What Should We Do?: Labeling with or without gloves?

Dear Center for Phlebotomy Education: 

After drawing a blood sample, is it good practice to remove our gloves before picking up a pen to write tube labels, or is it better to leave gloves on while writing/labeling, then removing gloves? This would be when drawing blood on non-isolation patients. My staff is arguing that if you label with the gloves on, the pen is then contaminated  with the patient's bacteria as well as the paperwork and the clean area of the bench. Others argue that you shouldn't handle filled tubes without gloves. What should we do?

Our response: 

This is a great question. CLSI's venipuncture standard doesn't state when to remove gloves, only that they must remain intact throughout the procedure. In our mind, that includes labeling. But keep in mind, the venipuncture standard is not an infection control document. That said, we don't think any CLSI guideline is that specific for non-isolation patients.

Keep in mind, gloves for venous access are primarily to prevent exposure to bloodborne pathogens, not bacteria from other sources. Besides, the pen you're picking up is not sterile to begin with. There's probably not a sterile pen anywhere in any healthcare setting (except for surgery, perhaps). While we appreciate your concern about phlebotomists spreading HAIs, focusing on pens is far less important than the role tourniquets and hand hygiene play, neither of which are being effectively managed in most facilities. 

All that being said, there's nothing wrong with keeping the gloves on for the labeling, especially if it's done prior to bandaging. In fact, we would recommend you require it. Sooner or later the pen will be used without gloves, anyway, so it could be argued either way.  If your staff is performing proper hand hygiene, it shouldn't matter. If you think they're not, I'd leave the gloves on until the patient is dismissed. 

Got a challenging phlebotomy situation or work-related question? Email us your submission at WSWDpanel@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)