What happened to Sterile Technique?

Why are nurses not using sterile techniques anymore?

My friend Judy was a qualified nurse before she became a teacher. She said on the first day of her training, the student nurses were taught how to carry out a dressing change using a sterile (also known as aseptic) technique.

And yet, during the 26 years that I have had scleroderma and antiphospholipid syndrome, I can only think of a handful of nurses who have dressed my various wounds in a completely sterile way (thank you Andrew Cuthbert and other conscientious nurses.)

I had my second leg amputated on December 5, and since then, the wound has required changing at least every two or three days and more recently, every day. Right from the start, the nurses on the ward poo pooed sterile technique. When my dressing fell off and I raised my amputation stump into the air so that it wouldn’t touch the sheets on my bed, various nurses told me to rest it down on the used sheet, and then proceeded to dress it without even washing their hands or using alcohol handwipe.

The only person in Glasgow who used a sterile technique on my new amputation wound was my wonderful physiotherapist, Rosie. When I told her this, she laughed and said that she was just old-fashioned. But if you look up the regulations for dressing of amputation wounds, they do state that they should be done in a sterile way.

Sterile means not allowing any contamination whatsoever. It means the person washing their hands beforehand, then putting on sterile gloves, and thereafter only touching other sterile objects before doing your dressing. This means that they either open the dressings before they wash their hands and put on their sterile gloves, or they have an assistant to hand them what they will use, with the assistant not actually touching the dressing but simply tearing open the packaging.

It isn’t a big ask. And yet as well as the nurses on the hospital ward not using a sterile technique, the nurse in the prosthetic centre in Glasgow, Westmarc, also didn’t use one. She would put on sterile gloves but then she would touch things which were clearly contaminated, like a non sterile paper tape measure that she had left on the non-sterile trolley, which she then held touching my wound in order to measure it . Then she would pick up the non sterile tube of ointment and squeeze some out on her gloved fingers which had handled all the contaminated objects, and smear it directly onto my wound.

I raised my concerns with my wonderful Physio, but she is not in a position to question the nurses who are supposed to be more up-to-date with dressing techniques than physios.

Then I came down to London, and I have been visited by two district nurses so far. They were both pleasant, but neither of them used a sterile technique. The first one washed her hands in my bathroom, but then dried them on a piece of kitchen roll, lying on top of my chest of drawers which had been there for years gathering dust. Then she came and contaminated her hands by touching all sorts of things in her bag.

The second district nurse in London was even worse. She didn’t bother to wash her hands at all. She had driven there and pressed the bell and handled many door knobs in order to get to my flat. She could see that there was an ensuite off my bedroom, but she didn’t ask to wash her hands there. I offered her my bottle of alcohol hand gel as a hint and she used a tiny bit of her own, pinned to her dress, but then delved into her huge bag full of contaminated miscellaneous items like a phone and a purse, and drew out a sterile dressing pack - which is not sterile on the outside, where it has been lying in her handbag. She opened it quickly while it was still in her hands and then, with her contaminated hands, started moving everything in the kit about, even handling the sterile swabs, in order to find the small plastic bag that acts as a bin.

I told her I would pour my bottle of cleaning solution onto her swabs so that she didn’t have to further contaminate her hands, but she took the bottle from my bedside and said she would do it. More contamination. That bottle came down from Glasgow in a suitcase full of items.

The dressing she was going to apply - which was one of mine - was too long, so she burrowed her hand into her pocket and drew out a pair of metal scissors. ‘ But they are not sterile’, I said. ‘Yes, they are’, she lied. She didn’t know I was a doctor. I baulked and said I would rather have the long dressing on uncut.

I have been using a sterile dressing impregnated with petroleum jelly to protect the dry flaking skin around my wound from the secretions and to moisturise it. However, she took this dressing when I offered it and placed it directly on my wound, which is the wrong place to put it. It also meant that she had put something which she had dirtied straight into my wound.

The local GP surgery in London has already told me that they will not issue any dressings for me whatsoever unless I agree to have my dressing done by the district nurses. This came from the stroppy deputy practice manager, not from any of the GPs. It’s impossible to contact the GPs directly because all my emails are intercepted by this deputy practice manager who doesn’t pass them on to the GP on-call, as I request each time.

After having my wound manhandled with contaminated hands twice in London, and a few times by the prosthetic centre nurse in Glasgow, I developed signs of severe wound infection, with my amputation stump becoming bright red, hot to touch, inflamed, and excruciatingly painful, and my wound leaking pus. I made an appointment with the GP and spoke to her, and she said I should go straight to A&E as I needed iv antibiotics for a severe life and limb, threatening wound infection and cellulitis.

This upset me. I do my own wound dressing every single day, including immediately after the contaminated dressing done by the nurses. Before I touch anything, I sterilise my hands with plenty of alcohol gel, and if I then need to touch something that is not sterile, I go through the whole sterilisation of my hands again. This is what you are meant to do. If I can manage to do it with no legs and extremely limited hand function in my claw hands missing digits, why can’t a nurse do it?

Reader, I didn’t go to A&E. I have spent most of the last three years in hospital. When I am there, I am always cold, I can’t bear the first 48 hours in a noisy A&E, and even when moved on the ward I have no sleep unless I am in the hospital in Glasgow where patients are given single rooms, I don’t eat because I can’t bear the fatty nursery food, and I have difficulty getting to the toilet because I don’t have any legs now and ambulance paramedics often refuse to take my wheelchair and hospital wheelchairs do not allow the patient to drive themselves but have to be pulled by a porter. This is because so many of them were stolen so they had basically had to make them almost useless, so no one will want them.

I am still at home in London, now taking two oral antibiotics. I am really upset that I have been raising concerns about nurses dressing my wounds using a dirty technique since December, and yet they continue to do this. After I had my leg amputation in December, I had to spend two weeks in the high dependency unit with bilateral pneumonia and heart failure. To my astonishment, a vascular nurse came down to see me there, and not only did not use a sterile technique, she also turned the non-sterile tap on the sink and splashed tapwater into my wound, saying that it had been shown to be no worse than sterile saline. However, this is not what the research showed, the research said that further follow-up would be required to see if there was a greater risk of infections if non-sterile water was used to clean the wound. Why on earth, when you have all the sterile equipment sitting next to you, would you choose not to use it?

Every single hospital policy document says that amputation wounds have to be dressed using a sterile technique and yet I have not come across one nurse who has done this since my leg amputation. Now, if my severe wound infection does not settle, I may have to have more of my stump cut off, resigning me to a wheelchair forever, since it is much more difficult to walk on prosthetic legs if you have an above knee amputation than a below knee one. Please, nursing union, do something about this. Bring back matrons and strict asepsis.

NB this was written five days ago. Four days ago, I was taken by ambulance to A&E with wound infection and cellulitis, and I am currently on a surgical ward receiving intravenous antibiotics and awaiting surgery to debride the wound and a possible skin graft to cover the gaping wound. There has been talk of cutting the tibia in my stump but the skin is stuck to it, so it would mean the loss of that skin and a huge hole .

I’m in a famous London hospital where the staff have been amazing: kind, caring, and clinically excellent. My dressing was changed a few times in A&E in a non sterile way: the nurses were delightful but extremely busy and arguably not au fait with dressing amputation wounds.

Yesterday, instead of my usual hinting that a sterile technique is best as I get infected readily, I directly asked a fantastic senior nurse who was about to do my dressing if she could please do it in a sterile way and she did. Thank you, dear Catherine. Please, other nurses, don’t wait for patients to ask.