I&D...sterile procedure?

Been there,done that, ASN, RN · Aug 24, 2016

An I&D is a sterile procedure. The patient does not need another organism entered into their bloodstream during the procedure. The doc does not need pus all over their hands. The culture would also be contaminated and useless.

You don't need a policy specific to your facility. This is evidenced based protocol. In the future , let this doctor ( ? )know that . Be firm that you expect them to don sterile gloves. Doctor also needs to wear full PPE to assure the PUS does not squirt into their eye or any other place. :sarcastic:

Now.. go do some serious teaching.

deefizzle · Aug 24, 2016

Thank you for your response (and reassurance). This doctor has some very questionable judgment at times. I will definitely educate him.

AceOfHearts<3 · Aug 24, 2016

If somebody had a UTI and needed to be cathed, it does not mean that inserting the catheter is now magically not a sterile procedure. That's what I would equate this to. No need to introduce new/more bacteria, whether it is a urinary tract or some other area of the body (such as a wound that is being drained).

deefizzle · Aug 24, 2016

I should clarify just so I'm not making him sound worse than he is...he does wear gloves, just not sterile ones.

calivianya, BSN, RN · Aug 24, 2016

I should clarify just so I'm not making him sound worse than he is...he does wear gloves, just not sterile ones.

Clean gloves aren't good enough - they do need to be sterile gloves. I'd say you're making him sound exactly as bad as he is... which is pretty bad.

Anonymous865 · Aug 24, 2016

He may not be wrong.

Mt. Sinai School of Medicine says "Abscess I&D is not a sterile procedure but field is customarily sterilized."

Emergency Medicine News says

"Prep using sterile gloves to keep it a clean procedure, though it is not meant to be a sterile one."

Error

From the book "Wound Management in Urgent Care" says "abscess drainage is not a sterile procedure so you can don exam gloves as personal protective equipment."

Wound Management in Urgent Care - Brittany Busse - Google Books

I have found P&P from facilities that say it is a sterile procedure and other facilities say it is clean procedure.

With a quick search I haven't found any research to support one or the other. I'll try to dig some for it.

EBP does show that culture and sensitivity are not necessary. Patients given no antibiotic and patients given an inappropriate antibiotic do as well as those given an antibiotic that the organism is sensitive to.

Been there,done that, ASN, RN · Aug 25, 2016

He may not be wrong.
Mt. Sinai School of Medicine says "Abscess I&D is not a sterile procedure but field is customarily sterilized."
Emergency Medicine News says
"Prep using sterile gloves to keep it a clean procedure, though it is not meant to be a sterile one."
Error
From the book "Wound Management in Urgent Care" says "abscess drainage is not a sterile procedure so you can don exam gloves as personal protective equipment."
Wound Management in Urgent Care - Brittany Busse - Google Books
I have found P&P from facilities that say it is a sterile procedure and other facilities say it is clean procedure.
With a quick search I haven't found any research to support one or the other. I'll try to dig some for it.
EBP does show that culture and sensitivity are not necessary. Patients given no antibiotic and patients given an inappropriate antibiotic do as well as those given an antibiotic that the organism is sensitive to.

EPB is ongoing and continually changing. In this case... what could be WRONG with using sterile gloves?

My son had an I &D performed in an urgent care setting. I assured it was performed under sterile technique. I also demanded cultures and sensitivities to be ran. My kid had green and yellow pus coming from the wound. A simple C/S assured ME that the correct antibiotic was prescribed.

In this case, to Hades with EBP. All patients deserve the same evaluation.

Anonymous865 · Aug 25, 2016

EPB is ongoing and continually changing. In this case... what could be WRONG with using sterile gloves?
My son had an I &D performed in an urgent care setting. I assured it was performed under sterile technique. I also demanded cultures and sensitivities to be ran. My kid had green and yellow pus coming from the wound. A simple C/S assured ME that the correct antibiotic was prescribed.
In this case, to Hades with EBP. All patients deserve the same evaluation.

I agree. If I were the patient, I would want it performed under sterile technique.

If I were the OP, I would want evidence to back me up before I attempted to educate the doc on why his use of clean gloves was not sufficient.

Anna Flaxis, BSN, RN · Aug 25, 2016

I&D is a clean procedure. C&S is unnecessary for simple abscesses, as most abscesses heal without antibiotics.

Been there,done that, ASN, RN · Aug 25, 2016

I&D is a clean procedure. C&S is unnecessary for simple abscesses, as most abscesses heal without antibiotics.

Per NIH "no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required." This is my kid we are talking about. Use sterile procedure, culture that green and yellow stuff, determine if and what antibiotics are necessary. I would expect the same for my patients.

allnurses Guide · Aug 25, 2016

It is a clean procedure where I work. Instruments are sterile but sterile gloves are not used. I don't routinely culture unless the patient has recurrent abscesses. Antibiotics are not necessary unless this is a recurrent problem or the patient has systemic symptoms. This is per our health system's protocol.