How many really use STERILE technique?

Nurses General Nursing

Published

I am having problems passing my sterile technique in lab. I want to know how often you use sterile technique to change a surgical dressing?

I have done dressing changes and NEVER used sterile technique!! I understand the importance of using sterile technique in urinary cath.

I realize that it is a required skill but I just can't seem to get it right!!

Thanks for your input!!

Specializes in Geriatrics, Pediatrics, Home Health.

The only thing I have done that requires sterile technique is a urinary cath. and that was in the lab on a dummy. The only thing I did wrong was putting the gloves on wrong.

This time, I put clean gloves on to change the dressing, kept them on to wash the surgical wound, and put on the betadine. I took them off and put on the sterile gloves BEFORE opening the packages.

Ok now some questions please? :

1.] When you do sterile technique do you use soap and water to clean the surgical wound, 1 day Post op?

2.] When do you apply the betadine?

3.] How do you keep from reaching across the sterile field?

4.] Do you drape the bedside table?

My aim is to do this right so that I can keep my pts. free of infection.

Thanks!!

Up Vote Up Vote ×
Specializes in med/surg.

This happened to me at my clinicals last friday..........

My patient was 104 yo with an infected Stage IV pressure ulcer on her coccyx. I was told to do the irrigation and dressing change. No problem. I start to gather up my sterile dessings and I am looking for sterile gloves when the nurse comes and asks me what I am doing. So I tell her I am looking for sterile gloves to do the dressing change. She say's "oh you don't need those" and also takes the sterile 2x2s from me and hands me a pack or regular 2x2s. Now I am confused. She tells me just to use regular gloves for the dressing change, to include packing the wound and applying new dressing. I was taught sterile technique in class but that all went out the window with this dressing change. I take of the soiled dressing with clean gloves, take off those gloves and don a new pair of clean gloves and do the irrigation and wound packing and apply dry 2x2 dressing. I just get done and Dr. shows up, off comes the dressing. He tells the nurse she needs to pick out some of the dead tissue in there and redress it. So, again, she comes in, using clean gloves, picks out wound, irrigates it, packs it (using the same dirty gloves) and reapplys dressing. I was very surprised to say the least. I felt very awkward as far as saying anything to her. Who am I to question her, I am a lowly student who has only been to 3 clinicals..........but I do feel this was very wrong. If it would have been just myself doing this I would have followed sterile technique.........and maybe I should have just said, No, this is what I was taught.......

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I appreciate the OP's earnest desire to do the right thing myself. NO slamming here. Good advice I see here, so do your best and learn to do it right.. Your patients will thank you!!!!! So do I!

Up Vote Up Vote ×
Specializes in Case Mgmt; Mat/Child, Critical Care.

kwagner....wow, this is hard, when you're not right with the person to demonstrate! It's important for you to learn this though. The best thing to do is to meet w/an instructor ...make an appt to meet at the clincals lab and have her/him demonstrate and then coach you through. This is the person you need to show that you can do this! Plus, it is crucial that you get down sterile technique. Also, clarify sterile, aseptic and clean techniques.

Different institutions will follow different protocols on wound care and many time different MD's will have specific orders for the pt's dressing changes and tx's so I'm not even gonna try to address the questions #1&2. What I will say is that most people take the sterile gloves, open the plastic outer pack and "drop" those on the bedside table, then open this package carefully, edges only, and this forms your "drape" so to speak for the rest of your sterile supplies. Now you can open packs of 4x4's, 2x2's, etc onto this field, not touching anything until after you have gloved and then you are ready to do your "sterile" work. You would not open packages after putting on your sterile gloves, because now your gloves are contaminated.....see....you would now have to put on a new pair of sterile gloves.

As for not reaching across the sterile field, this requires practice and you have to keep an eye on what you're doing. Try to set up your field so you can reach things from the position you are in at the pt's bedside...and take off a lab coat/jacket before hand to prevent it from hitting your field.

Hope this made some sense. Good luck! :)

The only thing I have done that requires sterile technique is a urinary cath. and that was in the lab on a dummy. The only thing I did wrong was putting the gloves on wrong.

This time, I put clean gloves on to change the dressing, kept them on to wash the surgical wound, and put on the betadine. I took them off and put on the sterile gloves BEFORE opening the packages.

Ok now some questions please? :

1.] When you do sterile technique do you use soap and water to clean the surgical wound, 1 day Post op?

2.] When do you apply the betadine?

3.] How do you keep from reaching across the sterile field?

4.] Do you drape the bedside table?

My aim is to do this right so that I can keep my pts. free of infection.

Thanks!!

Up Vote Up Vote ×

I use sterile technique with all my dsg changes.It is VERY important to properly learn to use sterile technique.A word of advice......do NOT reach over your sterile field...EVER.Do not ever bring any dirty items over your sterile field.I know that it is difficult,,,,,but you must learn this.I mean.......patients will be depending on you to use sterile technique on their post op surgical wounds.If you do not...think of the reprecussions...pts will get infections and could loose their limbs/lives.Think of diabetics....and their ulcers.Can you understand the rationale now?this is as equally important as the f/c to maintain a sterile fiels.

