FUNDAMENTALS+OF+NURSING+PRACTICE+1+LECTURE+5+WOUND+MANAGEMENT (1).pdf
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About This Presentation
Is a guide to Nursing skills
Slide Content
Wound Management
Dr Diana N. PhD
Dr Diana N. PhD
The skin is the largest organ in the body and serves a variety of important
functions in maintaining health and protecting the individual from injury.
Important nursing functions are maintaining skin integrity and promoting
wound healing.
Impaired skin integrity is not a frequent problem for most healthy people but
is a threat to elders; to patients with restricted mobility, chronic illnesses,
or trauma; and to those undergoing invasive health care procedures.
Dr Diana N. PhD
functions in maintaining health and protecting the individual from injury.
Important nursing functions are maintaining skin integrity and promoting
wound healing.
Impaired skin integrity is not a frequent problem for most healthy people but
is a threat to elders; to patients with restricted mobility, chronic illnesses,
or trauma; and to those undergoing invasive health care procedures.
Dr Diana N. PhD
To protect the skin and manage wounds effectively, the nurse must
understand:
1.The factors affecting skin integrity
2.The physiology of wound healing
3.Specific measures that promote optimal skin conditions
Dr Diana N. PhD
understand:
1.The factors affecting skin integrity
2.The physiology of wound healing
3.Specific measures that promote optimal skin conditions
Dr Diana N. PhD
Skin integrity
Intact skin refers to the presence of normal skin and skin layers uninterrupted
by wounds.
The appearance of the skin and skin integrity are influenced by internal
factors such as genetics, age, and the underlying health of the individual as
well as external factors such as activity.
Geneticsand hereditydetermine many aspects of a person's skin, including
skin color, sensitivity to sunlight, and allergies.
Ageinfluences skin integrity in that the skin of both the very young and the
very old is more fragile and susceptible to injury than that of most adults.
Wounds tend to heal more rapidly in infants and children, however.
Many chronic illnesses and their treatments affect skin integrity.
Dr Diana N. PhD
Intact skin refers to the presence of normal skin and skin layers uninterrupted
by wounds.
The appearance of the skin and skin integrity are influenced by internal
factors such as genetics, age, and the underlying health of the individual as
well as external factors such as activity.
Geneticsand hereditydetermine many aspects of a person's skin, including
skin color, sensitivity to sunlight, and allergies.
Ageinfluences skin integrity in that the skin of both the very young and the
very old is more fragile and susceptible to injury than that of most adults.
Wounds tend to heal more rapidly in infants and children, however.
Many chronic illnesses and their treatments affect skin integrity.
Dr Diana N. PhD
Skin integrity
People with impaired peripheral arterial circulation may have skin on the
legs that appears shiny, has lost its hair distribution, and damages easily.
Some medications, corticosteroidsfor example, cause thinning of the skin
and allow it to be much more readily harmed.
Many medications increase sensitivity to sunlight and can predispose one to
severe sunburns. Some of the most common ones that cause this damage are
certain antibiotics, chemotherapy drugs for cancer, and some
psychotherapeutic drugs
Poor nutrition alone can interfere with the appearance and function of
normal skin.
Dr Diana N. PhD
People with impaired peripheral arterial circulation may have skin on the
legs that appears shiny, has lost its hair distribution, and damages easily.
Some medications, corticosteroidsfor example, cause thinning of the skin
and allow it to be much more readily harmed.
Many medications increase sensitivity to sunlight and can predispose one to
severe sunburns. Some of the most common ones that cause this damage are
certain antibiotics, chemotherapy drugs for cancer, and some
psychotherapeutic drugs
Poor nutrition alone can interfere with the appearance and function of
normal skin.
Dr Diana N. PhD
TYPES OF WOUNDS
Body wounds are either intentional e.g. during therapy like venipuncture,
operations or unintentional/ accidental e.g. fracture
Wounds may be described according to how they are acquired or according to
the likelihood and degree of wound contamination.
Wounds, excluding pressure ulcers and burns, are classified by depth, that is,
the tissue layers involved in the wound.
Open wounds –skin or mucous membranes is broken
Closed wounds–tissues are traumatized without a break in the skin.
Dr Diana N. PhD
Body wounds are either intentional e.g. during therapy like venipuncture,
operations or unintentional/ accidental e.g. fracture
Wounds may be described according to how they are acquired or according to
the likelihood and degree of wound contamination.
Wounds, excluding pressure ulcers and burns, are classified by depth, that is,
the tissue layers involved in the wound.
Open wounds –skin or mucous membranes is broken
Closed wounds–tissues are traumatized without a break in the skin.
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Open wound
Dr Diana N. PhD
Dr Diana N. PhD
Open wound
Dr Diana N. PhD
Dr Diana N. PhD
Crush wounds
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Classification of wounds by cause
Intentional:Involves a wound that is the result of planned therapy
Unintentional: Involves a wound that is the result of unexpected trauma
By status of skin integrity
Open: involves a break in skin integrity or mucous membrane
Closed: involves no break in skin integrity or mucous membrane
By severity of injury
Superficial: involves only the epidermal layer of skin
Penetrating: involves penetration of the epidermal and dermal layers of skin and
deeper tissues or organs
Dr Diana N. PhD
Intentional:Involves a wound that is the result of planned therapy
Unintentional: Involves a wound that is the result of unexpected trauma
By status of skin integrity
Open: involves a break in skin integrity or mucous membrane
Closed: involves no break in skin integrity or mucous membrane
By severity of injury
Superficial: involves only the epidermal layer of skin
Penetrating: involves penetration of the epidermal and dermal layers of skin and
deeper tissues or organs
Dr Diana N. PhD
Classification of wounds by cause
By degree of contamination
Clean wounds are uninfected wounds in which minimal inflammation is
encountered and the respiratory, alimentary, genital, and urinary tracts are not
entered. Clean wounds are primarily closed wounds.
