1. Huber, Deb A. MSN, ARNP, CGRN

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As I was reviewing the Society of Gastroenterology Nurses and Associates (SGNA) online Discussion Forum, I came across a topic to which I had not given much thought. This topic at times seems so simple, but, in discussing it with others, it can become very complex. The topic pertains to wearing gloves when setting up an endoscope for procedures. To wear gloves, or not to wear gloves?


The initial posting on the Discussion Forum asked whether it was common practice in gastrointestinal (GI) labs to wear gloves when placing valves in the endoscope or when setting up an endoscope prior to a procedure. It seemed to be of especial concern if the patient was in the room during the set up. Are wearing exam gloves (not sterile gloves) better or more appropriate than simple hand washing?


We can look at this from a couple of different perspectives. You can do the same tasks equally well with or without gloves. Is one "cleaner" than the other? Is that our perception or is that the perception of our patients? When the public sees someone in a medical facility wearing scrubs, perhaps a cover gown, and gloves, do they get the impression that we are cleaner or more sterile than we would be in street clothes? We know the falsity of that believe from working in a safety-conscious environment. People can contaminate themselves in many ways. We have seen a healthcare professional go from one room to another wearing the same pair of gloves. We may ask a peer to brush a strand of hair from our face or to scratch our nose while they are wearing a pair of gloves.


We also expect that healthcare professionals do regular and meticulous hand washing. Endoscopic procedures are not sterile procedures, and the GI tract is not sterile. Look at what children put into their mouths on a regular basis!! When we go to a restaurant, are the servers wearing gloves or do the kitchen staff wear them when they are preparing our food? Most of us don't know the answer to this question, as we don't see the food preparation (which may or may not be a good thing).


I'm going to date myself again, but I can remember when gloves were not routinely worn for procedures (before the times of universal precautions). This was true not only of nurses but also of endoscopists. We look back now and can't believe we did such things, but that is how practices have evolved over time. We often see how pendulums swing from one side of the issue to the other. We need to find the center that encompasses safety, efficiency, and cost.


When we started fighting viruses, such as HIV and hepatitis C, we found employees working in protective garments that covered them from head to toe so as to avoid any contamination. Some of these garments were hot, cumbersome, difficult in which to work, and expensive. In addition to being a physical barrier against contamination, it was a barrier to the patient. We were not as accessible or as personable. Touch is a very important component of comforting the patient. Is some of that lost with barriers such as gloves?


Does the concern come strictly because the scopes are being brought into the procedure room and the patients are already there? Many units do their set ups before the patient is brought in. Sometimes simply seeing the scope itself invokes apprehension in a patient. Can the valves be put in the scope and the scope placed in the room before the patient arrives? If this is not possible, is it more reassuring to the patient to see you put gloves on, bring in the scope, and insert the valves? Again, who are we doing this for? Is this for the benefit of reassuring the patient of safety, or do we feel staff may be unsafe in handling the scope?


A gastroenterologist recently told me that in one of the units in which he does procedures, staff document the physicians' hand washing. My question to the physician was "Why?" With the use of universal precautions, everyone gloves for procedures. What does documenting hand washing prove?


I'd like to assume that all of us in healthcare wash our hands between interactions with patients, but we know this isn't always the case. Again, with gloves or without, contamination can occur. How many times in your training and experience have you seen a sterile field easily contaminated? Many times this is blatant, but sometimes it is unnoticed.


I did a quick "straw poll" of some nurses who do procedures and asked whether they use gloves when setting up scopes. Their replies and rationales varied, but all had good responses. On the "pro" side for wearing gloves, it was felt that it may give added protection from contamination. It was also felt that there may be exposure to chemicals when handling medical equipment, so wearing gloves protects the healthcare worker. It was also felt the patient may view staff wearing gloves as a sign of a cleaner or safer practice.


On the "con" side, it was felt that contamination was not truly prevented by wearing gloves. Contamination can occur with or without gloves. Is this something just being done as a pretense to the public, suggesting that it protects them? Hand washing offers just as much protection as do gloves, and contamination can occur with either.


Each practitioner needs to evaluate the situation for what is best for him or her and the patient. Again, there is no right or wrong answer as there can be equal cleanliness or contamination with or without gloves. Patient concerns are valid, but discussing things with patients, clarifying, or teaching play a role that is as important as observation. I believe each healthcare worker needs to do what is best in the given situation-to glove or not to glove remains a question for each individual practitioner.