Skin grafting - does your facility treat it as a sterile procedure?

eatmysoxRN, ASN, RN · Apr 16, 2013

I would think it would be because skin isn't sterile. Like many procedures, you clean the best you can and use aseptic technique, but when dealing with something that isn't sterile to start with using sterile technique is unnecessary.

ChristineAdrianaRN, BSN, RN · Apr 16, 2013

I have never done a skin graft that wasn't sterile.

nurseboudin · Apr 17, 2013

I've always done them sterile. The patients are at great risk for infection to begin with. We should make our best effort to keep all the bugs off.

stefanyjoy · Apr 18, 2013

Thanks for the input. While observing a skin graft was a really exciting experience for me, some things just left me reeling. The sterilization (or lack thereof) of course, but also, the circulating nurse forgot to strap the patient on the OR table. During the procedure some equipment broke and she and the surgeon left the room. I forget where the scrub nurse went but she wasn't there either -it was just me and the CRNA. The patient began to cough and heave while under general and his leg fell off the table. He was over 300 lbs so it almost brought him down with it, had I not grabbed it while the CRNA was trying to handle things on her end. Also, something was wrong with the dermatome blade and the surgeons made quite a mess with his thigh. They got a new dermatome but then opted not to use it and just to make due with the raggedy pieces of skin they had. I don't mean this to be a dump on the OR team and I know things can go wrong in even the simplest of procedures, but it just all seemed like quite a big mess to me. This facility is home to the best burn unit in our region so it kind of left me a little surprised and disappointed.

ChristineAdrianaRN, BSN, RN · Apr 19, 2013

Oh, that is NOT okay. Wow. Yes, they definitely need to be sterile, first of all, because an infected skin graft won't take and will cause a lot of problems for that patient. Raggedy mangled skin won't work either! And the safety belt? Talk about a lack of concern for patient safety all around. Pretty astounding.

stefanyjoy · Apr 19, 2013

I should clarify just for full disclosure - during the pre-op interview the circulating nurse told the patient he would have a safety strap. The patient expressed severe anxiety over this, as he had a big fear of being confined. He almost seemed like he wouldn't proceed with the surgery because of it. She eventually agreed to not strap him until after he had received anesthesia. I guess since this changed her normal routine, she forgot about the strap after he had been anesthetized until the incident occurred with the leg.

NurseLife329 · Apr 19, 2013

I am a nursing student and I had an OR rotation last week. I observed a split autograft and xenograft. The procedure was "clean" and not sterile. I asked the resident as to why it wasn't a sterile procedure and he simply stated there was just "no point" in having it be sterile. The scrub nurse didn't really have a definitive answer for me either. I just wanted to ask - is this normal?

Maybe she meant the incision classification was not classified as sterile. For instance a cholecystectomy everyone scrubbed in is sterile and instruments are sterile etc but the wound is classified as clean/contaminated

ChristineAdrianaRN, BSN, RN · Apr 19, 2013

@NurseLife329 - but that doesn't make sense, either. Belly cases are different because once you take any part of the bowel out, you're considered contaminated, but if you scrub the skin and you're only taking off skin, it's sterile through and through. The only thing I can think of is if the graft went somewhere like in the mouth or nose where you can't ever really be completely sterile.

NurseLife329 · Apr 20, 2013

@NurseLife329 - but that doesn't make sense either. Belly cases are different because once you take any part of the bowel out, you're considered contaminated, but if you scrub the skin and you're only taking off skin, it's sterile through and through. The only thing I can think of is if the graft went somewhere like in the mouth or nose where you can't ever really be completely sterile.[/quote']
I'm not sure i don't do a lot of skin grafts. I know you are contaminated taking out bowel.