Systems For Touching Gurney/Clipboard/Pens without Gloves?

[AnthonyM83]

What kind of systems do you guys use on the ambulance for keeping things uncontaminated?

My partner and driver likes taking gloves off (after pt care) before touching gurney, to keep it clean (less decon).

He also keeps one sheet on the gurney tucked in all nice. Then when loading a patient, he spreads open a second one, drapes it over gurney and the bottom sheet, loads patient, then folds it over the patient kind of like a taco/cocoon/mummy. I personally think it looks sloppy and I always have to pull the sheet open to take vitals in the back of the rig. Then we transfer patient to ER/SNF by lifting the top sheet and he doesn't need to replace the bottom one (usually).

I'm trying to work out a system for my clipboard. Fire doesn't use gloves on clipboard, because they have a dedicated note taker. When FD/medic hops in back of our rig, he takes off gloves and writes. I don't think that'll work for me. I have to write down new vitals in the ER or I throw my clipboard somewhere on the gurney that might be dirty. Or we get to ER, take off gloves to write, but then we're assigned a room, so reglove to put patient in a bed, then unglove to finish writing, then reglove to have them sign with your throwdown pen, then unglove to carry clipboard, but then have to help push gurney back to the rig (and sometimes medics might have touched it with diry gloves...or does it matter, am I being a germaphobe?)

Also, where do you keep your throwdown pen and your good pen?

I just feel like giving up on these systems and just wearing gloves for EVERYTHING. I keep seeing all the things that get touched with 'used' gloves when on codes/ressus or traumas and it realize everything's contaminated. Outside door handles, BP cuff, light switch in back of rig!

[akflightmedic]

No worries. You are being a germaphobe.

Its funny how soon as you get in the "medical response" mindset, everything is contaminated. Do you worry like this when you are off the job. You touch doors, windows, shake hands, pick things up in stores and set them back down, pick fruit everyone else has touched, read magazines everyone else has touched, go to the bank and use the same pen everyone else has touched...but all of a sudden because we arrive in an ambulance, everything is "contaminated". You look at the person you are transporting and determine whether they are good enough to touch your pen or whether they have to use your throw down pen. You look around the box and wonder what has touched what. How is this any different from any other public place. Sick people, nasty people, urban outdoorsman, booger picking, non hand washing after ass wiping people go to the same places you do every single day. Some of them even serve your food at restraunts. So tell me what is the problem? Why so worried?

If you think about it, how many of the people you transport are really, truly sick? How many of them are bleeding all over the place uncontrollably? Not too many is my guess. So if you wash your hands or use the little bottle of antibacterial wash frequently, there isnt too much to worry about.

I will catch some shit from some people over this one, because it is something I preach but do not follow 100 percent myself, yes I am a hypocrite folks but I have to follow teaching standards.

I typically do not put on gloves until I have made visual contact with the patient. It pisses me off watching drivers of the rig steering with their elbows trying to put gloves on. Did you really save that much time and was it worth the risk to save a few seconds? I think not.

If it is toned out as a trauma and I am not driving, I may go ahead and put on gloves and if it sounds like a really bad trauma, I put on two pair of gloves. This is not for added protection, it is for the simple fact that when they get soiled or if I have to make contact with a 2nd patient, I strip off the first pair and have one already on. Ever try to put gloves on after stripping one pair and your hands are all sweaty? Not an easy task.

Anyways, once I deem gloves necessary, due to patient condition or performing an IV or something of the sort, I put them on. But as soon as I have everything hooked up, IV flowing, pt stable, I get rid of them. There is no need for them at that point. I am now free to touch everything in the truck without "contaminating" it. Upon arrival at the ER, I will put on another pair if the pt is going to need assistance with moving as I don not wish to put my hands in urine on a ALF resident nor do I wish to support someones weight under their arms with no gloves.

