Exposure ?

[MariB]

/> We have had our share of scary diseases or symptoms that are just too close to not be a believer in universal precautions. If you live in an area with a busy international airport, you have to be suspicious sometimes.

Someone mentioned carrying gloves in their pocket. Do not do this. Your clothes rubbing against the gloves along with body heat can make these gloves worthless and you might even be aware of it. Consider it like a defective condom which you discover after the fact. Also, every time you reach to your pocket for a clean set, you risk contaminating your pocket. This seemed to be a learned thing passed on from one person to another as a neat shortcut until a whole ambulance service was carrying gloves in their pockets. Some EMTs did end up with nasty infections to their eyes and skin. A staph infection is also nothing to laugh at.

I am a volly an have a vest, my pocket is not up against me and I keep those for switching out old for new to carry out equipment etc. Its a designated pocket just for that purpose. You don't have to dig around to grab one, you can pull one out at a time. With bare hands, not gloved hands.

Gloves are kept on us, a few pair at a time because we have responded to scene from home. It is a little bit of a different situation as these gloves are grabbed with bare hands for equipment, and not kept in clothing pockets.

However the advice is good and should be noted for people who wear uniform.

[EMS4Life11]

So I'm curious EMS4Life11, why don't you wear gloves on every call?

It's an honest question.

I also don't fully expect that you're going to post here again simply because so many people on what sounds like multiple EMS discussion forums have told you you were wrong

There is no need to wear gloves on every call. Do you wear gloves to touch door handles or shake a persons hand where maybe there was dried blood or infectious bodily fluid without you even seeing or knowing it was there? No you don't. You just wash your hands throughout the day. Its the same thing for patient care. Anyone can become a patient. Just because there riding in the ambulance dosn't mean there infected and need gloves to take a BP or pulse .etc. If there is visible contamination or the patient tells your they have something, by all means glove up and I do. As for my situation, I have been told by several doctors and nurses that my non intact skin proves no exposure to hep c. CDC and many other places show that non intact skin is not a risk for contracting hep c. It only becomes a risk when your non intact skin is repeatedly exposed to the virus. I don't know where you guys are getting your information from, but maybe you all can use a little bloodborne pathogen refresher. You don't need a body condom to be near people.

Edited August 8, 2013 by EMS4Life11

[uglyEMT]

There is no need to wear gloves on every call. Do you wear gloves to touch door handles or shake a persons hand where maybe there was dried blood or infectious bodily fluid without you even seeing or knowing it was there? No you don't. You just wash your hands throughout the day. Its the same thing for patient care. Anyone can become a patient. Just because there riding in the ambulance dosn't mean there infected and need gloves to take a BP or pulse .etc. If there is visible contamination or the patient tells your they have something, by all means glove up and I do. As for my situation, I have been told by several doctors and nurses that my non intact skin proves no exposure to hep c. CDC and many other places show that non intact skin is not a risk for contracting hep c. It only becomes a risk when your non intact skin is repeatedly exposed to the virus. I don't know where you guys are getting your information from, but maybe you all can use a little bloodborne pathogen refresher. You don't need a body condom to be near people.

Please stay the HELL away from my family, my patients and myself!!!

I mean come on. From day one in Basic class they teach BSI/PPE on all patients. They drill it into your head. I want to know how you can just look at someone and know if they are a carrier for diseases. Plus you add to the mix NON intact skin?!? and dont think its a risk factor for anything?

You say Drs and nurses told you non intact skin is not a risk factor for Hep C? Tell me where so I can avoid them. CDC says the same?? Umm NO they don't. A quick check on their website in their FAQ page they state dried blood is infectious from 16hrs to 4 days!!! Gloves should be worn and to disinfect the area with bleach.

Let me guess you don't clean the cot and straps between calls because the patient didn't have any fluids spill either.

Where do i get my information from? Its called reality where I come from. There is no way I can look at someone and tell if they have something. Not all diseases have outwards signs or symptoms. People can be carriers of nasty stuff and not even know it. Trust someone to tell me they have something? I guess all your patients are 100% honest with you all the time, you're lucky. Mine lie and withhold info all the time for whatever reason. Not saying they all do but a majority do.

