Mike McEvoy, paramedic, nurse, firefighter, author, speaker…, provides an excellent comment on some of the problems we cause when we do not think about what we are doing – such as with the use of disposable medical gloves.[1]
Nothing spells ridiculous more than providers who hop out of their engine wearing gloves.
Often without having worn a seat belt while driving to the call.
Lord knows what germs they’re bringing as a gift to their soon to be patient.
With a good study, we could find out. Maybe ultraviolet coloring could be applied to the gloves, so that we could see everything that has been touched/contaminated with dirty gloves. Once the gloves are out of the box (on your hands, in a carrying case, in our pockets, et cetera), the gloves are dirty.
There have been studies of the bacteria on the various interior surfaces of the ambulance.
It might shock those who think the Gloves on, scene safe, parrot phrase is a good idea.
If they knew how much bacteria they were carrying on their “clean” gloves, how might that change behavior?
In conclusion, data we obtained for a large national sample of wards and hospitals shows that although the rate of glove use is relatively low, gloves are still often worn when not indicated and vice versa. The rate of compliance with hand hygiene is significantly worse if gloves are worn for all types of hand hygiene moments, especially high-risk patient contacts and before patient contacts.[1]
It amazes me how quick readers are to criticize a magazine for pictures of firefighters without helmets, SCBA, or the proper tools yet, never have a seen a letter complaining about inappropriate use of medical PPE.
How many of us receive good education about appropriate use of disposable medical gloves?
How many of us throw them on the floor of the patient’s home or the emergency scene?
If we are disposing of a mess that we would put in biohazard bags, why is it appropriate to treat the mess as if it is clean?
Take a look at any EMS magazine. You’ll see providers carrying bags while wearing gloves, pushing stretchers while wearing gloves, hooking up oxygen while wearing gloves, writing out paperwork wearing gloves, talking on radios while wearing gloves, blah, blah, blah.
Bad training/education.
Mindless oversight by managers/supervisors who do not understand how gloves prevent infections and how glove spread infections.
Gloves are a temporary barrier.
Gloves are contaminated on the outside.
Gloves are usually more contaminated on the inside.
Gloves are for people, not equipment. Every one of these actions would be flagged in a hospital or health care facility and the employee counseled. Time to get with the program in EMS.
Hospitals are getting better. EMS is often far behind in infection control practices.
We claim that we work in unique circumstances, so the hospital rules do not apply. This is a mistake.
We work in occasionally unique circumstances. Because of that, we need to be better at not transmitting germs between patients or even from ourselves to our patients, or to ourselves.
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Footnotes:
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[1] Apparent DNA Transfer by Paramedics Leads to Wrongful Imprisonment
Fri, 05 Jul 2013
Rogue Medic
Article
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[2] “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves are worn.
Fuller C, Savage J, Besser S, Hayward A, Cookson B, Cooper B, Stone S.
Infect Control Hosp Epidemiol. 2011 Dec;32(12):1194-9. doi: 10.1086/662619. Epub 2011 Oct 17.
PMID: 22080658 [PubMed – indexed for MEDLINE]
Free Full Text from Infection Control and Hospital Epidemiology.
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It’s an interesting debate, but the EMS setting is markedly different from say the hospital setting.
In a hospital there is a intermediate ‘zone’, before encountering a PT, there is normally a chance to clean hands and assess the need for PPE in the corridor before entering a ward/room.
In the EMS setting, there is a problem. Lets start a thought experiment.
Day Zero, and we have a brand new, box fresh ambo, cleaner than a nun’s mind.
Run the first call, messy one, the back of the bus is now dirty. In an ideal world the driver would remove any contaminated items clothing, PPE etc. before getting in to the cab and doing the needful. But time seldom allows. So the idea that the cab is a ‘clean area’ separate from the treatment area doesn’t hold.
Assuming [dangerous I know but go with it for now], that there is time to deep clean both cab and treatment area, before the next job, then fine return to starting conditions.
But the reality is likely different, the treatment area is cleaned as required during the shift, but the cab might get cleaned once per shift at best. (Depts might have different SOPs depending on local management.)
If the latter applies, then the cab might be more ‘dirty’ than the treatment area and hence providers are justified in wearing gloves at all times. (I will freely admit I have no data to back this up but I would welcome a pointer to any studies carried out.)
(Similarly I would like to see a study where a luminessing chemical is sprayed on eg. a cot rail and then several simulated jobs are run, before everything Crew, Kit and Ambo are all taken off to be examined under UV light to see just which areas are contaminated.)
The pragmatic compromise would seem to be as well as good hand hygiene, gloves at all times, but fresh gloves before touching a patient, and fresh gloves before hitting the cab.
But I’m sure there are much wiser heads than mine about.
I’m curious about this, too. I’ve taken the approach of always putting on gloves before arriving on-scene so that I have barrier protection if I need it. I have a pocket of my uniform dedicated to holding removed, dirty gloves to avoid cross-contamination. I take them off before driving the vehicle from the scene, applying a new set if appropriate (from a pocket dedicated to clean gloves).
Is there any good writing about when we should *not* be wearing gloves? Clearly there are cases where we don’t but should.
Thanks!