When do the gloves come off?

[JJR512]

After making patient contact, when do you take off your gloves?

I have heard two schools of thought. The first is that the gloves come off before touching anything you don't want to get cross-contaminated (the stretcher, equipment, etc.). This school of thought is take off the gloves, then put on a fresh pair right before you touch the patient or something that may be contaminated again.

The other school of thought is to leave the gloves on until you probably won't need them on anymore. This school of thought says go ahead and touch everything you need to touch, then decontaminate it all later. The theory here is that you should be decontaminating after every patient anyway, so why waste time and gloves by doffing/donning them multiple times.

The first school of thought is what most of my co-workers (at a private ambulance company) subscribe to, saying that's what they were taught so it's what they've always done. The second is what some hospital staff have been preaching, and it does seem to make some sense.

So I'm curious to hear what your own personal practice is and why you do it that way. I'm also curious to know if, after having read this question, you still think that whatever you've been doing is the best (or at least adequate or sufficient), or if you think you might consider changing your practice.

 

[OreoThief]

I will be the first to weigh my inexperienced opinion here. I remove gloves when "completely done" with a patient, or if switching between patients. I considered what you said about cross contamination, however, as fast as things move, I think it's just impractical to remove gloves and put new ones on almost constantly as a matter of habit. Having said that, if I am wearing gloves covered with obvious biohazard, of course, change gloves before touching other things, such as the cot or rig.

 

[BossyCow]

First, I'm a bit of a freak about infection control. I change gloves a lot while giving patient care. Gloves are a barrier, they are not magical germ killing garb. I can't imagine leaving icky dirty gloves on and touching everything and 'cleaning it all up later'. Because its almost impossible to remember to clean every surface you touched.

Gloves are cheap, easy to change and should be changed for clean at every opportunity. If there is visible ickies on the gloves, take them off (properly!) dispose of them and get yourself another pair. I find that changing them frequently makes me more aware of the stuff on them and the possibility of cross contamination.

 

[JJR512]

...as fast as things move, I think it's just impractical to remove gloves and put new ones on almost constantly as a matter of habit.

...Because its almost impossible to remember to clean every surface you touched.

You both make excellent points, each of you supporting opposing sides of this question. This just goes to show there probably isn't just one single answer that's clearly superior.

 

[Kendall]

Personally I leave them on until done with the patient. I'm one for writing info on my gloves until the documentation can be filled out - so having it on hand (literally) is preferable. If there are obvious ickies and or gooies, then they get changed.

At one of our venues we use CaviWipes - they're awesome. After a call we wipe down everything that may have come in contact with the patient or contaminated objects and we're done.

http://www.metrex.com/index/metrex-products-us-surfacedisinfectants-caviwipesandcaviwipesxl

 

[ffemt8978]

The gloves are to protect me, not my equipment. I leave them on until I'm done with the patient. If they get crapped up, I'll put on a second pair or change them. If I'm expecting it to be a nasty call, I'll put on two pair of gloves before I get out of the rig.

 

[Ridryder911]

I am fortunate my service uses those thick type of gloves that does not tear. So personally, I do not change until the call is over. Everything gets wiped down, after each call. Of course I change in-between and if I get blood, fluids, etc.

I personally never heard of placing a pair on then removing before touching the patient. Your equipment should be thoroughly decont after each call. I would imagine administration would be wondering why they would be going through a box of gloves in 10 calls. Remember, exam gloves are not sterile gloves they already have some contaminants already on them from the manufacture.

R/r 911

 

[medicdan]

I think I belong to the second school of thought... my partners make fun of me because I go through 2-3 pairs of gloves/case. For many of my calls (BS), I wear the gloves from the pt's door into the amb, and though vitals, then take them off. If I need to write vitals, I write them directly on the back of my hand (I have yet to master writing with a ballpoint pen on latex or nitrelite (sp?)... Once I am done with vitals and treatment (O2), I start my report, and it is always easier for me to write it glove-less. As we approach the hospital, I put on another pair, remove the cot, then transfer the patient. I ALWAYS then remove my gloves and wash my hands.

Again, my partners make fun of me because I have a pocket in my work pants that is just for gloves. When I see a box of a kind of glove I like, I grab a handful and stuff them in. Right now (as I check), I have an assortment of blue nitrelite, latex and those clear plastic gloves. This means that I dont need to go searching for the glove box in the ambulance every call, and as some partners have come to realize, neither do they (they mooch off of me and my taste in gloves).
It is a topic for further discussion, but MDA is terrible at infection control policy. The inside of the Ragil (BLS) ambulances are very rarely wiped down. I was given a precious chance to wipe down the backboarding equipment and cot last week after a patient bled all over them. The cots and inside of the ambulances sometimes have stains of who-knows-what. The thin plastic sheets on the cots are not normally changed after every patient (I do, and my supervisor gets mad at me). I am told that they have periodical swab-checks of the ambulances, and they come back "clean".

