Pimples, blackheads and acne

[weirdRN, RN]

While cleaning a patient's face, blackheads were mistaken for ground in dirt. (The individual had had a seizure and had fallen pretty heavily onto his forehead, enough so he was bleeding from a cut on his forehead) The nurse was observed picking the blackheads.

The individual actually looked much better after she was done, and the patient appeared grateful for the cleaning but...

My question is shouldn't she have just left them alone? What about pimples? And cystic acne? And boils? Should we be draining boils and other skin infections after they have opened up? I have noticed that this older nurse does this and the areas appear to heal up remarkably quickly. What is best practice?

[ERRNTraveler, RN]

If I was hospitalized, unconscious, and had a huge zit on my face, I would hope someone would pop it for me!

[Dolce, RN]

One time I was caring for an older woman with dementia. She had a large spot on her face next to her mouth. I asked her about it as it appeared fairly large, irregular, discolored and flat--all potential marks of skin cancer. She said she had noticed it but had never mentioned it to her doctor. She couldn't remember how long she had had it. I squeezed it gently and low-and-behold it wasn't skin cancer but a giant blackhead. :barf02:A bunch of greasy, cheesy, gross, dead skin poured out and she looked sooo much better afterwards. She was so grateful for me "taking care of it" that she hugged me.

However, it is not my general practice to be a blackhead-picker or zip popper. I don't think it is probably best to be popping patient's skin lesions if we aren't sure what they exactly are.

[NursingAgainstdaOdds]

In nursing school, I took care of a patient in his mid-late 20s who landed himself in the hospital for 2 weeks with cellulitis after "popping" a skin blemish. (For the record, the technique he described sounded very aseptic!) I actively discourage people from doing this now.

With the high rate of nosocomial infections resulting from poor hand hygiene, and the increased risk for infection posed by a break in the skin - let alone an intentional break - I'd be really upset with any health care worker that took it upon themselves to "take care of" my blemishes for me.

[Duflinkka]

Just about a week ago my co-worker went in to check a boil on a resident's arm. She went in to look, picked up his arm, and it exploded all over her. She had disgusting, foul-smelling pus in her hair, on her face, and worst of all in her eye. She of course went to rinse her eye out in the utility room, went home and took a shower, then filled out an incident report. We're waiting for the culture to come back.

It was quite possibly the most disgusting thing I have ever seen in my life, and I felt so sorry for her.

[Duflinkka]

I just want to add that she did not pick at it, or poke it, or anything. She just picked up his arm.

Who knows what she'll get from having some of that pus in her eye? I would never take it upon myself to "pop" someone's blemish, or anything of that nature.

[EmmaG, RN]

Ok, that's pretty disgusting...

[oramar]

Just about a week ago my co-worker went in to check a boil on a resident's arm. She went in to look, picked up his arm, and it exploded all over her. She had disgusting, foul-smelling pus in her hair, on her face, and worst of all in her eye. She of course went to rinse her eye out in the utility room, went home and took a shower, then filled out an incident report. We're waiting for the culture to come back.

It was quite possibly the most disgusting thing I have ever seen in my life, and I felt so sorry for her.

At any given moment an unforseen event can occur that puts a nurse at risk. Usually when I was expecting something I would glove and gown. Then I rarely had an incident. It was when I least expected it and was not prepared that the accidents like this happened.

[Tweety, BSN, RN]

I don't think we should be routinely treating a patients ance and blackheads. We should wash their face with soap and water and leave it alone.

I do express the area sounding those types of wounds you describe to bring out puss, if there's puss remainingm but do it gently, without force. I've seen NPs do that in clinicals when they I&D a wound, and my NP instructed me to do it during dressing changes when I had a spider bite turn into a MRSA wound in my arm, and he would do it during my checkups.

But take my answer with a grain of salt, but I'm not sure what the evidenced based best practice is.

[SICU Queen]

Just about a week ago my co-worker went in to check a boil on a resident's arm. She went in to look, picked up his arm, and it exploded all over her. She had disgusting, foul-smelling pus in her hair, on her face, and worst of all in her eye. She of course went to rinse her eye out in the utility room, went home and took a shower, then filled out an incident report. We're waiting for the culture to come back.

It was quite possibly the most disgusting thing I have ever seen in my life, and I felt so sorry for her.

Okay I think I want to throw up now... EEEEEEEWW!!

I DO NOT "pop" anything on anyone... and I'd be severely PO'd if anyone did that to me (unless it was someone VERY close to me). Hand hygiene isn't what it should be and a newly "popped" blemish is yet another entry route for some nasty infection.

I'll just keep my zits, TYVM.

[P_RN, ADN, RN]

Just remember your anatomy about how CLOSE the face is to the brain. In many cases only a thin sphenoid separates the nose from it and nasty stuff like meningitis and encephalitis.

Let's not "espress" depress, squoosh or otherwise move around cellulitis without a doctor's OK. OK?

[marie-francoise]

Regarding P_RN's post: Yes - some docs have told me about this "triangle of death" around the nose, where if you squeeze or pop a zit, there is a chance for the infected material to travel back into the sinus and infect the brain, and in some cases this has resulted in death. (!)

Anyway, just knowing that made me leave my face alone many a time...