Would You Tell

[emtwacker710]

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.

 

[Anomalous]

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.

 

[Firesurfer75]

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.

 

[skyemt]

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...

 

[Firesurfer75]

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.

 

[Jon]

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).

 

[rsdemt]

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.

 

[Firesurfer75]

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"

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.

 

[Ridryder911]

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

 

[WuLabsWuTecH]

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?

 

[WuLabsWuTecH]

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

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!

 

[Jon]

...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.

 

[skyemt]

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...

 

[Firesurfer75]

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!

 

[Amill]

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.

 

[CFRBryan347768]

This turned out to be a very interesting thread! hehe

 

[ErinCooley]

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!!

 

[MAC4NH]

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.

 

[Katie]

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.

 

[Tincanfireman]

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.