Surgical Asepsis and Wound Care

• Equipment:• ABD pads• Sterile 4x4’s• Betadine swabs• Cotton tip applicators• Silk tape, paper tape, canvas tape, Montgomery

straps• Sterile basin for soaks• Clean gloves• Sterile gloves• Sterile aseptic syringe and solution for irrigation• Swabs (with medium) for specimen collection if

ordered• Hemovac and Jackson-Pratt (JP) for demonstration

Surgical Asepsis and Wound Care

• Principles of Asepsis (General)- A sterile object is free of microorganisms, whereas asepsis is as

contaminate free as possible- All items that are not sterile are considered contaminated- ONLY

STERILE ITMS CAN CONTACT STERILE ITEMS OR THEY ARE CONTAMINATED.

- Skin cannot be sterilized but the number of microorganisms may be reduced through vigorous scrubbing.

- Microorganisms can be transmitted by:– direct contact -airborne droplets– air currents _fluids – capillary action

- Microorganisms cannot penetrate dry cotton fabric, non woven paper or plastic wrappers. Intact skin helps to prevent the entry of microorganisms.

- Never leave a sterile dressing you are working on open

Surgical Asepsis and Wound Care

• Principles of Surgical Asepsis- Never assume that an object is sterile. Check for

sterility by checking expiration dates, intactness and integrity of outer wraps and sterilization indicators inside the package.

- If there is a question of sterility it is considered CONTAMINATED.

- Sterile objects out of the field of vision or below waist level are considered contaminated.

- Reduce air currents around a sterile object by not reaching across a sterile field, keep doors and curtains closed and move sterile objects as little as possible on a sterile field.

- Fluids flow in the direction of gravity- Masks may be necessary; keep tips of sterile instruments pointed down; keep hands up after performing a surgical hand scrub.

Surgical Asepsis and Wound Care

- Capillary action can move fluids against gravity and contaminate a sterile object/field. Keep caps of open sterile bottles right side up to prevent contamination of rim; avoid splashing or spillage when pouring liquids, use a lipping technique when pouring

- The outer edges of a sterile field (2.5 cm or 1 inch) are considered contaminated.

- Purpose of sterile dressings are to decrease risk of infection, comfort and promote healing.

Sterile Procedure• Open sterile packages away from you.• Touch only outside of sterile wrapper if you are not

wearing sterile gloves• Do Not reach across a sterile field.• Clean wound from top to bottom, laterally, away from

incisional site, and cleanest to dirtiest• Use only one swab for each motion.• Drop additional items onto sterile field- do not flip or

throw.• Clean drains in circular motion from closest to drain

to outward.• Use spilt 4x4 or trach dressing for drain.• Empty closed drainage systems (JP or Hemovac)

maintaining sterility of connections, measure amount and re-establish suction.

• If dehisces continue with dressing & notify MD

• Nurses notes note:– Color (describe if it bright thick red blood, pale red

and watery=serosanguineous, clear with a yellow cast= sanguineous, yellow and thick)

– Odor– Amount of drainage as minimum, moderate, or

copious– Level of pain before and after– If any type of drainage apparatus– Note the size of the wound in cm ( length, width,

depth) and presence of sutures or staples.– Note if wound is free of dressing which is noted as

open to air, (OTA)– How patient tolerated procedure

Pressure Ulcers

• Please read pages 432-450 in Perry & Potter

• Please be familiar with staging