Wound care w/o gloves

[teeniebert, LPN]

Hi everyone. I'm in week 9 of a 50-week LPN program. Today at clinicals (Long-Term Care) I got a chance to observe the facility's wound care nurse. There was a new admission, someone who's stayed at the facility before for care of pressure ulcers. Her entire 'bottom' is in various stages of breakdown, and she also has sores on both heels. Seeing the ulcers wasn't as bad as I thought it would be, until the nurse started putting a new dressing on. She applied Silvadene gel to 4x4s and placed them on the patient, without putting gloves on! I don't know what is going on in this woman's head...she used gloves to remove the old dressing and clean the wounds, why would she not wear them to place the new dressing? Maybe she thinks she's immune to bloodborne pathogens or something? Or that body fluids are less 'icky' after the wounds are flushed with saline? Maybe she has some magic handwashing technique that's guaranteed to remove every microorganism? I really doubt that last one, since she has insanely long fingernails on one hand. I don't know what to do here. This might be an isolated incident, but somehow I don't think so. Do I report her to management? Do I call State? I know there is another patient in the facility with MRSA, is this woman potentially spreading it to all the wound-care patients? Help! :uhoh21:

[chilibean]

When I would change dressings during clinicals we had to use sterile techniques. I think I had to change my gloves two or three times. I had to have on sterile gloves when applying a new dressing once I had cleaned the wound. So I'm sure this nurse wasn't following proper procedure. I think performing wound care on a patient is just gross. That nurse is putting herself at risk and also she is putting her patient at risk for infections. However, I am just a student so that is my opinion. My instructor told me that I should always speak up when I thought something wasn't quite right but turn my concern into a question. For example, if I thought someone should have on gloves I would ask if they needed a pair of gloves and try to hand them a pair or ask the nurse if this procedure required gloves.

[Jules A, MSN]

What a shame, like you noted not only is she putting herself at risk but also this patient and others in facility. I would notify your instructor and let her handle it if she fees like it should be reported. My guess is that this is an old timer and the facility is probably aware of her outdated practices.

[FutureNurse23]

I'm just a CNA and new at my career, but I don't even take my gloves off when applying lotion to a patient after a bedbath. Also, gloves are a must when coming in any contact with a patients clothed area epecially wound care.

[suanna]

I think you noted a telling point when you said she has "insanely long fingernails" JCAHO forbids long nails as well as every nursing dress code I've ever read. I doubt this person cares at all about universal infection control precautions. I pity her poor patients. I doubt there is anything you can do to change her ways. You can't teach a pig to whistle- it wastes your time and annoys the pig!

[morte, LPN, LVN]

most wound care in LTC is CLEAN not sterile....did she pick up the dressing itself. or the package it was in/on? i have done the later.....and you specified long nails on only one hand, just curious did you ask why? (not that you should have, i am just curious, would wonder if she perhaps played an instrument)

[teeniebert, LPN]

most wound care in LTC is CLEAN not sterile....did she pick up the dressing itself. or the package it was in/on? i have done the later.....and you specified long nails on only one hand, just curious did you ask why? (not that you should have, i am just curious, would wonder if she perhaps played an instrument)

She picked up the dressing itself. The long nails are on her left hand, which makes me wonder if she considers her right hand her 'working' hand and keeps those nails short. I'm going to talk to my instructor and the director of my program--the director is the person who brings students' concerns to the DON at the various clinical facilities. Also, regarding the long nails, a student who observed wound care last week told me that the nurse used her long nails to scrape off tape and kerlix fibers from a wound.

[MeJane19]

There's no good reason for even one long nail when doing nursing duties. No sterile wound dressings are not necessary the majority of the time but out of protection for yourself and your patient you should "always" wear gloves.

[vashtee, RN]

To play the devil's advocate, and I would never do it because I am too big a germ-freak, but if she picks up the bandage on one side, and applies the other side to the wound, is not the side touching the patient still sterile?

[MeJane19]

Yes it would be sterile but I don't think that's the point. The nurse could easily contaminate herself or the patients surroundings with bacteria from the old dressing and if she didn't wash her hands she could infect herself or carry the germs to another room.

[trepinCT]

I thought that if it was an open, deep wound, sterile is the way to go, if not its clean..either way she should have worn gloves..being in a LTC or being an "old timer" are poor excuses for not doing the right thing..plain ignorance and in a heartbeat I would report it..what if it was your family member????

[trepinCT]

what if the patient were YOUR family member? Treat it that way. being in a LTC or being an 'old timer" are poor excuses for delivering substandard care.