Gloves

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Intensivist

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How often you wear gloves when inducing someone? l just realized l spent whole day today wearing no gloves. l had them on for emergence. Do you wear them routinely for each anaesthetic, or for some groups? l realized many don't wear them when doing paediatric cases. Bare in mind that l work in very low HIV/HCV positive population, not that l'm justifying my actions.
 
universal precautions are universal

the first thing i do when i walk into any OR is put on gloves, and the last thing i do when i leave the OR is take them off
 
cchoukal said:
100% of my inductions, intubations, IVs, and a-lines are done with gloves.
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Mine too.

Rarely I have pulled off a too-big glove to better feel for a neonatal or infant IV or a-line placement, but shame on me -- this is a practice that should be put behind us as a breach of universal precautions. (Now that I am no longer a resident, I will simply get a smaller glove if I need to feel better.)
 
How can you not wear gloves during induction? Disregarding any blood-bornes, there are still all of the every-day garden-variety infectious agents.

There is so much contact in/near the mouth and nose that you must be exposing yourself (and likely bringing it home), whether you want to admit it or not.

And so easy to do...
 
Idiopathic said:
universal precautions are universal

the first thing i do when i walk into any OR is put on gloves, and the last thing i do when i leave the OR is take them off
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I take my gloves off once the airway is secured and I'm done touching the patient. I keep the anesthesia cart as "clean" as I can and try not to touch it at all with dirty gloves on. It makes me feel better about setting up for the next case if my cart is a clean zone.

The machine knobs and cart drawer handles get wiped down between cases but I still try to keep patient goo off them.
 
Absolutely. I don't ever bag the patient with my dirty gloves (I'm a scissor technique guy). Intubate, remove right glove, bag/confirm etco2, turn on the machine with clean right hand, secure AW with silk tape, remove left glove.
We have disposable blades, so they go right into the trash tucked away in my left glove.
 
Never for iv's (except Hep C) or intubations always for alines.
Some people go through a box of gloves in a day, i think it's stupid.

Universal precaution:
mask-suit.jpg
 
Intensivist said:
How often you wear gloves when inducing someone? l just realized l spent whole day today wearing no gloves. l had them on for emergence. Do you wear them routinely for each anaesthetic, or for some groups? l realized many don't wear them when doing paediatric cases. Bare in mind that l work in very low HIV/HCV positive population, not that l'm justifying my actions.
Click to expand...

There was a good paper a little while back looking at nosocomial infections in the ICU and different transmission rates, preventative measures, etc. One of the factors that was very significantly associated with transmission of VRE and MRSA from the patient to the health care worker was contact with the ET tube. The other one was contact with a PEG or G tube.

Interestingly, gowns didn't seem to make a big difference.
 
I would never intubate a patient without gloves. The last thing I want to get is herpetic whitlow, let alone Hep C or HIV. Just because the patient doesn't admit to having one of these diseases they could very well be harboring a number of undiagnosed diseases.

I rarely even touch a patient without gloves unless it's a hand shake or part of the physical exam during pre-op.

Dentists have been contracting herpetic whitlow for years. Anesthesiologists are just as susceptible with their frequent contact with patients mouths.


Herpetic whitlow looks like loads of fun:
herpetic-whitlow-on-the-thumb.jpg


herpesSimplexVirusHSV_25795_lg.jpg



herpes02_2072_1_1_7856.jpg
 
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I'd rather go through a box of gloves a day than deal with recurrent herpes infections on my hands for the rest of my life. Sometimes I leave my mask on until I'm in the PACU. I've seen patients cough some nasty phlegm in the faces of the OR staff shortly after extubation.



dhb said:
Never for iv's (except Hep C) or intubations always for alines.
Some people go through a box of gloves in a day, i think it's stupid.

Universal precaution:
mask-suit.jpg
Click to expand...
 
