Glove use in Thai hospitals

[sarab00n]

This is something that I have noticed in the past year, which is really starting to bother me - Thais seem to be VERY relaxed about glove use in hospitals, I remember while I was pregnant getting blood tests and shots, and while in labor being put on a drip and no one seemed to be wearing gloves for needle use at all. It was the same whether we were at one of the expensive BKK hospitals or a little rural hospital. The OBGYN did for exams, thankfully. It has been a constant source of argument with my Thai husband and I when we go to hospitals now - him always saying "this is one of the best hospitals, it is fine, they know what they are doing." So basically the blindly trusting the doctor attitude. But having lived among Thais for a few years now, they do not seem anywhere near as conscious of hand/mouth hygeine as westerners. With that in mind it really worries me that gloves are not worn for administering vaccines or taking blood, especially now that my baby son is getting his vaccines here.

Had an argument about this with my husband in the waiting room at Chiangmai Ram hospital last weekend, because I watched the kids before us getting their vaccines without gloves being worn and I wanted to say something, but my husband didn't want to make a fuss. In the end I agreed to pay attention and say something if I thought the needle was not sterile. so i watched the nurse like a hawk, they wiped my sons leg with alcohol, and were very careful and seemingly sterile when handling the needle, it didn't contact anything between removing the cap and injecting, and the nurses hands were clean and finger nails cut short, but still no gloves. I don't get it at all!!! It seems very strange to me as I'm used to western doctors wearing gloves for everything.

My question is - has anyone requested that gloves be worn in a medical situation in thailand and has it gone down OK? I'd rather not just keep quiet to avoid losing face and risking my son getting an infection under the mindset that "it will probably be ok."

[harrry]

Gloves are more for protecting the nurses than the patient.

Handwashing should be practiced a lot more than it is and gloves are sometimes used a substitute. I would not worry about gloves but it could help if you carry a bottle of the alchahol hand wash that is used and ask her to wash her hands with that. It should remind her.

[Sceptict11]

The vast majority of interactions between heath care professionals and patients do not require that the heath care professional wear gloves!

Hand washing is by far the most important technique associated with reducing the risks of "cross infection". Health care practitioners should wash their hands prior to and at the end of any individual patient contact.

Many procedures may require the use of gloves which may be sterile or simply "socially clean".

Giving a simple injection for example would not necessarily require the use of gloves but undertaking a major burn dressing would mandate not only the use of sterile gloves but a sterile gown, a face mask and cap.

What fascinates me about Thai hospitals is the overuse of face masks. I have yet to ascertain why the use of masks is so popular. I have given up asking the reason for masks as the question causes embarrassment and an inability to provide a coherent answer !

It pleases me that the "lay" person is beginning to hear the message about cross infection risk but do not be fooled into thinking that "good practice" is equated with the use of gloves !

[harrry]

I attended a major private hospital in Thailands ed today for an injection. I was there for an hour and during that time I saw at least 6 patients treated. Not once did I observe any handwahing or alchahol cleaning. I did see gloves used a few times.

[sarab00n]

Interesting - thanks for the replies . I think it is just odd not to see gloves being worn as they were when i have been in hospitals in the usa or uk. from what i understand inserting an IV or taking blood definitely requires gloves, and they were not worn for that when i was treated in Nakornthon in BKK while pregnant. vaccines are not sterile procedures so gloves may or may not be worn, but alcohol should be wiped at the site before.

the disconcerting thing is - knowing that thais are less aware of hand-transmission of bacteria and disease etc. (this is not a discriminatory comment, just an observation that my thai husband has also agreed with, thais are often far less conscious of hand washing and sterilizing with hand gel than westerners), AND gloves are not being worn, the combination worries me a bit. now i am a mom i tend to worry about every little thing too so even though it will probably be fine, maybe it will not! the thing with gloves is that you can see them being worn and feel somewhat assured that there is concern about hygeine. you may or may not see the dr/nurse washing their hands and so might just have to trust and hope they have!

I agree with sceptict about face masks - the dr was wearing one at the hospital last weekend and i usually associate that with thais being ill as they always put on face masks when ill. i interrogated the hubby about that in the waiting room too lol - it raised a lot more questions than the gloves.

[Sceptict11]

As a matter of interest the need for alcohol swabbing prior to injections is not clear cut !

http://www.knowledge.scot.nhs.uk/clear/answers/public-health/should-practitioners-use-a-70-alcohol-swab-on-the-site-prior-to-administering-an-intramuscular-injection.aspx

[sustento]

I go for regular blood tests in the UK and none of the phlebotomists use gloves. They do use an alky swab though.

Edited September 23, 2013 by sustento

[David48]

I have to agree with most here.

