Ask the expert: What, no gloves needed in blood donation centers?

By: May 12th, 2011 Email This Post Print This Post

Q: I am a phlebotomy instructor who always emphasizes adherence to wearing gloves when drawing blood. One of my students told me that he regularly donates blood and platelets at a blood bank that has a sign on the wall that states, “Gloves are not required when drawing blood. If you want your phlebotomist to wear them, you must request them.” I have never heard of this. Is it correct?

A: OSHA’s Bloodborne Pathogens standard does make a glove-wearing exception for phlebotomists in volunteer blood donation centers. Sections (d)(3)(ix)(D)(1–4) explain that if an employer in a volunteer blood donation center judges that routine gloving for all phlebotomies is not necessary, then the employer shall periodically reevaluate this policy, make gloves available and not discourage the use of gloves by employees of the donation center, and provide gloves during training.

“Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens” explains: “Paragraph (d)(3)(ix) (D). The exemption regarding the use of gloves during phlebotomy procedures applies only to employees of volunteer donor blood collection centers, and does not apply to phlebotomy conducted in other settings such as plasmapheresis centers or hospitals.”

Comments

By Jerry Petersen on May 13th, 2011 at 10:24 am

Really? OSHA is really dropping the ball on this one. OSHA should be fined for allowing a group of employees to be at increased risk of exposure. I hate to bash OSHA because I know the organization does a lot of good for many people, but what was the thought process behind the decision to allow such a total lack of consistancy?

By David LaHoda on May 13th, 2011 at 11:14 am

The reasoning for this exception can be found in the section 9 of the preamble to the Bloodborne Pathogens standard. In brief, the Council of Community Blood Centers, American Association of Blood Banks, American Blood Resources Association, and American Red Cross argued that their workers were at less risk for bloodborne pathogens transmission than other healthcare workers. Apparently OSHA agreed.

I personally don’t buy the explanation, but somebody did.

I totally agree with you David. OSHA basically backed down under the pressure of groups like the ARC. I do not see any significant difference in risk of blood exposure from standard phlebotomy as from blood bank phlebotomy, yet OSHA makes a specific carve out exception for blood banks.

Of interest is that OSHA also says you do not have to wear gloves when doing regular injections as long as exposure to blood is not anticipated (http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=20819)

I can tell you from experience, that patients expect you to wear gloves and are not shy of telling you so. The public feels it is protecting them from things the person giving the injection may give to them.

^^Agreed–puncturing the skin with a needle to obtain blood in a donor setting is the same as puncturing the skin in a non-donor phlebotomy setting; you’re still making a hole where infection and exposure can occur in both settings. Not to mention the fact that the patient/donor and/or the tech obtaining the sample could also have an infectious skin rash/disease/fungus that could be passed on without the barrier protection of gloves. But too, people being subject to free will, can choose to adhere to or ignore warnings and mandates and take their chances as far as using or not using gloves for PPE. I personally wouldn’t fool around with not wearing gloves in any patient specimen setting; that’s no different than the population using condoms with some of the people but not all of the people because that group there doesn’t look like they might have cooties when in fact, no one can really tell for sure what anyone might be harboring in their blood and body fluids. Yuk.

I am at least glad to know about this exception. I agree it does not make any sense but then most lobbied exceptions do not. In response to Lisa’s comment about individual free will. While it is true people have free will, unfortunately in other settings OSHA holds the emoployer accountable and liable for their employees’ actions. When an exposure occurs it is the employer who pays the financial cost of testing and if needed treatment. If the employee is not satisfied with the follow up, most likely they will sue as well.

I was so dismayed to read about this OSHA exception. I have lost TWO nurse colleagues to HIV infection over the years. ONE had a needle stick exposure and one was exposed to a large blood spill when a needle disconnected from a syringe and sprayed her hands with blood. She washed up immediately, but did have chapped hands and small cracks in her cuticles. These events occurred in a “LOW RISK” PRENATAL CARE OUTPATIENT SETTING, before gloves were mandatory and before prophylaxis guidelines were established. Both nurses went merrily on their way since they were working in a “LOW RISK” SETTING, until they became ill and subsequently succumbed to the disease.

I think this is totally ridiculous. OSHA mandates everything in Healthcare (that is what I tell my students). I am not a judgmental person; but from experience it seems to me that a “blood bank” or “plasma center” is the one place that a phlebotomist would wear gloves! But, then again, the “plasma centers” hire off the street and train people to do what they do, they are not healthcare professionals, but people that need jobs. They go into the work for the money not any “I want to help” philosophy! Where I live they start a “greeter” at the plasma center at $12.00 per hour and they will then train them to do phlebotomy after 3 or 4 months and pay them $17.00 per hour. This is absurd! I think the whole “plasma donation” business needs a closer look by the powers that be! My experience is that the poor, unemployed, possibly homeless alcoholic and drug abusing populations are donating plasma. So, a 19 year old with perfunctory infection control training gets a job and then decides not to wear gloves because “it’s not required” and becomes infected with a potentially fatal disease. This needs to be revamped ASAP!

Holy crap! I gave blood today and the phlebotomist wore the same gloves while collecting blood from myself and two others. She actually stuck one guy then came over to take the needle out of my arm. I asked her to please change her gloves and she did reluctantly. She went into a long explanation of why she didn’t change them. Sorry, but as a phlebotomist, I find it very disturbing that OSHA has such a double standard when it comes to gloving up. As long as there are people, blood, and needles being used there is an increased risk to the employees as well as to the patients.

By David LaHoda on August 17th, 2011 at 4:31 pm

Cindy:
What was her explanation? I’m sure it was lame.

what else is intersting is that the CDC says you dont have to use gloves to give immunizations which i would kinda understand due to lack of blood your dealing with however you still do deal with blood yet you dont have to wear your gloves

Craziness! I recently had a blood draw by a phlebotomist at a lab for medical reasons and she did not wear gloves. I was so shocked and it was so unexpected I didn`t say anything. When it was over though I got angry and I called my regular Dr. office who refer me to a Customer Service number for the hospital the lab was affiliated with who then referred me to a phone number for the person in charge of the lab. I haven`t heard back and it would be just my luck that the person in charge and the lady who did the bloodraw are same person. Then I went to my regular Dr. office for a bloodraw because I refused to go back to that lab, and believe it or not, I had to ask the nurse who did the booldraw there to wear gloves!!! She was irritated too, I could tell, but she put them on. Then she gave me some explanation about their office getting new gloves with texturized finger tips that made it hard to feel veins. I told her I was sorry to make her job harder for her (in a nice tone). She responded with “Well we got the job done. That`s all that matters” Personally, I disagree. Getting the job done safely and the right way, is what matters most. What a careless medical professional!

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