Should students double glove when attendings don't?

[The Squid]

---

Members don't see this ad.

I'm a student just starting to spend some time in the OR. I have noticed that the attendings, residents, and students NEVER double glove (with the exception of neurosurgery). Some of the scrub nurses do. The neurosurgery attendings and residents always do (and I've heard them tell the other residents they should, but of course they don't). I have asked some of them why they don't and the answer is almost always something about it decreasing their dexterity or being uncomfortable. I figure now is a good time to learn to do stuff despite any decrease in dexterity that double gloving might cause, since I'm just learning to tie knots anyway. The problem is that they think it's unnecessary and I've been told from the start I should do what the attendings and residents say. I'm just not sure they're right about this one. Any advice? I don't want to risk my life just so the attendings and residents won't decide they don't like me, but I want to make sure its worth rocking the boat, you know? I'm a first year and being the one to go against all the attendings and residents is kind of scary.

 

[Blade28]

You can get used to the loss of dexterity (and occasional feelings of numbness) by ALWAYS double-gloving. I now do it even on simple or laparoscopic cases. (I've been stuck by a suture needle once so far, back in July.) You'll get used to it, and after a while, you'll be doing everything naturally.

I think, in this instance, it's worth rocking the boat if that's what you're afraid of.

 

[mysophobe]

I wear the ortho gloves. They let me feel comfortable enough to not worry about needle sticks, and since I switched over to those, I've had zero problems.

 

[fourthyear]

Absolutely - protecting yourself is so much more important than worrying about what others think of you. I can't imagine anyone would hold it against you if you double glove and they don't. Everyone has their own preference. It took a while to get used to the 2 glove feel, but you learn.

I know lots of people who only double glove if a pt is known to have something...you need to treat every patient as if they might have Hepatitis or HIV, because many many people have these diseases and have no idea they have it.

 

[Blade28]

As long as you can perform the tasks required when double-gloving, then no one has any right to judge you.

Now if you fumble with the instruments and can't do a two-handed tie, well, then you need some practice. 🙂

I know lots of people who only double glove if a pt is known to have something...you need to treat every patient as if they might have Hepatitis or HIV, because many many people have these diseases and have no idea they have it.

Exactly. It's called "universal precautions." Nowadays you can't tell who has hep B/C or HIV.

Similarly, you should always wear eye protection. I can't tell you the number of times I've seen residents without eye protection. I don't wear glasses, and don't have loupes yet, so always wear the mask with the plastic faceshield thingie.

 

[surg]

Just because they are willing to take the chance of contracting HIV or Hep B/C doesn't mean you have to. You should absolutely double glove whenever humanly feasible. As a student it is unlikely that you are carrying any disability insurance that would compensate you for your future lost earnings if you end up with a disease that might have been prevented by you double gloving. Single gloving even with ortho gloves is not as good as double gloving. The 2nd glove layer decreases the amount of contamination reaching the skin after a puncture by something like 80-90%. Also wearing 2 different color gloves will make it more obvious when a puncture occurs since after about a 3 hour case the chance of an inadvertent breakage of the outer glove (especially the "whites") is actually quite high.

Insist on double gloving. If you start now, you'll never miss the dexterity you lose. If you only do it on the "dangerous" cases, you'll end up being the most clumsy when it matters most! Guess what? You being able to marginally tie a knot better now is probably not going to get you a better grade, and if you catch something, it definitely wasn't worth it!

BTW, I give this same lecture to every medical student I scrub with who doesn't double glove.

 

[Pir8DeacDoc]

I have adopted the ortho gloves as well, at least as a student. However, once I start internship in July I'm pretty sure I'll go to the double. Spending two months on a surgery rotation is one thing, but doing it day in and day out, I'll take the added protection and the loss of dexterity.

 

[Blade28]

The residents should have told you to start as a student - that way, by the time internship rolls around, double-gloving is no big deal.

 

[mysophobe]

Similarly, you should always wear eye protection. I can't tell you the number of times I've seen residents without eye protection. I don't wear glasses, and don't have loupes yet, so always wear the mask with the plastic faceshield thingie.

I hate those things. They get all fogged up and I can't see anything. The only time I ever wore them was during a BKA with a surgeon notorious for being ridiculously messy and spraying bone everywhere. That time I wore two face masks, one on my head facing down and one on my face the normal way. It made sort of like a full-face shield.

 

[Blade28]

I hate those things. They get all fogged up and I can't see anything. The only time I ever wore them was during a BKA with a surgeon notorious for being ridiculously messy and spraying bone everywhere. That time I wore two face masks, one on my head facing down and one on my face the normal way. It made sort of like a full-face shield.

