Does anybody use sterile technique anymore?

ShantheRN, BSN, RN · Mar 18, 2012

We use sterile technique for all central line dressing and cap changes, accessing ports, and inserting the rare foleys/caths. It doesn't matter if my pt's ANC is 0 or 5000. I did my role transition in an adult hospital and a lot of their procedures were clean instead. It weirded me out.

RNsupermom99 · Mar 18, 2012

I've witnessed doctors reinsert the tube during a straight catheter...on babies even. This physician also made a mistake and inserted it into the baby's lady parts, then tried to insert it into the urethra afterward. Sigh.

hiddencatRN, BSN, RN · Mar 18, 2012

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?

Those would be issues with clean technique too. Just because we're not doing sterile technique doesn't mean we're not following STANDARD precautions.

bookwormom · Mar 18, 2012

The studies cited above are great, but I'm not sure they entirely address the issue of wound care in the current hospital environment, especially with the increase of resistant bacteria.

The first study doesn't early address wound infection rates, rather rate of wound healing and cost. It only includes 30 patients and was done 16 years ago.

The second addresses catheterization in a rehab setting, not wound care in a hospitable setting. Safe practices in rehab and home care are often different than in the hospitable.

The third addresses potential contaminants found on boxed clean gloves. It is certainly interesting, but I'm not sure it is generalizable.

GiantJerk · Mar 18, 2012

I was taught in school to use sterile technique on a new incision or wound, and then clean technique on one that's a few days old. The rationale for switching to clean technique is that the incision / wound has now had time for the patients own bacteria to colonize it, and it no longer needs to be sterile. That's what I learned, and how I practice now in the hospital setting.

cayenne06, MSN, CNM · Mar 18, 2012

The studies cited above are great, but I'm not sure they entirely address the issue of wound care in the current hospital environment, especially with the increase of resistant bacteria.

Yes, those were just studies I found in about 30 seconds on google scholar, so I agree they aren't entirely pertinent. But I still think they speak to the point at hand.

DookieMeisterRN · Mar 18, 2012

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DookieMeisterRN · Mar 18, 2012

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DookieMeisterRN · Mar 18, 2012

I had a surgeon pop his head out of a pt room to tell me oh so seriously one morning, "I need some help in here" in a VRE isolation room. I barely had time to get my gown/gloves on when he pulled up the pt gown and snatched off the soiled ookey abdominal dressing off with bare hands (and no gown). He used alcohol gel on the way out and stepped directly into the wrath of our unit educator who has no qualms about telling one what they're doing incorrectly. Haha, he never pulled that again. Mind you, he is in his early 40's so it's not like he was ever practicing medicine before the use of gloves.

Another surgeon was checking the incisions on a head and neck resection with trach. I had to throw out all the bottles of gauze because he had managed to contaminate everything he touched. He cleansed the trach with a Q-tip and than used the same Q-tip to cleanse the neck incision. OMG, I saw him and knew what he was going to do, I couldn't shove an open sterile Q-tip at him fast enough. Yikes.

I do have to comment on what I've heard,"well if it's good enough for the wound/ostomy nurse to not use sterile technique, why should I".I think that's a bunch of bull. Would you want your family member's health compromised due to sloppy technique and not having "enough time". Of course you wouldn't !

Stop treating your patients like 2nd rate citizens and treat them like you would your own. If we as a whole practiced dressing changes the correct way with sterile technique don't you think infection rates may go down. I would be scared to death to be a patient in some hospitals judging by what I've heard on here!

ETA: thankfully I've left the above floor. I also wanted to add that I'm by no means perfect but I always take the time to practice in the correct way and not what I see my peers doing.

hiddencatRN, BSN, RN · Mar 18, 2012

I do have to comment on what I've heard,"well if it's good enough for the wound/ostomy nurse to not use sterile technique, why should I".I think that's a bunch of bull. Would you want your family member's health compromised due to sloppy technique and not having "enough time". Of course you wouldn't !

Perhaps the wound/ostomy nurse isn't using sloppy technique, but has advanced knowledge about the appropriate supplies and procedures to use for dressing changes? According to the WOCN, for chronic wounds, clean gloves are appropriate for all dressing changes except those involving sharp debridement. http://www.wocn.org/resource/resmgr/docs/clvst.pdf

I'm wondering if folks who are shocked that there are slackers out there who don't use sterile technique have done a literature search on it. Because a quick google suggests that there's not an evidenced-based answer to the clean vs sterile question and that there is actually a lot of professional disagreement on the topic. So perhaps we can drop the accusations of laziness and not caring about our patients.

leslie :-D · Mar 18, 2012

i *think* the concern here, is not using sterile technique when our knowledge base and common sense would dictate otherwise.

as has been stated, some are too stressed/busy to do it right.

those are legit concerns.

and while sterile isn't always (or even often) indicated, doing a dsg as clean as possible, is (always indicated).

it'd be more reassuring to get the sense that everyone agrees with this.

leslie

wooh, BSN, RN · Mar 18, 2012

it'd be more reassuring to get the sense that everyone agrees with this.

I agree, in fact I believe everyone agrees with that.

I think, as I said earlier, that a lot of people are confusing "clean" with "sloppy."

As support for sterile, a lot are using examples of sloppy technique being used, such as being in a VRE room without gown or gloves. THAT is SLOPPY, not "clean" technique!

Clean technique may not be sterile, but it does still include the basics of infection control, gloves, standard precautions, isolation and bug specific precautions when called for.

NOBODY is advocating for sloppy technique.