Gloves? ALWAYS! Not interested in getting the VRE or MRSA action-- not interested in getting someone's saliva all over my hands, on the adult side, 100% yes yes yes to gloves. can't imagine doing anything without them. Even with kids, always wear them, only exception is maybe in the ex-preemie or small infant when placing the IV and taping the tube when there's little room for error- no gloves makes it a little easier sometimes.

GLOVES are the bomb! proud to be an obsessive glove user...
 
To the person who said they work in a "low HIV/HCV" population-there are plenty of folks out there that don't even know they have one of these diseases, including anyone who received blood in the 90's or prior (which includes a TON of people)-I just had an 80 something y/o guy the other day who had no "risk factors" for HCV-some of our ortho guys institutionally check for HCV as part of their pre-op labs (yeah I know-crazy)-But this guy tested positive for HCV-turns out he had a bloody nose in the 1980's and got a unit of blood (only thing we could think it was from)-crazy.... Be careful out there folks-no need to be cavalier with your welfare.
 
Wear them from induction until the tube is taped. Then throw 'em back on as the gas drifts low before emergence. Basically, if I think I'm gonna need to react quickly, I have them on.

I do find that I often don't wear them during peds inductions, like < 2 y/o. Feel like it gives me a little better control with the blade in that tiny mouth.

I'll always remember an attending I worked with 15 yrs back. Wouldn't wear gloves for a-lines during liver transplants. Just waltzed out to the scrub sink after it was in, hands all bloody.
 
Always wear gloves.....

(disclaimer, except peds, where i cut a hole on the index finger only...i know, it's weird)
 
dhb said:
Never for iv's (except Hep C) or intubations always for alines.
Some people go through a box of gloves in a day, i think it's stupid.

Universal precaution:
mask-suit.jpg
Click to expand...

Amazingly stupid. Sorry.
 
sevoflurane said:
Absolutely. I don't ever bag the patient with my dirty gloves (I'm a scissor technique guy). Intubate, remove right glove, bag/confirm etco2, turn on the machine with clean right hand, secure AW with silk tape, remove left glove.
We have disposable blades, so they go right into the trash tucked away in my left glove.
Click to expand...

I am similar. For a routine intubation: intubate, remove blade from laryngoscope and place in used blade can (to be sterilized), take off gloves and reglove, and then hook up circuit, bag/confirm ETCO2, tape, vent. The only thing I do without gloves in the OR is use my iPhone. 🙂

The routine changes a little for peds, obviously.
 
sevoflurane said:
Absolutely. I don't ever bag the patient with my dirty gloves (I'm a scissor technique guy). Intubate, remove right glove, bag/confirm etco2, turn on the machine with clean right hand, secure AW with silk tape, remove left glove.
We have disposable blades, so they go right into the trash tucked away in my left glove.
Click to expand...

Double-glove the right hand.

Scissor, DL, place tube, pull off outer glove, ventilate, secure ETT. Now everything's still clean.
 
jwk said:
Amazingly stupid. Sorry.
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I wasn't aware that our predecessors were dying in droves from Hep C, HIV while tormented by neuro syphilis for not wearing gloves during their careers.
If your skin barrier is intact how are you safer with a pair of gloves on?
Do you systematically wear eye protection too? i would believe the cornea is much more vulnerable to infections.

Sorry but to me Universal X and Protocol Y are made for people incapable of exercising critical judgment.
 
quoth dhb:

"I wasn't aware that our predecessors were dying in droves from Hep C, HIV while tormented by neuro syphilis for not wearing gloves during their careers.
If your skin barrier is intact how are you safer with a pair of gloves on?
Do you systematically wear eye protection too? i would believe the cornea is much more vulnerable to infections. Sorry but to me Universal X and Protocol Y are made for people incapable of exercising critical judgment."

well, bless your heart, aren't you just all that...and so smart too, and just a resident! 😍

Oh wait... maybe our skin, especially on the hands, gets broken all of the time in small ways without us being aware.

