Wearing sterile sleeves or a sterile gown for foley insertion?

[Axmann, RN, BSN, NREMT-B]

While it may seem silly to some, I believe I'd find myself more comfortable inserting a urinary catheter if I was able to ensure the sterility of my hands. The entire technique of open-gloving for sterile procedures always seemed shifty to me, because it ultimately leaves you with very little sterile length on the hands given that it's extremely difficult for even experienced nurses to completely prevent the outer edges of the cuffs from touching the bare arms (whether it be due to rolling, etc, or whatever)

With sleeves, you'd have a much wider range of movement with your hands, and you would also be CERTAIN that the entire area around your hands is sterile, since the gloves would stay in contact with the sterile sleeves even if they rolled nonstop, since the outer cuffs of the gloves are sterile until you actually touch them with bare hands (regardless of what they are "considered"). If you use the sleeves correctly, there's a lot of wiggle room in the cuffs without contaminating anything.

What do you guys think?

[THELIVINGWORST, ASN, RN]

Are you using your wrists to insert the cath? As long as your hands stay sterile and you're not rubbing your hands on anything but the foley, it will be ok.

[DalekRN]

I've never had my wrist area even close to any sterile part.

[ruralnurse84]

I just inserted a foley the other day...first male one as student...honestly my gloves weren't even on that well and there certainly was no issue...my instructor was with me the entire time...imo it would be going way overboard to think about doing sterile gowning for a catheter.

[Axmann, RN, BSN, NREMT-B]

Are you using your wrists to insert the cath? As long as your hands stay sterile and you're not rubbing your hands on anything but the foley, it will be ok.

I don't know. Do surgeons use their wrists to insert and operate laparoscopes? As long as their hands stay sterile and they're not rubbing their hands on anything but the laparoscope, will it be ok?

The goal of sterile technique is providing an area as close to "free of organisms" as possible and with as little impediment to the operator as possible. CAUTI is on the rise and given that a lot of people are poorly-skilled in sterile gloving, I am positing that the closed-glove method could be a way to improve outcomes.

Your response isn't helpful and it doesn't address the topic.

[JBudd, MSN]

You get pretty good at keeping your hand sterile, although you are not in a sterile area (ie the OR). Slinky was on topic, a foley insertion is not nearly as invasive as a lap procedure, apples to oranges.

I use the gloves in the kits, but if I suspect there will be difficulties, such as a large person where a 2nd person is needed to keep skin folds up out of the way, I tend to get a package of gloves which has a longer cuff. I have never contaminated my field with my arms or wrists, the area deemed "sterile" is rather small, and the time period is short (unlike a lap).

So no, I don't think that sterile sleeves or gowns would be beneficial in reducing contamination rates (UTIs), which is the main concern with the use of Foleys.

[THELIVINGWORST, ASN, RN]

You get pretty good at keeping your hand sterile although you are not in a sterile area (ie the OR). Slinky was on topic, a foley insertion is not nearly as invasive as a lap procedure, apples to oranges. I use the gloves in the kits, but if I suspect there will be difficulties, such as a large person where a 2nd person is needed to keep skin folds up out of the way, I tend to get a package of gloves which has a longer cuff. I have never contaminated my field with my arms or wrists, the area deemed "sterile" is rather small, and the time period is short (unlike a lap). So no, I don't think that sterile sleeves or gowns would be beneficial in reducing contamination rates (UTIs), which is the main concern with the use of Foleys.[/quote']

THANK YOU! Inserting a foreign body into an orifice for days at a time is dangerous period. Inserting sterile objects into a cavity that has been prophylactically treated with abx using sterile gloves, gowns, scrubbed skin is an entirely different subject. A foley is inserted sterile but it is still open without the benefits of prophylactic treatment for infection.

[mrsboots87]

I feel sterile gowning would be overboard. Surgeons uses sterile gowns, double glove, and a sterile room because they will be cutting your protective skin layers to expose your inner body and giving pathogens a direct path to your blood and organs. There is a MUCH higher risk of contamination and later infection in a surgery thats not sterile then with a foley insertion. I could maybe see the point of a sterile gown if the nurse is sloppy, but in that case they are likely breaking their sterile field anyway and should start over. Also, the foley is left in for long periods of time. Sterility is gone after max of 1 hour. So at that point, pathogens could contaminate the meatus area anyway. The sterile gloving is just to make sure that the end of the foley that enters the bladder is free from pathogens. Basically just dont go rubbing your wrists on the sterile items and everything should be fine.

[Nursing_Mamacita]

If you are truly comfortable with foley insertion, this shouldn't be an issue. I like to wind the cath up a bit in my hand and sit the box with the collection bag in it as close to the insertion site as possible to minimize contamination risk.

With practice, my friend.

[nurseprnRN, BSN, RN]

I don't know. Do surgeons use their wrists to insert and operate laparoscopes? As long as their hands stay sterile and they're not rubbing their hands on anything but the laparoscope, will it be ok?

The goal of sterile technique is providing an area as close to "free of organisms" as possible and with as little impediment to the operator as possible. CAUTI is on the rise and given that a lot of people are poorly-skilled in sterile gloving, I am positing that the closed-glove method could be a way to improve outcomes.

Your response isn't helpful and it doesn't address the topic.

Surgeons in the OR doing laparoscopy have to be prepared for an open procedure, and the laparoscope is a much larger piece (actually, pieces) of equipment. Not a good comparison. Also, while of course we are very concerned about CAUTI, a bladder infection is rapidly identified, pretty easy to treat, and not as dangerous as an intraabdominal or intraarticular one.

Short answer, if this is a homework question, you are entitled to make your argument and defend it. But in actual clinical practice, this is really not an issue. If you want to practice your technique with donning sterile gloves, do that. If you want to try to get those elbow-length ones from OB they use for vag exams, good luck with that. But I think the rest of this is, to put it kindly, not going anywhere.

[psu_213, BSN, RN]

I second what most everyone else has said. Just a couple other things:

If you liken inserting a Foley to surgery (with the same infection risks), why not insert all Foleys in the OR with proper, controlled airflow? Why not do a full surgical scrub before inserting a Foley, not just 'simple' hand washing?

Finally, what a waste of resources to use a surgical gown for each Foley insertion. In understand that someone might say "lives are on the line...you can't put a cost on that!" Well, unfortunately, in the real world, resources are limited and this is a legitimate consideration.

[Axmann, RN, BSN, NREMT-B]

Thanks for the responses, everyone.

Yes, I'll admit that my comparison of surgical laparoscopy to a Foley insertion is quite apples to oranges, but my point really lies more along the lines of "if we're going to apply sterile procedure to Foley insertion, why not apply it at least a bit more correctly?" I think we all can agree that the use of sleeves/gown is superior in ensuring sterility when it comes to surgical procedures, yes?

While I put gowns in the topic title, even I agree that such a thing would be overkill. I'm more focusing on sterile sleeves here, which I should've made clearer. It's just that some hospitals might not have them.

If it could be demonstrated at least that sterile sleeves decrease infections related to catheter insertion.... wouldn't their use be justified?

Yes, this is all a theoretical discussion: something I started thinking about and seem to have a hard time joining the "it's not worth it because it costs too much" crowd. I'd like to see a study on it, perhaps.