(Editor's Note: This feature was adapted from an article originally appearing in Phlebotomy Today-STAT!, reprinted with permission from the Center for Phlebotomy Education Inc.)
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. Fast forward to 2010. According to survey results published in Phlebotomy Today-STAT! on glove use, many healthcare professionals who draw blood are routinely non-compliant. The results of the survey are as follows:
Survey Question No. 1: How would you describe your glove use during phlebotomy procedures?
I always wear gloves: 90.5 percent
I usually wear gloves: 4.2 percent
I seldom wear gloves: 4.2 percent
I never wear gloves: 1.1 percent
Survey Question No. 2: Do you ever tear the fingertip off your glove to palpate a vein?
Yes: 17.9 percent
No: 82.1 percent
Always, Always, Always
The good news is the vast majority of survey participants (90.5 percent) indicated they always wear gloves during phlebotomy procedures. The bad news is that 15 percent of those promptly rip off the fingertip to palpate for a vein. Overall, nearly 18 percent of all survey respondents do the same.
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 percent who reported they do not always wear gloves during phlebotomy procedures, nearly half (44 percent) 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.
When is a Glove Not a Glove?
Factoring in the "tip rippers," the actual percentage of those surveyed who always wear intact gloves is only 76 percent. As gloves by definition have fingers, removing a fingertip essentially removes the glove and creates only an illusion of compliance with OSHA's Bloodborne Pathogens Standard. When a fingertip is removed from a glove, its intended purpose as personal protective equipment is lost. According to OSHA, "disposable (single use) gloves ... shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised."
It's All About Timing
While glove use in the U.S. is mandatory, it doesn't have to be a barrier to performing phlebotomy procedures. OSHA does not specifically state when during the course of a venipuncture the gloves must be donned. To aid compliance, the Clinical and Laboratory Standards Institute (CLSI) instructs collectors to put on gloves after site selection and just before site preparation. One exception being draws performed on patients in isolation.
Glove Protection: Facts and Fallacies
If you think gloves are unnecessary because blood splashes and splatters don't occur during phlebotomy procedures, think again. In 2008, DenLine Uniforms Inc., of Quincy, IL, in conjunction with the Center for Phlebotomy Education, conducted a national survey of healthcare professionals who perform blood specimen collection as part of their assigned responsibilities in the workplace.
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