Dear Center for Phlebotomy Education:

I know my staff is tearing the tips of their glove's finger off to palpate for veins. The problem is, I can't catch them. When I'm in the area, they're on their best behavior, but I hear about it all the time and often find gloves without fingertips in the trash. I know there's a fine for such reckless behavior in the U.S., but we're not subject to OSHA in my country. What should I do? 

Our response:

You are right to be concerned. Even where there is no threat of fines and citations, the consequences can be devastating to the healthcare professional. Often, those who engage in this practice argue that a glove won't prevent an accidental needlestick. They are correct, but that's not the purpose of a glove in the first place. You should bring to their attention the results of a study that showed when a person sustains an accidental needlestick while wearing a glove, the glove's material wipes off up to 86 percent of the potentially infectious blood on the needle before it enters the flesh. Fine or no fine, who wouldn't want that kind of protection?

Clearly, your staff is not going to violate your policy while you are watching. The fact that they're insubordinate when you're not watching is concerning. It's hard telling what other policies they're abandoning when you're not in the area. When you find evidence, you should put the entire staff on notice that you take the violation seriously, and lay out the consequences. Use it as an opportunity to have an open discussion on why they find it necessary. Those who do comply will likely have pointers on how to locate a vein after gloves have been donned for those who don't. Placing an alcohol pad on the patient's skin with a corner pointing to where the vein was initially palpated is just one technique. 

In the U.S., the fine for something as blatant and willful as ripping the tip off of a gloved finger is $129,336 per occurrence plus a citation. All it takes is one concerned employee who sees a safety violation go undisciplined to file a complaint that brings an unannounced inspection. At that point, it's too late to check the trash.

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