Witnessed unsterile procedure and feeling terrible about it

Nurses General Nursing

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I am a new grad and have been working as an RN for 5 months. Everyone I work with is very experienced and I am definitely the newbie. Yesterday I witnessed an LPN with 30 yrs experience straight cath a male without using sterile gloves. I asked if she had sterile gloves and the iodine that is necessary (we didnt have a kit so all items had to be gathered seperately). I found the iodine and brought it to the bed side. She then asked for a packaged wipe on the bedside to clean the insertion area. I asked her if she wanted me to do the iodine and she replied that she was just going to do the wipe but I could if I wanted to. I did and realized that she never put on sterile gloves only clean gloves. She completed the procedure without ever applying sterile gloves and I am feeling absolutely awful that I didnt stop her and tell her she needed sterile gloves. The whole procedure was totally against what I learned in nursing school. I am thinking about going to the nurse in charge of training and telling her what happened in confidence. Thinking maybe she can hold in inservice on proper techinique. I do not feel comfortable talking to the nurse who did the procedure about it. It would not go well. I have been stressed about this for the last 24 hrs! Any advice? I'm afraid I could be held responsible for not intervening as well.

Specializes in Operating Room.

This will sound snarky, but I've found there's a good number of floor nurses with horrendous sterile technique while putting in Foleys. Ditto for some Pacu nurses as well. I would have said something, but I have a big mouth and I'm not a new grad anymore.

Since you're new to the organization, you can play dumb and act like you have this novel idea that is best practice and will decrease the rates of UTIs among cathed residents to avoid rocking the boat & becoming a target: :woot:

http://people.westminstercollege.edu/students/ncb0708/Program%20Files/FA%20Davis/Fundamentals%20of%20Nursing%20ESG/proc_check/pc_ch27-05.pdf

Just ask someone the policy b/c people may be getting sick there that shouldn't.

I'm just going to add- don't forget that there are differences in people's intents....as a new nurse it takes a while to pick up on how some people practice nursing. Some people are genuinely trying to do the best they can and have picked up some 'short cut's' over the years-maybe wrong short cuts-but ones they have never had pointed out to them are wrong. They are not trying to practice sloppy, they just might be and not realize it. Other people just practice nursing sloppily, period.

Watch how she cares for other patients and you might have a better understanding of the person that she is. Give her the benefit of the doubt, maybe she has just picked up a bad habit.

My opinion still is that a catheter is always a foreign body entering into a bodily cavity. And a cavity highly prone to infection. Most cath kits have the sterile gloves with them....so why not use them?

All other suggestions about facility P and P are good also. However, it's not hard and doesn't take long to use sterile gloves. I think it should have been done. But I don't think the LPN should be faulted for not doing it...unless there is a pattern of shoddy practice.

Not to devalue this but at least it wasn't something crazy like a K+ push.....there is bad practice and then there is serious bad practice....:p

Specializes in geriatrics.

Honestly, it shouldn't be a chore to find sterile gloves. If you don't have a box handy, then use a catheter kit. Sterile gloves come inside the kit, and nursing homes have those. Aside from that, you should definitely speak with the coworker first. We worked with someone who often felt the need to go to management without saying a word to the person involved. Not fun, because no one likes to feel blindsided.

Time to reprint my handy-dandy, never-fail, no-lady partsl-contamination Foley-insertion trick.

When you are prepping the woman, tuck the last betadine-soaked cotton ball into the introitus. Not deep, just enough so it blocks the lady parts. Then when you are trying for insertion and you miss, the cath only hits the sterile cotton ball and you can keep trying (ask for a cough and look for the "wink" or a little urine output) because it isn't contaminated. Retrieve the cotton ball when all is secure and cleaned up.

I never went lady partsl with a Foley again after learning that. Works every time.

Thanks for this great info, will do this when I start my residency position soon. GrnTea, you're awesome!

