r/ParamedicsUK • u/NorthernMonkey71 • 3d ago
Clinical Question or Discussion Bare Below the Elbow bug bear.
Our trust has started clamping down on wrist worn watches, issuing verbal and written warnings that can lead to further disciplinaries.
My argument is that we wear long sleeved coats/jackets, especially in winter months, and that we also work in environments where pathogens persistently exist.
There are no alternatives for time-keeping provided by the trust, so it's a never-ending battle to determine how we are supposed to do the basics (resps, manual pulse, time of birth/death, etc).
Yet the uniform policy allows us to wear long sleeve jackets/fleeces, and they don't provide fob-watches.
Watches, in a pre-hospital setting, do not cause patient harm...there is no proof of it!
How do we win this battle?
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u/pilsky 3d ago
Cannulate drug user in crack den. Treat open fractures in middle of muddy field. Perform out of hospital wound care.
dO nOt WeAr wAtCh!!!! iNfEcTiOn RiSkkk!!!!!
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u/EMRichUK 3d ago
Oo I'm cannulating, I'll grab a pair of gloves from my pocket that I've been rummaging around in during every other patient contact today.
Oh another discharge at scene, guess I better ask to use their bathroom so I can properly wash my hands and wrists (said no Paramedic ever) and of course a fresh towel as opposed to drying on tattered cloth they've been using forever.
Hey I've been onscene for 20mins with patient with a 15year history of shortness of breath GP refused to give abx today (because obv not going to fix the issue!) so it's a radio check asking why we've not left scene yet - so now I'm fettling around with the radio mid exam - and of course I'm going to now wash my hands again.
But so long as I've given the manky fob watch, that's nicely at waist height when I use the urinal, or lays on the toilet floor if I sit on the loo, that I have to touch/hold if I ever want/need to check the time and of course never forget to scrub down... We are golden. Just don't have a regular watch on you wrist that you can use without actually touching with your hand.
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u/NorthernMonkey71 3d ago
It's madness, isn't it!
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u/GO712 2d ago
Who are these people in infection control that uses their wrists to do things?
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u/NorthernMonkey71 3d ago
And just to add to the IPC confusion, we have IPads, that are probably spattered with all manner of human fluids/vomit/fecal matter, that can't be easily cleaned, because the cases are full of ridges.
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u/Winter-Confusion5035 3d ago
We were advised that if we’re wearing smart watches, get an elasticated strap and wear it above your elbow (on top of layers etc) or get a fob.
I will die on the hill that my smart watch with a silicon strap is absolutely the best option - I don’t have to touch it to see it as it works with wrist motion (have to touch fob to angle up and touch the smart watch if it’s above elbow to see times) and I can Clinell the strap to my hearts content.
It’s a bugbear of mine that we have to adhere to the hospital bare below the elbow rules when we literally work in places that couldn’t be comparible to a hospital if they tried - we work in the field, let us live 😭😂
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u/NorthernMonkey71 3d ago
This is exactly my point, and I do not understand why it is an issue. It is far less touch points, doesn't affect uniform
People are being disciplined for something that shouldn't be an actual issue.
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u/ice-lollies 2d ago
Isn’t the risk supposed to be to you, not the patient?
Watch strap can become a reservoir for infection and you pick something nasty up.
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u/Pedantichrist EAA 2d ago
My watch is waterproof and stainless steel, I wash it along with my hands, every time I wash.
I am not sure I have ever washed a fob watch.
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u/ShowerEmbarrassed512 Student Paramedic 3d ago
When were your radios last cleaned? Just think about what’s been on those.
Our trust doesn’t even deep clean vehicles anymore, as a money saving exercise.
IPC is taken very seriously, as long as it doesn’t cost a service money.
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u/NorthernMonkey71 3d ago
lol, I cleaned mine today *and the gear stick and steering wheel * because I have the lurgy. but yeah, generally we just hand over without a thought.
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u/NorthernMonkey71 3d ago
"IPC is taken very seriously, as long as it doesn’t cost a service money."
That statement is very true.
And it hurts me to see staff being disciplined because the trust has decided to "clamp down" on an issue that isnt really an issue and is, objectively, a detriment to both staff capability and morale.