The key is to "pull" the face shield a little away from your face, so it's not touching anymore. Most people just put on the mask, tighten the nose part and don't adjust it.

 

[The Squid]

Bump for more input. Thanks for the replies so far.

 

[mysophobe]

The key is to "pull" the face shield a little away from your face, so it's not touching anymore. Most people just put on the mask, tighten the nose part and don't adjust it.

Gimmie a little more credit than that! Nah, it just doesn't work for me. I just wear my glasses most of the time. If I forget and put my contacts in, I just wear nothing.

 

[Blade28]

Gimmie a little more credit than that! Nah, it just doesn't work for me. I just wear my glasses most of the time. If I forget and put my contacts in, I just wear nothing.

Maybe you're too nervous during the case. 😉 I know my face shield fogs up when I'm nervous (happened during med school), or when the OR is hot (trauma cases).

 

[drpectin]

Those face shields always fog up on me. You really have to adjust it firmly forward. I can remember my first case as a med student where my face shield fogged up so much, I couldn't see through it. It really helped when my chief nudged me and told me to change masks.

 

[mysophobe]

Maybe you're too nervous during the case. 😉 I know my face shield fogs up when I'm nervous (happened during med school), or when the OR is hot (trauma cases).

I'm going to take that for the sarcasm that I know it is. 😉 I've been in the OR for many years (was a scrub nurse pre-med school at a place with no residents or students, so we did a lot of first-assisting, suturing, etc.). So, as far as being nervous in the OR goes, that I am not. I'm just not the nervous type. I know they'll yell at me before I can do something ridiculously stupid, so I'm just focusing on the case rather than being nervous.

Anyway, it's probably the way I wear the mask, or the way my face is shaped or something. Either way, I refuse to use. 👎

 

[Blade28]

OK then. 🙂

 

[mysophobe]

Out of curiosity, what kind of gloves do you prefer? I use either orthopedic/browns or those blue biogel gloves that come in the orange package. The only thing I don't like about the biogels is they bunch up real easily, exposing your wrist unless you catch it or keep your sleeve practically all the way up to your knuckles.

 

[daisygirl]

I also have a problem with the face shield. Ninety five percent of the time the shield fogs up so bad on me that water droplets form and then drip down the mask. I've done everything to prevent it- taping the mask to my nose; pulling it from my face; blah blah blah

I once had to ask a scrub nurse to rip the shield off the mask during the middle of a vascular case 🙄

I no longer use them since they nearly always cause a problem for me. Luckily, my hospital offers the disposable plastic eye shields (the one where you snap a shield into a frame).

 

[Orange Julius]

Bump for more input. Thanks for the replies so far.

What more imput do you need. Just double glove. Not a big deal.

 

[Orange Julius]

I also have a problem with the face shield. Ninety five percent of the time the shield fogs up so bad on me that water droplets form and then drip down the mask. I've done everything to prevent it- taping the mask to my nose; pulling it from my face; blah blah blah

Yeah, those can be a pain. Trick is to tighten the nose part as well as possible (duh) but also (more important) leave it fairly loose at the bottom. 😉

I also prefer the disposable eye shields. But in some situations - like trauma calls - the 2 in 1 type is all there is.

 

[mysophobe]

I once had to ask a scrub nurse to rip the shield off the mask during the middle of a vascular case 🙄

I hope you didn't ask the scrub nurse to do that, and if you did, I hope she didn't actually do it.

 

[tRmedic21]

Maybe the circulator. 😉

 

[mysophobe]

Bingo. 👍

I was in on a case where the scrub nurse bent down to pick up a sponge she dropped. I almost had a heart attack.

 

[Blade28]

Out of curiosity, what kind of gloves do you prefer? I use either orthopedic/browns or those blue biogel gloves that come in the orange package. The only thing I don't like about the biogels is they bunch up real easily, exposing your wrist unless you catch it or keep your sleeve practically all the way up to your knuckles.

I use 8 Biogels on the bottom, 7 1/2 Biogels/whites/Protegrity/whatever else they have on the top.

They don't bunch up for me - but then again, my gown sleeves are past my MCP joints. 🙂

 

[daisygirl]

Bingo. 👍

I was in on a case where the scrub nurse bent down to pick up a sponge she dropped. I almost had a heart attack.

Actually it was the former scrub nurse...I should have mentioned that the nurse had just scrubbed out of the case.

 

[DW3843]

I too remember a rather steamy encounter with the face shield.

Do any of you have your own glasses/goggles. I'm asking about safety glasses I guess. Not the cheap plastic disposable ones, not the clunky dorkified kind like you had back in Gen Chem lab, and not the super expensive Oakleys or Gargoyles.