Oh wait... maybe nobody knows the transmission rates to anethesiologists via the various routes for the various bugs that we encounter everyday. Who's polling all of the retirees?

Perhaps your critical judgement sucks but you don't know it. I'm sure you would argue that mine does... but good luck with this position, I'm sure it'll do you and your famaily a world of good to stand firm with this! :meanie:
user_online.gif
 
Dogdaze said:
Oh wait... maybe nobody knows the transmission rates to anethesiologists via the various routes for the various bugs that we encounter everyday. Who's polling all of the retirees?
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Wouldn't you think that it would be known if the rate of infection for anesthesiologist was much higher than average?
I can tell you a great number of people i've worked with (in europe) do not use gloves systematically and don't seem to suffer from it.
 
dhb said:
Wouldn't you think that it would be known if the rate of infection for anesthesiologist was much higher than average?
I can tell you a great number of people i've worked with (in europe) do not use gloves systematically and don't seem to suffer from it.
Click to expand...

This is silly and I think just about everyone here will agree.
 
dhb said:
Wouldn't you think that it would be known if the rate of infection for anesthesiologist was much higher than average?
I can tell you a great number of people i've worked with (in europe) do not use gloves systematically and don't seem to suffer from it.
Click to expand...

I'm surprised your residency program isn't A) requiring you to use gloves, and B) teaching you better. Most of the places I'm familiar with, using gloves is not optional. Do you wear gloves only for the patients you think are scuzzy?

I didn't wear gloves for years. Not for IV's, not for A-lines, not for intubations - only for sterile procedures. But, I also didn't put my fingers in anyone's mouth (no scissors technique) because as a wise old anesthesiologist told me 30 years ago, "...you don't know where that mouth has been, son...". But, as most of us do, I grew up, got smarter, and started thinking of the potential of catching something I really didn't want to catch, as well as the possibility of passing it on to someone else if I did catch it. Now I glove up for just about everything.

Just curious - do you wash your hands between patients? Why or why not?
 
Im just gonna have to just say this is one of the most ******ed things Ive ever heard an educated person say. When is it ever a good Idea to just say no to gloves..I mean come on..
 
jwk said:
I'm surprised your residency program isn't A) requiring you to use gloves, and B) teaching you better.

Just curious - do you wash your hands between patients? Why or why not?
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Maybe it's a cultural difference...
I wash my hands if they get soiled and use alcohol based solution because it's the best proven method to decontaminate your hands.
I'm surprised no one can give a rational explanation to the use of gloves, i've defended my position.
I'm just relating my position and the one of many of my colleagues i though you might be interested in how things are done outside of the US, apparently not...
 
The defense of your position is that, as far as you know, none of the dozen or so people you work with have contracted a disease from a patient as a consequence of not using gloves? Where does "resident opinion" fall in the hierarchy of evidence?
 
Isn't this Darwinism at its finest?
 
dhb said:
Maybe it's a cultural difference...
I wash my hands if they get soiled and use alcohol based solution because it's the best proven method to decontaminate your hands.
I'm surprised no one can give a rational explanation to the use of gloves, i've defended my position.
I'm just relating my position and the one of many of my colleagues i though you might be interested in how things are done outside of the US, apparently not...
Click to expand...

Personally, I found the herpetic whitlow argument rather convincing. Tack on that universal precautions are there for a reason... If you wear gloves for pts with Hep C then you should be doing it for everyone. I know I'm just a med student, but if it's obvious to me then you should realize that plenty of people arent diagnosed... And even I've seen patients who don't "look" like the type who would have Hep C/HIV/etc.
 
dhb said:
I wasn't aware that our predecessors were dying in droves from Hep C, HIV while tormented by neuro syphilis for not wearing gloves during their careers.
If your skin barrier is intact how are you safer with a pair of gloves on?
Do you systematically wear eye protection too? i would believe the cornea is much more vulnerable to infections.

