I received an email from a friend of mine who is an EMS supervisor over across the Atlantic in Great Britain,
The gray mafia here have decided that in their relentless aim of blaming Ems for Amy infection in hospitals, that we should only be allowed to wear gloves that come out of packets.
They do not have to be sterile or individually wrapped, but they cannot be in a pocket or belt pouch.
While this may work in a lot of environments, I am concerned that it will encourage some staff to put gloves on when they get the call, and keep them on until they are back in the truck.
Personally I will often use several pairs of gloves on a call. I don’t like having the same pair on for any length of time.
On one of my previous trips across the pond I saw a supplier that did a small pack that was designed to hang on a belt. It had four or five pairs of gloves in.
Does anyone know who they were made by? Any good?
I couldn’t help him with the glove problem, but it certainly started me thinking. For almost as long as I’ve been in EMS, nurses have been trying to blame EMS for giving patients infections. They seem to not understand that it’s a dirty world out there. They also don’t seem to understand that the purpose of the gloves we wear is to protect US from the PATIENT, not the other way around. The patient is the one with the medical problem, not us. At least that’s a good presumption.
On my ambulance there are several boxes of gloves in various sizes. There are N95 masks, surgical masks, eye shields, some Tyvek apron things, and lot of disinfectants. All of those serve to protect me from exposure to the yucky things that patients already have.
We talk about sterility in EMS, but it’s more myth than fact. Very clean is an achievable goal, but sterility isn’t. IV insertions are about as close as we come and I’m always leery when hospital staff tells us about the rate of infection from out of hospital IV placement. They cite studies, but can never seem to come up with one when asked. Or they’ll say, “It’s an internal study and we can’t release the data.” Right.
Intubation? Not sterile.
One little fact that seems to escape a lot of in hospital people, is that trauma patients aren’t sterile either. You’d think that they would know that because one of the first things that happens to trauma patients when they come in is that they get IV antibiotics. Lot’s of IV antibiotics.
I haven’t done a peer reviewed, double blind, IRB approved study, but I’d be willing to bet that bad guys don’t sterilize their bullets or knives before they go out to shoot or stab anyone. Nor does the city sterilize the street before pedestrians get run over.
If the Gray Mafia in Great Britain are looking to find and fix the source of patient infections in hospitals, maybe they should look in the hospitals instead of coming up with dumb ideas about gloves in ambulances.
Up to 1,200 patients died unnecessarily because of appalling care
Labour’s obsession with targets and box ticking blamed for scandal
Patients were ‘routinely neglected’ at hospital
Report calls for FOURTH investigation into scandal
I think more than having EMS crews use gloves in pouches is in order here.
That is just plain stupid… If they’re serious, they need to turn the back of the bus into an autoclave and put the patient in there enroute… at the hospital, take out one ‘sterile’ patient (and probably a dead one too)… sigh
I was going to suggest that they put the patients into giant zip lock bags, but I was worried about how many dead patients there would be before the figured out I was kidding.
My uncle, a paramedic from days of yore, used to tell me when I was still a real youngster in EMS – “Better to have a slightly infected patient, than a very sterile corpse…”
Wise words I think…
Sadly in this day of “risk management” many administrative type seem to think that the reverse is true.
Comparison of clinically significant infection rates among prehospital-versus in-hospital-initiated i.v. lines.
Levine R, Spaite DW, Valenzuela TD, Criss EA, Wright AL, Meislin HW.
Ann Emerg Med. 1995 Apr;25(4):502-6.
PMID: 7710156 [PubMed – indexed for MEDLINE]
RESULTS:
Three thousand one hundred eighty-five patients who had a prehospital or an in-hospital i.v. line placed were admitted from the ED. Eight hundred fifty-nine i.v. lines were prehospital placed (27%), and 2,326 were in-hospital placed (73%). There was one infection in the prehospital group and four in the in-hospital group (infection rate: .0012 for prehospital patients and .0017 for in-hospital patients; P = .591 by Fisher’s exact test).
CONCLUSION:
Both cohorts had exceptionally low infection rates. No clinically or statistically significant increase in the risk of infection among prehospital- or in-hospital-initiated i.v. lines was identified.
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Thanks for sharing! As a provider who works both in EMS and in the hospital setting, I have started a lot of IVs in both situations. I use the same technique regardless of where I’m working …
The hospital that I work for has a policy regarding IVs: If the IV was placed in-hospital, either in their own facility or in another facility, it may be left in place for up to 96 hours, as long as there are no signs of any complications at the site.
Any IVs that are started by EMS must be discontinued within 24 hours and restarted in another site, period.
Apparently the hospital either thinks that an average hospital room truly is a clean environment, or else believes that EMS providers are out there rubbing dirt on our patients and such prior to initiating IV access … “oops, I just dropped the angio on the ambulance floor … 10 second rule!”
I always wondered if there was any legitimate research to back their policy up.
While I think the whole concept is silly, he asked for a source for the gloves he saw. It was Microflex Gloves that offered a 10 pair belt pack of gloves. Search for “Supreno Cuff First” on google for sources.
How are things in Thurston County? Thanks for the tip, but as you’ll see I don’t use Google. I Bing it, instead.