When preparing to change a sterile dressing over an incision, it is most important to remember to

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When applying or changing dressings, an aseptic technique is used in order to avoid introducing infections into a wound. Even if a wound is already infected, an aseptic technique should be used as it is important that no further infection is introduced. This technique should be used when the patient has a surgical or non-surgical wound in or around the eye.

A clear available work space, such as a stainless steel trolley. The space must be big enough for the dressing pack to be opened on
A sterile dressing/procedure pack
Access to hand washing sink or alcohol hand wash
Non-sterile gloves to remove old dressing
Appropriate solution for cleaning the wound, if needed.

Introduce yourself to the patient and explain what you are doing and why. If possible, provide privacy.
Position the patient comfortably and make sure the surrounding area is clean and tidy before you start.
Check the patient's care notes to update yourself on any changes in the patient's condition and to make sure the dressing is due to be changed.
Wash your hands and put on an apron.
Clean the trolley using soap and water, or disinfectant, and a cloth. Start at the top of the trolley and work down to the bottom legs of the trolley using single strokes with your damp cloth.
Place the sterile dressing/procedure pack on the top of the trolley.
Open the sterile dressing pack on top of the trolley. Open the sterile field using the corners of the paper.
Open any other sterile items needed onto the sterile field without touching them.

Wash your hands and put on non-sterile gloves (to protect yourself) before removing an old dressing. Dispose of this dressing in a separate dirty clinical waste bag.
Complete a wound assessment. This includes a visual check and comparing and evaluating the smell, amount of blood or ooze (excretions) and their colour, and the size of the wound.
If the site has not improved as expected, then the treating physician or senior charge nurse must be informed so they too can evaluate it and consider changing the care plan.

‘If the site has not improved as expected, inform the treating physician or senior nurse.’

Make sure that you have selected the correct dressing type and materials to provide full and appropriate coverage of the type, size and location of the wound as per the care plan or the physician or senior charge nurse's recommendations.
Wash your hands and put on sterile gloves. If the gloves become desterilised, remove them, re-wash your hands and put on new sterile gloves. This is best practice, but where resources are not available, safe modifications to this process can be made, for example by using non-sterile gloves to protect the nurse while removing the dressing and then washing the hands with gloves on and using alcohol gel on the gloves to make them clean enough to clean the wound and redo the dressing. This then protects both the nurse and the patient.
Start from the dirty area and then move out to the clean area. Be very careful when doing this as the tissue or skin may be tender and there may also be sutures in place. Clean the area without causing further damage or distress to the patient.
Make sure you do not re-introduce dirt or ooze by ensuring that cleaning materials (i.e. gauze, cotton balls) are not over-used. Change them regularly (use once only if possible) and never re-introduce them to a clean area once they have been contaminated.
Make sure that you have selected the correct dressing type and materials needed to provide full and appropriate coverage for the type, size and location of the wound, according to the care plan or the physician's or senior charge nurse's recommendations.
Dress the wound as per instructions.
Note: Ensure that the materials and dressing pack are only used for one eye at a time to prevent cross-contamination. If, for some reason, another part of the face or the other eye also needs a dressing change, then open another pack and start on the other side with clean hands and gloves.

Fold up the dressing/procedure pack and place all contaminated material in a bag designated for clinical waste, making sure all sharps are removed and disposed of in a sharps container.
Remove gloves and place in waste bag.
Clean the trolley with soap and water or disinfectant solution as before.
Record (document) on the patient's chart your wound assessment, the dressing change and the care you have given.
Provide the patient with some dressing management education and answer any questions before you go.
Report any changes to a senior nurse or doctor.

Articles from Community Eye Health are provided here courtesy of International Centre for Eye Health

The health care provider chooses the appropriate sterile technique and necessary supplies based on the clinical condition of the patient, the cause of the wound, the type of dressing procedure, the goal of care, and agency policy.

Agency policy will determine the type of wound cleansing solution, but sterile normal saline and sterile water are the solutions of choice for cleansing wounds and should be at room temperature to support wound healing.

For more complex wounds with delayed healing, antiseptic solutions such as povidone iodine or chlorhexidene may be used for cleansing based on agency policy and the recommendation of a wound clinician or physician.

Checklist 33 outlines the steps for performing a simple dressing change.