Clean-contaminated wounds are surgical wounds in which the respiratory,
alimentary, genital, or urinary tract has been entered. Such wounds show no
evidence of infection.
Contaminated wounds include open, fresh, accidental wounds and surgical
wounds involving a major break in sterile technique or a large amount of spillage
from the gastrointestinal tract. Contaminated wounds show evidence of
inflammation.
Dirty or infected wounds include wounds containing dead tissue and wounds with
evidence of a clinical infection, such as purulent drainage.
Dr Diana N. PhD
By degree of contamination
Clean wounds are uninfected wounds in which minimal inflammation is
encountered and the respiratory, alimentary, genital, and urinary tracts are not
entered. Clean wounds are primarily closed wounds.
Clean-contaminated wounds are surgical wounds in which the respiratory,
alimentary, genital, or urinary tract has been entered. Such wounds show no
evidence of infection.
Contaminated wounds include open, fresh, accidental wounds and surgical
wounds involving a major break in sterile technique or a large amount of spillage
from the gastrointestinal tract. Contaminated wounds show evidence of
inflammation.
Dirty or infected wounds include wounds containing dead tissue and wounds with
evidence of a clinical infection, such as purulent drainage.
Dr Diana N. PhD
Classification of wounds by cause
1.By depth
Partial-thickness: involves only the epidermal and dermal layers of skin
Full-thickness: involves the epidermal and dermal layers of skin, subcutaneous tissue
and, possibly, muscle and bone
2.By descriptive qualities
Laceration: involves tearing apart of tissues resulting in irregular wound edges
Abrasion: involves scraping or rubbing the surface of the skin by friction
Contusion: involves a blow from a blunt object resulting in swelling, discoloration,
bruising, and/or ecchymosis
Incision: involves cutting the skin with a sharp instrument
Puncture: involves penetration of the skin and, often, the underlying tissues by a sharp
instrument
Dr Diana N. PhD
1.By depth
Partial-thickness: involves only the epidermal and dermal layers of skin
Full-thickness: involves the epidermal and dermal layers of skin, subcutaneous tissue
and, possibly, muscle and bone
2.By descriptive qualities
Laceration: involves tearing apart of tissues resulting in irregular wound edges
Abrasion: involves scraping or rubbing the surface of the skin by friction
Contusion: involves a blow from a blunt object resulting in swelling, discoloration,
bruising, and/or ecchymosis
Incision: involves cutting the skin with a sharp instrument
Puncture: involves penetration of the skin and, often, the underlying tissues by a sharp
instrument
Dr Diana N. PhD
Wound healing
Healing is a quality of living tissue; it is also referred to as regeneration
(renewal) of tissues.
Healing can be considered in terms of:
Types of healing, having to do with the caregiver's decision on whether to
allow the wound to seal itself or to purposefully close the wound
Phases of healing, which refer to the steps in the body's natural processes of
tissue repair. The phases are the same for all wounds, but the rate of healing
depends on factors such as the type of healing, the locationand size of the
wound, and the health of the client.
Dr Diana N. PhD
Healing is a quality of living tissue; it is also referred to as regeneration
(renewal) of tissues.
Healing can be considered in terms of:
Types of healing, having to do with the caregiver's decision on whether to
allow the wound to seal itself or to purposefully close the wound
Phases of healing, which refer to the steps in the body's natural processes of
tissue repair. The phases are the same for all wounds, but the rate of healing
depends on factors such as the type of healing, the locationand size of the
wound, and the health of the client.
Dr Diana N. PhD
There are two types of healing, influenced by the amount of tissue loss.
Primary intention healing
Secondary intention
Dr Diana N. PhD
Primary intention healing
Secondary intention
Dr Diana N. PhD
Primary intention wound healing
Occurs where the tissue surfaces have been approximated (closed) and there
is minimalor no tissue loss.
Characterized by the formation of minimal granulation tissue and scarring.
Also called primary union or first intention healing. An example is a closed
surgical incision, use of tissue adhesive, a liquid "glue" that can be used to
seal clean lacerations or incisions which may result in better appearing scars
Dr Diana N. PhD
Occurs where the tissue surfaces have been approximated (closed) and there
is minimalor no tissue loss.
Characterized by the formation of minimal granulation tissue and scarring.
Also called primary union or first intention healing. An example is a closed
surgical incision, use of tissue adhesive, a liquid "glue" that can be used to
seal clean lacerations or incisions which may result in better appearing scars
Dr Diana N. PhD
Secondary intention wound healing
The wound is extensive and involves considerable tissue loss, and the edges
cannot be approximated. An example is a pressure ulcer.
Secondary intention healing differs from primary intention healing in three
ways:
(a) The repair time is longer
(b) The scarring is greater
(c) The susceptibility to infection is greater
Those wounds that are left open for 3 to 5 days to allow edema or infection to
resolve or exudate to drain and are then closed with sutures, staples, or
adhesive skin closures, heal by tertiary intention ordelayed primary
intention
Dr Diana N. PhD
The wound is extensive and involves considerable tissue loss, and the edges
cannot be approximated. An example is a pressure ulcer.
