Does anybody use sterile technique anymore?

umcRN, BSN, RN · Mar 17, 2012

Clean technique for any wounds I've seen on the two units I work on (NICU/Peds CICU)...and that includes midsternal incisions. Sterile line dressing changes & foley cath placement...our chest tube dressings aren't even sterile.

I recently had surgery and had 50 staples across my scalp and never had the wound cleaned while I was in the hospital. The first dressing was removed by the surgeon and I was told not to get it wet until after my staples came out 10 days later, no new dressing, no cleaning, nothing.

bookwormom · Mar 17, 2012

So, it looks like the reasoning for those who do not use sterile technique to change dressings in the hospital is:

Too expensive

Too time consuming

Unnecessary because skin isn't sterile

Unnecessary based on what we see respected colleagues doing

Some thoughts:

Are these reasons are good enough, given the frequency of hospital acquired infection? That is to say, would increasing attention to sterile dressing procedures reduce the incidence of wound infections? (It's possible that there might not be an decrease.)

If patients don't require sterile dressings, does that mean that this skill need not be included in professional nursing education?

What then should be the standard for clean technique if it is to be advocated? Are sterile supplies required? Gloves? Is it okay to take the dressing tray from room to room? Does it matter if one part of the patient's body is colonized with a pathogen when we are dressing a wound in another part?

bookwormom · Mar 17, 2012

I guess I should state what I am seeing: use of clean gloves, sterile 4x4s etc , picking up 4x4 with gloved hands, never forceps, using one's own scissors to cut tape and packing (e.g. iodoform gauze). This is for central lines, fresh and older wounds in orthopedics, abdominal surgery, etc. Urinary catheterizations are the only thing I have seen done with sterile technique on the floors where I have had students.

leslie :-D · Mar 17, 2012

personally, i believe some have just become careless, apathetic, rushed, or just don't truly understand (cross) contamination...

and i've seen it more often with drs.

it boggles the mind.

in nsg school, we observed a team of drs packing a pt's back that was totally open (had all hardware removed).

there were total of 4 drs, 2 on ea side of pt.

2 of these drs were gloved, 2 were not.

i certainly don't use sterile technique on all wounds...

but am extra vigilant for those that are draining, as well as pts who are immunocompromised.

always clean my scissors with alcohol wipes, inbetw pts...and even my stethoscope i wipe clean.

and keeping my pts immediate area clean, has always been important to me.

just because an area may be colonized or unsterile, doesn't mean i want to add anything more in terms of contaminating.

yet everything seems to be much more casual these days.

i don't understand.

leslie

dudette10, MSN, RN · Mar 17, 2012

So, it looks like the reasoning for those who do not use sterile technique to change dressings in the hospital is:
Too expensive
Too time consuming
Unnecessary because skin isn't sterile
Unnecessary based on what we see respected colleagues doing

Re: too expensive. You used the example of iodoform gauze packing. Having had to do that a few times, it is indeed too expensive to open suture kits for a sterile pair of scissors for every change. The best one can do is used sterile q-tips to pack the cleaned wound, and clean the scissors with alcohol prior to cutting the strip. That would make the technique "clean" not "sterile."

I'm thinking through the process for dressing/packing changes, and I can't visualize any technique in which it would be completely sterile. There are cleaner techniques than others, certainly, but completely sterile?

Are these reasons are good enough, given the frequency of hospital acquired infection? That is to say, would increasing attention to sterile dressing procedures reduce the incidence of wound infections? (It's possible that there might not be an decrease.)

There would have to be research on this. I would think cleaner-than-clean technique vs. sterile would be good variables to include.

At any rate, just changing out the clean gloves between removing the dressing and applying the new one would be a step up in practice for some nurses!

If patients don't require sterile dressings, does that mean that this skill need not be included in professional nursing education?

I think it should be included, even if not practically used on the floor.

momof2guys · Mar 17, 2012

Unless your a inexperienced GN we all should know when to use sterile technique. With that been said if your using clean technique instead of sterile bc your to busy, wrong supplies or ...... This is not best/acceptable nursing practice, with not so good outcomes for patient or nurse. If your unsure if that wound or dressing change should be done using sterile technique stop and ask.

anotherone, BSN, RN · Mar 18, 2012

I try to use sterile technique as much as possible. or at least REALLLLY clean technique. there is a scary lack of that from many people. recently, I had a doctor I assisted with a big dressing change say, "ideally this would be sterile but it is not and is already infected with bacteria." well why add more, maybe even some resistant to current antibiotics?

cayenne06, MSN, CNM · Mar 18, 2012

People, I will try to get back here with some better references, but there are numerous studies that back up clean technique vs sterile in many situations. Obviously sterile technique is still called for in many circumstances, but as we learn more about nursing and medicine, it is normal for standards of care to shift and change. Clean technique is not "less than" sterile technique, as many are insinuating. It is simply different.

These are just a few abstracts, but you get my drift.

http://www.sciencedirect.com/science/article/pii/S1071575497900437

http://cre.sagepub.com/content/20/6/461.short

http://www.sciencedirect.com/science/article/pii/0002934393902117

Time and money are two very good reasons to only use sterile technique when it is evidence based.

wooh, BSN, RN · Mar 18, 2012

People act like for "clean technique" we're going and wiping the toilet with the gauze before we pack the gauze.

The basics of infection control are still happening. You're not going from a room with MRSA, where you dipped your ungloved hand in whatever hole has the MRSA, skipping handwashing, then changing the dressing in the next room.

We still have isolation. We still have standard precautions. We still have handwashing.

PureLifeRN · Mar 18, 2012

As an OR nurse I understand the necessity for sterile technique for a lot of dressing changes. But if you arent prepping the skin with betadine paint or some other type of skin prep, I'm not sure it would make that big of a difference and would think clean technique would be fine. But I think this is why surgeons like to do their own first dressing changes, so they are the ones in control. After the first one is done, they usually dont mind if the nursing staff does the dressing change.

dudette10, MSN, RN · Mar 18, 2012

People act like for "clean technique" we're going and wiping the toilet with the gauze before we pack the gauze.

:yeah:

wooh, BSN, RN · Mar 18, 2012

After the first one is done, they usually DEMAND THAT THE nursing staff does the dressing change SO THEY DON'T HAVE TO.

Fixed that for ya. :)