Confused: Sterile Field for Wet Dry Wound Dressings?

Daytonite, BSN, RN · Jul 9, 2008

i am confused on when to use clean vs. sterile gloves

clean, or nonsterile, gloves are used to remove the old dressing. these clean gloves are then removed and the sterile gloves applied so the sterile dressing can be done.

when to actually set up the sterile field

you set up as much of the sterile field as you can before removing the old dressing--beginning the dressing change.

when to pour the saline solution, where to pour the saline solution (into an empty container or into the 4x4 gauze container?)

you set up as much of the sterile field as you can before beginning. the saline solution comes in a container, the outside of which is

not

sterile although the saline inside it

is

sterile. therefore, you cannot place the container of saline in the sterile field. sterile dressing trays usually have a sterile container in them for the sterile cleaning liquids that you are going to use. when you are setting up the sterile field, make sure this container is placed so that you will be able to pour some of the sterile saline into it. you do not need to be gloved to do this. your bare hand is not sterile and neither is the outside of the bottle of saline. just hold the bottle over the sterile container and pour out the amount of sterile saline you think you will need into the sterile container. often, the sterile dressing kit is a plastic sterile tray into which all the sterile dressing materials are packed. once all the gauze, tape, scissors and forceps are removed from it, you have your sterile container that will hold the sterile saline.

fyi:

every facility has these sterile dressing change kits custom made for them and they specify exactly what they want placed in them and then sterilized. in the old days central supply used to put these kits together for use and autoclave them in their department because we re-used the towels and the solution bowls. today, everything is disposable and one-time usage only.

are you supposed to dump some or all of the 4x4's onto the sterile field (are you supposed to leave some in the container for the saline solution)?

when you open a sterile dressing kit, you open it carefully, try to touch the outer under part as much as possible, and consider the outer edges contaminated. everything in the middle of the now open wrap is sterile. with the exception of carefully picking up and gloving yourself, you touch nothing in the center of this work area you are now creating. if you are bringing 4x4s into the sterile field from outside, you can open them all with your bare hands, careful not to touch the inner contents of each package and drop them onto your sterile field as close to the center as you can. the outside of the packages of the 4x4s are

not

sterile unless they were included in the sterile dressing kit. if that was the case, you cannot begin opening them until you have sterile gloves on.

the principle to remember is sterile to sterile; nonsterile to nonsterile--always. if you can't remember or you don't know if the surface you are about to touch is sterile or nonsterile you must assume it is nonsterile.

from pages 581-2, nurse's 5-minute clinical consult: procedures from lippincott williams & wilkins on surgical wound management:

assemble the equipment
put a waterproof trash bag near the patient to avoid reaching across the sterile field or the wound
turn down the top of the trash bag to provide a wide opening and prevent contamination of instruments or gloves by touching the bag's edge
confirm the order for wound care
confirm the patient's identity
explain the procedure to the patient
provide for privacy
expose the wound site
wash your hands, put on clean gloves and a face shield if appropriate
remove the soiled dressing: hold the patient's skin and pull the tape or dressing toward the wound to protect the newly formed tissue and avoid stress on the surgical incision; use an adhesive remover if necessary; remove dressing slowly; if gauze adheres to the wound moisten it with sterile saline
observe removed soiled dressing for amount, type, color and odor of drainage
discard the dressing and your gloves in the waterproof trash bag
wash your hands again.
set up your sterile field with the equipment and supplies you will need for the dressing care and dressing
if using an antiseptic from an unsterile bottle, pour the antiseptic cleaning agent into a sterile container so you won't contaminate your sterile gloves later on
put on sterile gloves
saturate the sterile gauze pads with the prescribed cleaning agent
clean the wound working from the center outward; for an incision wipe once vertically from the top of the incision to the bottom and discard the pad; work outward from the incision in lines running parallel to it; always wipe from the cleanest area to the dirtiest (top to bottom; inner to outer) and only wipe once per pad/gauze; clean to one inch beyond the end of the new dressing that will be applied
for wet to dry dressing: pick up a moistened gauze pad and squeeze out excess solution to be used (i.e., sterile saline or sterile water); place moistened gauze over the wound; cover with 2 to 3 dry layers of gauze over the wet layer; use a large absorbent dressing (i.e., abd pad) if needed to provide greater absorbency
secure the edges of the dressing to the skin with tape or use a t-binder or montgomery straps to prevent skin excoriation from repeated tape removal; tubular elastic netting can also be used on limbs to hold dressings in place
discard used supplies

here are videos and procedures that are listed on this sticky thread of allnurses: https://allnurses.com/forums/f205/any-good-iv-therapy-nursing-procedure-web-sites-127657.html - any good iv therapy or nursing procedure web sites. some of the videos are old. it is very hard to find videos and facility procedures online.

http://lib2.hacc.edu/nursing/nursing205/ - click on "videos" at left side of page. then click on "wound packing". there are 3 videos that show you how to do a sterile dressing change
http://lib2.hacc.edu/nursing/nursing205/ - click on "videos" at left side of page. then click on "nursing skills". click on "sterile dressing" for a short video of the equipment needed for a sterile dressing change
http://www.delmarlearning.com/companions/content/1401897118/skillscklists/cklistskill_58.doc - skill check list for wet to dry dressing change
http://www.mccfl.edu/pages/2461.asp - changing a dry sterile dressing
http://www.csufresno.edu/dcg/videos/faculty/dutra/n110a/ - this site has links to wound care videos

principles of sterile technique - http://www.lhsc.on.ca/resptherapy/students/orient/sterile.htm

Papi15437 · Jul 11, 2008

Thank you so much for clearing that up for me and those videos were really helpful! I start clinical in 2 weeks, and now I feel more confident about setting up a sterile field.

imafostermom · Jul 13, 2008

As a nursing instructor, I could not have explained it better!!

LaceyRN · Jul 13, 2008

Wow, great info!

I'll use it to brush up on skills before my last semester's clinical skills re-validations. :)