Secondary intention healing differs from primary intention healing in three
ways:
(a) The repair time is longer
(b) The scarring is greater
(c) The susceptibility to infection is greater
Those wounds that are left open for 3 to 5 days to allow edema or infection to
resolve or exudate to drain and are then closed with sutures, staples, or
adhesive skin closures, heal by tertiary intention ordelayed primary
intention
Dr Diana N. PhD
Types of wound drainage
Exudate is material, such as fluid and cells, that has escaped from blood
vessels during the inflammatory process and is deposited in tissue or on tissue
surfaces. The nature and amount of exudate vary according to the tissue
involved, the intensity and duration of the inflammation, and the presence of
microorganisms.
Three types of exudate:
1.Serous exudate: consists chiefly of serum (the clear portion of the blood)
derived from blood and serous membranes of the body. fluid in a blister from
a burn
2.Purulent exudate: consists of serum and pus (leukocytes, liquefied living and
dead bacteria, dead tissue debris). Thicker than serous exudate because of
the presence of pus. The process of pus formation is referred to as
suppuration, and the bacteria that produce pus are called pyogenic bacteria.
Dr Diana N. PhD
Exudate is material, such as fluid and cells, that has escaped from blood
vessels during the inflammatory process and is deposited in tissue or on tissue
surfaces. The nature and amount of exudate vary according to the tissue
involved, the intensity and duration of the inflammation, and the presence of
microorganisms.
Three types of exudate:
1.Serous exudate: consists chiefly of serum (the clear portion of the blood)
derived from blood and serous membranes of the body. fluid in a blister from
a burn
2.Purulent exudate: consists of serum and pus (leukocytes, liquefied living and
dead bacteria, dead tissue debris). Thicker than serous exudate because of
the presence of pus. The process of pus formation is referred to as
suppuration, and the bacteria that produce pus are called pyogenic bacteria.
Dr Diana N. PhD
Types of wound drainage
3.Sanguineous exudate: consists of large amounts of red blood cells, indicating
damage to capillaries that is severe enough to allow the escape of red blood
cells from plasma. frequently seen in open wounds.
Mixed types of exudates are often observed.
Serosanguineous(consisting of clear and blood-tinged drainage) exudate is
commonly seen in surgical incisions.
A purosanguineousdischarge (consisting of pus and blood) is often seen in a
new wound that is infected.
A bright sanguineous exudate indicates fresh bleeding, whereas dark
sanguineous exudate denotes older bleeding.
Dr Diana N. PhD
3.Sanguineous exudate: consists of large amounts of red blood cells, indicating
damage to capillaries that is severe enough to allow the escape of red blood
cells from plasma. frequently seen in open wounds.
Mixed types of exudates are often observed.
Serosanguineous(consisting of clear and blood-tinged drainage) exudate is
commonly seen in surgical incisions.
A purosanguineousdischarge (consisting of pus and blood) is often seen in a
new wound that is infected.
A bright sanguineous exudate indicates fresh bleeding, whereas dark
sanguineous exudate denotes older bleeding.
Dr Diana N. PhD
Phases of wound healing
1.Inflammatory
2.Proliferative
3.Maturation (remodeling)
Dr Diana N. PhD
1.Inflammatory
2.Proliferative
3.Maturation (remodeling)
Dr Diana N. PhD
Complications of wound healing
Hemorrhage
Internal hemorrhage detected by:
Swelling or distention in the area of the wound and, possibly, by sanguineous
drainage from a surgical drain.
Hematoma, a localized collection of blood underneath the skin appears as a
reddish blue swelling (bruise). large hematoma may be dangerous in that it places
pressure on blood vessels and can thus obstruct blood flow.
The risk of hemorrhage is greatest during the first 48 hours after surgery.
Hemorrhage is an emergency; the nurse should apply pressure dressings to
the area and monitor the client's vital signs.
In many instances, the client must be taken to the operating room for
surgical intervention
Dr Diana N. PhD
Hemorrhage
Internal hemorrhage detected by:
Swelling or distention in the area of the wound and, possibly, by sanguineous
drainage from a surgical drain.
Hematoma, a localized collection of blood underneath the skin appears as a
reddish blue swelling (bruise). large hematoma may be dangerous in that it places
pressure on blood vessels and can thus obstruct blood flow.
The risk of hemorrhage is greatest during the first 48 hours after surgery.
Hemorrhage is an emergency; the nurse should apply pressure dressings to
the area and monitor the client's vital signs.
In many instances, the client must be taken to the operating room for
surgical intervention
Dr Diana N. PhD
Infection
Contamination of a wound surface with microorganisms (colonization) is an
inevitable result.
Infection suggested by the presence of a change in wound color, pain, or
drainage is confirmed by performing a culture of the wound.
Severe infection causes fever and elevated white blood cell count.
A wound can be infected with microorganisms at the time of injury, during
surgery, or postoperatively.
Dr Diana N. PhD
Contamination of a wound surface with microorganisms (colonization) is an
inevitable result.
Infection suggested by the presence of a change in wound color, pain, or
drainage is confirmed by performing a culture of the wound.
Severe infection causes fever and elevated white blood cell count.
A wound can be infected with microorganisms at the time of injury, during
surgery, or postoperatively.
