sterile technique question

linnaete, ASN, BSN, MSN · Sep 6, 2010

I would say #3, since inserting an IV itself is aseptic. I know both 1 and 2 require sterile technique per my instructors and my experiences and are at higher risk for infection.

Jolie, BSN · Sep 6, 2010

Think about the level of invasiveness of your interventions.

IVF and a Foley catheter are going inside a patient's body, by-passing normal barriers to infection.

A surgical dressing is superficial, covering a wound, but not penetrating into the body.

Now, what are your thoughts?

linnaete, ASN, BSN, MSN · Sep 6, 2010

Think about the level of invasiveness of your interventions.
IVF and a Foley catheter are going inside a patient's body, by-passing normal barriers to infection.
A surgical dressing is superficial, covering a wound, but not penetrating into the body.
Now, what are your thoughts?

I would imagine a surgical wound would more than likely be penetrating into the body, no? And since you will be changing the dressing, you'll be exposing the wound. #3 indicated just changing the bag of fluids, not the IV. And from what I have been taught, peripheral IV's are not sterile, just aseptic. Please correct me if I'm wrong. Thanks! :)

Jolie, BSN · Sep 6, 2010

I would imagine a surgical wound would more than likely be penetrating into the body, no? And since you will be changing the dressing, you'll be exposing the wound. #3 indicated just changing the bag of fluids, not the IV. And from what I have been taught, peripheral IV's are not sterile, just aseptic. Please correct me if I'm wrong. Thanks! :)

The wound has already been created. It was imperative to maintain sterile technique at the time of surgery to minimize the risk of introducing micro-organisms below the skin surface. When changing the dressing, you are not introducing anything thru the would or under the surrounding skin. The wound and surrounding skin (even under the dressing) are not sterile, and never were, even at the time of surgery.

Let's leave the Foley out of our discussion. I think we all agree that must be a sterile procedure.

When changing the IV bag, you remove the empty bag from the tubing set and replace it with a new one. Doing so requires you to "spike" the new bag with the existing tubing. If you touch the spike of the existing tubing with your hand or bed linens, you risk introducing micro-organisms into the IV tubing, contaminating the fluid with bacteria that will then be infused into the patient.

Now again, your thoughts...

Jolie, BSN · Sep 6, 2010

This is an important concept.
It is never possible to "sterilize" skin. To use heat or chemicals which would actually kill all micro-organisms on the skin would also destroy the skin itself. Any time we perform an invasive procedure, penetrating the skin, we do our best to clean it, but it is never really sterile.
However, the equipment and supplies we use to penetrate the body (scalpels, IV catheters, needles, Foley catheters, etc.) must be sterile to minimize the risk of infection.
So we cleanse the skin as thoroughly as possible prior to inserting an IV and we use only sterile equipment and supplies (IV catheters, tubing and fluids). That constitutes sterile technique, even though the skin is not sterile.

kgh31386, BSN, MSN, RN · Sep 6, 2010

Jolie does have a good point, you can't touch your IV stuff to the bed and all that. Also, with surgical wounds...it really depends on the orders you have whether or not it's to be sterile. I'm a nurse on a floor where I see a lot of post op amputees and stage III or IV ulcers...so I had a pt who dehisced, and I was doing q12h dressing changes. Now I could look about 3 inches down into her gut, and it wasn't to be sterile. Also my fresh amputee patients who require dressing changes, you do a simple wash with soap and water or normal saline depending on the doctor's order. And when you have a pt with a sacral wound, it always seems that whenever they have a BM...it finds its way into the wound. So you clean it out and do a simple wet to dry. So...your thoughts haha

linnaete, ASN, BSN, MSN · Sep 6, 2010

Doesn't sterile technique require sterile gloves and sterile field? I think I'm more confused now lol....

diane227, LPN, RN · Sep 6, 2010

Probably #3. When you remove the covers for the tip of the tubing and the insertion site of the IV bag, those areas will be sterile and as long as you do not touch the tip of the tubing that you are inserting into the bag, the area will be sterile.

