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I am seeking information about doing "clean" dressing changes in the home as apposed to "sterile". With IPS/PPS we are seeking ways to save money. Anyone have a suggestion for documentation to support the validity of this?
Our agency rarely does sterile dressing changes in a home environment, except for central lines. You should be able to have an agency policy on dressing changes that shows your practice standard. As long as you follow your agency policy you should be in compliance with any regulatory agencies. You would need to educate the physicians you service as to what is realistic in the home.
I do homecare in Ontario, Canada. For a clean drsg. change, we have the patient/ family boil or microwave plastic dressing forceps in a coffee mug for 8-10 min. If they're using a pot, it must have a lid. If they're microwaving them, the cup is covered with plastic wrap. If N.S. is needed, table salt is added to the water, using a spoon which has also been boiled.
If I don't have time for the water to cool, because the patient forgot to do the forceps before I arrived, I use a couple of 10 ml ampoules of NS, or I cut open a small IV bag (50 ml minibag if I have one.) Homecare will provide NS in bottles, but it must be discarded 3 days after being opened, so it is more cost-efficient for the patient to make their own.
This system works well, and the infection rate in the home is much lower than in hospital, which is where most of our patients acquired their wound infections in the first place! We use sterile technique for central lines only, and even with central lines, I've had patients who were allergic to the occlusive dressing. We just secure their line with a couple of steri-strips, and cover it with 4x4's and some mesh to hold it in place!
In B.C. Canada where I work , our policy is now this to avoid cross contamination. We very seldom use strile forceps that require boiling for sterelization due to patient's not always doing properly. Also, if we do, we must first scrub the instruments with a brush and wash with soap and water prior to sterilization at home. The protein in bacteria has been showed to stick to the instruments even with boiling and causing infection. We now use disposable trays and instruments for short term dressings changes- use once only and we tend to use 30ml bottle of saline. If needed for irrigation, I also tend to use several bottles of 30ml to avoid waste. For chronic wound care, we ensure proper teaching with the patient and or family for instruments cleaning and making of saline at home and we consider this technique as clean as opposed to sterile. We also inform and obtain a doctor's order for clean technique. This is only used for chronic wound care.
In home health we use mostly clean technique, for most dressings, sterile for central lines/piccs, etc. If the wound is a deep wound in a body cavity, then we use sterile. We no longer have clients make up their own saline, we usually use saf-clens,a spray which works well, as can be kept long term for cleaning, and usually use N/S that clients purchase for themselves. We have a policy, and procedure to reflect this. Clients must purchase their own supplies, unless there are extenuating circumstances, and then we purchase for them (the agency, not me). We also have wound care clinics for clients to be referred to, and we try a lot of different wound care products to try for different wounds, especially the chronic ones.