 

[MMiz]

I put on one pair before patient contact. I use that for my initial on-scene assessment.

I remove those gloves and put on another pair after the patient is on the stretche on the way out to the unit.

I then remove that pair and put on another pair before transferring the patient to their final location.

That pair then is removed, and another pair is put on for decontamination of the stretcher/unit.

That's how it usually worked at my service for most people.

 

[VentMedic]

When wearing gloves on your ambulance, just remember where you've been to wipe thing down, especially in the front driver and passenger compartment. Don't forget to clean the ink pen. Don't keep sticking your dirty gloved hand in your pockets. For those that wear powdered gloves, it's easy to tell where your hands have been. Even after the gloves are off, your hands are considered dirty. Wash them before touching something else or as soon as possible. Keep a bottle of waterless wash handy.

After you get to the hospital either to drop off or pick up, don't continue touching things in the ED with dirty gloves. Remove them before you leave the patient's beside. Wash your hands and then sit down at the nurses' station to fininsh your paper work. If you touch your notebook computer with dirty hands or gloves, clean it.

The same goes if picking up or dropping off a pt on the the patient care floors. Don't wear gloves when you're are charting at the nurses' station. We don't know if they are clean or dirty and really don't like to embarrass other professionals by asking if we can avoid it. Change to clean gloves before leaving a room so you are not touching everything in sight on your way to the truck with dirty gloves. If you haven't cleaned your stretcher yet we understand but still remember not to share what is on your stretcher with other fixtures on your way out. Most nursing stations have disinfectant wipes where you can do a quick wipe of you stethoscope and equipment before you leave the patient area until a more thorough cleaning later. Be conscious of your movements throughout the patient care areas.

(See MMiz's post)

I also do not put my stethoscope around my neck on scene, between patients or anywhere regardless of how well I have cleaned it. I have a clip on my belt. When I'm wearing scrubs, I wear a small washable "fanny pack" so I have something to clip my stethoscope to. Fanny packs are discouraged in the hospital settings usually due to the chance of wearing dirty gloves while searching for something in them. For the same reason, lab coats are also being discouraged. Long sleeves can also be contaminated easily. Of course long sleeves in EMS may be necessary but just be aware of what part of the patient they have touched especially when lifting.

When you write on gloves, you may be breaking the barrier by inadvertently poking small holes in them with your pen. Now, you are not fully protected. You can get a cheap velcro band and note pad to attach or wrap around your wrist or on your uniform pants.

Remember, your hands are still dirty after the gloves come off. Pet peeve is to see EMS people stop at a restaurant or grocery and then pull off the gloves just prior to entering the store. Public trash cans are also not the place for used gloves that have touched patients. Kids and homeless people or just people (usually elderly) looking to make a few extra dollars risk being exposed.

I do not wear my uniforms to work or home from work. They are bagged until they are at the cleaners or in a hot washing machine. If you take your uniforms to the cleaners, be nice and warn the person if they have "icky" on them.

Most of this sounds like common sense, yet, everybody may need a little reminder about how not to spread germs.

 

[firecoins]

I usually wear 1 pair of gloves for a call.

My average call is not particulaly bloody. More likely to have other body fluids which I manage not too touch. At the end of a call that was particularly messy , I will wipe down the stretcher ans handles, the back and side door handles, the handles of any bags I carried with the gloves on and equipment used on the call. Sometimes I will wash down the bench if anything messy might have touched it.

If its a bloody call, most things gets washed down.

 

[Flight-LP]

I keep mine on until the pt. is transferred to the ER bed. I'm not concerned about what I touch in the truck as everything in the back is wiped down after every call. The stretcher, the monitor, the bags, the seats, and the cabinets that were used; all are disinfected after every run..................

Really the only time I change them is when they are grossly contaminated or when I need to put sterile gloves on. Those always rip on me when I try to put them over regular gloves........

 

[Alexakat]

I'm a bit of a freak too. I've gotten into the habit of wiping everything down with antimicrobial wipes/spray as part of my check-off on the truck when I first go on shift. I like to hit all surfaces, benches, the stretcher surfaces, straps, the COR handset, etc., etc., etc.

