Wound care w/o gloves

[teeniebert]

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:

[shaa]

Are you sure that, reallt it need strile gloves. as in our ward after 1 post operative day we do not use sterile techniques (sterile govves)

[CitrusBeeRN]

Gross. There is almost nothing I do without gloves on, including something as simple as adjusting the thermostat for a patient, turning lights on/off, silencing a pump, etc. After seeing those surfaces touched by other nurses wearing gloves with some bodily fluid on them, I adopted a personal policy of wearing gloves at all times. It takes 2 seconds to put a pair on....why not?

[Icaria]

I just finished micro and all I can say is

[Tash4nvyblues, RN]

Chronic wound care can be quite different to acute wound care. On district if we have an acute wound we use a sterile dressing tray and use aseptic technique, which is not sterile, I think it may be what you call a clean dressing. We take the dressing of with gloves or the forcep provided, then throw the gloves/forcep away and we attend to the primary dressing using the forceps and no gloves. The secondary dressing is placed on with our hands as there is no contact with the wound. We use the sterile procedure for PICC dressings, wound drainage tube dressings, IDC's ETC.

We manage chronic wounds by calling the client half an hour before the dressing and they take the dressing of for us and wash the wound in the shower. It gets way cleaner then any saline we can run over the wound. When the nurse comes we apply the dressing often without gloves. We wash our hands well after each client and alcohol our hands as well. And our hands are probably cleaner then the gloves.

That nurse should cut her nails, no nurse should have long nails, it is dangerous to the client, but before you report this nurse make sure you are informed as to whether her practices are in fact policy or not. What you have been taught may have either changed (health care policy is an ever revolving door), or the policy may be differnt in different settings.