Up Vote Up Vote ×

First get all your supplies and arrange them at the bedside.

If you are right handed set up on your patients right side, use the bedside table and set the table to your right side ( your left side should be at the head of the bed, your right to the foot) the bedside table should be at right near the foot of the bed...if you are left handed follow the same but replace right with left. In this setup you should never have to worry about reaching across the sterile field.

Open your dressing tray or whatever you are going to use as a drap, this could be a sterile towel or the inside sterile glove package. Open everything you are going to need for the dressing change on to the sterile field EXCEPT for anything that is not sterile..keep your disposable gloves out. Have all your liquids poured and betadine ready to go. Have a garbage by the table .

So now you have everything you need on the table to your right.

Put disposable gloves on and remove the dressings..throw the dressing out along with your disposable gloves...this is where you made your mistake...you kept contaminated gloves on when your addressed the wound and then you contaminated the betadine and the wound with gloves you used to touch a dirty dressing.

So the gloves go into the garbage with the dirty dressing.

Now you put the sterile gloves on and clean the wound...the wound is considered sterile and two inches around the wound should be treated as sterile also.

To avoid leaning over your sterile field always keep it to your dominant side. You will turn to the dominant side naturally and because it is at your side you wont need to turn your back on it or need to reach across it.

Up Vote Up Vote ×

okay, been doing this soo long I have to really think about it! I only do sterile with any incision period, I don't understand the clean.

POD 1 cabg, sternum closed and dressed now, if not vented becomes OTA, clean gloves remove the dressing. Soap and water to the site, betadine swabs, three of them one swipes neck to belly via midline, the next to one side the remaining to the other, never using it again to cross comtaminate.

chest tubes, clean gloves removes all open ns, three times as many packs of 4x4 as tubes, have betadine, betadine ointment, one of each for each tube, a gauze pad for each and paper tape.

I'm right handed, so I open the NS, place a sterile towel on the patient groin, if they will stay still, if not to the right of your tray which is positioned on a diagonal near their shoulder, NS to the left. Open all the 4x4's dump one group, one for each wound (if that's enough) in a pile. Take the open NS with non dominate, now CONTAMINATED hand, bring it from the front of the tray and wet the 4x4's in that pile. return the NS by backing away from the front of the tray out of the sterile filed then to the left, back on the tray.

Now wipe in a circular motion from center out if cleaning wound. swipe with betadine in circular motion from center out, then grab betadine ointment and squeeze it so it drops on area. Change sterile gloves. grab 4x4's, cover each area and apply tape.

If packing a wound. pour NS onto the amount of 4x4's which you think will be required to pack the wound, always overestimate, then open, keeping ends sterile, two long Q-tips to help gently push into wound. you can now put on sterile gloves and freely grab the wet 4x4's and use the Q-tip to help pack, the place the dry 4x4's and tape.

This was long and I'm so sorry if there is an error, I tried my best to recall what I do. Realize you must follow your facility policy, mine may be different, just as easily as I may have had a brain fart and either forgot something or typed it wrong.

Just ask someone you trust to show you, someone whom you know will do it right and not cut corners. a few months later, then ask them to show you how to cut a few corners WHILE keeping it sterile... you can do it.

Up Vote Up Vote ×

Your directions were clear and helpful. Wish i had you during clinicals!

Up Vote Up Vote ×
Specializes in Geriatrics, Pediatrics, Home Health.

QUOTE: "Soap and water to the site, betadine swabs, three of them one swipes neck to belly via midline, the next to one side the remaining to the other, never using it again to cross comtaminate." QUOTE

When you use soap and water, are you using an unsterile wash cloth?

I ask because the only thing I can tell that is different from clean procedure is the sterlie packages and the sterile gloves.

I do NOT understand how a washcloth can be used if we are trying to maintain sterility!!!

Should I be using 4x4 sponges dipped in a soapy solution; or should I be using some other sterile solution?

Thanks! I see lots of things I am/was doing wrong!!

Back to the lab to practice.

Up Vote Up Vote ×

I've often thought of this when scrubbing my hands and arms in preparation of gloving and gowning for surgery - does ANYONE understand how many microbes are in treated city water? Water ain't sterile!

Up Vote Up Vote ×
Specializes in Geriatrics, Pediatrics, Home Health.

Just thought I'd let you know how things went today.

I PASSED!!!

I couldn't have done it with out the support of all of you and my family!! :D :D :D

Thank you all SO much!!

Up Vote Up Vote ×

Let me be the first to say:

CONGRATULATIONS!!!!

Keep up the good work :balloons: :balloons:

Up Vote Up Vote ×
+ Add a Comment