Gloves are not the #1 Health Issues within Hospitals.

though I was less then impressed with this procedure.

[Sheryl]

In the West, ever since HIV became a problem, it has become standard procedure to practice what is called "universal precautions" i.e. to treat every patient as if they had a blood borne disease. This is for the protection of the health care provider, not the patient. (and to help hospitals avoid law suits from staff who contacted HIV or Hep B on the job).

Certainly they should do the same in Thailand but the fact that they often don't is a risk to them, not you. The gloves used during injection are not sterile.

Note that some procedures require the use of sterile gloves to prevent infection of the patient. That is a totally different matter, and injections are not among them. As long as nothing touches the needle or the inside of the syringe beforehand, the injection is sterile even if done ungloved.

Ditto starting an IV. Which by the way is much harder to do gloved.

[harrry]

In the West, ever since HIV became a problem, it has become standard procedure to practice what is called "universal precautions" i.e. to treat every patient as if they had a blood borne disease. This is for the protection of the health care provider, not the patient. (and to help hospitals avoid law suits from staff who contacted HIV or Hep B on the job).

Certainly they should do the same in Thailand but the fact that they often don't is a risk to them, not you. The gloves used during injection are not sterile.

Note that some procedures require the use of sterile gloves to prevent infection of the patient. That is a totally different matter, and injections are not among them. As long as nothing touches the needle or the inside of the syringe beforehand, the injection is sterile even if done ungloved.

Ditto starting an IV. Which by the way is much harder to do gloved.

Would you like to comment about handwashing. I know the topic was gloves but I think infection control is of concern to many of us.

[Sceptict11]

Believe most now follow the CDC's advise published in 2007 Guideline for Isolation Precautions: "Preventing Transmission of Infectious Agents in Healthcare Settings". ( Now called "Standard Precautions")

Detail here

http://www.cdc.gov/hicpac/2007IP/2007ip_table4.html

There may, of course , be more recent updated guidance

[Sheryl]

In the West, ever since HIV became a problem, it has become standard procedure to practice what is called "universal precautions" i.e. to treat every patient as if they had a blood borne disease. This is for the protection of the health care provider, not the patient. (and to help hospitals avoid law suits from staff who contacted HIV or Hep B on the job).

Certainly they should do the same in Thailand but the fact that they often don't is a risk to them, not you. The gloves used during injection are not sterile.

Note that some procedures require the use of sterile gloves to prevent infection of the patient. That is a totally different matter, and injections are not among them. As long as nothing touches the needle or the inside of the syringe beforehand, the injection is sterile even if done ungloved.

Ditto starting an IV. Which by the way is much harder to do gloved.

Would you like to comment about handwashing. I know the topic was gloves but I think infection control is of concern to many of us.

Hand-washing is of great importance and providers should wash hands between every patient contact as well as before any invasive procedure.

Compliance is any issue pretty much everywhere. And most especially in settings where staff are overworked.

[sarab00n]

some great replies, thank you! As I mentioned before, it is more of a concern to me that handwashing/sanitizing in thailand is not as vigilant, coupled with less consciousness about the surfaces their hands come in contact with before eating/preparing food - which my husband has admitted Thais are not as worried about as us, i have to remind my husband all the time when handling our baby/making food after he has been working in the garden or using the bathroom or fixing under the sink etc and he admits he just doesn't think about it. this alongside no gloves worries me. because we can't automatically assume that the ungloved nurse/dr has sanitised their hands before touching their patients. maybe they have, maybe they havn't. I am not making the assumption that gloves absolutely equals good hygeine as some suggested, but the relaxed hand hygeine in general here worries me especially in hospitals.

[Sceptict11]

I suspect my Thai wife would be horrified by your husbands lack of thought !

Don not judge all by the performance of one

[David48]

While we have to be careful about the serious nasties, I firmly believe that we, in the West have been scared and not seduced by advertising to make out lives as apparently germ free as possible ... and nothing could (apart form death itself) worse for your health.

The rise in Asthma has been linked to overzealous Mothers sterilising everything.

Honestly, the best thing you can do for your kids, apart from the usual course of vaccines is to have a cat and dog in close contact with them while they are growing ... from walking to 1st year of school.

Let their immune system build while it's learning.

[sarab00n]

thanks but im not talking about home life im talking about hospitals - how do you know we dont have pets?

[sustento]

I bet that all proctologists wear gloves at work...

[sarab00n]

I suspect my Thai wife would be horrified by your husbands lack of thought !

Don not judge all by the performance of one

I'm not thats why i am saying it often happens not always

[David48]

I suspect my Thai wife would be horrified by your husbands lack of thought !