Dr Diana N. PhD
Dehiscence with possible evisceration
Dehiscenceis the partial or total rupturing of a sutured wound. Usually involves
an abdominal wound in which the layers below the skin also separate. likely to
occur 4 to 5 days postoperatively before extensive collagen is deposited in the
wound
Eviscerationis the protrusion of the internal viscera through an incision. A number
of factors, including obesity, poor nutrition, multiple trauma, failure of suturing,
excessive coughing, vomiting, and dehydration, heighten a client's risk of wound
dehiscence.
Sudden straining (coughing or sneezing) precede dehiscence.
When dehiscence or evisceration occurs, support wound quickly by large sterile
dressings soaked in sterile normal saline.
Place the client in bed with knees bent to decrease pull on the incision. The
surgeon must be notified because immediate surgical repair of the area may be
necessary
Dr Diana N. PhD
Dehiscenceis the partial or total rupturing of a sutured wound. Usually involves
an abdominal wound in which the layers below the skin also separate. likely to
occur 4 to 5 days postoperatively before extensive collagen is deposited in the
wound
Eviscerationis the protrusion of the internal viscera through an incision. A number
of factors, including obesity, poor nutrition, multiple trauma, failure of suturing,
excessive coughing, vomiting, and dehydration, heighten a client's risk of wound
dehiscence.
Sudden straining (coughing or sneezing) precede dehiscence.
When dehiscence or evisceration occurs, support wound quickly by large sterile
dressings soaked in sterile normal saline.
Place the client in bed with knees bent to decrease pull on the incision. The
surgeon must be notified because immediate surgical repair of the area may be
necessary
Dr Diana N. PhD
Dr Diana N. PhD
Factors affecting wound healing
Developmental considerations: Healthy children and adults often heal more
quickly than elders, who are more likely to have chronic diseases that hinder
healing.
Nutrition: for wound healing diet rich in protein, carbohydrates, lipids,
vitamins A and C, and minerals, such as iron, zinc, and copper are needed.
Lifestyle: Smoking reduces the amount of functional hemoglobin in the blood,
limiting the oxygen-carrying capacity of the blood, and constricts arterioles.
Regular exercise provides good circulation for wound healing
Medicationse.g. anti-inflammatory drugs like aspirin interfere with wound
healing, Prolonged use of antibiotics may make a person susceptible to wound
infection by resistant organisms.
Dr Diana N. PhD
Developmental considerations: Healthy children and adults often heal more
quickly than elders, who are more likely to have chronic diseases that hinder
healing.
Nutrition: for wound healing diet rich in protein, carbohydrates, lipids,
vitamins A and C, and minerals, such as iron, zinc, and copper are needed.
Lifestyle: Smoking reduces the amount of functional hemoglobin in the blood,
limiting the oxygen-carrying capacity of the blood, and constricts arterioles.
Regular exercise provides good circulation for wound healing
Medicationse.g. anti-inflammatory drugs like aspirin interfere with wound
healing, Prolonged use of antibiotics may make a person susceptible to wound
infection by resistant organisms.
Dr Diana N. PhD
Dr Diana N. PhD
Dressing wounds
Purposes
Protect the wound from mechanical injury
Protect wound from microbial contamination
Provide/ maintain high humidity of the wound
Provide thermal insulation
Absorb drainage or debride a wound or both
Prevent haemorrhage
Splint or immobilize the wound site thereby facilitate healing and prevent
injury.
Dr Diana N. PhD
Purposes
Protect the wound from mechanical injury
Protect wound from microbial contamination
Provide/ maintain high humidity of the wound
Provide thermal insulation
Absorb drainage or debride a wound or both
Prevent haemorrhage
Splint or immobilize the wound site thereby facilitate healing and prevent
injury.
Dr Diana N. PhD
Types of dressings
Type of dressing used depends on:
The location, size, and type of the wound
The amount of exudate
Whether the wound requires debridement(removal of the necrotic material), is
infected, or has sinus tracts
Frequency of dressing change, ease or difficulty of dressing application, and cost
Dr Diana N. PhD
Type of dressing used depends on:
The location, size, and type of the wound
The amount of exudate
Whether the wound requires debridement(removal of the necrotic material), is
infected, or has sinus tracts
Frequency of dressing change, ease or difficulty of dressing application, and cost
Dr Diana N. PhD
Dressing Materials
The best material to use for dressings is plain cotton gauze.
Usually, all that is needed is just enough gauze to cover the wound lightly;
multiple layers are unnecessary and wasteful.
Dr Diana N. PhD
The best material to use for dressings is plain cotton gauze.
Usually, all that is needed is just enough gauze to cover the wound lightly;
multiple layers are unnecessary and wasteful.
Dr Diana N. PhD
Dressing solutions
Betadine
Normal saline
Ointments –silver sulphadiazine, Bacitracin
Dr Diana N. PhD
Betadine
Normal saline
Ointments –silver sulphadiazine, Bacitracin
Dr Diana N. PhD
Types of dressings
Wet-to-Dry
Indication
The objective of the wet-to-dry dressing technique is to clean a wound or to
prevent build-up of exudate. It is called a “wet-to-dry” dressing because you
place a moist dressing on the wound and allow it to dry.
When the dressing is removed, it takes with it the exudate, debris, and
nonviable tissue that have become stuck to the gauze.
Wet-to-dry dressings are indicated for wounds that are dirty or infected.
Dr Diana N. PhD
Wet-to-Dry
Indication
The objective of the wet-to-dry dressing technique is to clean a wound or to
prevent build-up of exudate. It is called a “wet-to-dry” dressing because you
place a moist dressing on the wound and allow it to dry.
