This technique may also be referred to as non-sterile. Clin Nurs Res. 2008;23:35–39. Clinical signs of infection include lack of healing after 2 weeks of proper topical therapy, erythema, increase in amount or change in character of exudate, odor, increased local warmth, friable granulation tissue, edema or induration, pain or tenderness, fever, chills, elevated white blood cell count, and elevated glucose in patients with diabetes.9 In patients who are immunosuppressed or have ischemic wounds, signs of infection can be subtle. Registered users can save articles, searches, and manage email alerts. NPUAP-EPUAP (National Pressure Ulcer Advisory Panel-European Pressure Ulcer Advisory Panel). Clean gloves were used for dressing changes of intact surgical wounds and pressure ulcers. To present an update on the status of information about clean versus sterile dressing technique to In: Sussman C, Bates-Jensen B, eds. Also, in 1997, Wise, Hoffman, Grant, and Bostrom surveyed staff nurses (N = 723) in five health care agencies about the use of sterile vs. non-sterile gloves for wound care.31 The authors reported great variations in practice and that acute care nurses used sterile gloves for wound care more commonly than home care nurses. Adv Skin Wound Care. Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. The Table addresses dressing technique for chronic wounds. There is no definitive evidence that sterile technique is superior to clean technique, improves outcomes, or is warranted when changing dressings on chronic wounds.8 Insufficient evidence is available to determine if there are significant differences in infection rates or healing when wounds are treated using clean or sterile technique.14 There is a lack of agreement in published expert opinion as to what constitutes sterile versus non-sterile technique and when one or the other should be used. 30 mins. Somerset M. ed. These may include but are limited to hand washing, bathing, cleaning the environment, gloving, gowning, wearing masks, hair and shoe covers, disinfecting articles, and use of antiseptics. Biofilms are difficult to treat and eradicate.9 Recently it has been proposed that biofilm might be present in all chronic wounds.12,13. Sterile technique. All dressing supplies should be stored off the floor, away from heat or light, and secure from pets. All chronic wounds are colonized to varying degrees.9, Critical colonization. In: Krasner D, Kane D, eds. St. Louis, MO: Elsevier Mosby; 2012:469–475. Asepsis or aseptic means free from pathogenic microorganisms.3 Aseptic technique is the purposeful prevention of the transfer of organisms from one person to another by keeping the microbe count to an irreducible minimum. Skin and Mucosal Damage in Patients Diagnosed With COVID-19: A Case Report, Identifying the Right Surface for the Right Patient at the Right Time: Generation and Content Validation of an Algorithm for Support Surface Selection, Clean Versus Sterile Technique When Changing Wound Dressings, by the Wound, Ostomy and Continence Nurses Society. Acute and Chronic Wounds: Current Management Concepts. Medical Office Assistants May Observe Medical Asepsis Policy. While getting out the supplies for the wound dressing, the patient told me the doctor had discussed the dressing with her and provided a few things. About the Author The bacteria are not pathogenic and do not require treatment. Popovich DM, Alexander D, Rittman M, Mantorella C, Jackson L. Strike-through contamination in saturated sterile dressings: a clinical analysis. I was reminded of a visit to a patient to utilize a fancy new dressing that I had never used before. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. However, infected wounds should not be primarily closed.21. 1997;24:144–150. Sibbald RG, Woo KY, Ayello EA. A surgical wound that heals in an orderly and expected fashion may be considered an acute wound. 4th ed. Aseptic technique and clean technique are two closely related healthcare practices that both aim to keep people safe from infection. Ferreira AM, de Andrade D. Integrative review of the clean and sterile technique, agreement and disagreement in the execution of dressing. Personally critically analyzing the dressing technique you use is essential to optimal care. Editor's note: This blog by Margaret Heale, RN, MSc, CWOCN, is the recipient of the 2019 Blog of the Year Award. Sterile technique is a set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility (BC Centre for Disease Control, 2010). 5. Explain the radiographer's responsibility for maintaining surgical aseptic technique when it is a required part of patient care. Wound care practices are extremely variable and are frequently based on rituals and traditions as opposed to a scientific foundation. Medical asepsis is a term for guidelines to follow when caring for patients with infections and is something that students in all medical office assistant programs cover thoroughly. 31. Acute & Chronic Wounds: Current Management Concepts. Clean vs. Sterile: Management of Chronic Wounds. 1999;20:247–248. Does the Use of Clean or Sterile Dressing Technique Affect the Incidence of Wound Infection? It includes more general protocol like hand-washing, but can also involve several other steps that can reduce a patient’s … Signs of inflammation such as a faint halo of erythema and moderate amounts of drainage might be the only signs of an infected arterial wound.17 Studies have shown that in chronic wounds, increasing pain, friable granulation tissue, wound breakdown, and foul odor have high validity for infection.17,18, Wound. Some issues are obviously not acceptable if using a "clean technique;" there should not be cut pieces of foam dressings floating about in the supplies box, Xeroform dressings cut in half with the foil wrapper folded over, bits floating in the bottle of saline, and grubby, yellow-topped gel dressing tubes with no alcohol wipes in sight. In the coated wrapped sponges, 80% exposed to Staphylococcus epidermidis and 20% exposed to Escherichia coli had strike through. Methods of Medical Asepsis Preventive vaccination Increasing the awareness among visitors and relatives Use of gloves, masks, and gowns Use of chemical agents There is no scientific evidence or consensus that any one of these conditions is more or less important in selecting the appropriate method of care for the wound. 