Survey Says: Glove Use
[Editor's note: Our monthly online survey was so overwhelmingly popular last month that we couldn't help but promote it as this month's feature article. If you participated, thank you. But whether you did or not, we think you'll find the results fascinating.]
In 1991, the Occupational Safety and Health Administration (OSHA) released its Bloodborne Pathogens Standard mandating glove use for all U.S. employees who perform vascular access procedures.(1) Fast forward to 2010. The results of our latest survey on glove use completed by visitors to our website indicate that facilities are still falling short of 100% compliance nearly 20 years later:
Survey Question #1: How would you describe your glove use during phlebotomy procedures?
Survey Question #2: Do you ever tear the fingertip off your glove to palpate a vein?
Always, Always, Always
Not only does OSHA mandate glove use during venipunctures, but whenever it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infections materials, mucous membranes, and non-intact skin.
So if it violates OSHA regulations, why do some choose to draw blood without gloves? Not all who responded fall under OSHA jurisdiction. Of the 9.5% who reported that they do not always wear gloves during phlebotomy procedures, nearly half (44%) reside outside the U.S. where OSHA regulations don't apply. But for the rest, reasons for shunning gloves include the inability to find a vein, not liking the type of gloves available, underestimating the potential for exposure to pathogens, and skepticism regarding the actual protection gloves provide, as illustrated by the following comments:
When is a Glove Not a Glove?
It’s All About Timing
Glove Protection: Facts and Fallacies
Have you heard the old argument that gloves won’t prevent an accidental needlestick? That may be true, but a new study conducted by Canadian and U.S. researchers indicates that glove use by healthcare workers may result in a 66% reduction in risk of experiencing a sharps injury.(4) It has also been reported that gloves can reduce the volume of contaminated blood delivered to the healthcare worker's flesh by up to 86%.(5) With the reduced inoculum, less of the potentially contaminated blood infects the healthcare worker. So, donning gloves might not offer 100% protection, but the risk reduction they provide may be much greater than you think.
Students and Donor Phlebotomy
The Price of Noncompliance
Another cost of noncompliance comes in the form of OSHA fines. In the twelve months ending July 31, 2010 OSHA levied fines in excess of $490,000 for violations to the Bloodborne Pathogens Standard.
Don’t make those most vulnerable and in need of healthcare services wait for “someday”. Do yourself a favor and commit to wearing gloves without exception and not tearing off fingertips. And be your facility's advocate for exposure prevention by nurturing a culture of compliance. Let's face it; some people need to be protected from themselves. Everyone who draws blood without gloves has loved ones depending on them. How will you feel if a coworker acquires a life-threatening pathogen, an exposure you could have prevented had you only brought the behavior to the attention of someone who had the authority to change the behavior? Consider it tough love. Friends don't let friends draw gloveless.
1. Occupational Safety and Health Administration.(1991) Occupational exposure to bloodborne pathogens: Final rule. 29 CFR 1910.1030. Link. Accessed 8/31/10.
2. CLSI. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture: Approved Standard –Sixth Edition. CLSI document H3-A6. Wayne, PA. Clinical and Laboratory Standards Institute; 2007.
3. Ballance, L. Survey Sheds New Light on Blood Splash Exposures. Phlebotomy Today. 2009;10(6).
4. Branswell, H. Love the Glove: Glove use in hospitals appears to cut risk of needlestick injury. Winnipeg Free Press.7/31/10. Link. Accessed 8/31/10.
5. Mast ST, Woolwine JD, Gerberding JL. Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury. J Infect Dis 1993; 168(6):1589-1592.
[Editor's note: For a copy of the CLSI venipuncture standard, H3-A6, "Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture," visit the “Books & References” section of the Center for Phlebotomy Education's website at www.phlebotomy.com/product/8250.cpe ]
This month’s survey question:
UVa Sponsors Needlestick Safety Conference
For registration information, you can view their registration form (pdf).
This fall, healthcare professionals looking for conferences and web presentations have a multitude of options. We've assembled a rundown of all the preanalytical presentations we could find being given this fall in hopes you will find one or more worthy of your presence.
Ernst to Give Keynotes at Alverno, Geisinger
In November, Ernst travels to Danville, Pennsylvania to deliver the keynote address to the 2010 graduating class of Geisinger Health System's School of Phlebotomy, which was newly established last year. Ernst will motivate graduates to lead by example, and become leaders within the profession.
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 11th year of publication, are reading about this month:
For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.
Q: Is it acceptable to pre-label all collection tubes with the patient’s information, prior to performing a venipuncture?
A: Not at all. The standards are solidly against this practice. The risk is that labeled but unused tubes could be inadvertently left behind and accidentally used on another patient. Let’s say it’s your practice to prelabel tubes before the draw. The venipuncture is unsuccessful after two attempts and you leave the inpatient’s room, forgetting to discard the tubes from your tray. (Or, worse yet, leaving them in the room for someone else to use.) You’ve created a situation that opens the door for all kinds of medical mistakes.
Each month, PT-STAT! will publish an excerpt from our latest publication Blood Specimen Collection FAQs. For a preview and for information on obtaining your copy, click here.
What Would You Do?
Each month, What Would You Do? presents a different case study, then asks readers to contribute their ideas as to how each situation would best be handled. The following month, selected responses will be chosen by the editor and published (sender will be identified by first name and state only). The most accurate, well written response will receive a free download from the Center for Phlebotomy Education’s library of articles. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.
Readers who responded to last month’s case study sure know a lot about protecting patient confidentiality. They also agree that blood is not thicker than the bonds of professional ethics. While several readers expressed sympathy for their sister’s situation, none would allow emotion or family ties to cloud their professional judgment. The two main reasons given for denying the request to access the baby’s test results were 1) it’s a violation of facility policy, HIPAA and/or patient privacy laws (76%), and 2) such action is grounds for termination (38%). One reader shared that such employee queries are periodically audited by their facility, concluding that “it’s not a smart move.” Instead of granting their sister’s request, over 90% stated they would refer her to the nurse or attending physician who could provide not only the baby’s bilirubin result, but its meaning in proper context.
Protecting a patient’s health information is serious business with serious consequences if compromised. Although some readers considered this to be a clear-cut scenario, it’s not an unfamiliar one. Mary from Wisconsin shared “…My own relatives have made similar requests of me in the past until I enlightened them...”
Here’s how another reader described the personal/professional dilemma: “This is a difficult position that many MLTs have found themselves in over the years. On one hand you want to do anything you can to help your family and friends, but on the other hand you have a responsibility to maintain a code of ethics and confidentiality. Having been put in this position myself in the past, I simply explained that I am not qualified to offer this information and that they should speak with their physician or nurse. I also try to calm their worries by explaining that by doing this test, their healthcare provider is offering the best care possible to the patient.”
Heather from Kentucky summed it up this way: “…As a medical laboratory technician, or a phlebotomist, we do not have the right to diagnose, report, or instruct any patient with regard to their laboratory results. HIPAA states that medical information is shared with healthcare givers only on a "need-to-know" basis. In no way is the bilirubin result pertinent to the job of a phlebotomist, even if the lab worker is related to the patient. In this particular case, I would advise my sister that I understand her anxiety with regards to the baby's test results, but she needs to direct all of her questions to the nurse caring for the baby or the doctor that ordered the blood work. It seems to be in the best interest of the medical facility and the healthcare worker to never personally involve yourself in the treatment or care of a close friend or family member. This may help with the temptation to find out information that otherwise is prohibited.”
For her detailed explanation of what every health professional needs to know, Heather will receive a free download from our library of articles
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