Describe the steps you will use to change a patient's sterile dressing?  What are the most common mistakes made in breaking the sterile field, and what are the important aspects to document when...

Describe the steps you will use to change a patient's sterile dressing?  What are the most common mistakes made in breaking the sterile field, and what are the important aspects to document when assessing a patient's wound?

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kipling2448 | (Level 3) Educator Emeritus

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When changing the dressing on a patient’s wound or surgical incision, the highest priority is on ensuring the sterility of the surroundings and of the process. 

Because of the very serious threat of infection, protecting the environment surrounding the patient is vital.  That means washing hands, putting on surgical gloves and a mask, and, depending upon the circumstances, a sterile gown.  The risk of exposing a wound or incision to aerosols or contaminants on one’s skin is high, and no such procedure should be conducted without, at a minimum, these basic precautions.

Certain measures are required in preparing the surroundings and the patient for the changing of a dressing, including ensuring that all equipment and the sterile dressing are properly handled.  That means ensuring that antiseptic solutions, antibiotic ointments, and a means of disposing of the old dressing are all immediately at-hand and, again, properly situated on a clean sterile surface so as to avoid possible contamination.  Fresh dressings and tools should be easily attainable and situated within the nurse’s line of sight.  Every effort is required to prevent direct contact between the nurse’s skin and the sterile material, which usually involves using the wrappers in which the material was provided to handle the material. The “4x4” that provides a sterile surface is easily contaminated if it comes into contact with the nurse’s skin, so extra effort is made to prevent any sterile item from coming into contact with the borders of the 4x4 that were handled by the nurse.

Once the procedure is underway, care is taken to ensure that removal of the old dressing results in minimal discomfort for the patient and that the old dressing is properly disposed of in an appropriate receptacle.  The wound has to be closely examined for any visible sign of infection that, if discovered, requires treatment with the appropriate regimen of antibiotics.  Cleaning the wound, as with removal of the old dressing, requires attentiveness to the comfort of the patient, and should involve use of an antiseptic fluid and cotton to gently clean any dried blood, previously-applied ointments, and residue from the old dressing. 

Once the new dressing is applied, the old dressing and all waste associated with the cleaning of the wound must be placed in plastic medical waste containers, often inside sealed plastic bags that are then placed in the larger receptacle.  Hands must be washed again following the removal of surgical gloves.  The attending nurse or physician’s assistant is generally required to write a report on the procedure including the nurse’s observations of the wound, such as signs of infection, whether the wound is draining, etc. 

Common mistakes include failure to wear surgical gloves, cutting through old dressing without properly determining the precise site of the wound and inadvertently coming into contact with it, improper opening and handling of the sterile gauze and other material, contaminating the 4x4 that is used to establish a sterile platform on which to set fresh gauze and equipment, failure properly assess the visible wound, failure to apply topical ointments when warranted, and improper recording of the wound’s characteristics.  The importance of properly recording the wound’s characteristics cannot be overstated, as failure to observe and/or record indications of infection can have very serious repercussions.

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