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

Specializes in Adult Internal Medicine.
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.

It wasn't a personal attack on you. I used the same words that were used previously in the thread, that's all.

Everyone can have an opinion. In this kind of discussion regarding best practices and evidence-based practice the extant data matters far more than limited anecdotal experiences. I know you have observed this procedure a few times, did you ask any questions about it? Does the facility have a policy that the providers follow? What is the policy based on? Did you have any formal training on the procedure? Have you done any reading on the topic?

Facilities may have policy about using sterile gloves, but the data doesn't support it and it doesn't make it "the right way" to do the procedure.

Again, we are talking about minor surgical procedure of a cutaneous lesion done at the bedside, not a major surgical procedure done on invasive lesions in the OR.

Heal, C., Sriharan, S., Buttner, P. G., & Kimber, D. (2015). Comparing non-sterile to sterile gloves for minor surgery: a prospective randomised controlled non-inferiority trial. Med J Aust, 202(1), 27-31.

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Specializes in Adult MICU/SICU.
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?

That's nice of you. The quote button seems to be used to shame people. I'm glad you can smile doing that. I hope you can still smile when it happens to you.

I've seen people have numerous people attack one person before on this site smelling blood in the water all swimming out to take a bite and thought it was pretty nasty. I bet you wouldn't like it.

Enjoy quoting this and laughing. I bet you'll probably get a few pages out of it.

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Specializes in Critical care.
That's nice of you. The quote button seems to be used to shame people. I'm glad you can smile doing that. I hope you can still smile when it happens to you.

I've seen people have numerous people attack one person before on this site smelling blood in the water all swimming out to take a bite and thought it was pretty nasty. I bet you wouldn't like it.

Enjoy quoting this and laughing. I bet you'll probably get a few pages out of it.

I'm thinking the laughing was regarding your use of 'ladies' in your comment. Several of the previous posters are not ladies.

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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.

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.

"Snarky , dismissive comment.." yes no kidding. Thats the reason a lot of GNs quit their jobs after a few months, because of people like that, who think theu know everything and us , new grads know nothing. And they MAKE SURE they let us know how little we know. And then you wonder WHERE the say that "nurses eat their young" comes from?? Prime example right here.

I was just highred on in a Neuro PCU unit , pending my licence BTW.

So take that haters. Smh

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That's nice of you. The quote button seems to be used to shame people. I'm glad you can smile doing that. I hope you can still smile when it happens to you.

I've seen people have numerous people attack one person before on this site smelling blood in the water all swimming out to take a bite and thought it was pretty nasty. I bet you wouldn't like it.

Enjoy quoting this and laughing. I bet you'll probably get a few pages out of it.

Thank you Orphan.

It's sad, but this is what happens in real life as well. Sadly.

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Specializes in Public Health, TB.
"Snarky , dismissive comment.." yes no kidding. Thats the reason a lot of GNs quit their jobs after a few months, because of people like that, who think theu know everything and us , new grads know nothing. And they MAKE SURE they let us know how little we know. And then you wonder WHERE the say that "nurses eat their young" comes from?? Prime example right here.

I was just highred on in a Neuro PCU unit , pending my licence BTW.

So take that haters. Smh

Bingo! Was waiting for this one. The Godwin's law of Allnurses.

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Specializes in ER, PCU, UCC, Observation medicine.
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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Let's stay on track, folks — the OP asked for information on clean vs. sterile I&D procedures from people with more experience. Let's not get personal. Thanks!

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Specializes in Adult Internal Medicine.
people like that, who think theu know everything and us , new grads know nothing. And they MAKE SURE they let us know how little we know.

To be totally honest, new grads don't know much about practice. Nursing and medicine is humbling, especially in your first years of practice. Learning what you don't know is perhaps the most important thing a new healthcare professional can do. Not knowing what you don't know is a risk for you and for the patients.

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Specializes in Research & Critical Care.
I'm thinking the laughing was regarding your use of 'ladies' in your comment. Several of the previous posters are not ladies.

Lol thank you.. I thought it was funny. Clearly comedy isn't my calling.

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I was just highred on in a Neuro PCU unit , pending my licence BTW.

So take that haters. Smh

Lol, ok. :)

The most important thing you can do to start off on and remain on track is to acknowledge what you don't know. Nursing school prepares you to take and pass NCLEX, but there is no way they can teach you everything you need to know to be competent in a given specialty. Be prepared to learn tons this year from experienced nurses who actually do know a whole heck of a lot more than you do, don't let pride keep you from asking questions, and for goodness sakes, don't waltz in there acting like you know everything already, or you won't last long on the unit.

Congrats on your job offer, and good luck on the NCLEX. Report back on how things are going if you feel like it.

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Specializes in OR, Nursing Professional Development.

My personal experiences with I&Ds has been that they are sterile procedures. But, I don't work with the garden variety I&D. I work in the surgical environment, where our extensive debridement intends to eliminate all non-viable tissue and infection. Many of these wounds will be closed after they are debrided, and sterility is an absolute must. We may even implant cement beads made with various antibiotics, such as vancomycin.

Do we mark the wound classification as clean/class 1 just because we used a sterile setup and adhered to aseptic technique, including removing all "dirty" instruments from the field, changing gowns and gloves, placing clean drapes over the dirty ones, and having a completely separate closing setup that is not touched before the regowning/regloving? Of course not- it's still a contaminated/class 4 surgical wound but we don't want to introduce something new.

And to the comment about nurses all being colonized with MRSA- after a recent rash of MRSA infected surgical wounds, all OR staff were cultured. None of us were positive.

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