1. Surgical Asepsis and Dry Dressings
5/27/2019
Sir Sandford Fleming College

2. Sir Sandford Fleming College
5/27/2019
Sir Sandford Fleming College

3. Sir Sandford Fleming College
Handwashing
most effective way to prevent spread of organisms
significantly reduces nosocomial infections
when you arrive, prior to giving care, after giving care, before and after gloving, before and after eating, before you go home
any time you use your hands, wash them!!!
5/27/2019
Sir Sandford Fleming College

4. Sir Sandford Fleming College
Hand washing (review)
turn on water and adjust temperature, wet hands and wrists
keep hands lower than elbow
use about 1 tsp liquid soap
lather thoroughly -wash palms, back of hands, between fingers, fingers, wrists and forearms
continue friction for seconds
clean under nails
rinse thoroughly
dry from fingers to forearms
use clean towel to turn off taps
Medical Asepsis: clean technique
don’t allow uniform to touch sink
remove jewelry
5/27/2019
Sir Sandford Fleming College

5. Sir Sandford Fleming College
Surgical Asepsis
used routinely in OR, L&D
also used at the bedside for insertion of catheter, sterile dressing changes, preparing injections
object is considered sterile when all micro-organisms have been destroyed
if you suspect you’ve contaminated a sterile object or field, stop what you’re doing and start over with new, sterile supplies
asepsis is only effective if the practitioner is conscientious
don’t take chances on contaminating a patient due to your break in technique!!!
5/27/2019
Sir Sandford Fleming College

6. General Principles of Surgical Asepsis
only a sterile object can touch another sterile object
open sterile packages so first edge is away from you to avoid touching clothing
avoid spilling a liquid on a sterile field as moisture will draw contaminants through the field
hold sterile objects above the waist to prevent accidental contamination
5/27/2019
Sir Sandford Fleming College

7. Sir Sandford Fleming College
Surgical Asepsis
avoid talking, sneezing, coughing or reaching over a sterile field
never walk away from or turn back on sterile field
anything coming into contact with broken skin, penetrating the skin or being inserted into normally sterile body cavities should be sterile
5/27/2019
Sir Sandford Fleming College

8. Sir Sandford Fleming College
Surgical Asepsis
use dry, sterile forceps as necessary -wet ones are not considered sterile
consider the outside edge of your field to be contaminated about 1”
consider an object contaminated if you have any doubt as to it’s sterility
5/27/2019
Sir Sandford Fleming College

9. Preparing a Sterile Field……….
gather equipment
wash hands
check that trays, gauze etc. packaging is dry and intact
prepare a work area waist high or higher
open sterile tray - do not reach over
place additional items on tray/field PRN
5/27/2019
Sir Sandford Fleming College

10. Sir Sandford Fleming College
use sterile gloves or sterile forceps to handle sterile items
check date and time on opened solution bottles - discard after 24 hours
only pour as much as you will need
place cap on table with edges up
pour from 4-6 inch height and avoid splashing
never reach over field to pour
drop sterile items (gauze, scissors etc.) from about 6 inch height to avoid contaminating field with packaging
may need an additional sterile bowl if using a large amount of solution
5/27/2019
Sir Sandford Fleming College

11. Putting on Sterile Gloves…….
wash and dry hands carefully
place sterile glove package on clean, dry surface above waist
open outside wrapper by peeling back
remove inner package
open inner package with cuff end closest to you
5/27/2019
Sir Sandford Fleming College

12. Sir Sandford Fleming College
with thumb and forefinger of non dominant hand, grasp folded cuff of sterile glove for dominant hand
lift glove with fingers down
insert dominant hand - leave cuff folded
slide fingers of gloved hand under cuff of remaining glove and lift upward
insert non dominant hand and adjust gloves
5/27/2019
Sir Sandford Fleming College

13. Removing Sterile Gloves…...
using dominant hand, grasp other glove near cuff and remove by inverting it keeping the contaminated area on the inside
continue to hold on to the glove
slide fingers of ungloved hand inside remaining glove and remove by turning inside out over other hand and other glove
discard and wash hands
5/27/2019
Sir Sandford Fleming College

14. Cleaning a wound and applying a Sterile Dressing……….
check order for type of dressing
gather equipment, wash hands
close door or curtain, drape patient
position patient for comfort and access
place open, cuffed plastic bag near area
loosen tape on existing dressing & remove wearing disposable gloves. Note amount, colour and odour of the discharge. Discard
if dressing sticks to skin, moisten with sterile saline (may have to soak for a while)
5/27/2019
Sir Sandford Fleming College

15. Sir Sandford Fleming College
open sterile dressing tray and prepare supplies, solutions
put on sterile gloves
clean wound from least to most contaminated (clean to dirty)
use one gauze pad for each wipe
clean around drain in a circular motion
Dry
Apply clean dressing
5/27/2019
Sir Sandford Fleming College

16. Sir Sandford Fleming College
remove gloves and discard
apply tape or ties to secure dressing
wash hands, discard equipment
position patient as required
record dressing change, appearance of wound, describe drainage, note patients tolerance of procedure
5/27/2019
Sir Sandford Fleming College

17. Sir Sandford Fleming College
Wound drainage……..
serous - clear and watery
sanguineous - bright red indicates fresh bleeding, dark red indicates old blood
serosanguineous - little of both
purulent - thick, musty or foul odour, varies in colour (may be dark yellow, green) depending on causative organism
5/27/2019
Sir Sandford Fleming College

18. Collecting a wound culture…….
gather equipment - make sure it’s correct
wash hands
wear clean gloves, remove dressing and assess wound and drainage
put on sterile gloves and clean wound- Why???
discard gloves
prepare culture equipment keeping inside sterile
5/27/2019
Sir Sandford Fleming College

19. Sir Sandford Fleming College
carefully insert swab into drainage and roll gently
use separate swabs if more than one site and label carefully
place swab in culture medium being careful not to touch outside of container with swab
apply new dressing to wound
5/27/2019
Sir Sandford Fleming College

20. Sir Sandford Fleming College
label specimen container with pts. name, date, time, nature of specimen
attach lab requisition to specimen and send to lab
record collection of specimen, appearance of wound, description of drainage
5/27/2019
Sir Sandford Fleming College

21. Sir Sandford Fleming College
Documentation…….
Jan 19/ hrs
Dressing changed for (small, moderate, large, copious) amount of (serous, sanguineous, serosanguineous, purulent) drainage. Wound appears (describe colour, odour, consistency of drainage, wound edges etc.) Area cleansed with N/S (or whatever is ordered) and dry (specify) dressing applied. Tolerated (well, poorly) by patient S Smartnurse RPN
5/27/2019
Sir Sandford Fleming College