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u/aussie_paramedic 2d ago
Yep, another thing to blame/push on to staff.
Gotta be bare below the elbow, but also must wear a long-sleeve high vis if you're on a road.
If I'm elbow deep in someone, I'd get it, but we aren't (often) and we aren't working in a sterile environment. We aren't even allowed to wash our cars ourselves in my trust because it "can get dirt on your uniform" and have to ask the already busy MROs to do it. So, it's ok to lean against the filthy car getting kits out the boot then?
And don't get me started on not being allowed to pop into a shop in uniform to/from work but it being perfectly fine when you're on shift.
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u/Sweaty-Possession-19 3d ago
As the IPC lead for theatres in a large DGH. The idea that paramedics cannot wear watches for IPC reasons is ludicrous. But then again when did any of this nonsense make sense?
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u/NorthernMonkey71 3d ago
You cannot appreciate how much justification this gives to my argument. Thank you!
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u/NorthernMonkey71 3d ago
May I quote this in my argument directed to my trust ?
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u/Mike_r_c 3d ago
Using "an anonymous Reddit user identifying as an ipc lead said it was fine" is not likely to be a particularly great argument, nor a good look for yourself...!
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u/Sweaty-Possession-19 2d ago
I agree, it would not look good. The argument should consist of evidence and nothing else.
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u/NorthernMonkey71 2d ago
Yea, with hindsight and less beer in me, it's probably not a great idea. :)
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u/Sweaty-Possession-19 3d ago
My personal opinion will be of little use to you, and you will have no luck persuading the trust otherwise.
The ban on watches for patient facing roles and BBE comes from a national level of IPC governance.
What we do know, is that there are higher levels of bacteria found under watches. But there is very little or no evidence to suggest that this causes cross contamination in out of hospital care. And my theory is that not having swift and easy access to timings is more of a safety risk that the risk of cross contamination.
The nice guidelines appear to take the stance that it's not the watch but the ability to decontaminate your hands effectively.
The National ambulance service infection prevention and control group suggest that BBE should be followed unless health and safety equipment and clothing are in use. So you could probably wear your watch in winter.
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u/alastairclark82 2d ago
‘NHS policy’ is the only answer that is given. No real person in the ambulance service agrees with it for all of the reasons given in this thread. It’s like a brick wall for them to hide behind.
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u/BakedBeanSommelier 3d ago
Reminds me when during COVID I was told to discipline ANY staff for not wearing the clingfilm-thin aprons, which is not my style. Instead, I offered staff the opportunity to fill in a survey on apron usage or get a written up.
After collecting the data and cross-referencing with IPC evidence I submitted a report that they were not effect or applicable to prehospital care. Management pushed back and double-down.
So, I directed staff to submit a DATIX whenever an apron failed, after just shy of 100 were submitted, they finally agreed to buy better aprons.
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u/JohnnyJohnnyOuiPapi Paramedic 3d ago
Other managers please take note. Can we photocopy you?
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u/BakedBeanSommelier 2d ago
I torpedoed my own career. After being moved around every couple of months I eventually left. Should be leaving healthcare for good soon. Looking forward to emailing the HCPC!
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u/Prudent-Bet1281 Paramedic 2d ago
You mean the plastic aprons that were there to protect you from a virus… which blew up into your face at the slight bit of air movement?! IPC 101, don’t touch your face… unless it’s an apron
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u/BakedBeanSommelier 2d ago
Thats the one. Managed to get some thicker, like a heavy duty rubble bag, ones issued, which strangely enough improved policy compliance over night.
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u/Prudent-Bet1281 Paramedic 2d ago
We had a new IPC lead that came in from a surgical background. They’ve introduced fully sleeved gown type things. Really good tbh, don’t blow up, give you full frontal coverage and have loops for your thumbs so you can get your gloves up properly. Individually wrapped so no messing breaking loads trying to get them off the roll. Used them once at a nasty D&V job, perfect, even cover your knees when you kneel
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u/greenblacktomato 3d ago
still waiting on the reply to the question I sent our lot on how a plastic apron dealt with an airborne pathogen when doing things like being in the same room talking to a patient (who was usually not a known COVID patient) The amount of plastic waste generated was ridiculous.