When the dressing is removed, it takes with it the exudate, debris, and
nonviable tissue that have become stuck to the gauze.
Wet-to-dry dressings are indicated for wounds that are dirty or infected.
Dr Diana N. PhD
Types of dressings
Technique
Moisten a gauze dressing with solution, and squeeze out the excess fluid. The
gauze should be damp, not soaking wet.
Completely open the gauze (it usually comes folded), and place it on the
wound. You do not need many layers. Then cover with a thin layer of dry
gauze.
Dr Diana N. PhD
Technique
Moisten a gauze dressing with solution, and squeeze out the excess fluid. The
gauze should be damp, not soaking wet.
Completely open the gauze (it usually comes folded), and place it on the
wound. You do not need many layers. Then cover with a thin layer of dry
gauze.
Dr Diana N. PhD
Types of dressings
Optimally, a wet-to-dry dressing should be changed 3–4 times/day, depending
on how much debridement is needed.
The dressing should be changed more frequently for a dirty wound than for a
clean wound.
Dr Diana N. PhD
Optimally, a wet-to-dry dressing should be changed 3–4 times/day, depending
on how much debridement is needed.
The dressing should be changed more frequently for a dirty wound than for a
clean wound.
Dr Diana N. PhD
Types of dressings
Wet-to-Wet
Indication
A wet-to-wet dressing does not debridethe wound, which remains as it is.
The dressing remains wet so that when the gauze is removed, the top layers
of the healing wound are not removed with it.
This dressing should be used on clean, granulating wounds with no overlying
exudatein need of removal.
Dr Diana N. PhD
Wet-to-Wet
Indication
A wet-to-wet dressing does not debridethe wound, which remains as it is.
The dressing remains wet so that when the gauze is removed, the top layers
of the healing wound are not removed with it.
This dressing should be used on clean, granulating wounds with no overlying
exudatein need of removal.
Dr Diana N. PhD
Types of dressings
Technique
Moisten the gauze dressing with solution. It should not be soaking wet, but it
should be a little wetter than damp. Unfold the gauze, place it over the
wound, and then cover with dry gauze.
The dressing should still be wet or damp when it is changed. If the bottom
layer of gauze has dried out, saturate the gauze with saline or water before
removal.
How Often?
The wet-to-wet dressing should be changed at least twice a day to prevent
drying.
Dr Diana N. PhD
Technique
Moisten the gauze dressing with solution. It should not be soaking wet, but it
should be a little wetter than damp. Unfold the gauze, place it over the
wound, and then cover with dry gauze.
The dressing should still be wet or damp when it is changed. If the bottom
layer of gauze has dried out, saturate the gauze with saline or water before
removal.
How Often?
The wet-to-wet dressing should be changed at least twice a day to prevent
drying.
Dr Diana N. PhD
Types of dressings
Antibiotic Ointment
Indication
Antibiotic ointment may be used as an alternative to wet-to-wet dressings for a
clean wound that is healing well and has no need for debridement.
Technique
Coat the wound with a small amount of ointment. A thick layer of antibiotic
ointment over the wound offers no advantage and wastes supplies.
Cover with a dry gauze if the wound is large or if it is in an area that will be
covered with bed clothing or rubbed by clothing. Otherwise the wound can be left
open to air with the antibiotic ointment alone.
How Often?
Remove the old ointment with gentle soap and water or saline, and reapply the
ointment once or twice a day.
Dr Diana N. PhD
Antibiotic Ointment
Indication
Antibiotic ointment may be used as an alternative to wet-to-wet dressings for a
clean wound that is healing well and has no need for debridement.
Technique
Coat the wound with a small amount of ointment. A thick layer of antibiotic
ointment over the wound offers no advantage and wastes supplies.
Cover with a dry gauze if the wound is large or if it is in an area that will be
covered with bed clothing or rubbed by clothing. Otherwise the wound can be left
open to air with the antibiotic ointment alone.
How Often?
Remove the old ointment with gentle soap and water or saline, and reapply the
ointment once or twice a day.
Dr Diana N. PhD
When to do which dressing
Remember, the goal is to promote healing. We know that a moist environment
facilitates healing.
For a clean wound, it is best to use a wet-to-wet or ointment based dressing
For a wound in need of debridement the wet-to-dry technique should be done
until the wound is clean and then change to a different dressing regimen.
For a wound covered with necrotic tissue, dressings cannot take the place of
mechanical debridement. When present, necrotic tissue must be sharply
debrided and then the wound treated with appropriate dressings.
Dr Diana N. PhD
Remember, the goal is to promote healing. We know that a moist environment
facilitates healing.
For a clean wound, it is best to use a wet-to-wet or ointment based dressing
For a wound in need of debridement the wet-to-dry technique should be done
until the wound is clean and then change to a different dressing regimen.
For a wound covered with necrotic tissue, dressings cannot take the place of
mechanical debridement. When present, necrotic tissue must be sharply
debrided and then the wound treated with appropriate dressings.
Dr Diana N. PhD
Sterile Technique vs. Clean Technique
Sterile technique uses instruments and supplies that have been specifically
treated so that no bacterial or viral particles are present on their surfaces.
Examples of sterilized supplies include instruments that have been autoclaved
(subjected to high temperatures to kill microorganisms) and gauze and gloves
that have been especially prepared at the factory and are individually
packaged. Procedures in an operating room are usually done with sterile
technique.
