nonsterile gloves to do wet-dry packing? This according to a doc!

[chenoaspirit]

Today I had a patient who had a huge abdominal incision (wet to dry packing). The surgeon came in, removed the packing and started fingering around in the wound...without sterile gloves. I offered him some sterile gloves, he said there was no need, that all dressings just need clean gloves. He said that nurses are taught to use sterile technique because they dont know how to differentiate when to use sterile vs clean so its just easier to teach them to do sterile with all. Needless to say, this patient's abdomen is infected. Hmm, I wonder why! That ticks me off. This was all said over the patient's bed. She was so upset and I dont blame her!

Now correct me if Im wrong here, but those gloves are in those rooms thru multiple admissions/discharges and they are GERMY! Ive seen this doc go from room to room and fingering around in wounds, not washing hands in between and carrying a soda in the rooms with him! GRRRRRRRRRR. ANd we nurses get blamed for the spread of MRSA.

[blueheaven]

I'm old school, I believe you should use sterile gloves whenever you are poking around a wound. The gloves in our rooms do not get changed from patient to patient...what if the previous patient had pseudomonas, or MRSA? You know people have been poking their unclean hands in those boxes!!

We had a patinet who had an open abdominal wound (Open GB with dehiscence) and we were doing his dressing changes sterilly. The patient had NO signs of infection, wound looked nice and clean and his WBC count was normal. In walks "wonder surgeon" he tells us there is no need for sterile drsg changes. Goes poking his fingers around the wound in "clean" gloves...pt. spikes temp, starts having drainage and gets very septic.

[chenoaspirit, ASN, RN]

The gloves in our rooms do not get changed from patient to patient...what if the previous patient had pseudomonas, or MRSA? You know people have been poking their unclean hands in those boxes!!

:yeahthat:

[BookwormRN]

This makes me think of the time I was precepting a student and she was putting in a Foley and contaminated her gloves.

The doc came in as I was going to get a new set of gloves and said, "Well you know, putting in a Foley is just a "clean" procedure", but I know you nurses have to learn the sterile procedure."

HELLO!!!! Can you say UTI???

[shellsgogreen]

it bugs me when i walk into a room and find a dressing has been removed; with no replacement - i have absolultely no problem coming in to change it if they are inspecting it, but really, is it that difficult to mention it to the nurse (or perhaps cover it up themselves) so the patient doesn't acquire some nasty critters?

[Vito Andolini]

Well, I guess I am in the minority here, but I have seen many, many docs ordering clean dressing changes as opposed to sterile ones. I don't have the studies that demonstrate this but I have heard that the evidence doesn't necessarily support sterile over clean dressing changes. Again, I don't know what those studies were but I am just stating what I have seen. I have done very complex dressing changes with extensive tunneling, wet-to-dry, etc as a clean dressing change.

I would like to see research support one or the other. Sterile dressing changes, as we all know, are very expensive. There should be some sort of evidence to support them.

Clean does not mean no gloves and unwashed hands.

The surgeon the OP is describing makes me think of childbed fever and how doctors would go from one woman to the next, no handwashing between patients, no nothing. Just lots of women dying unnecessary deaths and newborns becoming motherless and families losing wife/mother/dtr/sister.

OP needs not only to document but call this old-fashioned behavior to the attention of her manager, the Chief of Surgery, and Administration.

She can present it in terms of money, since that what will get the attention of those who have the power to make the surgeon change his ways. She can let them know that insurers, like Medicare/Medicaid are no longer paying for nosocomial problems and how much money the hospital will lose if it has to pay to treat all of these post-op infections.

On so many levels, this surgeon is almost unbelievable. The arrogance of saying that nurses don't know when to use clean and when to use sterile, for instance, alone earns him shunning and ostracism and being expelled and reported to the board that licenses him.

That's another way to approach this problem - just report him anonymously to the state Board of doctor licensing, whatever it's called in your state. That way OP can avoid being the bad guy.

I wonder if he scrubs pre-op. What does he do to protect himself, if not his next patient? Has he had a mental status exam lately? He is truly nuts.

What did the patient do or say, OP?

[Vito Andolini]

I'm old school, I believe you should use sterile gloves whenever you are poking around a wound. The gloves in our rooms do not get changed from patient to patient...what if the previous patient had pseudomonas, or MRSA? You know people have been poking their unclean hands in those boxes!! quote]

Throw them out after the patient is discharged. To cut expense, don't put a whole box of gloves in the room to begin with. You can always replenish them.

[PedsAtHeart, LPN]

Well, I guess I am in the minority here, but I have seen many, many docs ordering clean dressing changes as opposed to sterile ones. I don't have the studies that demonstrate this but I have heard that the evidence doesn't necessarily support sterile over clean dressing changes. Again, I don't know what those studies were but I am just stating what I have seen. I have done very complex dressing changes with extensive tunneling, wet-to-dry, etc as a clean dressing change.

I would like to see research support one or the other. Sterile dressing changes, as we all know, are very expensive. There should be some sort of evidence to support them.

I agree with you. But I can see the other side too. I, too, think we need to see some studies... a doc I worked for used to tell me something about clean vs sterile but silly me forgot what it was he told me (he told me A LOT) haha...

[racing-mom4, BSN, RN]

We use clean not sterile technique and here is how it was explained to me---the patient will most likley go home with some wound still present--they will not be sterile in changing thier dressing at home, they will use clean. Yes hosp are dirty, but not as dirty as some of the homes are patients live in.

If we use sterile all the time at the hosp and then send them home to finish by using clean, they will most likely develop a worse infection at home.

Granted some wounds are different and may in fact require sterile tech first, but the majority of our wet to dry wounds are done using clean.

Logic being, when a baby has a colostomy you put a bit of stool in thier diaper a few times a day for an hour or less. that way thier skin gets used to the stool so when the colostomey is reveresed they dont develop a wicked diaper rash.

[chenoaspirit, ASN, RN]

Well we were taught that when a patient goes home, clean would be considered ok because in their own home, they are being subjected to their OWN germs that are already growing on their skin as normal flora. I still teach sterile to them, the home health nurse also taught her sterile with last admission (1 week ago).

Today, the doc thinks she may have C-diff, mentioned an antibiotic. I suggested Acidopholus, yogurt, etc to aide in replenishing the "good" bacteria in the gut along with the antibiotic. He appeared offended because he shunned my idea saying that what LITTLE effect that would have wouldnt be enough to be benificial. I asked if ProStat would be good supplement to aide in wound healing, he didnt like that either. I think I just need to keep my mouth shut because my ticking him off isnt helping anything. But I honestly didnt mean to, I was only trying to help. He obviously considers nurses as substandard intelligence. He even made the comment that the nurses are stupid..IN FRONT OF THE PATIENT. I am going to research this a bit more though. Thanks for all your replies. Its amazing how so many nurses have totally different techniques.

[lsyorke, RN]

Clean does not mean no gloves and unwashed hands.

The surgeon the OP is describing makes me think of childbed fever and how doctors would go from one woman to the next, no handwashing between patients, no nothing. Just lots of women dying unnecessary deaths and newborns becoming motherless and families losing wife/mother/dtr/sister.

Hmmm, I don't believe she said that he was ungloved or hadn't washed his hands. While his comment was ignorant, reporting a doctor to the medical board for not using sterile gloves in a non sterile, infected wound is a bit over the top.