Do you worry about MRSA? Know the leading cause of spreading? Unclean hands!! Guess those gloves are not necessary at all since I can see the infection on people and surfaces. Oh wait no I can't so better be safe then sorry and wear proper PPE /BSI

This one single post has me so angry I better stop before I violate TOS and get banned from here.

Hopefully someone else can get through to this poster for the sake of thier patients.

[MariB]

There is no need to wear gloves on every call. Do you wear gloves to touch door handles or shake a persons hand where maybe there was dried blood or infectious bodily fluid without you even seeing or knowing it was there? No you don't. You just wash your hands throughout the day. Its the same thing for patient care. Anyone can become a patient. Just because there riding in the ambulance dosn't mean there infected and need gloves to take a BP or pulse .etc. If there is visible contamination or the patient tells your they have something, by all means glove up and I do. As for my situation, I have been told by several doctors and nurses that my non intact skin proves no exposure to hep c. CDC and many other places show that non intact skin is not a risk for contracting hep c. It only becomes a risk when your non intact skin is repeatedly exposed to the virus. I don't know where you guys are getting your information from, but maybe you all can use a little bloodborne pathogen refresher. You don't need a body condom to be near people.

Oh my goodness

I'm truly speechless

[paramedicmike]

There is no need to wear gloves on every call.

There was a need to wear gloves on this call and you didn't. Your argument is invalid.

Do you wear gloves to touch door handles or shake a persons hand where maybe there was dried blood or infectious bodily fluid without you even seeing or knowing it was there? No you don't. You just wash your hands throughout the day. Its the same thing for patient care.

No. It's not. That's the whole purpose for the use of PPE. You don't know what their status is. You have to assume from the outset, for your protection and the protection of families and friends with whom you interact outside of work, that the patient has something potentially infectious and fatal. Failure to do so can lead to your becoming infected.

People will lie through their teeth to you about their status. They will lie through their teeth and to your face. Or they will be infected and not know. Are you really willing to bet your health on this?

I'm curious, too, what your employer's policy on using PPE is. I'd bet money that it doesn't say "only use PPE if it looks like you might need it or if the patient tells you they're infectious". (Coincidentally, failure to follow your employer's policy on PPE can lead to you being on your own for medical coverage for your exposure and treatment to bloodborne diseases if it has been determined you failed to follow that policy.)

Anyone can become a patient. Just because there riding in the ambulance dosn't mean there infected and need gloves to take a BP or pulse .etc.

Distraction and not valid to the discussion at hand.

If there is visible contamination or the patient tells your they have something, by all means glove up and I do.

Except in this case there was visible contamination and you didn't glove up. Then you came here, and at least one other site from the sounds of it, and queried us as to whether or not you had an exposure.

So which is it there, sport? Glove up like you do? Which is apparently not nearly often enough? Or glove up all the time?

As for my situation, I have been told by several doctors and nurses that my non intact skin proves no exposure to hep c. CDC and many other places show that non intact skin is not a risk for contracting hep c. It only becomes a risk when your non intact skin is repeatedly exposed to the virus. I don't know where you guys are getting your information from, but maybe you all can use a little bloodborne pathogen refresher. You don't need a body condom to be near people.

Then why did you come here asking for input? Why did you put two different stories out there omitting information here that you included in your post on another site? Why be deceitful about the whole thing? Why withhold information? Why did you just not go to your organizations infection control officer? A position that is required by law for all EMS agencies?

Our information is coming from due diligence in our research. Our answers to you are based on your sketchy, apparently incomplete, version of whatever events transpired to make you worry about an exposure. Because it seems you were, in fact, worried. You came here asking questions about whether or not you'd suffered an exposure. If you didn't really want other opinions then you wouldn't have come here or that other site. You *knew* you were wrong and are now trying to argue that you weren't.

"BSI Scene safe" is not some useless mantra they teach you to say for testing purposes in EMT school. It's something that is designed to get your to act in your own best interest. Something that didn't take with you.

If you aren't willing to take your own safety seriously then you have no business being responsible for anyone else's well being.