It seems like you can get some decent, functional, and realtively benign looking glasses for pretty cheap. Is that something that a lot of people do, and if so any suggestions?

 

[mysophobe]

I use 8 Biogels on the bottom, 7 1/2 Biogels/whites/Protegrity/whatever else they have on the top.

They don't bunch up for me - but then again, my gown sleeves are past my MCP joints. 🙂

That hurts my hands, so I keep them at my wrist. Only the blue biogels bunch up on me, so maybe we're using different kinds. I love them though, they're so comfortable.

As far as goggles go, I've seen some people with sports glasses/goggles, but usually people either wear the face shields or their own glasses (or nothing 😉 ).

 

[Blade28]

Blue Biogels...hmmm...are those the old latex-free ones?

 

[mysophobe]

Yeah, I've never seen anyone use them except this one doc from Pakistan. I decided to try them and they were great. They're called Biogel Skinsense N.

http://www.regentmedical.com/global/range.aspx?product_id=8

 

[Zummy]

I too remember a rather steamy encounter with the face shield.

Do any of you have your own glasses/goggles. I'm asking about safety glasses I guess. Not the cheap plastic disposable ones, not the clunky dorkified kind like you had back in Gen Chem lab, and not the super expensive Oakleys or Gargoyles.

It seems like you can get some decent, functional, and realtively benign looking glasses for pretty cheap. Is that something that a lot of people do, and if so any suggestions?

Allheart has some cheap and (somewhat snazzy) protective eyewear...

http://www.allheart.com/wx9522.html

 

[Zummy]

I too remember a rather steamy encounter with the face shield.

Do any of you have your own glasses/goggles. I'm asking about safety glasses I guess. Not the cheap plastic disposable ones, not the clunky dorkified kind like you had back in Gen Chem lab, and not the super expensive Oakleys or Gargoyles.

It seems like you can get some decent, functional, and realtively benign looking glasses for pretty cheap. Is that something that a lot of people do, and if so any suggestions?

Allheart has some cheap and (somewhat snazzy) protective eyewear...


http://www.allheart.com/wx9522.html

 

[MD Dreams]

During my surgical rotation I

1. Always double glove, no matter how small the case, nor if anyone else was double gloving

2. Always wore eye protection. I always wore it the right way vs. upside down (the mask and shield together) as many people do because upside down leaves a small area where blood can still enter the eyes

3. Wore shoe coverings. If I thought it would be a big bloody case (my favorite) I wore the small ones with the big ortho ones on top becuase sometimes they soak through

4. If Flrouro was in the room always wore a shield properly, unlike some orthopods who only covered their gonads, and I made sure that I grabbed a shield with a thyroid collar

After having done all this, if I still were to get exposed, I could at least be at peace with the fact that I did my best to protect myself

You can't take care of others if you don't take care of yourself first

 

[mysophobe]

4. If Flrouro was in the room always wore a shield properly, unlike some orthopods who only covered their gonads, and I made sure that I grabbed a shield with a thyroid collar

When fluoro is being used, I wear the skirt and rip a thyroid shield off one of the vests. Wearing the whole dealy kills my back.

 

[ivan lewis]

For the fogging problem I suggest putting the mask on, tightening the nose, then breathing out upwards to see if there's seepage. If there isn't, I've found that the shield is good for the rest of the case.

 

[highball]

You can find cheap glasses at a home store like Home Depot/Lowes. Get lawn mowing/weed eating goggles. THey look like Oakleys, but are adjustable and really comfortable. Good eye coverage. At most 15 bucks.

 

[mysophobe]

For the fogging problem I suggest putting the mask on, tightening the nose, then breathing out upwards to see if there's seepage. If there isn't, I've found that the shield is good for the rest of the case.

I've tried that dozens of times, and even if it seems all well and good at first, as soon as I'm scrubbed, it's fog city.

 

[Blade28]

Hmmm...for fluoro cases I've just been wearing the vest - no thyroid protection. Yikes.

Doesn't bother my back, though, but I was wearing the vest for 1-3 cases a day, 4 days a week, for a month during my ortho month.

Agreed that the mask tends to fog if your breath is seeping upwards - tighten the nose part!

 

[mysophobe]

Hmmm...for fluoro cases I've just been wearing the vest - no thyroid protection. Yikes.

Doesn't bother my back, though, but I was wearing the vest for 1-3 cases a day, 4 days a week, for a month during my ortho month.

Agreed that the mask tends to fog if your breath is seeping upwards - tighten the nose part!

Yeah, I've been wearing lead for years, so I'm definitely used to it. I just have a bad back. Standing or sitting for a long time hurts too, so add lead into that, and I'm finished. Luckily, one of our attendings has a failed back, so he understands. We both sit during lap choles. 😎

 

[Blade28]

Damn, sitting during a lap chole? That's awesome!

