Editor's note: This blog was originally published on December 24, 2014. It was updated and republished on December 11, 2020.
I had shopped before lockdown and had not needed to go to a supermarket for a while. Before my first big shopping event, I came across this online video: preventing your kitchen getting contaminated from your shopping.1 I smiled at the thought of people trying to use an aseptic technique in their kitchen while trying hard not to contaminate the kitchen, its contents, or themselves with imagined glitter (or coronavirus). As I ruminated, my thoughts wandered to dressing technique, so I did a search on YouTube. What I came across rather surprised me. I watched three clips on dressing procedure2-4 and most notably observed that:
It is not easy to make such videos, and to be honest, every dressing is slightly different either because of the differences among primary dressings, basic policy differences among home health, hospital, and rehabilitation units, and the type and position of the wound. All of these make a one-size-fits-all video approach a daunting prospect.
The 2012 joint guideline of the Association for Professionals in Infection Control and Epidemiology (APIC) and the Wound, Ostomy and Continence Nurses Society (WOCN) on clean versus sterile technique5 has had no recent revision but stands up well currently. It starts with defining sterile and clean technique. Sterile dressings are applied using a sterile field and instruments, with contamination managed by ensuring sterile-to-sterile transfers. With clean technique, a clean field is set, but some sterile instruments and package contents may be handled with clean gloves, so the sterile-to-sterile transfers are not practiced. A sterile technique minimizes the possibility of contamination, and a clean technique attempts to do the same but using a clean field and clean gloves. Sterile instruments may be used, and some gauze and primary dressings may be kept for use at the next dressing change. A clean dressing procedure takes less time and is less costly.
A single operator manages clean technique much more easily, but a sterile technique poses difficulty if there is no second person to assist, and this can lead to breaks in sterility and thus contamination. Kent et al.6 conducted a literature review to produce an evidence-based report card for WOCN.
The conclusion was that for acute wounds, clean technique does not increase the incidence of wound infection, but there is insufficient evidence to say the same for chronic wound care. The document goes on to state that to reduce the risk for infection when performing wound care, clinicians must critically analyze the technique to be used based on the patient’s overall status, wound type, and wound location. This is very sound advice because performing a dressing on a patient with exposed structures who is compromised calls for much more care and attention to detail than changing a bordered foam dressing on a skin tear. Critical thinking is the key.
Utilizing the guidelines from WOCN and APIC, the following list was compiled to help ensure good clean technique.
Using these guidelines for decisions about dressing a wound requires access to materials, some idea of the type of wound being dressed, and the best procedure to be used. It is helpful to think of a dressing procedure in three main parts, after handwashing and with hand decontamination between each part.
Having the wound care supplies listed and the order written out within the framework of set procedural details is immensely helpful if it is customized and kept brief. For example:
It is essential to ensure that staff members know what is expected of them. Clear, helpful policies are important, but competencies or checklists with peer review can help staff and managers to ensure that best practice is continued. Staff members need to know it is essential that they have a physician’s order and that they decontaminate their hands before and after every glove change, with care taken to change gloves at appropriate times. It is not acceptable to use scissors from their pocket or bag to cut a primary dressing.
A clean field is necessary between them and the wound during cleaning the wound and a fresh one to place the dressing. Critical thinking skills are not easily built into nursing, particularly because of our order-driven, tick-box, computer algorithm world. Self-assessment (reflective practice) and clinical supervision from a peer are helpful especially if they are structured within the employee evaluation process. Most importantly, “Apply every dressing as if you are a master of your art teaching a student,”
1. VanWingen J. Preventing your kitchen getting contaminated from your shopping. https://www.youtube.com/watch?reload=9&v=TKx-F4AKteE. Accessed November 30, 2020.
5. Association for Professionals in Infection Control and Epidemiology and the Wound, Ostomy and Continence Nurses Society. Guideline. 2012.
6. Kent DJ, Sardillo JN, Dale B, Pike C. Does the use of clean or sterile dressing technique affect the incidence of wound infection? J Wound Ostomy Continence Nurs. 2018;45(3):265-269.
Canadian Agency for Drugs and Technologies in Health. Use of single-use sterile dressings from a previously opened package in the community setting: safety, harms, and guidelines. 2012. cadth.ca/media/pdf/htis/june-2012/RB0507%20Single-Use%20Dressings%20Final.pdf. Accessed November 30, 2020.
Gray M. Doughty D. Clean vs. sterile dressing techniques for management of chronic wounds: a fact sheet 14. J Wound Ostomy Continence Nurs. 39(2 suppl):S30–S34.
Nazarko L. Good hygiene when dressing wounds. Nursing in Practice. 2016. https://www.nursinginpractice.com/clinical/good-hygiene-when-dressing-w…. Accessed November 30, 2020
Rowley S, Clare S, Macqueen S, Molyneux R. An updated practice framework for aseptic technique. Br J Nurs. 2010;19:S5S11.
Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review. BMC Health Serv Res. 2017;17:786.
Surgical Site Prevention and Treatment of Infection. NICE Guidelines 2008 London, United Kingdom: RCOG Press; 2008.
About the Author
Margaret Heale has a clinical consulting service, Heale Wound Care in Southeastern Vermont and draws on her extensive experience as a wound, ostomy and continence nurse in acute and long-term care settings to provide education and holistic care in her practice.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.