Does anybody use sterile technique anymore?

DookieMeisterRN · Mar 19, 2012

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.pdfI'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.

I found this in the above link:

"A review of the literature revealed no specific scientific research studies to support the use of either “clean” or “sterile” technique in any given patient care setting. However, a study was performed that compared the use of sterile saline or tap water for cleaning acute traumatic soft tissue wounds.12 Analyses of strikethrough contamina- tion associated with saturated sterile dressings have also been published.13,14 Clinical Practice Guidelines published by the Agency for Health Care Policy and Research, rec- ommend that “clean dressings, rather than sterile ones, be used in the treatment of pressure ulcers” as long as dress- ing procedures comply with institutional infection control guidelines.6 However, these recommendations are based on expert opinion and not on evidence-based research. It must be reiterated: There is no consensus or expert opinion on the controversy of “clean versus sterile” in the manage- ment of chronic wounds. Expert opinions are based on cur- rent practice and anecdotal notes, not on evidence-based practice. In addition, it should be noted that current practices have not been shown to be either beneficial or harmful."

If there's not evidence based practice who do you believe if there are varying opinions? I'd rather lean toward sterile than clean. That's just my opinion though.

wooh, BSN, RN · Mar 19, 2012

Burn units use clean. If anyone can't handle infection, it's burn patients. Tap water and soap on a washcloth to clean the wounds. If there are varying opinions, I'm going with the experts' opinion which happens to coincide with my experience. Clean technique works. Sterile, when it's not called for, adds needless costs to an already overburdened budget. I'd rather that money go towards staffing than an extra pack of scissors everytime I change a dressing. (Although in reality, I know that money is going into a hospital or insurance company bigwig's bonus check.)

Anna Flaxis, BSN, RN · Mar 19, 2012

What would be the rationale for not using sterile technique when changing postoperative dressings?

In my facility, the surgeon places the first dressing under sterile conditions in the OR. That dressing stays in place for the first 24 hours postop. If it begins to become saturated during that 24 hour period, it is simply reinforced, not changed.

After 24 hours (by 24 hours postop, epithelization, how surgical wounds heal, is well underway) daily dressing changes are performed by RNs using the "no touch" method.

Wash hands, don clean gloves, remove old dressing. Clean around wound with tinted Chloraprep sponge. Have new gauze pad already opened. Pinch new gauze pad between thumb and forefinger, and place the side you haven't touched, which is still sterile, against the suture line. Once the wound is covered with the gauze pad, you can remove gloves in order to secure the gauze into place with medipore squares.

This isn't sterile technique in the true sense: No sterile field, no sterile gloves. But, nothing non-sterile has come into contact with the wound.

Vespertinas · Mar 19, 2012

Tell me the name of the MAN who said catheterizing a woman could be a sterile technique.

I do still try as much as possible. Even if it means bringing in multiple pairs of gloves and certainly extra catheters. Too often I see healthcare workers just shoving em in with no prep and nary a sterile glove. Sad.

coupb8222 · Mar 21, 2012

Hey Everyone. I have a fact sheet for you! There is published expert opinion in this area from The Wound Ostomy Continence Nurses Society.

CDC recommends sterile technique for the first 48 hours of a surgical wound. For chronic wounds there is no evidence that shows any benefit from sterile vs. clean. Of course all of us want what is best for our patients, and you want to maintain the cleanest environment possible.

I love the debate! Follow your facility policy and procedure and your good!

Here is the Fact Sheet which is a Good read (Source the Wound Ostomy Continence Nurses Society)

http://www.wocn.org/resource/resmgr/files/clean_vs_sterile_dressing_te.pdf

drBerry · Mar 21, 2012

I am an old retired practitioner. I was a patient myself recently. Back in the early 50's sterile tech was

required for every procedure.... but now it seems that is ignored by almost all...including the docs. when I chided one he became angry. I think that in the late 60's people had the attitude of "... oh well..antibiotics will take care of any infection"

See where that got us now...

kb

dirtyhippiegirl, BSN, RN · Mar 22, 2012

Burn units use clean. If anyone can't handle infection, it's burn patients. Tap water and soap on a washcloth to clean the wounds. If there are varying opinions, I'm going with the experts' opinion which happens to coincide with my experience. Clean technique works. Sterile, when it's not called for, adds needless costs to an already overburdened budget. I'd rather that money go towards staffing than an extra pack of scissors everytime I change a dressing. (Although in reality, I know that money is going into a hospital or insurance company bigwig's bonus check.)

Meh. At least on my unit, you cut down and clean wounds using clean technique but you're supposed to dress wounds using sterile technique. Still doesn't get done. (1-2 hour dressing changes, anyone?)

sarsan · Dec 5, 2013

Tap Water for Wound Cleansing

Tap water for Wound Cleansing

Not_A_Hat_Person, RN · Dec 6, 2013

I work in home health, where there is no such thing a sterile field. I've only had to set up 2, for a straight cath.

sbostonRN · Dec 6, 2013

I had posted way back in 2012 about my use of clean technique on ortho procedures. Haven't read the comments since then, and wanted to say that I was working in a SNF at the time. These patients were several days post-op and their wounds were healing to the point where sterile technique was no longer necessary. I now work in a hospital and sterile technique is generally used, though the patient doesn't usually stay more than a day or two to have their wound dressings changed.

Racer15, BSN, RN · Dec 7, 2013

I was taught that evidence based practice has shown that clean dressing changes are the general rule of thumb, that was a year ago.

Racer15, BSN, RN · Dec 7, 2013

I will also say, I'm in the ER now, by the time most folks come to us with issues, the wounds are so infected you can smell them before you see them. With immuno-compromised folks I try to use sterile technique, but when the infections are so bad you can smell them before you go in the room...we do clean dressing changes.