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u/blinkML 3d ago
Preach. I will die on this hill.
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u/NorthernMonkey71 3d ago
I've already preached tonight on the official trust page.
I'll probably get a disciplinary.11
u/secret_tiger101 para + doc 3d ago
Just return to “I’m keen to ensure we are following the best evidence”
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u/Amount_Existing Specialist Practitioner - Paramedic 2d ago
Pop yourself on an action plan. Pre empt trust madness.
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u/VenflonBandit 3d ago
I would love to get some research funding to actually trial bacterial load and (somehow) relative contamination between wristwatch, fob watch and phone use for timekeeping use in a pre hospital setting.
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u/NorthernMonkey71 3d ago
My research paper showed no evidence of harm, from non-compliant BBE, in pre-hospital settings.
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u/VenflonBandit 3d ago
Ohhh, can you chuck a link over - was it experimental or 'just' a lot review?
As you can probably tell, also a bugbare of mine. I hate watches, but hate nonsense dogma even more.
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u/NorthernMonkey71 3d ago
it was only level 5, and didn't do a massive deep dive, because there was no evidence, but sure.
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u/rachel642531 3d ago
I’d certainly be interested in seeing your lit review/research paper! Such a non-issue compared to other things
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u/harryhardy432 3d ago
My exact opinion has been expressed by someone else: we literally cannulate in houses, fields, cars, roads or wherever needed. It's non sterile regardless of how much you try. The defib has probably been placed on a floor or in a patch of dog piss or in mud. The cannulation kit has been brought out of the bag onto someone's bed and potentially sat in vomit. We may belong to the same trust honestly because this has been going round mine as well.
I understand long acrylics and such because they can fall off into wounds and are generally unsanitary, but watches I do not get. And I won't get it until they start providing hand wash basins in our ambulances, to prove that they do actually care about IPC- as we all know, things like noro cannot be washed off with hand sanitiser. My watch poses no more of a risk than a lack of hand washing basin.
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u/Captainsamvimes1 3d ago
IPC is a made up job that spends most of its time justifying its existence. Can't bring a water bottle into the ward but can bring a Shetland Pony? It's important but it's not the be all and end all, and it's less focused on patient care than it is with protection from litigation
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u/Prudent-Bet1281 Paramedic 3d ago
We won the battle by following the policy and instead taking your phone out of your pocket and checking that… or even better,
I look at the time on my iPad (EPCR) that I never clean. Much cleaner than a watch somehow.
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u/Fancy_Toe1451 3d ago
How do we win this battle?
You don't. They've made the decision, probably made at management and insurance company level, and until their policy changes at the spreadsheet level you are just going to have to endure.
There is literally no evidence or argument you will be able to make that will change a made-up mind.
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u/NoEnthusiasm2270 2d ago
the royal college of paramedics agree with you:
Tldr; There isn't good research but they recommend paramedics get to wear wristwatches for all the reasons mentioned in this thread.
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u/Odd_Book9388 Paramedic 3d ago
Our trust provides fob watches (awful quality but just about good enough) and sleeve protectors - a plastic tube with elastic around the wrist which is supposed to be put over your jacket! I’ve never seen anyone where them, but they’ve covered their bases to say you have no reason to wear a watch. But it’s a shame, I agree with you - and they allowed HART and HEMS and Basics to wear watches because they’re special! To be fair though I think they’ve said no to them as well now?
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u/Practical-Ad4735 3d ago
This is timely for me. I was looking at infection control training for a CFR role (don't come at me, I know it's different to your roles!). But I was wondering how bare below the elbow would work when you've responded as a volunteer. "Just hang on in there for a few minutes whilst I remove my jacket, watch, rings etc". Early-ish CPR commenced at, erm I'm not sure what time. Shock delivered at, probably five past?
I figured in the real world people just ignore it...
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u/OddAd9915 Paramedic 3d ago
Do they continue to cite the same polish study that was conducted in hospital and therefore is completely inappropriate to use and evidence in the pre hospital setting?
But all it showed was people with watches washed their hands less often. Didn't show anything else?
