It’s Time for the School Nurse to Retire
Do you remember me from the emergency room? You gave me that IV and took my blood sample. You did not use gloves. While you were stabbing into the crevice of my arm repeatedly I considered how unsanitary it was that you were ungloved. In case you had forgotten, as you were in the middle of a twelve-hour shift and I imagined you were tired, I asked whether you were supposed to wear gloves for needlework. You explained that you became a nurse before AIDS was “a big deal,” and found it difficult to “feel for the vein” with gloves on. Well, my dear, now that AIDS is indeed a “big deal,” I suggest you adapt to the new HIV precautions, “universal precautions.”
Universal precautions, the national standard for Body Substance Isolation and general safety practices, includes a gloving policy that requires, most simply, that nurses don gloves when in contact with non-intact skin, mucous membranes, and bodily fluids of any patient. According to the article, “Gloves and the Questions at Hand,” published in Nursing Management “…glove use in recent years was stimulated by the fear of HIV infection and the Center for Disease Control’s (CDC) 1985 recommendation that health care workers follow universal precautions.” In addition to that recommendation, The Occupational Safety and Health Administration (OSHA) instituted universal precautions as a rule. In the case of more serious threats other standards may be used in addition to universal precautions, but universal precautions is always part of the defense. So, why would a nurse—why would you—neglect these precautions?
Hospitals can choose from a myriad of gloves, though most hospitals opt for a non-latex glove, which employers must provide free of charge to healthcare workers. According to one Doylestown Hospital nurse, “There is a box at every bedside, at least two in every room, and all along the hallways.” Thus, access to gloves is not the issue, though finding gloves that fit was listed in Nursing (“Gloves: On or Off?”) as one of the two most common reasons for not wearing gloves.
The second reason was difficulty locating a vein. A common tactic in attempting to comply with the universal precautions and overcome the difficulty of finding veins is poking a hole in the index finger of the gloves. This unfortunately still violates universal precautions and undermines the effectiveness of the gloves to isolate body fluids.
Perhaps it is not training in needlework that prevents certain nurses from wearing gloves, but training in attitudes. Rural nurses are more likely than urban nurses to take safety for granted. According to a recent study in The Journal for the Association of Nurses in AIDS Care, “selective compliance was related to nurses’ HIV attitudes” and that “Rural nurses’ use of personal protective equipment is not homogenous but discrete and idiosyncratic.” This constitutes a diagnosis-dependant isolation system, though infection is always...