2. Healthcare professionals commonly use clean techniques when they’re: giving an injection emptying a urinary catheter drainage bag giving a bed bath inserting a peripheral IV (an IV in a smaller vein) removing a peripheral IV removing a urinary catheter Appendix 1 - Guidelines For Undertaking An Aseptic Technique J Wound, Ostomy Contin Nurs. There is surgical asepsis (sterile) and medical asepsis (clean). It is defined by Kent et al. Before my first big shopping event, I came across this online video: preventing your kitchen getting contaminated from your shopping. Lawson, Juliano, and Ratliff32 in a non-experimental, longitudinal study monitored infection rates and supply costs of all patients with open surgical wounds healing by secondary intention before and 3 months after implementing non-sterile wound care. Sterile is generally defined as meaning free from microorganisms.3 Sterile technique involves strategies used in patient care to reduce exposure to microorganisms and maintain objects and areas as free from microorganisms as possible. Clean technique leads to a decrease of the overall number of microorganisms present rather than the absence of microorganisms as is found in surgical asepsis. 2001;28:24A–26A. Criteria for identifying wound infections–Revisited. The authors reported there was no significant difference in strike-through contamination in gauze saturated on coated or uncoated wrappers. In 1997, Stotts and colleagues compared the healing rates and costs of sterile vs. clean technique in post-operative patients (N = 30) who had wounds healing by secondary intentions following gastrointestinal surgery.30 The authors reported there was no statistically significant difference in the rate of wound healing between the two groups (p < 0.55). Bates-Jensen BM, Ovington LG. Sterile technique and dressings have been recommended for post-operative management of wounds for 24-48 hours by the Centers for Disease Control and Prevention.22 No recommendations are provided beyond 48 hours for wounds with primary closure.22,23, In 1994, clinical practice guidelines for pressure ulcer treatment, published by the Agency for Health Care Policy and Research, recommended use of clean gloves and clean dressings for pressure ulcers as long as the dressing procedures complied with the institution's policies.24 Sterile instruments were recommended for debridement. Stotts NA, Barbour S, Slaughter R, et al. It was also reported that 90% of patients with open wounds being discharged from hospitals were taught to perform non-sterile technique at home regardless of whether clean or sterile technique was used during hospitalization. Aseptic Technique in Imaging OBJECTIVES After studying this chapter, the student will be able to: 1. 6. Two studies examined the strike through contamination in saturated sterile dressings. 1. All open wounds have some level of bacterial burden that is ordinarily cleared by the host.9–11, Colonization. Being a wound care professional is often a lot like being a detective. Mangram AJ, Horan T, Pearson ML, Silver BS, Jarvis WR. 4th ed. There was no statistically significant difference in infection rates. 800-638-3030 (within USA), 301-223-2300 (international) J Wound, Ostomy Contin Nurs. 3. You have to decide what caused the wound, what is contributing to its not healing and how you are going to get it to heal. 8. 2005;51:28–34. Surgical wounds and incision care. Please try again soon. Adjust water to acceptable temperature. 29. Bergstrom N, Bennett MA, Carlson C, et al. 1992;1:28–34. Eur J Surg. Journal of Wound Ostomy & Continence Nursing39(2S):S30-S34, March/April 2012. Wound, Ostomy and Continence Nurses Society (WOCN) Wound Committee and the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) 2000 Guidelines Committee, Updated/Revised: WOCN Wound Committee, 2011. This is sometimes also called the clean technique. Flores A. Sterile versus non-sterile glove use and aseptic technique. Crow S, Thompson PJ. Three factors that were identified as the most influential in glove choice were type of wound, exposed bone, and immunosuppression. Date Approved by the WOCN Society Board of Directors: This website uses cookies. 21. Surgical asepsis is the absence of all microorganisms within any type of invasive procedure. Angeras MH, Brandberg A, Falk A, Seeman T. Comparison between sterile saline and tap water for the cleaning of acute traumatic soft tissue wounds. Nurs Stand. 33. 95-0652.; 1994. Few national guidelines have addressed the topic of clean vs. sterile technique. Acta Palulista de Enfermagem. Wound Care Made Incredibly Easy. After cleaning the wound and drying the surrounding skin, I used the skin barrier wipe and placed the second sterile towel between me and the patient's wound. Gloves used for wound care should not be stored in the bathroom or under a sink. Wound Repair Regenerat. Surgical Asepsis • This requires the absence of all microorganisms, pathogens, and spores from an object. Terms have been used interchangeably and all are subject to individual interpretation. What about re-using syringes and cannula? Put soap on hands. 2. Clean vs. sterile dressing techniques for management of chronic wounds: a fact sheet. Having read a recent article on clean versus sterile dressing technique, commenting again on this issue seems highly appropriate. Keep items apart by using no touch technique. Investigators in both these studies concluded that the practice of saturating gauze sponges on their wrappers was unacceptable. Wound healing physiology. • The caregiver working within a sterile field or with sterile equipment must understand that the slightest break in technique results in contamination. Indications for use of a clean technique may include: The following factors should be considered when planning and selecting dressing technique for chronic wound care. 17. Variations in aseptic technique and implications for infection control. Research is needed to provide an evidence-basis to support either “clean” or “sterile” dressing technique to manage chronic wounds. The saline kept at room temperature had undesirable levels of bacteria after 2 weeks. 13. Upstream decontamination strategies, device and tool sterilization, sterile garments, clean-forward furniture, and aseptic technique all reduce the probability of cross contamination and ensure a high probability of sterility at each touch point of the workflow. Environment in which the care setting J, Grant L, Bostrom J that... Of equipment, handwashing and utilizing gloves, gowns and face masks and expected fashion may considered! Lower than elbows to allow water to flow towards the fingertips infection: are defining. Are required if it is a required part of patient care date Approved by the Society... Explain the radiographer 's responsibility for maintaining surgical aseptic technique is used to identify chronic. Gloves are used along with your password to log in Wilkins ; 2007:1–26 burden that is ordinarily cleared by host.9–11... 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