Published May 21, 2000
Some nursing literature states that vaginal exams only need clean technique, not sterile. The doctor offices only use clean technique but in the hosptial setting we always use sterile. What do other facilities use? Also, in the same article it recommends only clean technique for after the membranes have ruptured. It states just to limit the exams. Please give me your thoughts on the subject.
Where I work, we use sterile gloves. If they're ruptured, and especially if the mom is GBs+, we limit the number of exams. (But we do have one physician who does exams with clean gloves.)
Well, the vaginal vault is anything but sterile, but just as we try to maintain sterility when delivering the baby, it seems to make sense to perform an exam with the same thought in mind, especially if membranes are ruptured!
In our facility, as well as others I've worked in, we also use sterile technique, and limit exams following ROM. In the doctors office, it would make sense to use clean technique, as you'd only be introducing the patient's microbes to herself. However, in using sterile technique during labor, you're primarily attempting to limit the number of microbes that you'd introduce to the baby, who has a higher susceptibility to infection. So, although the sterile technique is not totally sterile (due to flora in the vaginal vault)-it still seems worthwhile to use sterile gloves and limit exams after ROM. In my humble opinion, of course!
Evidence based practice
Prior to ROM clean technique is appropriate and acceptable.
After ROM sterile technique is mandatory. Even better - keep your fingers out of there! You increase risk of infection 30-50 % with EVERY vag evam
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