Checklist 33: Simple Dressing Change




1. Check present dressing with non-sterile gloves.	Use non-sterile gloves to protect yourself from contamination. Apply non-sterile gloves
2. Perform hand hygiene.	Hand hygiene prevents spread of microorganisms. Perform hand hygiene
3. Gather necessary equipment.	Dressing supplies must be for single patient use only. Use the smallest size of dressing for the wound. Gather supplies Take only the dressing supplies needed for the dressing change to the bedside.
4. Prepare environment, position patient, adjust height of bed, turn on lights.	Ensure patient’s comfort prior to and during the procedure. Proper lighting allows for good visibility to assess wound.
5. Perform hand hygiene.	Hand hygiene prevents spread of microorganisms. Hand hygiene with ABHR
6. Prepare sterile field.	Prepare sterile field
7. Add necessary sterile supplies.	Add necessary supplies
8. Pour cleansing solution.	Pour sterile cleansing solution into sterile tray Normal saline or sterile water containers must be used for only one client and must be dated and discarded within at least 24 hours of being opened.
9. Prepare patient and expose dressed wound.	Prepare patient and expose wound
10. Apply non-sterile gloves.	Use non-sterile gloves to protect yourself from contamination. Apply non-sterile gloves
11. Remove outer dressing with non-sterile gloves and discard as per agency policy.	Remove outer dressing with non-sterile gloves
12. Remove inner dressing with transfer forceps, if necessary.	Remove inner dressing with transfer forceps
13. Discard transfer forceps and non-sterile gloves according to agency policy.	Discard transfer forceps as per agency policy Discard gloves
14. Assess wound.	Assess wound
15. Drape patient with water-resistant underpad (optional).	Water-resistant underpad protects patient’s clothing and linen. Drape patient with water-resistant underpad
16. Apply non-sterile gloves (optional).	Use non-sterile gloves to protect yourself from contamination. Apply non-sterile gloves
17. Cleanse wound using one 2 x 2 gauze per stroke. Strokes should be: From clean to dirty (incision, then outer edges) From top to bottom	The suture line is considered the “least contaminated” area and is cleansed first. 1. Using a sterile swab or gauze, clean the suture line by starting at the centre and working toward one end. 2. With another sterile swab or gauze, start at the centre of the incision and work toward the other end. 3. All other cleansing involves moving from one end to the other on each side of the incision. 4. Work in straight lines, moving away from the suture line with each successive stroke.
18. Cleanse around drain (if present).	If a drain is present, clean the drain site using a circular stroke, starting with the area immediately next to the drain. Using a new swab, cleanse immediately next to the drain and attempt to clean a little further out from the drain. Continue this process with subsequent swabs until the skin surrounding the drain is cleaned. Cleanse around drain
19. Apply inner dressing (4 x 4 gauze) with forceps to incision, then drain site (drain sponges/cut gauze).	1. Cover incision 2. Cover drain site 3. Tape drain tubing to skin
20. Discard non-sterile gloves if they were used.	This step prevents the spread of microorganisms. Discard gloves
21. Apply outer dressing, keeping the inside of the sterile dressing touching the wound.	This step protects wound from contamination. Apply outer dressing if required
22. To complete dressing change: Assist patient to comfortable position. Lower patient’s bed. Discard used equipment appropriately. Perform hand hygiene.	Taking these step ensures the patient’s continued safety. Hand hygiene with ABHR
23. Document procedure and findings according to agency policy.	Record dressing change as per hospital policy. Document the wound appearance, if the staples are intact, if the incision is well-approximated. Chart the time, place of wound, size, drainage and amount, type of cleaning solution, and dressing applied. State how the patient tolerated the procedure. Report any unusual findings or concerns to the appropriate health care professional.
24. Compare wound to previous wound assessment and determine healing progress, if any.	If there is no movement toward healing, or if there is deterioration, notify the physician or wound care nurse according to agency policy.
Data source: BCIT, 2010a; Perry et al., 2014

Video 4.1

Your patient has a post-operative hip incision. You notice that the wound is slightly inflamed and not approximated, with some yellowish exudate present. What would be your next steps?
As you select your supplies, you notice that the sterile saline container was opened exactly 24 hours ago. What would be your next steps?