Gauze usually comes folded into a square. For dressings, it is best to open the
gauze so that a single layer is in contact with the open wound.
Dr Diana N. PhD
Sterile technique uses instruments and supplies that have been specifically
treated so that no bacterial or viral particles are present on their surfaces.
Examples of sterilized supplies include instruments that have been autoclaved
(subjected to high temperatures to kill microorganisms) and gauze and gloves
that have been especially prepared at the factory and are individually
packaged. Procedures in an operating room are usually done with sterile
technique.
Gauze usually comes folded into a square. For dressings, it is best to open the
gauze so that a single layer is in contact with the open wound.
Dr Diana N. PhD
Sterile Technique vs. Clean Technique
Clean technique uses instruments and supplies that are not as thoroughly
treated to rid surfaces of all microorganisms. Nonsterile gloves and gauze,
which come many in a package, are examples of “clean” supplies. Clean
supplies are less expensive than sterile supplies. Hence, appropriate use of
clean techniques can save valuable resources.
Dr Diana N. PhD
Clean technique uses instruments and supplies that are not as thoroughly
treated to rid surfaces of all microorganisms. Nonsterile gloves and gauze,
which come many in a package, are examples of “clean” supplies. Clean
supplies are less expensive than sterile supplies. Hence, appropriate use of
clean techniques can save valuable resources.
Dr Diana N. PhD
Cleansing the wound
All wounds should be thoroughly cleansed to allow full examination and
subsequent closure. This will remove all loose particulate matter and
decrease bacterial content.
Remember, this can be painful, so whenever possible start by injecting local
anesthetic around the wound.
Dr Diana N. PhD
All wounds should be thoroughly cleansed to allow full examination and
subsequent closure. This will remove all loose particulate matter and
decrease bacterial content.
Remember, this can be painful, so whenever possible start by injecting local
anesthetic around the wound.
Dr Diana N. PhD
Wound cleansing
Requires the application of fluid to clean the wound and optimize the healing
environment.
The goal of wound cleansing is to:
Remove visible debris and devitalized tissue
Remove dressing residue
Remove excessive or dry crusting exudates
Dr Diana N. PhD
Requires the application of fluid to clean the wound and optimize the healing
environment.
The goal of wound cleansing is to:
Remove visible debris and devitalized tissue
Remove dressing residue
Remove excessive or dry crusting exudates
Dr Diana N. PhD
Wound cleansing
Principles
Wound cleansing should not be undertaken to remove 'normal' exudate
Cleansing should be performed in a way that minimisestrauma to the wound
Wounds are best cleansed with sterile isotonic saline or water
The less we disturb a wound during dressing changes the lower the
interference to healing
Fluids should be warmed to 37°C to support cellular activity
Dr Diana N. PhD
Principles
Wound cleansing should not be undertaken to remove 'normal' exudate
Cleansing should be performed in a way that minimisestrauma to the wound
Wounds are best cleansed with sterile isotonic saline or water
The less we disturb a wound during dressing changes the lower the
interference to healing
Fluids should be warmed to 37°C to support cellular activity
Dr Diana N. PhD
Choice of dressing
Considerations when choosing dressing products -
Maintain a moist environment at the wound/dressing interface
Be able to control (remove) excess exudates. A moist wound environment is
good, a wet environment is not beneficial
Not stick to the wound, shed fibresor cause trauma to the wound or
surrounding tissue on removal
Dr Diana N. PhD
Considerations when choosing dressing products -
Maintain a moist environment at the wound/dressing interface
Be able to control (remove) excess exudates. A moist wound environment is
good, a wet environment is not beneficial
Not stick to the wound, shed fibresor cause trauma to the wound or
surrounding tissue on removal
Dr Diana N. PhD
Choice of dressing
Protect the wound from the outside environment -bacterial barrier
Good adhesion to skin
Sterile
Aid debridement if there is necrotic or sloughy tissue in the wound (caution
with ischemic lesions)
Keep the wound close to normal body temperature
Conformable to body parts and doesn't interfere with body function
Be cost-effective
Diabetes -choose dressings which allow frequent inspection
Non-flammable and non-toxic
Dr Diana N. PhD
Protect the wound from the outside environment -bacterial barrier
Good adhesion to skin
Sterile
Aid debridement if there is necrotic or sloughy tissue in the wound (caution
with ischemic lesions)
Keep the wound close to normal body temperature
Conformable to body parts and doesn't interfere with body function
Be cost-effective
Diabetes -choose dressings which allow frequent inspection
Non-flammable and non-toxic
Dr Diana N. PhD
Preparation of patient
Explain the procedure, to gain consent and co-operation.
Draw screens around the bed and ensure adequate light. Clear the bed area,
close windows, turn off fans, etc.
Adjust bedclothes to permit easy access to the wound but maintain warmth
and dignity.
Assess the wound dressing.
Check patient comfort, e.g. position, convenience, need for toilet, etc.
Administer analgesics as appropriate and allow time to take effect.
Dr Diana N. PhD
Explain the procedure, to gain consent and co-operation.
Draw screens around the bed and ensure adequate light. Clear the bed area,
close windows, turn off fans, etc.
Adjust bedclothes to permit easy access to the wound but maintain warmth
and dignity.
Assess the wound dressing.
Check patient comfort, e.g. position, convenience, need for toilet, etc.
Administer analgesics as appropriate and allow time to take effect.