Foley catheters require sterile technique procedure with a two handed technique where one hand will end up sterile and the other non-sterile. The non-sterile hand will be the hand that you use to hold the labia or member.

As for dressing changes, you can remove a dressing with regular gloves but you must change to sterile gloves to apply the new dressing. Make sure you open all your packages ahead of time and have all your stuff ready because you cannot open those things once you put on sterile gloves. If you have to open something, you will have to change gloves.

queenjulie, RN · Sep 6, 2010

The wound has already been created. It was imperative to maintain sterile technique at the time of surgery to minimize the risk of introducing micro-organisms below the skin surface. When changing the dressing, you are not introducing anything thru the would or under the surrounding skin. The wound and surrounding skin (even under the dressing) are not sterile,

Are you sure? I just learned wet-to-moist dressing changes last week, and they very definitely require sterile technique (although as you noted, the skin itself is not sterile). Is a surgical dressing a different type? That may be why I'm confused.

Jolie, BSN · Sep 7, 2010

Hello,
Going bananas trying to figure out this answer,can't find it. It's all so new, finished core last year, start again one week from now,and I'm trying to get a head start.
could anyone tell me which one doesnt require a sterile technique
1. surgical wound dressing change.
2. insertion of foley catheter
3. changing a solution bag on an intravenous infusion.
thanks 1fabulon

OK. Let me backtrack a bit. I am sorry if I've created confusion. I've used the term "sterile technique" a little too loosely and should instead have said, "maintain sterility."

Let me explain my initial reasoning, then I'll answer the question again, taking into account all of the previous comments.

My initial response to the above question was #1 because by and large, surgical wound dressings are NOT sterile. As we've already discussed, the wound and the surrounding skin under the dressing are not and never have been sterile. Going to the time and expense of doing a surgical dressing change under sterile technique is usually unnecessary and does not produce any better results in terms of infection control or healing than simply using clean technique. My rationale for choosing #1 as the correct answer was that failing to maintain sterility of a Foley catheter or an IV infusion most definitely puts a patient at risk for infection, while changing a surgical dressing using non-sterile (clean) technique does not.

There are exceptions in which a surgical dressing change should be done under sterile conditions. For example, when a surgical procedure is performed to insert a device which will remain partially outside the body (a central venous line or a peritoneal dialysis catheter, for example) the dressing must be maintained using sterile technique to prevent micro-organisms from ascending the object into the body. Another example would be a procedure in which internal organs or tissues are not fully replaced into the body (gastroschisis repair in a newborn, in which it is not possible to place all of the intestines into the abdominal cavity.) In this example, the dressing (usually a silo) must be maintained using sterile technique to lessen the risk of infection until the abdominal wall can be closed. A third example would be dressings for extensive burns. When healthy skin is no longer available to protect against infection, extra precautions in dressing changes are necessary to protect the vulnerable patient from infection. But these examples are the exceptions, not the rule. Most surgical dressings from abdominal, orthopedic, laparoscopic and other general surgical procedures are not and do not need to be maintained under sterile conditions.

Now, on to my revised answer. linnaete asked, "Doesn't sterile technique require sterile gloves and sterile field? I think I'm more confused now lol.... " That made me realize that I may be confusing the term "sterile technique" with maintaining the sterility of an object. If "sterile technique" refers to the process of gowning, masking and gloving in order to prepare a special sterile field in which to carry out a sterile task, then my answer would be #3. This would be the procedure in which it would be posible to maintain the sterility of the object being used (IV tubing) without donning sterile garb and establishing a sterile field.

Whew! A very long winded answer that reminds me of why I enjoy the student forums. You guys made me think!

queenjulie, RN · Sep 7, 2010

That made me realize that I may be confusing the term "sterile technique" with maintaining the sterility of an object. If "sterile technique" refers to the process of gowning, masking and gloving in order to prepare a special sterile field in which to carry out a sterile task, then my answer would be #3.

Yes, at least at my school, sterile technique means setting up a sterile field, wearing sterile gloves, etc., which you wouldn't do for an IV bag change. I'm pretty sure the answer would be 3, but I'm a new student, so that's just my best guess.