I&D...sterile procedure?

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I work for an urgent care facility and cannot locate an exact policy on this scenario. Patient comes in with cyst, doctor performs I&D for culture. I&D tray is set up using sterile technique. Sterile field, all instruments are sterile from autoclaver. Doc says he does not need sterile gloves because "this isn't a sterile procedure." I'm a little skeptical of this practice. Can someone with more experience please give me their opinion? Thanks

I am not the only one having a different opinion than you, in this thread. Why the snark?

Haha, please tell me your kidding? An NP vs a new grad with no experience outside of a clinical rotation? Pretty sure an opinion pales in comparison to years of real experience.

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The point I was trying to make was in light of my friend's very recent fiasco I am coming down on the side favoring a sterile procedure -vs- a clean procedure (if I had a choice, and it was me or my own child). My own recent experiences color my point of view, this I realize too.

Nothing against you wanting sterile procedure over clean, but something to consider:

With all of the I&D that are being performed daily throughout the US, if we had to switch to 100% sterile technique how much would that raise the cost of healthcare? Sterile technique, to include the supplies AND preparation of the field / staff preparation takes more time and time = money. Pretty sure ED stuff is charged by the 15 min interval at my hospital. Insurance companies wouldn't want to lose money so consumers would eat the cost..

Just food for thought, healthcare in America is the most expensive there is.

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Specializes in Adult MICU/SICU.
Nobody touched on it yet but MRSA colonization on skin is extremely common. In fact we stopped swabbing nares to test for MRSA because it is A: extremely common, and B: usually has no significant impact on patient outcomes. I'm not saying MRSA doesn't cause issues, because it does, but simply testing positive for it may or may not have clinical significance.

This is true - especially with nurses. I had a MD say to me once, "All you nurses … you're all colonized with MRSA. Probably become active when you're old and immunocompromized too …". Urgh. I hope not.

But it was in the wound, and blood cultures. :(

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Specializes in Emergency Department.

"Garden variety" abscess I&D is a clean procedure. There's nothing wrong with setting it up as a sterile procedure, including doing appropriate skin prep but once that abscess is opened, whatever's in there comes out and completely wrecks sterility. Yes, the instruments used will be from a sterile pack but all that really does is limit the chance of new critters getting into the wound and causing a secondary infection on top of the initial one that was just drained. Abscesses can be packed or simply left open to drain. They're not closed. If an I&D was truly a sterile procedure, we'd close the wound to maintain sterility... but instead we leave the wounds open to drain. You can't keep those open, draining wounds sterile. Clean, yes but sterile, no. The body does an incredible job at cleaning up the mess...

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Specializes in Critical care.
This is true - especially with nurses. I had a MD say to me once, "All you nurses … you're all colonized with MRSA. Probably become active when you're old and immunocompromized too …". Urgh. I hope not.

But it was in the wound, and blood cultures. :(

I hear this repeated often, but it's actually around 7% for the European nurses in this pooled literature study, so there's hope for us.

MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review | BMC Infectious Diseases | Full Text

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Specializes in Med-Tele; ED; ICU.
Absolutely file an incident report! See what the response is...

Snicker, snicker

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Specializes in Med-Tele; ED; ICU.
I am not the only one having a different opinion than you, in this thread. Why the snark?

Probably because it's ridiculous to have a nursing student telling an experienced provider that their technique is wrong.

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When I worked general surgery outpatient, all the surgeons used sterile technique for certain I&Ds. The only time that procedure became a clean one was when the colorectal patients popped in...

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Haha, please tell me your kidding? An NP vs a new grad with no experience outside of a clinical rotation? Pretty sure an opinion pales in comparison to years of real experience.

Wow.. so you gave up on snark, to become completely hostile?? Gosh, hopefully I'll never run into you in real life. You simply can't deal with others dissagreing with you. Smh..

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Probably because it's ridiculous to have a nursing student telling an experienced provider that their technique is wrong.

Am I the only one in this thread dissagreing with her? Nope, I'm not. So why is she personally attacking me, but not someone else? Everyone is welcome to have an opinion, it's a discussion board. No need for personal nastiness.

And btw, I'm a GN, not a student.

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Specializes in Research & Critical Care.
Ladies - nice debate

This made me smile. Although with some of the sensitivity and back-and-forth, I can see the confusion.. :D

Side note, what's happening here -> :cheeky: Is he drinking water like a dog? Oddly licking an ice cream?

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Specializes in Med-Tele; ED; ICU.
Am I the only one in this thread dissagreing with her? Nope, I'm not. So why is she personally attacking me, but not someone else? Everyone is welcome to have an opinion, it's a discussion board. No need for personal nastiness.

Well first of all, BostonFNP has not personally attacked you, s/he has simply made a mildly snarky, dismissive comment. The opinion of a new grad nurse who's seen a procedure done a few times in fast track versus that of an experience provider who has performed many more of these procedures than you've ever seen carries no weight at all and it is laughable that you would challenge this experienced professional based on a few observations made during clinical rotation through the ED.

An expert nurse at least has the weight of experience behind them to provide a meaningful challenge to this provider's practice.

I get that you've had your feelings hurt but you probably should thicken your skin a bit once you pass the NCLEX and step into the real world of medical care.

All opinions are not created equal nor must they be treated as such. Those of expert professionals merit much more consideration and respect than those of novices.

And btw, I'm a GN, not a student.
No need to argue over semantics but in my book, until one obtains a nursing license, they remain a nursing student. As you said, you're not yet a nurse.
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