Xeroform: sterile or clean?

[waterdrop22, RN]

Hello fellow nurses :)

I work in LTC and we have a resident who fell and tore her skin to the muscle. We are placing xeroform on the section of the wound that has either dead skin or no skin, and kerlix over the top. One of the nurses I work with was a MA before he became an RN and argues that xeroform should be applied as a sterile procedure. Has anyone else heard of this practice?

So far I've kept it a sterile procedure, but I'm unsure if the other nurses are doing the same, and I'd like some evidence to back up either procedure. The plastic surgeon gave us orders to cut the dead skin, so I'm trying to figure out if we need sterile or clean scissors as well.

Your thoughts and current practice appreciated.

[CarreBarreLPN, ASN, RN]

It depends on the doctors order for the treatment. If they order it to be done using sterile technique then you have to do it that way. As far as the "cutting dead tissue" yes, the scissors or curette need to be sterile but I think the bigger question is....do you have training to do sharp debridement? Also, are nurses allowed to sharp debride in your state? if you're unusre I would check the sharpdebridement.com website for more information. Doctors orders or not if you don't have experience in sharp debridement I wouldn't perform it.

[waterdrop22, RN]

Carre, this is where I'm confused. The orders say nothing about it being a sterile technique.

As for sharp debridement (looking up now), for Washington it looks like we need to take a special course as an RN. Wow, I didn't even know there were restrictions for that. Well this is good to know, I'm surprised the plastic surgeon gave us this order if we cant even do it.

[CarreBarreLPN, ASN, RN]

hmmm...I'd probably clarify the entire order doesn't sound like the doc is certain about the whole thing. As far as in our LTC facility though we only use sterile technique if ordered- otherwise wound management is clean. Hope this helps!

[alphabetsoup]

Why is the skin dead? Is this a STSG that failed?

[waterdrop22, RN]

It was a skin tear, but d/t the psoriasis (and the cream we were using to counter the psoriasis) tore away 12X6cm of the superficial skin. She isn't a candidate for a skin graft because of the psoriasis.

At any rate, we are using sterile gloves while applying the Xeroform because our DNS requested it. And decided to let the wound clinic do the skin trimming (she sees the wound clinic weekly).

Still don't know if there is any policy about xeroform being a sterile procedure. But in the mean time, we are doing our best to prevent infection by making it sterile. So thats a good thing, right?

[caliotter3]

Recently worked with a home client with a wound with an order for xeroform. No way to keep it a sterile or clean procedure as the primary family caregiver would remove, replace, rearrange, etc., the wound packing and dressing without wearing gloves or washing her hands. Needless to say, constant infection. You could always tell how bad it was when the family member refused to let the nurse do the wound care at all. The odor gave it away. Glad to leave that case.

[waterdrop22, RN]

That is awful! I have never been more thankful that the wounds I care for have no odor.

[E. Chester, LPN]

Sharp debridement?!? No way. Order or not. I know it requires an RN with wound care cert and sharp debridement training in FL. (The entire reason for the bags under my eyes...)

[USN.HM, RN]

In my clinic when I am packing a wound with Iodiform I use clean technique. I believe that if you are doing the best you know how both you and your patient will be safe, when in doubt double check with the provider or bring it up in a team huddle/meeting.

I am definately going to look up Hawaii state law for nurses, this sounds very interesting.

[alphabetsoup]

So you are treating a skin tear. Xeroform is fine but it can dry out and stick to the wound base. I also like Tegaderm Clear Absorbant for non-exudative skin tears. It doesn't have to be changed as often, you can easily visualize the wound, and it seems to be less traumatic for the patient. Although with psoriasis, it would perhaps not adhere as well.