1. Karch, Amy M. MS, RN
  2. Karch, Fred E. MD

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Rita L'Engle, a 32-year-old mother of three, is seen by a home health care nurse three days postdischarge after emergency surgery to remove an ectopic pregnancy. The visiting nurse will evaluate wound healing and supervise wound dressing.


Ms. L'Engle is febrile today, at 101.1[degrees]F. She tells the nurse she's not feeling well, has no energy, and has found it difficult to care for herself and her children. The abdominal wound is found to be bright red and warm, with purulent drainage. Ms. L'Engle had changed her dressing three hours earlier, and the sanitary napkins she'd used for the dressing are wet, blood tinged, and coated with purulent drainage. The nurse arranges for Ms. L'Engle to be transported to the hospital.


The surgeon's evaluation reveals that Ms. L'Engle's abdominal wound is deeply infected. Cultures from the wound are sent to the laboratory, and she is admitted and started on ciprofloxacin 400 mg iv q12h, to be reevaluated pending culture and sensitivity results. She is hydrated with normal saline, at 150 cc/hour.


As the nurse caring for Ms. L'Engle, you review the wound care procedure with her and ask her about the use of sanitary napkins. Ms. L'Engle says that during her initial admission, her nurse had mentioned that sterile abdominal pad dressings were quite expensive and that sanitary napkins or disposable diapers, both of which were very absorbent, might be much more affordable. Ms. L'Engle received one pair of sterile gloves when she left the hospital. The first visiting nurse, telling Ms. L'Engle that the agency would not pay for sterile gloves, gave her a box of clean gloves to use.


Although Ms. L'Engle could correctly demonstrate the wound care procedure that she'd been taught, the equipment that she used for wound care might have contributed to the development of her infection.



Open surgical wounds require sterile wound care to hinder the introduction of bacteria. Sterile dressings should be applied using sterile gloves and strict aseptic technique. Ms. L'Engle used clean, not sterile, gloves and clean, not sterile, sanitary napkins.


The makers of sanitary pads are not required to list the contents of the products on the packaging. The Tampon Safety and Research Act of 1999 states that feminine products (including pads) may contain wood fibers, cotton, rayon, polyester, polyacrylate, absorbency enhancers, chlorine compounds, and fragrances. The act states that little information is available to the public about these products and mentions possible associated problems, including infections. The effect of sanitary pads on an open wound is unknown. Do they enhance bacterial growth or actually introduce bacteria into a wound?



Research on the use of sanitary napkins or diapers as wound dressings, or on the use of clean rather than sterile gloves, is lacking. Informal discussions with eight nurses from around the country in a variety of specialties (rural primary care, surgery, oncology hospice, emergency, and home care) revealed that all have used these nonsterile products (if their employer didn't provide sterile ones), have seen patients use them, or have recommended them to patients as alternatives.


All eight have seen infected wounds with nonsterile dressings. None was able to say whether they noticed higher rates of infection with nonsterile dressings, or whether they simply "noticed" an infection more when the dressing was nonsterile. All eight wondered whether using these products is appropriate, but often, they said, they had no choice.


It's unfortunate that health care providers must now make choices that save money but that can compromise patient outcomes. As this case shows, saving money on sterile dressings and gloves may have resulted in a potentially life-threatening infection and costly hospitalization. Staff and patient education may reduce the frequency of use of nonsterile dressings and gloves, where there's a choice. However, since these products are being used every day, research is necessary to test the safety and effectiveness of wound dressings fashioned from nonsterile products.[black down pointing small triangle]