Rashes - When do you wear gloves?

[metallo]

This is actually a question I've had for some time now, so I'd like to hear some other opinions on it. When one of your patients has a rash or other skin lesion, how do you decide when to wear gloves and when it's ok to palpate it bare-handed?

I have had attendings and preceptors who seem to love touching and rubbing every rash they find, and they never wear gloves. One guy I worked with last year frequently picked off keratoses with his fingernails. I assume most physicians know from experience which rashes are not contagious, but I mean, how can you always be 100% sure?

I saw a little kid with molluscum in clinic last week and I asked my preceptor if I should wear gloves, and she said no, just wash your hands really well. My feeling is that if you need to wash your hands "really well" that it would probably be safer just to wear gloves.

Thoughts?

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[DrMom]

every rash, every time

just simpler that way

 

[45408]

Lots of attendings don't wear gloves when they should. I wouldn't follow their example.

 

[dilated]

every rash, every time

just simpler that way

Ditto. WTF is the upside of touching a rash with your bare hands? That's just gross.

 

[Scaredshizzles]

Ditto. WTF is the upside of touching a rash with your bare hands? That's just gross.

Sometimes makes the patient feel a little more human and less isolated and makes you look a little less condescending. Just a complicated psychological kind of thing...On the other hand, some patients would much rather you wear gloves because they are keenly aware that you touch other patients too...It all depends on the patient.

 

[SouthernSurgeon]

The beauty of dermatology:

If you don't know what it is, for god's sake don't touch it.

If you do know what it is, you don't have to touch it.

 

[DaveinDallas]

....
I have had attendings and preceptors who seem to love touching and rubbing every rash they find, and they never wear gloves. One guy I worked with last year frequently picked off keratoses with his fingernails. I assume most physicians know from experience which rashes are not contagious, but I mean, how can you always be 100% sure?.....

Thoughts?

That'll stop the first time a patient says something like,'Yeah, this itches and look, it's in the webbing of my fingers and toes and you can almost see little squiggly lines.'.......and then the doc gets to go home hoping he doesn't need the 5% permethrin cream applied all over for 8-12 hours plus all the other things necessary to get rid of scabies......

You can wear gloves whenever you like.....I wear them all the time on every patient......

 

[Deferoxamine]

True story - Tuesday morning:

*opens door*

"Good morning, Mr. Patient, I'm Deferoxamine, a third-year medical student. Nice to meet you."

*handshake with patient*

"Nice to meet you too, Deferoxamine."

Mr. Patient is a 28 year-old male. Mr. Patient had poison ivy 2 weeks ago that went away with a combo of drugs, topicals, and waiting.

"Deferoxamine, I have poison ivy again, this time just on my hands."

Our workup for Mr. Patient included testing for secondary syphilis. FML.

 

[Scaredshizzles]

True story - Tuesday morning:

*opens door*

"Good morning, Mr. Patient, I'm Deferoxamine, a third-year medical student. Nice to meet you."

*handshake with patient*

"Nice to meet you too, Deferoxamine."

Mr. Patient is a 28 year-old male. Mr. Patient had poison ivy 2 weeks ago that went away with a combo of drugs, topicals, and waiting.

"Deferoxamine, I have poison ivy again, this time just on my hands."

Our workup for Mr. Patient included testing for secondary syphilis. FML.

Well, I don't know...I think if your hand's skin is intact, you can't really catch syphillis that way, although perhaps a man has tried to convince his wife of that before that he caught it from a handshake...but still, lol.

 

[Rendar5]

Well, I don't know...I think if your hand's skin is intact, you can't really catch syphillis that way, although perhaps a man has tried to convince his wife of that before that he caught it from a handshake...but still, lol.

Syphilitic chancres for primary and secondary have very high levels of spirochetes. One of the few things in derm i would not touch if I could help it.

 

[DrMom]

You can wear gloves whenever you like.....I wear them all the time on every patient......

This is precisely what I do. I touch too many people every day at work. I wash my hands and use the alcohol foam, but still... the glove get put on when I walk into the room and introduce myself.



And I've had one of those secondary syphilis patients, too. And tons of scabies patients. They'll motivate you to wear gloves!

 

[werd]

any break in skin, any exudate or crust.

 

[Janovec]

Learned my lesson in med school. Saw a guy in paeds clinic, had what I thought was a simple eczema, presented to the doctor and she diagnosed scabies. I still think it was dermatitis, the history never came together for scabies and I never caught anything, but I was itching for the rest of the day. Now, I don't touch anything.

 

[TMP-SMX]

Yeah a guy told me he had a vasculitic rash that turned out to be scabies. Derm was even treating it as a vasculitis at first because apparently four years ago he had the same thing at another hospital treated as vasculitis. I was touching it with no gloves on. Thanks derm.

 

[Doctor Bagel]

I pretty much always put on gloves for rashes and other infectious looking things on the skin. I don't wear gloves for just normal palpation, so I don't put on gloves for most of my patients. I think patients are probably pretty OK with you putting on gloves if they have something open, itchy or oozing, etc. I do think it's probably a good idea to be willing to generally touch patients without gloves, though.

 

[montessori2md]

Another thing to consider is that if you have anything that looks even slightly open, and Dr. Attending is touching it, he's putting his germs into it, which are likely plentiful, given that he's prone to touching everything barehanded and is probably just as unlikely to scrub his hands liberally as he is unlikely to grab gloves.
The infectious disease people would bludgeon you for trying to be empathetic by not wearing gloves.

 

[EM2BE]

wear gloves more often than not. patients sometimes even like it when you wear them...you are protecting them that way. (not just rashes, but other things too)

 

[AbbyNormal]

Sometimes makes the patient feel a little more human and less isolated and makes you look a little less condescending. Just a complicated psychological kind of thing....

Gloves must be worn for anticipated contact with blood and body fluids or contaminated items, for all vascular access procedures and for any contact with mucous membranes or non-intact skin. Wash hands immediately after gloves are removed. Hypo-allergic gloves are available.

 

[bsteven2]

Always wear gloves..the majority of people are disgusting lol atleast much of the population I meet in the ER. If a patient feels isolated or less human, simply tell them you want to keep them safe from your own "germs" as well. Hand sanitizer is your friend.

 

[cpants]

Sometimes makes the patient feel a little more human and less isolated and makes you look a little less condescending. Just a complicated psychological kind of thing...On the other hand, some patients would much rather you wear gloves because they are keenly aware that you touch other patients too...It all depends on the patient.

This is a case where it doesn't really matter what the patient's preference is. If they have a rash and you're touching it, you should be wearing gloves. How is the next patient gonna feel psychologically when you are examining him with a huge weeping rash, or even worse, pass that rash to him?

 

[g squared 23]

Personally, I won't even pat a patient on the shoulder without a latex barrier. You're not going to offend anyone by being sanitary and most will appreciate it. Attendings that don't wear them are probably why nosocomial infections are currently running so rampant and a lot of patients end up sicker than when they were admitted. Gloves and hand sanitizer are a must and they can only protect you and the patient.