PA didn't use sterile technique, then said it wasn't a sterile procedure!

[alwayschanging]

Hi!

Im not sure if this should go under infection control or wound care because its kind of both. Im a LPN student and today one of my patients I took care had a dressing changed by ortho. He's 89, and his skin is very frail, his wound is 3 deep incisions on his left thigh, he has Montgomery straps and the wound is packed with 4 4x4s (used to be beta-dyne) now Sterile saline. covered with 2 4x4, and a another heavy dressing on top of that. Sorry i dont remember the name.

Ne Who, Ortho came in today because he is 3 days post op, they changed the dressing horribly! First instead of un-doing the strings on the Montgomery they ripped it off, not even using any unisolve, or alcohol to loosen the adhesive ( he has a skin tear below already from some tape that was ripped off) Then using the same gloves they used to take off the old dressing, they packed the wound. Then they tried to re stick the Montgomery strap back on, and it was very obvious she didn't want to be there doing it, and when it wouldnt stick she tried to tape it down instead of putting a new one on. I was livid! I let my instructor and the charge nurse know what i had witnessed and when the PA was question she came back saying it was not a sterile procedure, there for no need to sterile technique. I've never heard of this, when your packing a wound not being a sterile technique. Any who i just wanted feedback from some one else. I know i did the right thing by alerting the right people because now there going to look into how many other dressings have been changed by this PA and her minions. On a VERY IMPORTANT side note, He is on isolation for MRSA.

[Isabelle49]

True it is not a sterile procedure. For this you must wear gown, sterile gloves and mask. Wound care is generally not sterile procedure. HOWEVER, the PA should have changed gloves after removing the old dressing, before packing the wound with the new dressing. ALSO, the PA should not have ever pulled the straps off - she may not know what they are, and that is not a good reason for her action. If I were the nurse who witnessed this, I would complete an incident report. This kind of less than standard care needs to be brought to the attention of risk management and that is where the incident report would go. An incident report is not a bad thing, necessarily. It can be a good thing since it will serve to improve standards of care.

[alphabetsoup]

EW. ICK. All I can say is that I like to change gloves after removing the old dressing, change gloves after cleaning the wound, and then change into sterile gloves when packing a deep wound. But that's just how I roll.

[rehabwoundnurse]

EW. ICK. All I can say is that I like to change gloves after removing the old dressing change gloves after cleaning the wound, and then change into sterile gloves when packing a deep wound. But that's just how I roll.[/quote']

Any type of packed dressing should be performed with sterile technique! This person just didn't want to be there and was taking it out on the patient!

[carl5480]

Any type of packed dressing should be performed with sterile technique! This person just didn't want to be there and was taking it out on the patient!

Sorry, but that's just not true. All wounds, excepting (possibly) only those directly from the OR, have some level of bacterial colonization. For this reason, wound care, and most particularly wound care at the bedside, is rarely a sterile procedure.

It is ALWAYS, however, a clean procedure, and as pointed out prior to me, at the very least gloves should be changed between removal of the old dressing and placing of the new one. Most appropriately, new gloves before you begin, new gloves after removing the old dressing, and new gloves after cleansing (before placing the new dressing) is optimal.

Having said all of that, there is now evidence to support sterile dressing change procedure on post-op care of a closed incision until complete epithelialization occurs, because you do not want to "trap" bacteria underneath a closed wound. But unless you are going to physically sterilize an open wound, sterile technique is not generally needed.

[rehabwoundnurse]

Sorry, but that's just not true. All wounds, excepting (possibly) only those directly from the OR, have some level of bacterial colonization. For this reason, wound care, and most particularly wound care at the bedside, is rarely a sterile procedure.

It is ALWAYS, however, a clean procedure, and as pointed out prior to me, at the very least gloves should be changed between removal of the old dressing and placing of the new one. Most appropriately, new gloves before you begin, new gloves after removing the old dressing, and new gloves after cleansing (before placing the new dressing) is optimal.

Having said all of that, there is now evidence to support sterile dressing change procedure on post-op care of a closed incision until complete epithelialization occurs, because you do not want to "trap" bacteria underneath a closed wound. But unless you are going to physically sterilize an open wound, sterile technique is not generally needed.

I guess each facility is different, but at mine, if it is a packed dressing it is done using sterile technique. Even the WOCN nurses perform the dressing changes this way. I can't imagine not doing everything I could to decrease the amount of bacteria in the surroundings for an open wound dressing change.

[followyourbliss]

I encourage you to read the research and efficacy around using clean vs sterile technique and well as using regular tap water for cleaning as opposed to n/s etc.

The Johanna Briggs Institute has the research and articles re potable water for wound cleaning.

Check out the Cochrane Review and other reputable resources.

Happy reading.