MRSA infection from a chronic patient? We have had Nurses get all kinds of crazy infections from patients.

Chronic and injured patients have communicable diseases via bodily fluids just like everyone else. Acutely sick patients are able to communicate things much more easily. Do I need to glove up to do an EKG on grandma who broke her hip, frankly I don't think so. Do I need to glove up to do an EKG on the guy throwing up with a 103 fever, maybe not but I prob will.

Injured and chronically ill patients present a MUCH lower risk of transmission then acutely ill patients.

And as far as MRSA goes...my wife is MRSA positive, my mother in law is, my little boy is...etc...etc.... I would venture at least 20% of all healthcare workers would test MRSA positive from a nasal swab (if not a lot higher).

 

[PaddyWagon]

Heck, I've had mrsa twice acquired in the wild. But the truth is that noscomial infections cost hospitals real money and for the inconvenience of gloves I think that safety is worth the trouble. Where I did my clinicals it was always gloves in the ER for any patient contact. The rig, too, for that matter.

 

[Rialaigh]

Let me pose a comparison.

If you know your hands are clean, you have no cuts, no open wounds, nothing of any kind - Then putting gloves on for every patient contact "just in case" is like wearing your seatbelt in your rig while parked in a parking lot "just in case" someone hit's you while your rigs in the parking lot and off.

You CANNOT get anything if you have no entry points for exposure. Not without someone else creating an entry point. Just like you cannot get in a car wreck while your rig is off, unless someone else hits you. I for one don't wear my seatbelt the entire time the rig is off...

 

[TheLocalMedic]

I carry two pairs of gloves on me, but I generally don't put a pair on until I deem it necessary. They just aren't warranted on most calls! Unbroken skin is a better barrier than gloves for BBP, and if I'm worried about the other stuff (scabies, MRSA, anything resembling a rash), then I can throw on gloves before I dive in.

For example, on a chest pain call I'll go glove-free until it's time to pop in an IV, and afterwards the gloves come back off. Easy peasy.

I also find it hilarious when people show up at a hospital for an IFT and put gloves on as soon as they pull up. They walk in, wait around, talk to a nurse, get report and then say hello to their patient... WHILE WEARING GLOVES. They haven't even touched the patient yet! Are we so scared of the thought of big, bad infections that we have to wear gloves to even take a report about a patient?

 

[Kevinf]

Hospitals are also famous for spreading infections around, let's not forget that.