Once you are done with the pt, a simple little wipe down should be sufficient. As for that bottom sheet thing your partner does, is it fair to all the other patients to keep reusing it? What if a pt has crabs and you pass them to the next person? That is a bad practice that should cease. Just take the few extra seconds, spray with Hibacleanse and wipe down your stretcher for crying out loud. Why so freaking lazy?

As for the throw down pen, all my pens are throw down pens. I never bring a good pen to work, no point in doing so. But I haven't done written reports for years. I have been electronic since 2001 so the pens I have are just for my note taking. I keep them in my pocket for easy retrieval and disposal. They arent going to bite you.

You should also be in the practice of deconing your truck at least once a week. Wipe down everything. Empty cabinets and wipe them down, Wipe the radio, wipe the overhead grab bars, O2 tree, steering wheel everything.

But whatever you do, do not ever, and I do mean ever, climb in the cab after assisting me with the patient, drive me to the ER and unload with the same gloves on, having never removed them, because you think it was unnecessary to change them. Big pet peeve of mine in case you didnt notice.

[BEorP]

Do you worry like this when you are off the job. You touch doors, windows, shake hands, pick things up in stores and set them back down, pick fruit everyone else has touched, read magazines everyone else has touched, go to the bank and use the same pen everyone else has touched...but all of a sudden because we arrive in an ambulance, everything is "contaminated".

Although you make some good points... most people who I associate with in day to day life aren't bleeding and Hep C positive.

[akflightmedic]

Although you make some good points... most people who I associate with in day to day life aren't bleeding and Hep C positive.

How do you know? I mean the bleeding part ok, but what about Hep C? Or how do you know they dont have it, had a minor cut and left some miniscule amount of blood behind on a public surface that you happen to come in contact with?

And you are implying that all your patients are?

I made it clear that I wear gloves when doing any procedure or with any patient that has active bleeding or involves bodily fluids. But the majority of our patients are not bleeding. As for having Hep C, its like AIDS or any other disease. You have no way of knowing who has it and who doesn't. A patient complaining of knee pain, headache, abdominal pain, back pain, whatever does not warrant being all freaked out over contamination. The calls that we do encounter where this is a valid concern are few and far between. Please do not misinterpret my point. I am a strong advocate for BSI, I just think there has to be a balance of common sense along with it.

[EmergencyMedicalTigger]

It's important too have good BSI habits, but I think you might be going a little overboard. Use gloves when working w/the pt. Try to prepare ahead of time like AK said if you're going to be dealing w/alot of exposure. If you drive take your gloves off before getting in the front cab. That drives me nuts to see people do that, not to mention it's gross. Wash your hands frequently. Wipe down the equipment you used on the call and do detailed unit decons once a week. If you use pens for written reports, wipe them off every once in awhile and don't stick them in your mouth :shock: (yes, some people do this).

[Dustdevil]

I solve this problem with this easy three-step plan that has worked for me for over thirty years:

• 1. I don't wear gloves, unless it is a sterile procedure or there is some other clearly visible source of concern, like messy wounds, or I will be sticking me fingers into someone's arse.

2. I wash my hands as if I owned stock in the surgical scrub manufacturer.

3. I decon everything in between every patient.

[EmergencyMedicalTigger]

I don't wear gloves, unless it is a sterile procedure or there is some other clearly visible source of concern, like messy wounds, or I will be sticking me fingers into someone's arse.

Soooo, if you get your "romantic" meeting with Asys, will you be wearing gloves? :twisted:

[BushyFromOz]

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[Cookie]

Since we have three truck stops, we always glove up before making pt. contact. That came from our Medical Director. If you saw some of these guys and their rigs you would surely understand. All linens come off the cot every run, the cot is then wiped down with disenfectant before its ever remade.

[AnthonyM83]

Okay, that sounds like a good system.

For us it's going to require doing total decon before every shift (meaning coming earlier b/c we usually have to roll out immediately) and I don't know what went on there during previous shift. You know those traumas with six people working it and gloves are red and they're touching everything imaginable.

What about different pens? One for writing V/S while gloved up and one for report writing w/o gloves. Or am I still being a phobe..