The Myclyns thread got me thinking, is our education on PPE inadaquate? I see new EMTs putting gloves on in the ambulance on the way to a BS sick call. I see people who are afraid to even touch a patient without gloves, ect. Yet many of these same people look at me like I've got three heads when I mention a mask for ETI. Are we doing a poor job of educating people where the real danger lies?
Have we missed the boat with PPE?
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abckidsmom
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And another word....
definitely.
I wear gloves for touching blood and body fluids, and touching anyone I wouldn't shake the hand of in the grocery store. These are the same people touching the apples and spinach I am coming to buy...I figure the least we can do is treat them like people.
I like to wash my hands a lot, but I'll touch a lot of things.
Don't even get me started on pen cross-contamination.
definitely.
I wear gloves for touching blood and body fluids, and touching anyone I wouldn't shake the hand of in the grocery store. These are the same people touching the apples and spinach I am coming to buy...I figure the least we can do is treat them like people.
I like to wash my hands a lot, but I'll touch a lot of things.
Don't even get me started on pen cross-contamination.
8jimi8
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You just have to put your hand on something wet once before you start wearing gloves on every patient contact. Case in point. Routine transfer from an ICU today to a rehab. 450+ pounder with a trach. Im bagging for 30+ minutes and then the pt needs to clear a plug. I ask if he needs suction, he shakes his head yes. My medic preceptor grabs a soft tip with ungloved hands. Then she starts inserting the catheter! I'm thinking how unsterile and stupidly brave you are... Graciously I took over control and withdrew the catheter. Wth was she thinking?!!!
abckidsmom
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How would wearing gloves on this contact help at all?
First, I'd wear gloves if I was bagging for 30+ minutes. Second, I'd use a vent for a transfer like that, if the patient needed continuous ventilation. Third, should we use sterile gloves if we're suctioning a trach?
Barehanded interventions are disgusting. I'm talking about the initial interview with a standard patient. Gloves that are in my pocket take about 5 seconds to put on.
The problem I see is that it is unrealistic to think everything needs to be absolutely sterile or that wearing gloves is always indicated.
Now in the above example, as sterile as possible when suctioning a device that bypasses the body's natural defenses is indicated. Especially with the complications that those patients can have.
But the idea of using fear to modify behavior precludes the purpose of education. That is how all that "you're going to kill the patient" crap gets started.
Bt the fact remains that we have at least partial symbiance with a number of organisms, and the idea that we should make every effort to seperate them from us is truly flawed.
If we removed every bacteria from contact with us, we couldn't survive as an organism.
But yea, definately keep the wet stuff off of you. No need to take a gamble on how well your immune system is working that day or if you come upon something truly potent like Shigella.
Now in the above example, as sterile as possible when suctioning a device that bypasses the body's natural defenses is indicated. Especially with the complications that those patients can have.
But the idea of using fear to modify behavior precludes the purpose of education. That is how all that "you're going to kill the patient" crap gets started.
Bt the fact remains that we have at least partial symbiance with a number of organisms, and the idea that we should make every effort to seperate them from us is truly flawed.
If we removed every bacteria from contact with us, we couldn't survive as an organism.
But yea, definately keep the wet stuff off of you. No need to take a gamble on how well your immune system is working that day or if you come upon something truly potent like Shigella.
8jimi8
CFRN
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In the role of the student I don't question during a call unless I see gross negligence, or a patient safety issue. I just asked my preceptor's partner and this service doesn't carry ventilators (yet they have MICU stamped on all of their rigs). Honestly the medic didnt even know we needed the soft tip to suction, she tried to hand me the nonconductive tubing... I had gloves on, she was writing while I was bagging.
The answer is yes, when we are inserting we should use sterile technique, it becomes clean technique once we are no longer sterile. Dont get me wrong, I see your point, but I'm sure you understand why we should be a clean as possible sticking something in someone's lungs.
I wear for for every pt contact too. And while ive been with people who take them off for the ride unless something needs to be done, ill keep mine on until the cot is cleaned/ clear or if i take them off to let my hands breathe if i had them on for a while, ill put another pair on. Some of the older medics wait to see what the call is. I ride with a medic whos is more old school and doesnt wear them even when starting an IV.
Rode with a few of those. If you don't feel like wearing gloves to protect yourself, at least protect your patient.....
citizensoldierny
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Call me a dork, but I wear gloves for every patient contact, every call, every time. It's a good habit to get into....
Dork !!
C.T.E.M.R.
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I also wear gloves for almost every PT, not only for my safety but there safety too. Working a shift you can end up in contact with lots of bacteria etc. Just glove up and save the trouble.
Dork !!
Thanks for that!
It's not quite as dorky as my first call as a basic, when I was so excited that I stepped into a hole and planted myself face first right out of the rig. Now THAT was a dork moment. I was mortified...
Ooh! That might make a cool thread- embarrassing EMS moments...
citizensoldierny
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EMSrush,
No problem, anytime.
As for my gloving habits when it comes to EMS, they're pretty bad, I often don't wear them unless there is something visible I'm gonna regret touching. I could see the wearing them for the protecting of your patients except for the fact that most people wear the same pair from beginning (sitting in ambulance) to end of call, unless they get damaged. Adios protection, hello fomite. Glove changing is a definite must if your serious about protecting the patient. In my regular job (LPN), I'll go through about three changes for a dressing change. One to remove old dressing, one to cleanse wound, one pair for new dressing and if it is a seriously messy wound it might be more. Not to mention all the stuff you contaminate once you've actually touched a pt..
No problem, anytime.
