Dressing Change Protocols

Hospitals in the United States have accepted the universal precautions for disease control. The CDC has written protocol for care of patients with infectious diseases such as HIV and hepatitis B. Universal precautions remain consistent throughout the country.

Institutions adopt basic dressing changes and aseptic (without germs) techniques according to their own protocol. The brand or type of supplies used rather than technique makes up the difference in protocol between institutions.

Basic Protocol

• The physician orders when and how dressings are to be changed. The nurse records the date and time on each new dressing to establish a time frame for wound healing.

  After removing and disposing of the existing dressing, clean the wound according to the treatment plan.

  Dry the wound and apply Vaseline around the edges.

  Apply sterile gauze to the wound packing lightly.

  Cover with gauze or transparent film. Use tape as tolerated by the patient.

  Dispose of all debris and wash hands.

Aseptic

• Gather supplies needed for cleaning, treating and dressing the wound. Sterile items should be opened before gloving.

  Wash hands with antibacterial soap.

  Dispose of dirty dressings by placing them in the proper trash container and remove the container from the patient's room.

  Wash hands and glove.

  Clean the wound and apply any treatment required.

  Apply dressing.

  Remove all debris and wash hands.

Infectious

• Universal precautions address the concerns of transmitting infectious disease through blood and bodily fluids that include blood, saliva, vaginal secretions, urine, and bowel and wound exudate (fluid).

  Aseptic technique is used for infectious disease control. Before entering the patient's room personnel dress in a gown, mask and gloves as part of an isolation procedure. Material used on the wound and dirty dressings are disposed of in a marked hazardous bag.

  After leaving the patient's room the staff should be careful not to touch anything until they have washed their hands.

Skin Tears

• A skin tear is an injury to a patient's skin when it rips. It is common in nursing home settings. Protocol to treat skin tears in nursing facilities should include a dressing that contains a continuous cleansing treatment.

  Adequate dressing should cover the wound so that bacteria can not travel through the material.

  The dressing should absorb any fluids without leaking through.

  The patient should receive the proper amount of solutions and medications to the wound in order to provide comfort.

  Steri-strips should not be used on skin tears because they do not protect the wound from infection.