2007 Sa Sawma Wound Cleansing and Dressing Procedure Nov 07
2007 Sa Sawma Wound Cleansing and Dressing Procedure Nov 07
2007 Sa Sawma Wound Cleansing and Dressing Procedure Nov 07
Margi Moncrieff
Define the aetiology of the wound and treat the underlying cause Identify factors affecting healing Wound assessment and documentation Management plan including dressing regimen Evaluation of healing and adjustment of plan Maintenance of healing
Overview
Purpose of wound cleansing Solutions Dressing techniques
Sterile Aseptic Wound field Clean
Wound Cleansing
The application of fluid to aid removal of exudate, debris, slough and contaminants Wound cleansing helps optimize the healing environment and decreases the potential for infection. It loosens and washes away cellular debris such as bacteria, exudate, purulent material and residual topical agents from previous dressings. Most wounds should be cleansed initially and at each dressing change
Tap water (showering) vs. no cleansing; no difference in wound infection Tap water vs. Normal saline; infection rate in acute wounds cleaned with sterile saline Sterile saline vs.. no treatment; bacterial count with N/S. ? Technique 1% Povidone Iodine vs. sterile NS. Lower infection rate when PI was used on contaminated wounds. No difference in acute Other comparisons with Procaine Spirit, ShurClens, boiled, distilled water
Potable tap water is an effective cleanser for acute and chronic wounds, in healthy adults (L3) Irrigation with Povidone Iodine is recommended for cleansing contaminated wounds (L3) PI should be applied to the area, left for 3 5 mins, then washed off (expert opinion) Pressure of 13psi (12cc syringe & 22g needle) effective in reducing infection, inflammation & bacterial count (L2) Showering of post-op wounds does not increase infection or slow healing (L1)
Showering does not impact on infection or healing rates of post-op wounds Showering ulcers and chronic wounds should be done with caution
Considerations
If the wound is on the foot, bag it for showering When considering solutions, need to weigh up impact of bacteria on wound vs. use of antiseptics If the solution causes pain, re-evaluate choice Environment may impact on technique and solution
Considerations
Wounds in different phases of healing require different cleansing techniques; Necrotic wounds may require more aggressive cleansing to assist debridement Gentler and non-traumatic for granulation tissue Ensure the aetiology of the wound is known and that cleansing choice is appropriate
Sterile technique
Method to reduce exposure to microorganisms Used in the OR for surgical procedures Involves use of sterile gown, gloves, masks, equipment, dressings and surgical drapes May be used in some ward situations i.e. burns dressings, VAC to sternum
Aseptic technique
Taught as standard dressing procedure in many Unis Asepsis; absence of pathogenic organisms Method used to minimize contamination by pathogens and protect the patient from infection Sterile gown and gloves not required Different pack required for different wounds If the dressing field becomes contaminated, the pack must be discarded
Aseptic technique
Where is the evidence that supports all aspects of strict aseptic technique for all wounds? Traditional vs. evidence based Nurses indoctrinated into technique and it is still being taught The focus becomes procedural, not on the wound cleansing/dressing Time for change
Often used in community / home care settings Instruments are still used to handle/apply dressings Objects can be placed back down on field again; place touched handles of instruments on edge of field Clean items are kept away from sterile
Gloves
Use sterile gloves when performing strict aseptic dressing procedure if you want to touch the dressing field, instruments and/or wound
4.6 AWMA guidelines; Use non-sterile or sterile gloves when there is a risk of contamination to the individual or clinician
Contamination is an act involving the introduction of microorganisms into a wound and the wound field Research demonstrates that exogenous introduction of microorganisms into wounds occurs principally by direct contact Limiting direct contact between the hands of the clinician is the most effective way of reducing contamination (case for gloves) All wounds have microorganisms present; only exogenous microorganisms can cause contamination
Consists of the wound to be dressed and the materials used to achieve this, including the dressing pack The wound and dressing sheet are a continuum and form the wound field Microorganisms can be transported from the wound to the dressing sheet; contamination is not considered to have occurred In effect, the dressing procedure is about preventing contamination
Clean technique
4.2 AWMA guidelines; the clinician will determine when a clean technique is acceptable; i.e. washing, showering Usually used for chronic wounds where the patient is not compromised Infection control principles continue to apply Incorporates the use of clean solutions and dressings Dressing pack may not be required
Regardless, follow the principles of do no harm and lets not introduce anything new to the wound!!!