LTC residents are already at higher risk for UTIs d/t their age & immune status; UTIs are one of the most common infections among LTC residents. If someone wants to complain a/b the cost of using sterile gloves for each straight cath, think of the potential cost savings from preventing UTIs & unnecessary antibiotic use.I think you should not stay out of it; it needs to be addressed because it affects patient care.
It's undeniable that using sterile technique every time is best practice. That's a fact that's well established with plenty of evidence.

But not all LTC facilities are capable of supplying sterile supplies for *every* single straight cath. This is a fact, too. It's inescapable. To stubbornly insist "well, it isn't best practice, so they should change their policy!" is unproductive and childish. It sucks that there isn't adequate reimbursement to ensure best practice for every procedure, but it is what it is. There's nothing brave or noble about fighting a battle that can't be won. I mean, seriously, the OP should risk being on everyone's s*** list by trying to change a policy that anyone with a little savvy knows won't be changed anytime soon? Some new grad RN is hired and says "clean caths aren't nest practice" and suddenly management will see the light and order a truck load of sterile kits?? Come on.....

And nurses who acquiesce to this policy aren't "lazy" or "bad". What, if we're not throwing ourselves on the sword and risking our jobs to protest every policy that isn't 100% like we learned in nursing school, then we're not good nurses? Things aren't as black and white as some posters here seem to think.

It's undeniable that using sterile technique every time is best practice. That's a fact that's well established with plenty of evidence. But not all LTC facilities are capable of supplying sterile supplies for *every* single straight cath. This is just a fact of life. I'm lucky to work at a government facility where we have kits for every straight cath. Because of this, it has never even occurred to me *not* to use sterile technique. But many (if not most) private facilities simply do not have the reimbursement to provide sterile supplies for a resident who might need 4 straight caths every day. Do you want this LPN to use up all the sterile gloves on multiple straight caths only to have the facility run out when a Foley needs to be inserted? I have considerable disdain toward private nursing homes, but even I know they don't make such polices because they're evil or stupid. They do it because they have to. Until reimbursement laws are changed these policies won't change either. That's why telling the OP to fight this isn't necessarily good advice.

So sterile supplies may be limited to Foley procedures. Darn shame. Gotcha. I am aware that it is well-established with plenty of evidence that asceptic technique is preferable. I think how I worded it may have led you to conclude otherwise.

Specializes in Cath lab, acute, community.

The question I ask myself is: would I want this done to me, or my mother? If the answer is no, then I would do something.

At least in the hospital, and it could be in any Medicare facility, foleys are regulated strictly, and UTI's acquired from foleys.

Catheter-associated Urinary Tract Infection and the Medicare Rule Changes

So it is of one's best interest, and the interest of the patient to use sterile technique.

If you report every nurse for not doing it the way you were taught in school you are going to have a very long career..

Exactly

Honestly it shouldn't be a chore to find sterile gloves. If you don't have a box handy, then use a catheter kit. Sterile gloves come inside the kit, and nursing homes have those. Aside from that, you should definitely speak with the coworker first. We worked with someone who often felt the need to go to management without saying a word to the person involved. Not fun, because no one likes to feel blindsided.[/quote']

I've worked at 2 separate Nursing homes in BC and neither one had cath kits.

It's undeniable that using sterile technique every time is best practice. That's a fact that's well established with plenty of evidence.

But not all LTC facilities are capable of supplying sterile supplies for *every* single straight cath. This is a fact, too. It's inescapable. To stubbornly insist "well, it isn't best practice, so they should change their policy!" is unproductive and childish. It sucks that there isn't adequate reimbursement to ensure best practice for every procedure, but it is what it is. There's nothing brave or noble about fighting a battle that can't be won. I mean, seriously, the OP should risk being on everyone's s*** list by trying to change a policy that anyone with a little savvy knows won't be changed anytime soon? Some new grad RN is hired and says "clean caths aren't nest practice" and suddenly management will see the light and order a truck load of sterile kits?? Come on.....

And nurses who acquiesce to this policy aren't "lazy" or "bad". What, if we're not throwing ourselves on the sword and risking our jobs to protest every policy that isn't 100% like we learned in nursing school, then we're not good nurses? Things aren't as black and white as some posters here seem to think.

This!!!!

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