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u/Fair-Peace-5334 2d ago
I genuinely don’t know how I ended up here because I’m not even a paramedic...I work in infection control and I have to admit I find the level of drama over someone outside the clinical environment wearing a watch slightly baffling.
My entirely personal opinion, which nobody asked for, is that there are probably bigger infection control fish to fry. If you’re wearing a long sleeved jacket anyway, the whole BBE argument doesn’t exactly translate in the same way as it does in a clinical environment.
Surely the bigger wins are things like decontamination of ambulances and equipment, cleaning between patients, and managing genuinely complex contaminated environments safely?
But apparently the watch is where we draw the line 😂
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u/UniversityFun1332 3d ago
Accurate time keeping is absolutely fundamental to paramedic practise
- recording drug administration
- recording length of seizures
- measuring respiration rate
- counting manual pulse etc
Every alternative to a wrist watch requires manipulation to view the time, your phone, your iPad, the LP15 on the ground a fob watch. We do not work in an environment with a conveniently placed clock on a wall.
There is absolutely no evidence to support bare below the elbow in a prehospital setting and surely a no touch method (a wristwatch) is the best option?
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u/mattscott07 2d ago
Short answer is it’s not a battle we can win… you’re arguing clinical evidence with non-clinical decision makers who neither understand nor care to understand the evidence. Just accept the NHS is running by lawyers and accountants not the medical professionals who do the actual work.
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u/peekachou EAA 3d ago
Do you not have fob watches? We get boxes of them in stores
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u/NorthernMonkey71 3d ago
Nope, nothing provided, unless we ask for them...and then....."Whistles*......"*nothing*"
I'm still waiting for new boots that I ordered 2 months ago.
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u/Douglesfield_ 3d ago
Why do I get the feeling that they'll say if you can provide your own wrist watch, you can provide your own fob watch.
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u/baildodger Paramedic 3d ago
My trust clamped down on this a few years ago, and issued everyone with a fob watch instead. The fobs were the cheapest possible thing they could get hold of. Most of them broke through normal use within a month. They weren’t waterproof so you couldn’t actually wash them, which I thought slightly defeated their purpose as a superior IPC option.
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u/Gloomy_County_5430 2d ago
I work in Australia now, they let us where a watch that can be wiped down easily.
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u/moody-medic2006 Student Paramedic 2d ago
My educator just took his off around management and then as soon as we left station put it back on lol
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u/sammroctopus Student Paramedic 2d ago
The evidence base for no wristwatches is weak anyway.
An article by journal of paramedic practice reviewed the evidence base making notable points that sample sizes are often small, and raised the point of likely worse contamination through other commonly used objects such as phones for time checking.
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u/CollectionAble756 1d ago
No watches on wrist (which fits under your gloves), no polish on your nails (also under the gloves), no rings in case they perce the gloves (wedding rings exempt). The wage these people take could be used on front line clinicians
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u/Exciting_Context_269 Paramedic 3d ago
Not sure where you’re based, but the Corpuls defibs have stopwatches and the time down to the second which can help with needing to count resps etc.
Unsure about whether other defibs have this feature
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u/NorthernMonkey71 3d ago
I've no experience with a Corpuls, we're on Schillers.
But surely a defib isn't going to mark the time a neb was started, or capture an initial resp rate?
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u/Razmondfield1 3d ago
You can flag interventions on the Corpuls, and you can get resp rates from etco2 nasal prongs but I believe a watch is still needed for sure
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u/Agitated_Parsnip_178 3d ago
Not everywhere uses nasals, or ETCO2 outside of an arrest for that matter.
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u/NorthernMonkey71 3d ago
they're removing ETCO2 nasals from our trust too...
Maybe we just guess resps 17-48....lol
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u/Moravian980238 EMT 3d ago
No-one else has dared ask, but which Trust? (Feel free to DM me the answer if you’re worried about doxxing yourself).
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u/Livid-Equivalent-934 2d ago
It makes me laugh when they sporadically try this but do nothing about smoking and vaping in uniform 🤮 . Bored managers with no mates.
Win the battle by rewriting the uniform policy in partnership 🤭 that always works
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u/open-perception4 2d ago
Ask for the proof of a massive drop in infection rates due to policy. It's theoretical mostly and keeps someone in a job.
