Universal precautions are not just to protect us
Do your part to limit the spread of infectious disease and hospital-acquired infections by improving your hand hygiene practices
One morning, a Joint Commission site surveyor was on a Med-Surg floor, when a BLS ambulance crew came in to transfer one of the patients to another hospital. The crew came out of the patient’s room with their gloves on and grabbed the hospital’s automatic blood pressure cuff, which was on a rolling cart in the hallway. They used it to take the patient’s blood pressure, and returned the cart to the hallway. The surveyor made a note that the cuff and cart handle were not cleaned before or after use and that the EMT had the same pair of gloves on the whole time.
Next, the EMT walked over to the counter at the nurse’s station, and entered the patient’s vital signs in her tablet computer with the same pair of gloves on her hands. A nurse came out of another patient’s room and asked if anyone could help him move his patient from a wheelchair back into bed. This same helpful EMT volunteered and went into the room, helped move the patient into bed. She then went back to transfer the original patient to the other hospital. The whole time she had the same pair of gloves on.
The surveyor reported her observations to the hospital administration with the admonition that the hospital would be penalized in the report for the unsafe actions of the EMT. She added that the hospital is responsible for the actions of EMS providers while they are in the facility.
This story was instantly shared with sister hospitals in the network.
That afternoon, a nurse educator working a shift in the ICU at one of these hospitals was at her desk. She observed an ALS ambulance crew doing an urgent transfer pushing their patient out of the hospital room with the same gloves on that they had used to move the patient onto their stretcher. One of the providers came over to the counter at the nurses’ station, wearing the same gloves, and picked up the patient’s transfer paperwork and touched the counter.
This nurse followed the crew to the ambulance and attempted to explain the risks of cross-contamination and why they needed to use better hand hygiene practices. Unfortunately, the crew was not receptive, stating, “Yea, that’s not going to happen,” as they pushed the elevator button (with the same gloves on).
Immediate steps to improve hand hygiene
Most of us were taught that universal precautions and the use of gloves are to protect us from getting sick. That’s only part of the equation. It’s time for us to join the rest of the healthcare world and protect our patients as well as we protect ourselves.
Over the last few decades, I’ve had the opportunity to ride with hundreds of fire, private ambulance, third service, air and hospital-based EMS crews throughout the U.S., Canada, Europe, Australia, Israel and Palestine. I’ve yet to see one crew that practiced hand hygiene that would allow them to serve burgers and fries at an average fast food restaurant. Ninety percent of the time, the gloves go on before we arrive on the scene and only come off after the stretcher has been re-made at the hospital.