Stick to OSHA rules

Q.I have a question about
following the OSHA rules concerning wearing gloves during venipuncture and other invasive procedures. I have seen in practice healthcare workers having difficulty feeling a vein and then poking their fingers through the gloves in order to do so. What kind of legal implications does this practice have?

A.I have a lot of sympathy for those who feel that gloves impede the venipuncture process. When I trained in phlebotomy (the earth was still cooling and dinosaurs roamed the streets), no one wore gloves. Palpating the vein was a simple matter of skin-to-skin contact, and it was much easier.

With the advent of government regulation of workplace safety, and the recognition of a wide variety of bloodborne pathogens, barriers were introduced to protect the phlebotomist from exposure to a variety of germs ones with which we all too often fell ill in the good old days. The purpose of gloves is to help prevent direct contact with pathogens, either from contact with body fluids by surface contamination or by needlestick.

Gloves do an excellent job of preventing contact with surface pathogens by imposing a barrier between them and the skin, especially if the skin is broken or cut. They are less efficient in preventing exposure by needlestick because needles easily penetrate the glove. Even so, there is some evidence that the passage through the glove can reduce the amount of surface pathogen on a needle if it does enter the skin, and thus affords minimal protection in that situation.

It is clear that gloves are for the protection of the phlebotomist, and common sense would dictate that the phlebotomist ought to be able to determine when the benefit afforded by the glove is secondary to his ability to draw blood with the least discomfort and greatest success.

OSHA, however, does not really provide for such latitude. Under OSHA rules and most, if not all, hospital policies for avoiding transmission of bloodborne pathogens, gloves are required for phlebotomy, even when they create difficulty. Poking a finger through the glove is a minimal deviation from the rule (the rest of the glove is still doing its job, after all), but should be strongly discouraged. If the phlebotomist develops hepatitis or HIV infection, it might be claimed that lax enforcement of protective rules contributed to the illness. Almost as bad, a disgruntled employee might file a complaint with OSHA that bloodborne-pathogen rules are being flaunted, triggering a full-fledged, time-consuming and potentially expensive inspection of the lab.

It is probably better to address why the phlebotomist feels that the gloves interfere with palpation. Is it because the phlebotomist refuses to learn the necessary palpation skills to go along with using new equipment, or is it because the gloves provided do not fit well? Adequate palpation requires a close fitting glove, not a one-size-fits all mitt. In any case, proper intervention, equipment and education should solve the problem and permit real compliance with the OSHA rules. Remember, surgeons accomplish the most delicate probing, cutting and sewing not only wearing gloves but also using instruments for the task at hand. By comparison, palpating a vein and drawing blood while wearing gloves is a far easier matter.

Barbara Harty-Golder is a pathologist-attorney consultant in Chattanooga, TN. She maintains a consulting law practice with a special interest in medical law. She writes and lectures extensively on healthcare law, risk management and human resource management.

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