Don not judge all by the performance of one

I'm not thats why i am saying it often happens not always

sarab00n ... is English your first language?

[Sceptict11]

I suspect my Thai wife would be horrified by your husbands lack of thought !

Don not judge all by the performance of one

I'm not thats why i am saying it often happens not always

"Observational " research is a valid tool.

However many 1,000's of observations need to be recorded by trained observers against an agreed protocol which has received ethical approval.

At the conclusion of the observational period the results have to be subject to rigorous statistical process before any valid conclusions can be drawn

Casual, ill informed. non professional and infrequent observation mean very little.

One individual health care professional who observes an instance of poor practice should take opportunity to educate and support the perpetrator.

Casual, non professional observers of what they consider to be "bad" practice should ask a polite question along the lines of " Is it not necessary to wear gloves for this procedure".

However, I accept that this can be difficult if one is seeking health care in a place where an individual does not speak the language.

There is a saying which relates to reaching a given destination -------there are many paths and non of them is wrong !

Edited September 25, 2013 by Sceptict11

[Sheryl]

No indication from what I have seen or read that the rate of hospital acquired infection is any higher in Thailand than in the west.

Notwithstanding, the OP's concerns re her husband making the child's food without first washing his hands are valid. But I wouldn't necessarily generalize that an overall problem of infection prevention in Thailand.

[Sceptict11]

Some interesting stats

http://www.cddep.org/tools/methicillin_resistant_staphylococcus_aureus_infection_rates_united_states_and_other_countries!

[ThaiBob]

My treatment at Bangkok Pattaya Hospital is no different than I receive in USA. Any nurse, doctor or medical staff has always used plastic gloves.

[sarab00n]

I suspect my Thai wife would be horrified by your husbands lack of thought !

Don not judge all by the performance of one

I'm not thats why i am saying it often happens not always

sarab00n ... is English your first language?

What on earth is your problem with me and my language now? Do you come on these forums to deliberately aggravate people and prove them wrong, and try and find an outlet for your high and mighty opinions? You took one look at my post and think you know everything about me, and now you are checking my grammar to find fault with me too? Who do you think you are? People like you make coming on here and hesitatingly asking advice about a serious issue without getting judgement and criticism clearly impossible - especially since you took one look at my post and decided you knew exactly what kind of mother I am, and that you know better. It seems like a lot of the responses are just trying to find a problem with everything I've said. Thanks a lot for putting me off posting on here ever again. For everyone else who gave a helpful and thoughtful response, thank you i appreciate it and to sceptict i really hope i didn't offend you or anyone else by seemingly calling Thais dirty, I certainly don't judge one person on the actions of many as you have suggested I do. And I deliberately tried to choose my words carefully to avoid it being interpretted that way but it honestly seems like everyone is so quick to attack and pick posts apart to find something wrong with the phrasing or whatever. I am seriously put off the forum after this - can't you give people the benefit of the doubt instead of being so quick to attack?

[Sceptict11]

I suspect my Thai wife would be horrified by your husbands lack of thought !

Don not judge all by the performance of one

I'm not thats why i am saying it often happens not always

sarab00n ... is English your first language?

What on earth is your problem with me and my language now? Do you come on these forums to deliberately aggravate people and prove them wrong, and try and find an outlet for your high and mighty opinions? You took one look at my post and think you know everything about me, and now you are checking my grammar to find fault with me too? Who do you think you are? People like you make coming on here and hesitatingly asking advice about a serious issue without getting judgement and criticism clearly impossible - especially since you took one look at my post and decided you knew exactly what kind of mother I am, and that you know better. It seems like a lot of the responses are just trying to find a problem with everything I've said. Thanks a lot for putting me off posting on here ever again. For everyone else who gave a helpful and thoughtful response, thank you i appreciate it and to sceptict i really hope i didn't offend you or anyone else by seemingly calling Thais dirty, I certainly don't judge one person on the actions of many as you have suggested I do. And I deliberately tried to choose my words carefully to avoid it being interpretted that way but it honestly seems like everyone is so quick to attack and pick posts apart to find something wrong with the phrasing or whatever. I am seriously put off the forum after this - can't you give people the benefit of the doubt instead of being so quick to attack?

Whoops !

I can assure you that both I and my wife are very difficult to offend !

If you care to review my comments with an open mind I am sure you will agree the remarks made by me were non offensive , not personal and reasonably objective.

There is always a risk associated with commencing a debate on an open public forum. There are always those who , for whatever reason, are less than helpful in their replies.

Whatever !

I wish you well and hope you are not deterred from seeking information/advise in the future.

