Do you put on sterile gloves?

[IsseyM]

I've been precepting with different nurses and notice that when they use Choraprep or Duraprep some will use sterile gloves and some will not. The nurses who don't use sterile gloves told me the their rationale is that they are not touching the end of the applicator that is on the skin, they are only holding the handle. The nurses who do use them tell me all preps require you wear sterile gloves because you have the chance of your unsterile hands contaminating your prep. What do you all do and what is your rationale. Just curious.

[mikethern]

In reality, you don't have to wear sterile gloves when using ANY kind of prep solution because once your prep sponge touches the patient's skin, it is no longer sterile. Of course, most people wear sterile gloves anyway. It's a sacred cow.

[ewattsjt]

our facility does it both ways. principles of aseptic technique state that an unsterile object must not cross over the sterile field. that would be a good reason for wearing the sterile glove.

preps only reduce the microbes to an irreducible minimum, therefore even after a prep, some microbes still exist. i would, however, have to disagree with mike's statement. the circulator's hand may contain different flora than that of the patient. if circulator's flora is not killed in the prep, then it may simply transfer it to the patient. their immune response may not be able to handle it in the open wound since it could be a different microbe from that of their normal flora. thus it has potential to create an infection.

[mikethern]

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undraped prepped skin is not a sterile field.

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you do not use sterile technique when you mark the skin with a marker to confirm correct site. you also do not use sterile technique when you shave the skin before prepping. the surgeon also does not use sterile technique if he manipulates the operative site before the prep. the patient's gown is not sterile when it is used to cover the patient during preop. all of these actions can introduce new flora to the skin. after doing all this, it does not make sense to wear sterile gloves to prep, especially since your prepping hand is unlikely to touch the skin.

during surgery, the "sterile" field is not actually sterile because prepped skin is not sterile. if betadine and chlorhexidine were considered unacceptable, then all surgeons would sheet all surgical sites with ioban drapes.

having said all this, i wear sterile gloves anyway when prepping. when in rome.....

[ewattsjt]

undraped prepped skin is not a sterile field.

you do not use sterile technique when you mark the skin with a marker to confirm correct site. you also do not use sterile technique when you shave the skin before prepping. the surgeon also does not use sterile technique if he manipulates the operative site before the prep. the patient's gown is not sterile when it is used to cover the patient during preop. all of these actions can introduce new flora to the skin. after doing all this, it does not make sense to wear sterile gloves to prep, especially since your prepping hand is unlikely to touch the skin.

i see your point but within the same token, most what is listed is prior to the prep. the prep is what is suppose to kill those microbes.

[mikethern]

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It kills MOST of those microbes. Not all. You cannot sterilize skin without killing the skin.

Think of it this way. After the prep is done, the unsterile skin underneath the betadine is constantly touching the betadine. Thus, prepped skin is actually contaminated at all times. This is why some surgeons especially ortho surgeons use Ioban drapes. They do not want their sterile gloves and gowns to touch the patient's skin.

[IsseyM]

Hmm i always wondered why ortho guys used Ioban, thanks mikethern. I was in a case today and my preceptor did not use sterile gloves when she prepped the knee with Duraprep, the surgeon asked her why she didn't have sterile gloves on. I'm not sure if he was being serious or just picking on her cuz those two joke around alot. I think i will use sterile gloves when i'm on my own. I don't see any harm in wearing sterile gloves. I'd rather have sterile gloves on rather than have a surgeon question me about it.

[mikethern]

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Yes by all means do so. Most O.R.'s have sacred cows. As long as it does not harm the patient, do what the other nurses do in order to fit in.

Other totally unnecessary sacred cows:

Wearing a cover gown over your scrubs when you leave the O.R.

Switching blades after you make a skin incision.

Counting laps even if the incision is tiny.

[ewattsjt]

Oh, I love counting rays when a percutaneous needle was the only entry made. LOL. Why count something that would never be able to pack into the wound? but it is our policy.

[Marie_LPN, RN, LPN, RN]

Switching blades after you make a skin incision.

Considering that a prep doesn't kill all "of those microbes," it's not a bad idea for a different blade for below skin.

Counting laps even if the incision is tiny.

Why count something that would never be able to pack into the wound?

Because you never know when the incision might have to go bigger.

I'd rather count stuff beforehand that would be too big to go in, than to wait 15-20 minutes for the flatplate X-ray after an incision went bigger.

[Marie_LPN, RN, LPN, RN]

And i'll always use sterile gloves for a prep.

[mikethern]

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I read an article that stated that switching blades had no affect on infection rates. If you insist on switching blades, then why don't you use Ioban on every case? Your gloves and instruments touch prepped skin, so technically, they are contaminated. What's the sense in switching a blade?

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The issue is not with initial counts. The issue is with closing counts. If you can fit a lap sponge into a 5mm incision, then you should be performing magic in Las Vegas.