Dr Diana N. PhD
Preparation of nurse
Consult the care plan to determine the type of dressing required, frequency
of change, etc.
Make sure hair is tied back securely.
Wash and dry hands thoroughly.
An apron should be worn. Additional protective clothing may be necessary if
indicated by the patient’s condition
Dr Diana N. PhD
Consult the care plan to determine the type of dressing required, frequency
of change, etc.
Make sure hair is tied back securely.
Wash and dry hands thoroughly.
An apron should be worn. Additional protective clothing may be necessary if
indicated by the patient’s condition
Dr Diana N. PhD
Preparation of equipment
Dressing trolley or other suitable surface
Dressing pack, syringe (for irrigating the wound), cleansing solution and new
dressing according to the care plan/local policy
Alcohol hand-rub or hand washing facilities
Clean the trolley or other appropriate surface according to local policy
Gather the equipment, check the sterility and expiry date of all equipment
and solutions. Place these on the bottom of the trolley
Dr Diana N. PhD
Dressing trolley or other suitable surface
Dressing pack, syringe (for irrigating the wound), cleansing solution and new
dressing according to the care plan/local policy
Alcohol hand-rub or hand washing facilities
Clean the trolley or other appropriate surface according to local policy
Gather the equipment, check the sterility and expiry date of all equipment
and solutions. Place these on the bottom of the trolley
Dr Diana N. PhD
Requirements
Top shelf
Sterile dressing pack containing:
2 pairs of dressing forceps
2 pairs of dissecting forceps
3 gallipots
10 cotton wool swabs
3 gauze swabs
1 kidney dish
1 hand towel/ 4 paper towels
Sterile gloves
Dr Diana N. PhD
Top shelf
Sterile dressing pack containing:
2 pairs of dressing forceps
2 pairs of dissecting forceps
3 gallipots
10 cotton wool swabs
3 gauze swabs
1 kidney dish
1 hand towel/ 4 paper towels
Sterile gloves
Dr Diana N. PhD
Requirements
Bottom shelf
Pair of scissors
Adhesive tape/ bandage
Antiseptic solutions as required
Kidney dish or jug with disinfectants
Topical drugs if required
Extra sterile swabs and gauze
Sterile gloves
Receiver for used swabs
Dressing mackintosh
Dr Diana N. PhD
Bottom shelf
Pair of scissors
Adhesive tape/ bandage
Antiseptic solutions as required
Kidney dish or jug with disinfectants
Topical drugs if required
Extra sterile swabs and gauze
Sterile gloves
Receiver for used swabs
Dressing mackintosh
Dr Diana N. PhD
Requirements
Accessories
Pedal bin for dirty dressings
Dressing mackintosh
Dr Diana N. PhD
Accessories
Pedal bin for dirty dressings
Dressing mackintosh
Dr Diana N. PhD
Procedure
Take the trolley to the bed area.
Adjust the bed to a safe working height to avoid back strain.
Opening Dressing Pack –your assistant will:
Remove the dressing pack from its outer packaging, place it on the top shelf
of the trolley.
Using the fingertips and touching the edges of the pack only, open the pack
and lay it flat to create a sterile field.
Dr Diana N. PhD
Take the trolley to the bed area.
Adjust the bed to a safe working height to avoid back strain.
Opening Dressing Pack –your assistant will:
Remove the dressing pack from its outer packaging, place it on the top shelf
of the trolley.
Using the fingertips and touching the edges of the pack only, open the pack
and lay it flat to create a sterile field.
Dr Diana N. PhD
Procedure
Prepare the patient –explain procedure, screen the bed, position, expose
only the area to be dressed.
Environment –close the windows, screen the bed, pedal bin near the dressing
trolley.
Nurse –wash hands, loosen dressing and remove the outer cover
Dr Diana N. PhD
Prepare the patient –explain procedure, screen the bed, position, expose
only the area to be dressed.
Environment –close the windows, screen the bed, pedal bin near the dressing
trolley.
Nurse –wash hands, loosen dressing and remove the outer cover
Dr Diana N. PhD
Procedure
The assistant pours lotion into gallipot
Remove inner dressing with dissecting forceps
Drop dressing in the pedal bin
Discard the used forceps into the kidney dish on the bottom shelf
Place the sterile green towel under and around the area to be dressed
Use the dressing forceps and swabs dipped in lotion to clean
Dr Diana N. PhD
The assistant pours lotion into gallipot
Remove inner dressing with dissecting forceps
Drop dressing in the pedal bin
Discard the used forceps into the kidney dish on the bottom shelf
Place the sterile green towel under and around the area to be dressed
Use the dressing forceps and swabs dipped in lotion to clean
Dr Diana N. PhD
Procedure
Swab from inside out, using one swab once.
Repeat until the wound is clean.
Dry the wound with a gauze swab
Apply sterile dressing with a forcep
Discard used forceps in the kidney dish on the bottom shelf
Fix the dressing with adhesive tape
Leave the patient comfortable
Dr Diana N. PhD
Swab from inside out, using one swab once.
Repeat until the wound is clean.
