Thursday, August 22, 2013

Gloves

Resident: "What size gloves do you need? I got out larges for myself."

Me: "I don't need gloves. I'm actually going to touch the patients with... my bare hands!"

Resident: "Oh."

Me: "Unless I have to do a rectal exam." [pause] "I really hope I don't need gloves today."

Seriously though, I never wear gloves when I examine patients. Unless of course, I'm sick... or the patient is icky. For most patients, my bare hands are fine, but for others, mere gloves aren't enough and I'd ideally like to be wrapped up in some sort of germ-proof bubble.

11 comments:

  1. I never wear gloves for a patient exam. So it struck me as odd, a few nights ago, when I took my son to the ER after an anaphylactic reaction to nuts and the ER doc donned gloves to do his exam. All she did was listen to his heart and lungs, look in his throat, and examine the skin on his arms and legs.

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  2. I believe the germ theory is over-rated.

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  3. I use gloves whenever I'm looking at some kind of incision or wound, or of course anything in the groin area. Or doing axillary lymph node exams. Most patients seem unaware of the existence of antiperspirant.

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  4. Only glove for patients in isolation or where...body fluids are involved. or if I've got an open wound on my hands which actually has happened once. Otherwise, I think its weird.

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  5. So glad to read this! In South Africa we are always reminded of the expense of gloves and so we are always asked only to use gloves when absolutely necessary. I once wore gloves for an examination of a child in isolation and actually found it quite hard to figure out what I was feeling (also doesn't help that we hardly ever have small or medium size gloves around).
    I have to say we (students) were very surprised on dermatology though, seeing how little the dermatologists used gloves. I shivered a little, but they seemed nonplussed.
    I'm currently on urology and have seen the registrars doing scrotal examinations without gloves too. That is not something I plan on doing.

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    Replies
    1. ewww God how can I un read the bare hand rectal exam. He needs to wear them for his own good!

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  6. I don't wear gloves unless: isolation/precautions in place, open wound/sore/incision, genital exam, or in surgery.

    Came back to bite me, though....was doing the breast and axillary lymph node exam on a standardized patient. She did not shave her armpits and did not wear antiperspirant. It was wet, smelly, slimy, hairy, and nasty. Now I at least look before I touch!
    ~Jasmine

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  7. In peds, I only use gloves for procedures. Like LP. I just wash my hands after I (inevitably) come in contact with diaper contents. I cannot percuss in gloves, so in situations where it matters (I need to know liver size or track an effusion) the gloves come off in isolation rooms, too. I'm still in a gown, and I'm sure I can do a good job of washing my hands up to the wrists.

    Yeah actually I don't remember the last time I used gloves except for procedures.

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  8. Thank you, thank you, thank you all. My sentiments exactly! Back in the bad old days, nurses hardly ever wore gloves unless it was a sterile procedure or we were dealing with something messy. I admit that I never got proficient at palpating a vein and starting an IV with gloves on. Now, people in the hospital wear gloves to take a blood pressure. It is my opinion that when people do this, they are unaware of the purpose of gloves and are much more likely to either never wash their hands, or to change their gloves, assuming that since THEY are protected, so is the patient. TCG

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  9. I had to break my habit of always wearing gloves once I became a PA. I used to work as a CNA and I quickly learned the lesson of ALWAYS GLOVES ALL THE TIME (seriously). You'd think a patient was fine, but then the bed would be wet. Or they just decided you stopped using antiperspirant or general hygiene after age 70. Or there was some other variety of grossness (blowing their nose/coughing into the sheets comes to mind). But yes, you are correct that gloves aren't necessary for most physical exams, but if I'm doing anything in the axillary or groin region or if it's a procedure, isolation, a wound, or if there's some kind of interaction with a body cavity.

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  10. Not sure if this has changed recently, but we're trained that we HAVE to have skin-to-skin contact during the physical exam, except for mucosal surfaces, open wounds, or patients with special precautions. This includes moving the gown out of the way to palpate lymph nodes, etc.

    Skin-to-skin contact for femoral pulse & inguinal lymph nodes is super fun.

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