Clean Wound Dressing Change Techniques Aseptic Dressing Changes
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Nurses ✓ Margaret ✓ Diabetic ✓ Wounds ✓ Wound ✓ Ulcers ✓ Human ✓ Dressing ✓ Health ✓ Management ✓ Pressure ✓ Continence
In many facilities, they would use just clean gloves to hold the moist gauze with the wound cleanser changing hands, back and forth. I have seen nurses put on sterile gloves then open cotton swab packets, place a clean chux over a soiled one, operate the bed to get it the correct height and answer their phone, then try to continue with the dressing. I have searched a cupboard for a dressing only to find a piece of Mepilex foam drifting about, a pair of scissors goopy from having cut Xeroform and a tube of Santyl under everything and with no lid on it.
Dressing overallField dressing (bandage)Dressed weightWoman in a Dressing GownSocial transformationToilet
" None of them taught clean technique. I once asked an RN what the difference between a sterile technique and clean technique and (with tongue in cheek) he quickly responded, "Isn't that something to do with the five second rule? " I thought it funny then, but now I am not laughing at all because what I see scares me. I have witnessed all of the situations below and been given no excuses, reasons or apologies for the blatant lack of basic cleanliness. Those items with the asterix, the nurses said when queried about the procedure, something similar to "Oh - we just use a clean technique here."Iodosorb tube covered in product, especially the grooved white top. Scissors used for removing a heavily soiled wrap then used to cut a dressing that was used to pack the wound. The portion of the primary dressing cut off was kept to be used for another dressing change a few days later. * A sterile field opened and packets opened and laid on it. Gloves were put on to remove the dressing, then worn to open up a bottle of saline and then clean the wound. The saline was kept for the next dressing change. *Clean gloves used to remove the dressing then open a debridement kit. The PA went on to run the same gloved finger along an exposed tendon and palpate exposed bone, as she pointed out the structures to a student. A soiled chux left in place while the wound was sprayed with skin cleanser (later noted to have stool on the handle.) Scissors used for cutting the ostomy wafer used to cut a primary dressing. Dressing field set up with a plant/urinal and hair brush within a foot. An experienced WOC nurse taking down a heavily soiled venous leg ulcer dressing without gloves on and then went on to clean the wounds, dress and wrap the wound without any hand hygiene at all (gloves were used for the cleaning and dressing). A bedside technique used for a NPWT dressing and the sponge dropped on the sheet more than once, picked up and placed in the wound. I am infuriated that nurses think any of these are accepted as clean technique. I have watched materials management filling up shelves in a store room, and items fall on the floor. They are picked up and put with everything else, on the shelf (and that is fine). The nurse then opens one of these packets, removes gauze and with the same gloves, irrigates and cleans the wound. In many facilities, they would use just clean gloves to hold the moist gauze with the wound cleanser changing hands, back and forth. Where do the gloves come from? One nursing home where I worked took gloves from the patient's bathroom to use for dressing changes. I was doing ostomy care recently and asked for another pair of gloves and the nurse brought over the box, no hand gel, just a box of gloves for me to dip my sweaty little digits in (but I didn't). How many times a day do you reach in and take gloves, then do your hands? I have also watched aghast as a pharmacy tech unloads creams for the cupboard onto the floor before placing them on a shelf. I then went to watch a burn dressing done and the tubes were handled expertly to get every last drop of cream out, the gloves handling them were different from those that dressed the wounds, and I was impressed but wondered "is it always so? " I have seen nurses put on sterile gloves then open cotton swab packets, place a clean chux over a soiled one, operate the bed to get it the correct height and answer their phone, then try to continue with the dressing. I have searched a cupboard for a dressing only to find a piece of Mepilex foam drifting about, a pair of scissors goopy from having cut Xeroform and a tube of Santyl under everything and with no lid on it. None of this is clean dressing technique, it is dirty and sloppy! It is not all bad. Nurses do sometimes ask "should I change gloves," is this or that "okay," so many of them are thinking and taking care as they go, but many, many are not. The Argument for Sterile Gloves in Chronic Wounds
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