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My wife has been receiving wound care in our home for an open breast cancer tumor for about four months now. The services are provided by independent nursing services (agencies) funded by the Ontario government (CCAC). Don't get me wrong, we are very thankful for this service but the quality of service is deficient in two areas that could be possibly life threatening.

First of all, from day one there has been a total lack of sterile technique. I have personally witnessed the incompetence of these nurses and we have endlessly complained to them about this. The nursing agencies justify this by saying it is not necessary to uphold traditional sterile procedures. We are shocked with this attitude and my wife has had recurring infections.

Secondly, the nursing agencies and their nurses cannot ever seem to have enough medical supplies on hand to perform the wound dressings properly.

It appears that both of these issues are as a result of budgetary restrictions and poor nursing training. Is there anything we can do to alleviate this situation? This is causing my wife undue stress.

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Wonderful picture, though, E/lass! :)
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OOPS!!!! Disregard! It's the suctioning of a tracheostomy that's a sterile procedure. I typed 'trachea'.
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There is 'sterile technique' and then there is 'clean technique' when doing a dressing change and there are numerous factors that indicate which technique should be used.

For example, a frail, elderly person with a weakened immune system and who is on immunosuppressant drugs and needs a daily dressing change might need the 'sterile' technique. Or a middle aged guy who was in a motorcycle accident and developed a Stage III pressure ulcer which needs a dressing changed every 3-4 days can manage just fine with the clean technique. There is nothing definitive written anywhere about which condition deserves which technique. Your caregiver should be following Dr.'s orders. If the Dr. ordered a sterile dressing change then that caregiver needs to be trained in how to apply a sterile dressing. There are many factors involved, you don't just whip out some dressings while wearing gloves. There are specific steps to be followed in a certain order.

I work as a nurse in home healthcare and I know that my agency doesn't expect nor train it's caregivers to do dressing changes. That's left to the nurses. And if you called my agency they would say that their caregivers are not trained to do dressing changes. Do our caregivers still end up having to do dressing changes at times? Yes. But usually the patient is proficient in how their dressings should be applied and can train the caregiver in how to do it. Or the RN trains the caregiver when the RN is in the home. Changing dressings isn't rocket science but it should be done properly and there is no across-the-board way to change a dressing. There are many techniques and types of dressing changes in addition to numerous types of bandages that are used for specific types of wounds. But in my experience the dressing change that is most common is done with a 'clean' technique. Even when I worked in the hospital we didn't have many 'sterile' technique dressing changes because they just aren't necessary much of the time. Even suctioning someone's trachea is a 'clean' procedure, not a 'sterile' procedure and that's a tube that goes down the throat.
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CBC might be FBC (Full) in Canada.

I was looking up Wound Care specialist nurses the other day for something completely different, and came across a number of learned journals. You might find it helpful and reassuring to read up on the latest guidance yourself, too; so that you can help visiting staff get up to speed more quickly.

We are bombarded with reminders about infection control; to these have now been added further notices urging patients and relatives to feel comfortable about kicking up a fuss and insisting that professionals go through the routines; but the fact is that saying "oi" to someone you have to trust with your relative's care is not something many people are at all happy to do. You shouldn't have to. I understand your frustration.

Back to being the expert patient, so that rather than telling the nurses what they're doing wrong, you're able to say exactly how you'd like them to get it right. It goes down better (usually).

For the supplies: check serial numbers and manufacturers' details on products you are happy with and bulk-buy. Take care to store them correctly.
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CBC is a complete blood cell count, with DIFF means a further count of white cells too see which types are present and at what level. CMP is a complete metabolic profile which can show kidney/liver function and electrolyte levels. MD is a medical doctor.
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Pstegman, thank you for your reply and suggestions. Could you explain what the medical acronyms represent?

Actually, my wife knows how to change the dressings herself even though she can't see all the wound. I assist her with the cling wrap. She often has to train each new nurse on technique. It's taken her almost two months to train the current nurse.
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Recurring infections are a red flag, not necessarily from changing the dressings, but a hint that the immune system is compromised. Discuss this with the MD and get a CBC with diff and a CMP to rule out any concurring problems. I would want to learn to change the dressings myself, as visiting nurses see multiple patients and if you can do this, there is less risk of disease transmission. The MD can order the supplies you need from the pharmacy.
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