Edited August 8, 2013 by paramedicmike

[Just Plain Ruff]

HOLY shit and crapola batman. EMS4LIFE are you really serious or are you just pulling our chains? Or do you play the stupid card a lot?

I'm so frustrated by your nonchalant attitude that I just can't understand how someone who I know or think is bright enough to be working on the streets, can be so naive about infectious diseases.

So before you come back with another silly rebuttal like you did above, my challenge to you, which I am betting that you WILL NOT take, is this

1. Go to your infectious control officer at your agency and ask them hypothetically about the exposure you suffered. Or if you have the cojones, tell them you were exposed because YOU WERE!!!!!, but I dont' think you have the guts to admit to your company about this.

2. Next, I challenge you to go to the CDC website and look around.

But I dont' really think you will do either.

And why did you leave out all that important information. My thoughts are that you read the responses to this thread and then you went to the doctors and nurses you referenced. Or you are just Screwing with us. Either or, what else don't you do that you should???

Maybe you are one of those nostalgia lovers who wants to go back to the days of no gloves and that the more blood you have on your uniform, the better medic you are. Or you might be one of those facebook posters who takes pictures of their bloody ambulances and posts them with some silly MEME saying "we do more in a 8x8 space than most ER's do with 1000 square feet" or some silly stupid thing like that.

Edited August 8, 2013 by Captain ToHellWithItAll

[MariB]

It appears he/she is anxiety stricken and is trying to reason with themselves. I mean the posts here and the other place surely show concern and then to go and say you need repeated exposure to broken skin etc... well if that was the case, he wouldn't have been nervous.

No we don't wear gloves in public to open doors etc, but we aren't cleaning open wounds while we do that. The blood on door handles if any are micro scopic, I wouldn't touch a door with blood on it without gloves!

[ERDoc]

EMS4LIFE, here is some guidelines from the CDC website. Read the section under "Definition of Health-Care Provider and Exposure", specifically read the second paragraph of that section.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

[triemal04]

The other day while on a call I had touched blood accidentally without gloves ( blood that was somewhat dry ? like when you let it sit on your skin for a couple of minutes and it becomes harder to remove unless you scrub it off ). On the top of my hands I have a few scrapes ( non bleeding ones that are maybe 1-2 days old ). The blood only touched my finger tips where no cuts are.

Technically no, there wasn't an exposure. It still should have been reported to your infection control officer to let them make the decision on what needed to be done next though; you may not have touched the dried blood to your scrapes but I'd say it was close enough. Basically, follow your procedures for what to do in the case of an exposure. It's a very low risk situation anyway, but you should've still gone through the hoops.

Now, I don't know if you were asking a real question or looking to stir discussion, but nicely done either way.

I would not listen to the people who are screaming about how you need to have full PPE on every call or you'll automatically catch the herpegonohepahiv virus. This is one of those sacred cows of EMS that get's beaten into people and taken as gospel...but isn't fully accurate.

If you are dealing with bodily fluids or there would seem to be a high likelihood of those being present...put some gloves on. If you are performing an invasive procedure...put some gloves on. If the patient is a known infectious risk...you'll probably feel better if you put some gloves on, but just touching someone with hepatitis/hiv won't cause you to become infected. If you are going to be touching a patient who's personal hygiene gives you the shivers...you'll feel better with gloves on. Wash your hands after every patient contact and use some common sense. You should do fine with that.

Now on to the rest.

When I'm working in the ER I don't wear gloves for every patient contact, either. When I was working EMS, though, I didn't get out of the ambulance or make a patient contact without gloves on. You just never know what you're walking in to and it's better to be prepared than fumble around trying to put them on when you're surprised by what you find.

You don't really know what you may find in the ER either. Or are you saying you've never been surprised or had a patient suddenly decompensate in the hospital? It doesn't take more than a second to put a pair of gloves on and you should always have a (fresh, new) pair with you, so what's the issue?

ok, true Doc, I also did not wear gloves on every call but that was before one of the two friends told me about his exposure and subsequent HEP C diagnosis from just possibly exactly the scenario that EMS4Life posted.