Sorry but to me Universal X and Protocol Y are made for people incapable of exercising critical judgment.
Click to expand...

dhb said:
Maybe it's a cultural difference...
Click to expand...

Where in the world are you?

You've posted some wacky stuff in the past, but this one sets a new standard.


Eye protection, while advisable, isn't really a valid comparison, as I'd wager that most of us are not in the habit of rubbing our corneas on exposed parts of patients.

But even if serious nasty infections weren't a risk, all that close contact with someone else's slobber puts you at risk for the kinds of unpleasant coughs, colds, and sniffles that are transmitted between people and doorknobs everywhere. URIs aren't fun. Pinkeye isn't fun. Poopin' q 20 minutes isn't fun.

I finished a slice of my own child's pizza a couple years ago. I didn't know he was sick. The next day he was miserable. The day after that I was so unbelievably sick I wanted to die. I'm not saying I employ universal precautions around my kids, but I don't finish their pizza anymore.

There's no way I'm going to needlessly expose myself to whatever crap my patients are knowingly or unknowingly carrying, whether it's HIV or hepatitis or herpes or some as-yet undiscovered pathogen that's about to sweep through the world HIV-1980s style.
 
cchoukal said:
The defense of your position is that, as far as you know, none of the dozen or so people you work with have contracted a disease from a patient as a consequence of not using gloves? Where does "resident opinion" fall in the hierarchy of evidence?
Click to expand...


Level F

..for FAIL
 
dhb said:
Maybe it's a cultural difference...
I wash my hands if they get soiled and use alcohol based solution because it's the best proven method to decontaminate your hands.
I'm surprised no one can give a rational explanation to the use of gloves, i've defended my position.
I'm just relating my position and the one of many of my colleagues i though you might be interested in how things are done outside of the US, apparently not...
Click to expand...

I am interested to hear your rationale and viewpoints on matters such as this although the last thing I am going to do is argue with you over this.

I hate to pile on you here, but this makes about as much sense as a thoracic subarachnoid block.
 
Yesterday l wore gloves WHOLE day for both indutions and emergences. But while inducing w/o gloves l had no contact with patients bodily fluids, and l guess that's the reason why some of the older attendings don't wear them on every induction. They all do for emergence. l'm not justifying them, but just trying to explain their behavior. And for IV placement, l rarely use gloves 🙂 (don't crucify me now for saying), because you're not exposed to patients blood unless you poke yourself on the needle. l now sometimes it gets to your finger, but rarely and we all now how low possibility of being infected this way really is.
 
Intensivist said:
Yesterday l wore gloves WHOLE day for both indutions and emergences. But while inducing w/o gloves l had no contact with patients bodily fluids, and l guess that's the reason why some of the older attendings don't wear them on every induction. They all do for emergence. l'm not justifying them, but just trying to explain their behavior. And for IV placement, l rarely use gloves 🙂 (don't crucify me now for saying), because you're not exposed to patients blood unless you poke yourself on the needle. l now sometimes it gets to your finger, but rarely and we all now how low possibility of being infected this way really is.
Click to expand...

😕

Sometimes you 'loose' palpation with gloves with starting IVs,etc. Nevertheless,it's not worth it to not wear gloves....Universal Precautions.
 
Intensivist said:
Yesterday l wore gloves WHOLE day for both indutions and emergences. But while inducing w/o gloves l had no contact with patients bodily fluids, and l guess that's the reason why some of the older attendings don't wear them on every induction. They all do for emergence. l'm not justifying them, but just trying to explain their behavior. And for IV placement, l rarely use gloves 🙂 (don't crucify me now for saying), because you're not exposed to patients blood unless you poke yourself on the needle. l now sometimes it gets to your finger, but rarely and we all now how low possibility of being infected this way really is.
Click to expand...

The possibility of HIV transmission through intact skin is so low as to be inconsequential. Broke skin and the nailbed, however, are unknowns, as is the transmission of other viruses. I just can't imagine taking that chance just to hold fast to an academic principle.
 
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