nonsterile gloves to do wet-dry packing? This according to a doc!

[chenoaspirit, ASN, RN]

Today I had a patient who had a huge abdominal incision (wet to dry packing). The surgeon came in, removed the packing and started fingering around in the wound...without sterile gloves. I offered him some sterile gloves, he said there was no need, that all dressings just need clean gloves. He said that nurses are taught to use sterile technique because they dont know how to differentiate when to use sterile vs clean so its just easier to teach them to do sterile with all. Needless to say, this patient's abdomen is infected. Hmm, I wonder why! That ticks me off. This was all said over the patient's bed. She was so upset and I dont blame her!

Now correct me if Im wrong here, but those gloves are in those rooms thru multiple admissions/discharges and they are GERMY! Ive seen this doc go from room to room and fingering around in wounds, not washing hands in between and carrying a soda in the rooms with him! GRRRRRRRRRR. ANd we nurses get blamed for the spread of MRSA.

[nerdtonurse?, BSN, RN]

Hmmm...wonder if he's the guy my hospital just let go because he KEPT KILLING HIS PATIENTS.....

This surgeon did the same kind of things -- wouldn't put on any gloves, fingering incisions, then blaming the nurses when they got infected (hello, I've got on gloves and a mask, you've got on a pullover and khaki's, which of us is the big walkin' fomite?)

Document, document, document!

[Blove86]

I think he should be reported, that's not safe, and you would think he would know better. I tell ya, just goes to show all the education in the world and still ignorance and lack of caring reign!!

[Dolce, RN]

Well, I guess I am in the minority here, but I have seen many, many docs ordering clean dressing changes as opposed to sterile ones. I don't have the studies that demonstrate this but I have heard that the evidence doesn't necessarily support sterile over clean dressing changes. Again, I don't know what those studies were but I am just stating what I have seen. I have done very complex dressing changes with extensive tunneling, wet-to-dry, etc as a clean dressing change.

I would like to see research support one or the other. Sterile dressing changes, as we all know, are very expensive. There should be some sort of evidence to support them.

[AirforceRN, RN]

From my experience...docs are by far the least compliant with sterile fields.

Whether the dressing is "clean" or "sterile"...does it take that much more effort to put on a pair of sterile gloves? I don't think so, I do it anyways.

[chenoaspirit, ASN, RN]

Well, we have a HIGH incidence of MRSA and wound infections. Most of the surgical patients end up with an abscess or a wound infection. Its RARE to have a good outcome there. If anyone finds any supportive research to support sterile vs clean for dressing changes, please post. I was always taught sterile sterile sterile! And I plan to continue doing so.

[lsyorke, RN]

Well, I guess I am in the minority here, but I have seen many, many docs ordering clean dressing changes as opposed to sterile ones. I don't have the studies that demonstrate this but I have heard that the evidence doesn't necessarily support sterile over clean dressing changes. Again, I don't know what those studies were but I am just stating what I have seen. I have done very complex dressing changes with extensive tunneling, wet-to-dry, etc as a clean dressing change.

I would like to see research support one or the other. Sterile dressing changes, as we all know, are very expensive. There should be some sort of evidence to support them.

Nope, you're not in the minority. I can't remember the last time I saw someone use sterile gloves for a dressing change.....clean yes, sterile no.(just try to find a sterile bowl in your hospital! ) I work in wound care and we do not use sterile gloves and clean is what is recommended. Our wounds are mainly healing by secondary intention which is not a "sterile" wound.

This has been a long standing debate with many studies. The majority of the studies have found minimal difference in infection rates.

Here's one from the WOCN

http://www.masspro.org/NH/PS/docs/pasteventmaterials/clvst.pdf

[Wicked Wahine]

I'm still in NS (graduate in December, yay!) and my fundamentals book just calls for clean gloves for packing a wound with wet-to-damp dressing. Sterile gauze and sterile saline of course, but just regular old clean gloves (a fresh pair after removing the old dressing). This is also how I've seen it practiced at my clinical sites.

[lpn1313]

I'm with the clean glove club. Although I'd be a little more concerned about the doc that orders wet to dry dressing changes- But then I've never had a doc that does dressing changes.

[EMSnut45, BSN, RN, EMT-P]

I'm in nursing school as well, and we have been taught that if the wound was created in a sterile fashion (surgical), then use sterile technique with dressing changes. If the wound is "dirty" (non-surgical wound, abcess that has been drained, surgical wound that had healed and come open again, etc...), then clean technique is used for dressing changes. The theory is that the "dirty" wound has already been introduced to bacteria/normal flora, and using sterile supplies won't alter the end result and will only cost the patient more money. Personally, I feel more at ease when I use sterile technique when dressing wounds (except when I'm on the ambulance or working in the ER dressing minor scrapes and cuts-- the big, deep wounds I don the sterile gloves and try to be as sterile as possible).

[Altra, BSN, RN]

(hello, I've got on gloves and a mask, you've got on a pullover and khaki's, which of us is the big walkin' fomite?)

What a great line - I think you just made my night.

[chenoaspirit, ASN, RN]

Nope, you're not in the minority. I can't remember the last time I saw someone use sterile gloves for a dressing change.....clean yes, sterile no.(just try to find a sterile bowl in your hospital! ) I work in wound care and we do not use sterile gloves and clean is what is recommended. Our wounds are mainly healing by secondary intention which is not a "sterile" wound.

This has been a long standing debate with many studies. The majority of the studies have found minimal difference in infection rates.

Here's one from the WOCN

http://www.masspro.org/NH/PS/docs/pasteventmaterials/clvst.pdf

That site is referring to "chronic" wounds ...wounds that dont heal in a timely manner. Im talking about fresh surgical wounds. Thats interesting article though!