I changed my practice after that. It did take a personal friend to acquire a disease in order for me to change my ways. Soon after I developed contact dermatitis which caused my skin to split . NOt a latex allergy but just due to washing my hands and using all the chemicals that we use for disinfecting and just good handwashing. Yes there is an unintended consequence to cleaning your hands too much. ha ha

I now am completely anal about glove usage.

But when I worked in the ER like Mike, I sometimes didn't wear gloves (even after my friend got sick) because if I'm discharging a patient or just going in to talk to a patient then I didn't wear gloves.

What is the difference between a patient in the ER and one in the field? Do they somehow magically get cured of whatever you are afraid they have once they set foot in the hospital? Somehow become less infectious (if that is what you are worried about)?

Hell, what is the difference between the random person you are introduced to and shake hands with and someone in the ER or field? Or any object that you touch that some filthy infected stranger may have been holding 30 seconds before?

I use gloves on every 911 call no matter what. However on transfers I may take them off depending on the situation. Closed skin fracture, heart pt etc with no nausea, I will take them off.

I will wear them the whole transfer if there is bleeding or vomiting etc. Then I will disinfect my pens, clipboard etc, anything the pt even touched.

So what is the difference between a transfer patient and a 911 patient? Both will have the same potential for disease transmission. Both will have the same potential to have an unknown disease. If you won't wear them for certain situations with a transfer, why not leave them off for the same situation with a 911 call?

Please stay the HELL away from my family, my patients and myself!!!

I mean come on. From day one in Basic class they teach BSI/PPE on all patients. They drill it into your head.

They also drill into your head that every patient get's high-flow O2 and a backboard and c-collar should be used for just about every type of traumatic or potentially traumatic injury. Just because something is a sacred cow doesn't mean it's right or should not be questioned.

There is no way I can look at someone and tell if they have something. Not all diseases have outwards signs or symptoms. People can be carriers of nasty stuff and not even know it.

I hope you wear gloves, eye protection, and a gown 24/7 in your daily life then. Because there is no way you can look at someone and tell if they have something. That buddy from work who's hand you shake...that friend of your wife's who you give a hug and kiss on the cheek...might pick up a deadly virus from them. And let's not forget all the inanimate objects that could be contaminated...

There was a need to wear gloves on this call and you didn't. Your argument is invalid.

No. It's not. That's the whole purpose for the use of PPE. You don't know what their status is. You have to assume from the outset, for your protection and the protection of families and friends with whom you interact outside of work, that the patient has something potentially infectious and fatal. Failure to do so can lead to your becoming infected.

I agree, he should have had gloves on for the given situation, and should have followed his infectious policy (even though the risk was minimal). But...

It is the same. You don't know the status of the people or things you touch on a daily basis. It is no different. Use common sense, use proper protection when the risks are there, but when the risk isn't there...what is the point?

I agree with assuming that the patient may have...something...that you might catch, but simply putting gloves on isn't the end all/be all cure for that. Take out bodily fluids, and how are gloves going to fully protect you and better than washing your hands after a contact? If I put a 12-lead on the 60 year old man with chest pain, what am I at risk for by not wearing gloves and simply washing my hands a few minutes later?

Then why did you come here asking for input?

Who cares? It is (or could anyway) generate discussion and maybe people could learn something.

"BSI Scene safe" is not some useless mantra they teach you to say for testing purposes in EMT school. It's something that is designed to get your to act in your own best interest. Something that didn't take with you.

Or you either apparently. Since you have allready said you don't wear gloves all the time in the ER.

No we don't wear gloves in public to open doors etc, but we aren't cleaning open wounds while we do that. The blood on door handles if any are micro scopic, I wouldn't touch a door with blood on it without gloves!

Wait...so has this changed from an "OMG! YOU TOUCHED SOMEONE WITHOUT A GLOVE YOU ARE GOING TO DIE OH GOD YOU ARE INFECTED" conversation to a, "you should not touch bodily fluids without gloves" conversation?

[MariB]

No the op said we don't wear gloves everywhere we go, every time we go in public. Etc