As for my gloving habits when it comes to EMS, they're pretty bad, I often don't wear them unless there is something visible I'm gonna regret touching. I could see the wearing them for the protecting of your patients except for the fact that most people wear the same pair from beginning (sitting in ambulance) to end of call, unless they get damaged. Adios protection, hello fomite. Glove changing is a definite must if your serious about protecting the patient. In my regular job (LPN), I'll go through about three changes for a dressing change. One to remove old dressing, one to cleanse wound, one pair for new dressing and if it is a seriously messy wound it might be more. Not to mention all the stuff you contaminate once you've actually touched a pt..
zmedic
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I usually put on gloves because
1: The call I find rarely represents what was dispatched
2: I'd rather take off gloves when I get there if I don't need them then be quickly trying to put them on in front of the patient
3: Forget infection, most of my patients are just plain sweaty/dirty. Sure I could just wash my hands but i'd rather just have the gloves on.
1: The call I find rarely represents what was dispatched
2: I'd rather take off gloves when I get there if I don't need them then be quickly trying to put them on in front of the patient
3: Forget infection, most of my patients are just plain sweaty/dirty. Sure I could just wash my hands but i'd rather just have the gloves on.
adamjh3
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I tend to wear gloves quite a bit, no matter the patient. The gurney is gross. The clipboards are gross. My pen is gross.
Yes, I cavicide and clean all of the above, yes, I wash my hands frequently on top of using the hand sanitizer in the rig, and yes, I might be paranoid. Who knows?
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Yes, I cavicide and clean all of the above, yes, I wash my hands frequently on top of using the hand sanitizer in the rig, and yes, I might be paranoid. Who knows?
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JJR512
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OK, I'll admit to being one of those guys that "[puts] gloves on in the ambulance on the way" to any call. Once I see for myself that it's a "BS sick call", I'll consider taking them off.
I like my gloves to be fairly tight, not loose; this means it takes me longer than "5 seconds to put [them] on", from the moment I decide I need them, to getting them out of my pocket, to stretching them over my hands x2. So my point is I'd rather have them on and have the option of removing them if I feel I won't need them.
I like my gloves to be fairly tight, not loose; this means it takes me longer than "5 seconds to put [them] on", from the moment I decide I need them, to getting them out of my pocket, to stretching them over my hands x2. So my point is I'd rather have them on and have the option of removing them if I feel I won't need them.
I think its funny to watch a emt touch a pt, get in the truck and drive without removing the gloves. Then drop pt off, remove gloves and drive back to the station,
Nice job there sherlock.
I also agree we dont wear mask enough or eye protection for that matter. When I was doing clinicals for EMT, some of the FF would laugh at me because we were required to wear glasses. Dude Id rather wear it then get spit in the eye and catch something.
I dont get the whole anti glove thing. And regardless if there is no blood, people could have lice or bed bugs or anything.
2 seconds for gloves to protect myself thats it.
Nice job there sherlock.
I also agree we dont wear mask enough or eye protection for that matter. When I was doing clinicals for EMT, some of the FF would laugh at me because we were required to wear glasses. Dude Id rather wear it then get spit in the eye and catch something.
I dont get the whole anti glove thing. And regardless if there is no blood, people could have lice or bed bugs or anything.
2 seconds for gloves to protect myself thats it.
The back of an ambulance is not a sterile environment, for the most part, despite how much (or not) we clean it.
But then again, we do lots of silly things. We take our suction catheter out of a sterile package, lubricate using sterile water, then stick the thing into the patient's very UN-sterile mouth.
We glove up, not only for our safety but theoretically for the patients... then we wear short sleeves, and a wristwatch, and wear the same clothes from patient to patient and, when it gets cold, the jacket we haven't washed since God knows when, provided it doesn't have blood all over it. I seem to recall there are studies saying Doctors' neckties and lab coats are vectors for disease, and I'm reasonably certain EMS uniforms are in the same boat - I'm sure that we're not helping hold down nosocomial infections, especially when we traipse right from that infectious patient to the one in nursing home filled with immunocompromised geriatrics.
I'm pretty sure it's required that every ambulance carry disposable gowns. Has anyone here EVER put one on? How about for a call that wasn't a childbirth? I think they're in the same cabinet in the rig that holds the N95 particulate masks and the surgical masks with face shields... By the way, I had a suspected meningitis patient, and when we walked into the ER, my crew and the patient were all masked. I caught /such/ hell from the nursing staff.
Taking vital signs without gloves on is probably the least of the things we're doing "wrong".
But then again, we do lots of silly things. We take our suction catheter out of a sterile package, lubricate using sterile water, then stick the thing into the patient's very UN-sterile mouth.
We glove up, not only for our safety but theoretically for the patients... then we wear short sleeves, and a wristwatch, and wear the same clothes from patient to patient and, when it gets cold, the jacket we haven't washed since God knows when, provided it doesn't have blood all over it. I seem to recall there are studies saying Doctors' neckties and lab coats are vectors for disease, and I'm reasonably certain EMS uniforms are in the same boat - I'm sure that we're not helping hold down nosocomial infections, especially when we traipse right from that infectious patient to the one in nursing home filled with immunocompromised geriatrics.
I'm pretty sure it's required that every ambulance carry disposable gowns. Has anyone here EVER put one on? How about for a call that wasn't a childbirth? I think they're in the same cabinet in the rig that holds the N95 particulate masks and the surgical masks with face shields... By the way, I had a suspected meningitis patient, and when we walked into the ER, my crew and the patient were all masked. I caught /such/ hell from the nursing staff.
Taking vital signs without gloves on is probably the least of the things we're doing "wrong".