I get in the front seat & wipe down all the places where one would touch (door handles, buttons, radios).

Overkill? Maybe...but I feel better & it makes everything smell fresh & clean. Plus, you never know how well the crew before you cleaned (or what kind of calls they had).

I double glove often too...smaller size on the inside & a larger pair over them. I know----FREAK!

 

[kashton]

1. When the patient is on the hospital bed with nurses attending.

2. When they have a significant amount of blood on them.

3. If I have enough time to change them and they have a small amount of blood or vomit on them.


Just use your best judgement and you will be fine.

The best way to keep yourself clean is to wash your hands, often!

 

[ErinCooley]

The first set comes off while I'm trying to find an IV vein.. I havent mastered it bare handed much less with those thick nitrile gloves. I find the vein bare handed then glove up, relocate it and do the stick. I can't wait until the rookie-ness wears off in that respect. Then....

When the patient is in the hospital bed, I take them off and wash my hands in their sink.

 

[reaper]

I put on a pair of those dish washing gloves at the beginning of shift and take them off at the end of shift, Keeps me protected from everything!!

 

[wolfwyndd]

I put on one pair before patient contact. I use that for my initial on-scene assessment.
I remove those gloves and put on another pair after the patient is on the stretcher on the way out to the unit.
I then remove that pair and put on another pair before transferring the patient to their final location.
That pair then is removed, and another pair is put on for decontamination of the stretcher/unit.

Who do you all buy your gloves from? I'll be sure to buy stock!! They must make a fortune from you. I could see that if it's a messy call, but for me it seems excessive for your average run of the mill BLS call.
Personally, I use one pair of gloves per patient. IE, I put my gloves on when I get on the rig to go to a call and don't take them off until I've transferred the patient to the hospital bed. If it's a standard 'taxi run' kind of call I'll usually even clean up / wipe down the entire rig with the gloves on from that patient. Now if it's a particularly messy call (blood or any other bodily fluids) then I will take that pair off and wear a fresh set of gloves to clean out the rig.

 

[JJR512]

Who do you all buy your gloves from?

BUY gloves? :lol: You're joking, right?

 

[BossyCow]

Who do you all buy your gloves from? I'll be sure to buy stock!! They must make a fortune from you. I could see that if it's a messy call, but for me it seems excessive for your average run of the mill BLS call.
Personally, I use one pair of gloves per patient. IE, I put my gloves on when I get on the rig to go to a call and don't take them off until I've transferred the patient to the hospital bed. If it's a standard 'taxi run' kind of call I'll usually even clean up / wipe down the entire rig with the gloves on from that patient. Now if it's a particularly messy call (blood or any other bodily fluids) then I will take that pair off and wear a fresh set of gloves to clean out the rig.

So, how many things have you touched with those gloves, contaminating that surface? The cost of gloves, which is minimal, is nothing compared to the cost of treating a MRSA, or HepC, or HIV infection resulting from being sloppy.

Just think about it next time you go on a call, how many surfaces have you touched? The radio? Cell Phone? Your nose? The door to the rig? Do you pick up the mop to wipe out the back of the rig with those same gloves? Then what.. who touches that mop next? Too easy to avoid and costly to fix. It's a no brainer to me, change 'em often.

 

[VentMedic]

Who do you all buy your gloves from? I'll be sure to buy stock!! They must make a fortune from you. I could see that if it's a messy call, but for me it seems excessive for your average run of the mill BLS call.
Personally, I use one pair of gloves per patient. IE, I put my gloves on when I get on the rig to go to a call and don't take them off until I've transferred the patient to the hospital bed. If it's a standard 'taxi run' kind of call I'll usually even clean up / wipe down the entire rig with the gloves on from that patient. Now if it's a particularly messy call (blood or any other bodily fluids) then I will take that pair off and wear a fresh set of gloves to clean out the rig.

Tell me you're joking! Do you think MRSA or VRE or MRSE or Pseudomonsas or any of the nasty deadly bugs are only on messy stuff? This is not a matter of getting your "hands dirty". This is the spread of very harmful infections that can be lethal to the patient, your partner, your partner's family as well as your family and you.

That poor little elderly routine transfer can easily acquire one of these infections and be dead in a few days. Have you ever seen what a septic patient must endure during their hospital stay and possibly the last few days of life? It ain't pretty and it is pretty darn painful.

Don't be cheap with patients' lives! Care a little about those around you also. Change your gloves often and be conscious of what you touch in your truck and in the hospitals/NHs.