Sceptict11

[sarab00n]

Thanks sceptict I just felt a bit drained having taken deliberate steps to avoid coming across saying that 'Thais are dirty' in my posts but being interpretted that way. Having fairly and honestly, over a few years of living among Thais - and speaking the language too, observed a general lack of the hand washing/sanitizing awareness there is in the West, and being seriously and I think validly concerned for my baby boy when he is in hospitals alongside sick children and adults (this is a MUCH different situation to when he is at home) while getting his vaccines - I just wanted to know that it is OK, which is why I posted, that is all... yet I am still getting called out as unfairly judging Thais, as an 'over zealous mother' an unthoughtful observer, with no scientific knowledge which is all inaccurate. And now this asking if English is my first language which I can't imagine is not meant to be insulting.. what is that about?? I just came on to ask for some advice so it is a bit draining to get picked apart. Many of the responses were very helpful so thank you all!

[David48]

I'm not thats why i am saying it often happens not always

sarab00n ... is English your first language?

What on earth is your problem with me and my language now? Do you come on these forums to deliberately aggravate people and prove them wrong, and try and find an outlet for your high and mighty opinions? You took one look at my post and think you know everything about me, and now you are checking my grammar to find fault with me too? Who do you think you are? People like you make coming on here and hesitatingly asking advice about a serious issue without getting judgement and criticism clearly impossible - especially since you took one look at my post and decided you knew exactly what kind of mother I am, and that you know better. It seems like a lot of the responses are just trying to find a problem with everything I've said. Thanks a lot for putting me off posting on here ever again. For everyone else who gave a helpful and thoughtful response, thank you i appreciate it and to sceptict i really hope i didn't offend you or anyone else by seemingly calling Thais dirty, I certainly don't judge one person on the actions of many as you have suggested I do. And I deliberately tried to choose my words carefully to avoid it being interpretted that way but it honestly seems like everyone is so quick to attack and pick posts apart to find something wrong with the phrasing or whatever. I am seriously put off the forum after this - can't you give people the benefit of the doubt instead of being so quick to attack?

What on earth is your problem with me and my language now?

Actually, I never said I had a problem with your language ... I factually and I think quite correctly asked if 'is English your first language?' ... is a pure question without tone or accusation.

When you write the words 'I'm not thats why i am saying it often happens not always' ... I think it's a fair question to ask.

Do you come on these forums to deliberately aggravate people and prove them wrong, and try and find an outlet for your high and mighty opinions?

You probably couldn't find a more caring poster then myself. I bend over backwards to assist others here. As a member here, you don't get to almost 8,000 posts on the Forum without some street cred.

You took one look at my post and think you know everything about me,

That's purely your supposition ... I never said anything of the sort. If I'm wrong, and I did say that ... please quote me where I did.

Who do you think you are?

I'm just a member here who is trying help.

Indeed I was judged by my peers last year as the Best Poster in the in the Sub-Forums such as this. Don't look to me ... look to the mirror

People like you make coming on here and hesitatingly asking advice about a serious issue without getting judgement and criticism clearly impossible - especially since you took one look at my post and decided you knew exactly what kind of mother I am, and that you know better.

Please indicate where I said that?

Thanks a lot for putting me off posting on here ever again.

Your posting in the future is up to you. Believe me ... I won't be following you round the Forum.

... can't you give people the benefit of the doubt instead of being so quick to attack?

I had to look long and hard for this one ... and I'm still not sure.

If, and I say if you think this statement http://www.thaivisa.com/forum/topic/669964-glove-use-in-thai-hospitals/?p=6857204 is directed at you ... you have a definite victim mentality. I never mention, nor imply that the comment relates directly to you.

There is an opinion that excessive cleanliness during a child's raising could contribute to the increase in Asthma. Many medical opinions for and against that. To see what I am referring to, read the article here ... Excessive-cleanliness-to-blame-for-allergy-rise

Just as a side note, in your next post you then go on to say ...

... yet I am still getting called out as unfairly judging Thais, as an 'over zealous mother' an unthoughtful observer, with no scientific knowledge which is all inaccurate.

I've read back through every post and nowhere has anyone mentioned that you ...

• called out as unfairly judging Thais,

• as an 'over zealous mother'

• an unthoughtful observer, with no scientific knowledge which is all inaccurate.

You may have been called that in public life ... I don't know, but not on this thread.

The majority of the responses have delivered you the answer that indeed, gloves are not normally required in all situations and hopefully you can rest more comfortably knowing that your children are safe and in the hands of medical professionals who may or may not do things as you are accustomed in your home country.

.

[Sheryl]

OK please cease and desist.

David48, a simple "Sorry if I in any way offended, certainly was not my intention" might have served better.

OP, you may have over-reacted a bit.

In future if a post bothers you or you feel it is unhelpful, just hot the "report" button and a Moderator will sort it out.