Hand Washing During Wound Dressing Changes
by Karen Zulkowski DNS, RN, CWS
Back in 2012, I blogged about glove change frequency and hand washing during dressing changes. Your comments were very informative. It is sad that facilities are being cited for not changing gloves, and rewashing and sanitizing hands during a dressing change. There is no evidence this does anything but add to the cost. What's important is to protect yourself from the patient's bacteria.
What the Research Says About Hand Washing During Dressing Changes
In 2013 I wrote an article for Advances in Skin & Wound Care on skin bacteria.1 This is a great reference article for all of you to use. In writing this article, I came across some very interesting literature. One of my favorites was by Sergent, A-P, et al (2012) in Orthopaedics & Traumatology: Surgery & Research. This study looked at bacterial contamination of the hospital environment during a dressing change. Results found the room was contaminated 38% of the time after a dressing change, with Staphylococcus aureus being the most common bacteria found.2 The authors recommend not only washing your hands after dressing change, but also wearing a mask and cleaning the room both before and after the dressing change to prevent cross contamination. You need to be protected.
Last year, I did a pilot study on the hands of the wound staff before gloving, their gloves during and after dressing change, and a culture of the wound itself. None of the bacteria from the staff's hands were present in the wound. Bacteria on the gloves during and after dressing change matched that of the culture. While this was a very small sample it does point out that more work needs to be done on transmission of bacteria, and surveyors should be more up to date in their expectations of evidence-based care.
What You Can Do to Stop the Spread of Bacteria
Sometimes staying current isn't easy for people that are not doing wound care daily. Many of textbooks are not current. I have found steps for wet to dry dressings, for example, that are not appropriate. As wound care professionals, we need to be involved in education for all staff. Write case studies, do QI projects, find advanced practice nurses to do small research studies with and above all, present and publish your work. Tell me what you have observed and what you think we need to do by commenting on this post.
1. Zulkowski K. Skin bacteria: implications for wound care. Adv Skin Wound Care. 2013;26(5):231-6.
2. Sergent AP, Slekovec C, Pauchot J, et al. Bacterial contamination of the hospital environment during wound dressing change. Orthop Traumatol Surg Res. 2012;98(4):441-5.
About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.