Wound Care Techniques: Dressing Changes and Pressure Ulcer Risk

Sterile vs. Clean Wound Dressing Techniques

The term sterile refers to being free from microorganisms, making the sterile technique a method that reduces exposure to microorganisms in a comprehensive way. A sterile wound dressing change involves meticulous hand washing, the use of a sterile field, sterile gloves, and sterile instruments (Potter et al., 2013; WOCN, 2012). Sterile technique is particularly important in acute care and other settings where patients may be at high risk for infection (WOCN, 2012).

The clean wound dressing change technique, by contrast, refers to methods that are sensible for reducing overall exposure to microorganisms without strictly adhering to "sterile to sterile" rules (WOCN, 2012). Meticulous hand washing and a clean environment are still required, but the procedure does not strictly prohibit contact between sterile instruments and non-sterile surfaces or products. While the clean wound dressing technique minimizes exposure to microorganisms and reduces the chance of infection, it is less rigorous than the sterile method. Clean wound dressing change techniques are effective for home health care and for patients receiving routine dressings who are not at high risk for infection.

A clean dressing change begins with meticulous hand washing. Hand hygiene goes beyond simply washing with soap and water. The hands should be washed with an antiseptic agent such as antimicrobial soap, which reduces bacterial counts on the hands for an extended period of time (Perry & Potter, 2012). Alcohol-based hand rub products can also be extremely helpful at this initial step.

The next step is to remove the soiled dressing gently. This may involve rolling or lifting the dressing, but whenever possible, the movement should follow the direction of hair growth to minimize patient discomfort. An inspection of the wound is then required prior to cleaning, to confirm that color and drainage are normal for the current stage of healing.

Steps for Performing a Clean Dressing Change

The wound is then cleaned using pads pre-moistened with cleaning solution or by applying a spray solution. The appropriate technique is to move from the least contaminated to the most contaminated area of the wound, using a clean pad for each wipe (Lippincott Nursing Center, 2008). After cleaning, the wound is dried using sterile gauze pads and dressed appropriately, taking into account the wound's condition and any existing complications.

Wound dehiscence occurs when the layers of a wound begin to part or split open. The condition can become severe, leading to further complications and infections. Causes of wound dehiscence range from excessive pressure on the sutures to weak tissue or vitamin deficiencies. As a result, each instance of wound dehiscence must be evaluated and treated individually.

Nursing interventions to prevent wound dehiscence include ensuring that sutures are applied properly — not too tightly and without excessive pressure. Closure procedures must be performed with particular care. The patient also needs to be educated about how to avoid placing undue pressure on the wound. Additionally, the patient should be informed about medications that may interfere with wound healing and potentially contribute to dehiscence or other complications.

When assessing a patient's wound, the healthcare worker must be observant of a range of factors. The healing process occurs in stages that may vary among individuals. It is therefore critical that the healthcare worker obtain the patient's history with wounds, along with relevant demographic and background information. For example, the healing process slows with age, increasing the risk of contamination and dehiscence (Perry & Potter, 2012).