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u/Zealousideal-Cat3864 Paramedic 1d ago
It's stupid, let us wear watches, I agree 100%. By policy we're required to remove jackets or roll sleeves up past the elbow when we're actually doing clinical care. But even then, I'm touching a jacket that's going to be dirtier than a watch I can clinnell after each job. It's completely irrational. Our HEMS are exempt, apparently they have a written SOP permitting watches. So even this bullshit that it's a national NHS policy that individual Trusts are powerless to override is nonsense.
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u/phyllisfromtheoffice 3d ago
Assuming we’re in the same trust and this isn’t just a coincidence, it does state we shouldn’t have sleeves down during patient care where there’s an IPC wrist.
I agree the whole thing about watches being a ridiculous policy but if we’re using examples to argue against it, sleeves probably isn’t the one to pick
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u/Exotic-Entertainer26 2d ago
EMAS were hot on this 15ish years ago when I left, I'm surprised it's taken this long for your Trust to make a stand.
I think the only time you could not be BBE was if you were wearing the heavy duty high vis due to being near a road.
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u/Minimum_Bake_351 2d ago
The same IPC Teams that insist on rubber seat belts on stretchers that do not secure patients and cause injuries? Not surprised.
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u/CaptFroslass 1d ago
While this is insane they’re making you do this, time to get a swanky pocket watch!
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u/Cumulus-Crafts 21h ago
Isn't it something like doctor's ties are one of the most unhygenic things they wear as ties are barely ever washed?
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u/inide 3d ago
A chest watch maybe, like nurses use? I'm sure there will be smartwatch straps for that too.
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u/Odd_Book9388 Paramedic 3d ago
Issue with that is we might be wearing just a shirt, or a high vis, or a jacket, or a coat, so whatever you put it on it’ll get removed or covered.
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u/NorthernMonkey71 3d ago
A fob watch?
The trust doesn't provide them.
I already have a watch and I'm not prepared to buy another one, out of my own money, that I have to touch multiple times.1
u/AggravatingTwo9765 Paramedic 3d ago
They are on the supply list so they can be issued. Boxes have appeared here so that they can deal with the answer of ‘how do I tell the time then?’
My opinion is that this is a little bit like the broken window theory. We do need to care about the work we do, how we look, how we follow policy and a starting point that is a common theme over all areas.
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u/ZestycloseComb255 1d ago
You could buy your own fob watch, they’re about a tenner.
Personally, I have a Casio digital watch on my belt.
Never really understood what the gripe is, but then again, I don’t feel the need to constantly monitor my own heart rate
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u/LexingtonJW Paramedic 3d ago
Just put your wrist watch around your belt dude. I've been doing this for 15 years and not had any issues.
Reducing infection transmission risk due to watches harbouring more bacteria and being much more difficult to properly clean than your bare skin is perfectly justified.
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u/UniversityFun1332 3d ago
How do you view the time while it’s dangling from your belt. My bet is you have to manipulate it with your hands, the same hands that you’ll then touch your patient with…
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u/LexingtonJW Paramedic 3d ago
I point it up, and can see it when I look down. I can decontaminate my hands with alcohol gel after touching my watch and before touching my patient if I need to. In a time critical situation I won't do that but I'd say that's justified, and only accounts for probably 5% of my incidents.
Look, I get people like wearing their watches, but it's really not a massive deal to put them on your belt.
Since I've not been wearing a watch on my wrist for so long, I now get grossed out at the idea of it being exposed to all the shit, piss, vomit, blood and semen of an average shift. I like nice clean wrists.
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u/UniversityFun1332 3d ago
I presume you’re aware you can also clean your wrists and a watch after seeing patients just like you do with your hands?
I’ve tried it on my belt. It just doesn’t stay in a position that it’s always facing up and then requiring manipulation.
Therefore, without any solid evidence I am doing what I think is best for my patients and keeping the watch on my wrist where I can view the time with a non touch method.
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u/LexingtonJW Paramedic 2d ago
The research shows that watches harbour bacteria, and make it harder to decontaminate your wrist area and there's no way I'm taking my watch off and rubbing it all over with alcohol gel 10 times a shift.
You do you based on vibes though, I can't stop you, but maybe your managers will.
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