I want to institute a sitting rule when I'm an attending. Don't know if that would ever happen, but it would great.

But what are you going to do for long cases, like Whipples, big liver whacks, etc.?

 

[mysophobe]

Usually if it's a big case, I get so caught up in it that I don't really notice the pain until we start to close, so it isn't that big of a deal. Lap choles are just so routine and boring that I don't have anything else to think about really. When my back does start to hurt during big cases, I have the circulator put a stool in front of me and I put one foot up on it. It really takes the pressure off.

 

[Blade28]

Sounds like you've done your fair share of operating. Your med school allowed you a lot of freedom in the OR?

 

[mysophobe]

For the most part, but I was real aggressive too. Most of the students waited and asked the attending if they could scrub into the case, but I just put out my gloves and a gown and scrubbed. Sometimes I just stood there, and sometimes they let me do stuff, but no matter what happened, at least I got a closer view of what was going on during the case. It didn't hurt that I didn't need to be taught how to scrub and act around a sterile field.

 

[Blade28]

No residents?

 

[Roux-en-Y]

Bingo. 👍

I was in on a case where the scrub nurse bent down to pick up a sponge she dropped. I almost had a heart attack.

that's so friggin terrible; I hope it was a smaller, minor case; did the attending kick her out of the OR?

 

[tRmedic21]

that's so friggin terrible; I hope it was a smaller, minor case; did the attending kick her out of the OR?

Come on, is it that bad? Does the surgeon have to act like an ass? No. How many times have you accidentally broken scrub because you weren't thinking? I mean, I never have, but then, I haven't been in the OR all that much, but I can imagine it would be pretty easy to do... I saw one of my fellow students reach up to catch his glasses as they were sliding off his nose (sweating in the OR is common as a student ). Yes, he broke srub, yes he had to rescrub, but did the surgeon make him feel like a loser because he tried to prevent his glasses from falling into the sterile field, or fall on the floor and break? No. They simply said go back and rescrub. No biggie.

People make a big deal out of situations like this, but ultimately it's not a huge thing. People make mistakes, and this is one that is relatively easy to correct. There's no need to belittle people for something like this, IMO. Maybe once I'm a big, bad surgeon (someday, hopefully) then I'll feel more strongly that people shouldn't make mistakes in my OR and I'll feel more comfortable deriding them for it. 🙄

I'm not trying to be a jerk, here, BTW, I'm just pointing out that sometimes on this board in particular, things seem a bit overblown to me. Just my $0.02

 

[mysophobe]

No residents?

Yeah, that's why I'm saying sometimes I didn't get to do anything. Sometimes there'd only be the chief or one resident on the case, so I got to do stuff, and sometimes there were like three or four of em, so I just watched. It varied from case to case. Overall, I think I got better exposure than the guys standing in the corner.

 

[mysophobe]

Come on, is it that bad? Does the surgeon have to act like an ass? No. How many times have you accidentally broken scrub because you weren't thinking? I mean, I never have, but then, I haven't been in the OR all that much, but I can imagine it would be pretty easy to do... I saw one of my fellow students reach up to catch his glasses as they were sliding off his nose (sweating in the OR is common as a student ). Yes, he broke srub, yes he had to rescrub, but did the surgeon make him feel like a loser because he tried to prevent his glasses from falling into the sterile field, or fall on the floor and break? No. They simply said go back and rescrub. No biggie.

People make a big deal out of situations like this, but ultimately it's not a huge thing. People make mistakes, and this is one that is relatively easy to correct. There's no need to belittle people for something like this, IMO. Maybe once I'm a big, bad surgeon (someday, hopefully) then I'll feel more strongly that people shouldn't make mistakes in my OR and I'll feel more comfortable deriding them for it. 🙄

I'm not trying to be a jerk, here, BTW, I'm just pointing out that sometimes on this board in particular, things seem a bit overblown to me. Just my $0.02

There's a difference between a med student breaking scrub and the scrub nurse breaking scrub. For one thing, the scrub nurse has been doing it for years, and should know better, whereas the med student probably has only had a few days to weeks of exposure to sterile procedure.

Secondly, if a med student breaks scrub, the case is not going to stop or slow down. If the scrub nurse breaks scrub, it's a pain in the ass for everyone because now if something has to be opened, counted, etc., or it's a bigger case and the surgeons can't reach back to get every single friggin instrument for themselves, the case has to stop and wait.

Anyway, I can't remember what the case was, but the attending was a super nice guy and just waited for her to re-scrub and made sure she understood her mistake.