Iodoform and infection control

[Zippy83]

I see an HH wound care patient four days a week for a daily dressing change, and another nurse sees her on the other three days of the week.

The wound care order calls for packing a diabetic ulcer on the foot with iodoform strips.

Today she told me that she just got a bill for the supplies and that they are very expensive, and she doesn’t like that I waste some of the strips when I cut them to pack, and she wants me to do what the other nurse does, which she described as holding the bottle a couple inches from the foot and packing the wound first, then cutting the strip off when finished.

I tried not to act totally horrified. I really try hard not to talk negatively about other nurses to the patients no matter what the situation is, because I know that all that does is erode trust with the patient, since they won’t know who to believe.

For the record, I’m not wasting a lot of the strip, maybe I go over by a centimeter or two sometimes. But I do understand her feeling the pressure of the bills piling up, especially since it’s a very slow healing wound.

Am I wrong or overreacting to think that the way the other nurse is doing it is totally disgusting and not good aseptic technique? That would mean that she’s packing the strip while it’s still one long strip, partially still in the bottle. Even though it might not be ‘sticking out’ I still feel like that makes the whole thing used/not sterile.

[michksmith14, MSN, RN]

Hi Zippy,

I understand your concern with the other nurse's strategy, though as long as the bottle is not touching the wound I don't really see a problem. Also as long as the bottle is only being used for a single patient. Wounds themselves are not clean and so generally wound care just follows clean technique unless it is a fresh surgical wound.

If the patient is concerned about cost of supplies, perhaps the wound care provider could suggest a cheaper option...

-Michelle

Edit: I have never packed a wound using that nurse's technique. I would cut a strip off as you have done but I don't think either one is necessarily wrong.

[CalicoKitty, BSN, MSN, RN]

I was taught at my old hospital to pack the wound and cut the strip from the bottle. Clean hand holds bottle, dirty hand uses forceps to gently pack. Dirty hand cuts when done. Part of the reason is you really don't know how much you'll need to pack the wound. Pack until it is full, then leave a few inches and snip. You don't want to use multiple strips of it because that will leave the risk of missing some when changing.

As mentioned, wounds are not sterile. And the thread is supposed to be bacteriostatic, so even if something did get on it, it wouldn't grow (and I figure if visible goo got on some, that would be cut off and discarded).

Obviously, don't share bottles of the stuff.