sterile vs. clean dressings?

[cherilee]

When is a dressing supposed to be clean as opposed to sterile? I know that central line dressings are sterile, but are all wound dressings sterile? I would think they would be, but I have heard people say certain ones dont need to be. Can anyone clear this up for me??

Thanks

[Daytonite, BSN, RN]

you know, that's a good question. i know that for some home care, dressings only have to be clean. however, for my own peace of mind, in the hospital or nursing home setting, i would insist on using sterile technique for all dressings that i did for the simple reason that there are bugs everywhere in the hospital. i don't want to be responsible for contaminating anyone's wound.

i've had two surgical wounds where the sutures opened up and the wounds took months to heal with lots of drainage. with the first one i was told to only use clean technique at home. i had to pack the wound every 4 hours with alternating gauze infiltrated with hydrogen peroxide or saline. the doctor just instructed me to pour the liquids onto the gauze and then just wring out the excess liquid with my hands (after i had washed them). i never had a problem with the wound becoming infected. but i was also on keflex for the entire time.

the last surgical wound was a different story. it was a strict sterile dressing change and it still went septic from bacteria in the bowel (had a hemicolectomy). when i was in the hospital on iv antibiotics for this, it was interesting watching the different nurses who changed the dressing (bid dressing changes). some did it strictly sterile. some fudged a little. i was on 3 iv antibiotics, however.

i think your decision as to whether to do clean or sterile has to be as to where the wound is and whether or not the patient has antibiotic coverage.

[fatoma]

when it comes to wounds, I use sterile tecnique...those patients are at high risk for infection...we don't want to give those vulnrable patients another hit..our rule is to minimize this risk!!!

[mcknis]

HOw about wet-to-dry or not wet-to-dry? Tell me if I am thinking on the right path here...if its a mucous membrane, then wet-to-dry, but if its a closed wound, then dry dressing. Is this right?

[Lady_Bing]

I have observed that most RNs on our floor do clean drsng when packing wounds or doing WD drsng. I asked about that and the thought was - well, when the pt goes home they will not be doing strerile drsngs anyway. However, I still use a sterile technique, because even if the pt will be utilizing a clean technique at home, they are HOME, not at a hospital. When they are at a hospital, we should be going an extra step to protect their immune system.

[TigerGalLE, BSN, RN]

I use sterile technique for all PICC line, Central line, and Perm-cath dressing. I also use sterile technique for any surgical wound. The only time I only use clean technique is when they have a sacral decub that is being changed daily or every time it is soaked with stool... For almost all other wounds I use sterile technique... or at least clean as possible... It depends on what it is really.

[cory39]

All dressing changes are not done by sterile technique. Obviously, the ones that ARE sterile are the central lines and open wounds where your doing wet-to-dry. If you have a pt. that just got out of surgery and had staples or stitches and dressing changes are ordered for them, why in the world would you use sterile technique? You put the sterile 4X4 on, tape it and move on. What it boils down to is basically what type of dressing change are you performing. Commen sense tells you to use sterile technique if the pt. has a open wound so big that you have to pack a foot of kerlix in it. There are many types of dressing changes, not all are sterile..............

[AMarie85]

I had a wound care nurse tell me one time that wounds are already populated with bacteria found on the patient's skin and that research shows there is no need for sterile technique....

That being said I also agree with the previous poster who said that in the hospital sterile technique should be observed due to the overwhelming risk of hospital aquired infection.

The doctor's order will tell you whether or not to dress a wound wet to dry....

[cory39]

I had a wound care nurse tell me one time that wounds are already populated with bacteria found on the patient's skin and that research shows there is no need for sterile technique....

That being said I also agree with the previous poster who said that in the hospital sterile technique should be observed due to the overwhelming risk of hospital aquired infection.

The doctor's order will tell you whether or not to dress a wound wet to dry....

So your implying that everything you do in the hospital you use sterile technique? I would like to see that.....

[AuntieRN]

HOw about wet-to-dry or not wet-to-dry? Tell me if I am thinking on the right path here...if its a mucous membrane, then wet-to-dry, but if its a closed wound, then dry dressing. Is this right?

Yes Mcknis...if its a closed wound you certainly do not want to do a wet to dry. And remember you need an order for wet to dry dressings. The thought process or at least what I remember being taught long ago is you pack it wet and as it dries the dead icky stuff (like my nursing terminology..im tired im sorry) adheres to the dry dressing and when you pull it out you are performing a type of debridement so the wound heals from the inside out. If you were to put a wet to dry dressing on a closed wound you will be making a breeding ground for more bacteria and can then make a closed wound an open one. Hope this makes sense and again im tired and sorry if it doesnt.

[AMarie85]

So your implying that everything you do in the hospital you use sterile technique? I would like to see that.....

If its an open wound then I use sterile technique....

If it's dry gauze over an incision then I place the sterile side of the gauze over the wound without touching it....

Yes I keep it as sterile as I possibly can.... When a patient comes back a week after surgery with a post op wound infection I'd like to think that I did everything I possibly could to prevent that from occurring.

[Mariposa2009, BSN, RN]

Ok, this is a question that I always had and still have. At my facility we do "clean" dsg changes, meaning we wear clean gloves, but use sterile materials (i.e. NS, gauze, etc.). The only dsg changes that are "sterile" are PICC/central line dsg changes. In this situation we do wear sterile gloves and maintain a sterile field. I recently had a pt who required wound packing and thought that I should be wearing sterile gloves. However, the wound nurse told me that I did not have to wear sterile gloves. She stated that as long as the materials are sterile then it would be ok. In school we were taught that all dsg changes are to be done using sterile technique. So, confused. Sorry if I sound stupid, but I'm still learning.