Does anybody use sterile technique anymore?

leslie :-D · Mar 16, 2012

i can't think of one good rationale for not using sterile technique...

esp with the outrageously high rates of nosocomial infections in the hospital.

i know of a young girl (16) who was recently in an mva, and her skull was crushed, w/shattered bone fragments embedded in her brain.

she also lost her eye and was overall critically injured.

yet - her dr. discharged her home - from the icu - fearing she would get secondary complications/infections, r/t all the "nasty germs" in the hospital.

NOT using sterile technique is a pervasive threat amongst hospitalized pts...

and we all need to guard their well being by handwashing a zillion times, and implementing sterile technique when it is indeed, warranted.

leslie

tokmom, BSN, RN · Mar 16, 2012

Curious on what you do see? Do you mean the entire sterile field with gloves, etc?

Lexirunner · Mar 16, 2012

We're taught to use sterile technique if it's a new wound (ex. a fresh stoma, trach, etc.), but to use clean technique for most/old wound dressing changes because it's assumed there's already bacteria residing in the wound by that point.

Double-Helix, BSN, RN · Mar 16, 2012

Sterile technique should be used in the hospital setting to reduce infection. Of course, when the patient goes home they will not be using sterile technique, it will be clean. I'll open my supplies sterilely and use the packages as a sterile field. Then remove the old dressing with clean technique, hand hygiene, change into new gloves to clean and redress the wound as sterilely as possible.

In some instances, it's just impossible to maintain sterile technique when changing a dressing. For example, I had a patient the other day with a dehisced abdominal wound and a fistula that was causing liquid bile/stool to literally pour out of the wound. Imagine trying to use sterile technique to clean and redress that while preventing the patient from becoming covered in drainage while the wound is open.

Been there,done that, ASN, RN · Mar 16, 2012

Certainly sterile technique needs to be taught.

I use it for the first dressing change. I believe that is policy in most facilities.

In reality.. we simply do not have time to use sterile technique , after that.

Clean technique would then apply .

cayenne06, MSN, CNM · Mar 16, 2012

I think the rationale for not always using sterile technique would be that it is a waste of time and resources if it is not indicated. Certainly it is indicated in fresh wounds ( I would gather, at least), but good clean technique is just as effective in many situations.

nurseprnRN, BSN, RN · Mar 16, 2012

if the skin is reliably closed and there are no foreign bodies going through the skin (e.g., drains, retention sutures, skin sutures), very clean technique is fine. normal epithelium in a normally-healthy person with good nutrition closes in 18-24 hours.

however, how often do we see people with subcutaneous sutures and healthy nutritional levels? sure, there are some. but don't forget all the ones who don't come to the hospital in such great shape.

it is perfectly possible to do a sterile dressing change with no-touch removal of the old dressings (grab old one with exam gloves and remove without touching wound-- and you can pull off the glove over the old dressing in your hand before you toss it in the trash), put on clean exam gloves and clean the wound with no-touch technique if you are very careful, and then don a sterile glove to place the new dressing.

OCNRN63, RN · Mar 16, 2012

I don't mean to pick on BTDT, but "not having the time" isn't an acceptable reason not to use sterile technique.

sbostonRN · Mar 16, 2012

We use clean dressings in my facility. Rarely I will use a sterile gauze as the first piece against a wound, depending on the area it's in (such as a spinal wound or a head wound). I use sterile technique when draining and applying dressings to chest tubes as well. In most cases, it's cost prohibitive to use sterile technique, especially on something like a knee or hip incision (we see a lot of ortho) that gets exposed to patient's clothing anyways.

LynnLRN · Mar 16, 2012

I deal with a lot of abdominal wounds and my fair share of pressure ulcers and have been told clean technique is good enough that sterile technique is not necessary. I'm sure this is based off of evidence based research (I've never checked myself) but I trust that policies I follow at work are of current literature.

Now for line dressing changes, chest tubes, catheters, things of that nature then sterile technique is always used.

DixieRedHead, ASN, RN · Mar 16, 2012

Now for line dressing changes, chest tubes, catheters, things of that nature then sterile technique is always used.

Tell me the name of the MAN who said catheterizing a woman could be a sterile technique.