Dry the wound with a gauze swab
Apply sterile dressing with a forcep
Discard used forceps in the kidney dish on the bottom shelf
Fix the dressing with adhesive tape
Leave the patient comfortable
Dr Diana N. PhD
Procedure
Clearing
Nurse one:
Wheel trolley to treatment room
Disinfect the trolley, instruments, take for sterilization
Take used towels to sluice room for laundering
Record
Dr Diana N. PhD
Clearing
Nurse one:
Wheel trolley to treatment room
Disinfect the trolley, instruments, take for sterilization
Take used towels to sluice room for laundering
Record
Dr Diana N. PhD
Procedure
Clearing
Nurse two:
Remove screens, open windows
Take pedal bin to sluice room and empty it
Clean the bin if necessary
Dr Diana N. PhD
Clearing
Nurse two:
Remove screens, open windows
Take pedal bin to sluice room and empty it
Clean the bin if necessary
Dr Diana N. PhD
Aseptic Dressing Technique
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dr Diana N. PhD
Dressing Changes Using Strict Aseptic
Technique
The nurse shall:
a. Observe the surgical wound dressing every shift and document status;
b. Report any signs of infection or dehiscence to the physician immediately
(redness, swelling, in duration, tenderness, separation of the incision, odor,
etc.);
c. Monitor each shift for changes in skin integrity;
d. Ensure patient is turned every two (2) hours while in bed. Document turning,
repositioning schedule per flow sheet or in nurses narrative notes;
e. Ensure patient changes positions while in chair or wheelchair every hour;
Dr Diana N. PhD
Technique
The nurse shall:
a. Observe the surgical wound dressing every shift and document status;
b. Report any signs of infection or dehiscence to the physician immediately
(redness, swelling, in duration, tenderness, separation of the incision, odor,
etc.);
c. Monitor each shift for changes in skin integrity;
d. Ensure patient is turned every two (2) hours while in bed. Document turning,
repositioning schedule per flow sheet or in nurses narrative notes;
e. Ensure patient changes positions while in chair or wheelchair every hour;
Dr Diana N. PhD
Stitches, Clips or Staple Removal
Normally stitches, clips or staples are removed within approximately 10 days
of the surgical procedure unless otherwise advised by the health professional.
Dr Diana N. PhD
Normally stitches, clips or staples are removed within approximately 10 days
of the surgical procedure unless otherwise advised by the health professional.
Dr Diana N. PhD
Staples
More rapidly placed
Less foreign body reaction
Scalp, trunk, extremities
Do not allow for meticulous closure
Dr Diana N. PhD
More rapidly placed
Less foreign body reaction
Scalp, trunk, extremities
Do not allow for meticulous closure
Dr Diana N. PhD
Dr Diana N. PhD
Staples
Staples can be applied more rapidly than sutures. They are associated with a
lower rate of foreign body reaction and infections.
Able to use in scalp, on trunk and extremities. Not over joints.
Do not allow for meticulous closure
Dr Diana N. PhD
Staples can be applied more rapidly than sutures. They are associated with a
lower rate of foreign body reaction and infections.
Able to use in scalp, on trunk and extremities. Not over joints.
Do not allow for meticulous closure
Dr Diana N. PhD
Bandages
Holds a dressing in place over a wound
Creates pressure that controls bleeding
Helps keep the edges of the wound closed
Secures a splint to an injured part of the body
Provides support for an injured part of the body
Dr Diana N. PhD
Holds a dressing in place over a wound
Creates pressure that controls bleeding
Helps keep the edges of the wound closed
Secures a splint to an injured part of the body
Provides support for an injured part of the body
Dr Diana N. PhD
Bandage is too tight if:
The skin around the bandage becomes pale or bluish in color (cyanotic).
There is a bluish tinge to the nearest fingernails or toenails.
The victim complains of pain, usually only a few minutes after you apply the
bandage.
The skin beyond the bandage (distal) is cold.
The skin beyond the bandage (distal) is tingling or numb.
Dr Diana N. PhD
The skin around the bandage becomes pale or bluish in color (cyanotic).
There is a bluish tinge to the nearest fingernails or toenails.
The victim complains of pain, usually only a few minutes after you apply the
bandage.
The skin beyond the bandage (distal) is cold.
The skin beyond the bandage (distal) is tingling or numb.
Dr Diana N. PhD
Bandage is too tight if:
You cannot feel the pulse beyond the bandage (distal), or it is very weak.
Capillary refill is absent or diminished in the fingernails or toenails beyond
the bandage (when you press on the nail, the nailbeddoes not immediately
turn pink again)
The victim cannot move his or her fingers or toes.
Dr Diana N. PhD
You cannot feel the pulse beyond the bandage (distal), or it is very weak.
Capillary refill is absent or diminished in the fingernails or toenails beyond
the bandage (when you press on the nail, the nailbeddoes not immediately
turn pink again)
The victim cannot move his or her fingers or toes.
Dr Diana N. PhD
Bandages
Triangular Bandages
Support fractures and dislocations
Apply splints
Form slings
Make improvised tourniquets
Roller Bandages
Dr Diana N. PhD
Triangular Bandages
Support fractures and dislocations
Apply splints
Form slings
Make improvised tourniquets
Roller Bandages
Dr Diana N. PhD
Dr Diana N. PhD
Slings
1. Place one end of the base of an open triangular bandage over the shoulder of
the uninjured side.
2. Allow the bandage to hang down in front of the chest so its apex will be
behind the elbow of the injured arm.
3. Bend the arm at the elbow with the hand slightly elevated (four to five
inches). When possible, the fingertips should be exposed so you can monitor for
impaired circulation.
Dr Diana N. PhD
1. Place one end of the base of an open triangular bandage over the shoulder of
the uninjured side.
2. Allow the bandage to hang down in front of the chest so its apex will be
behind the elbow of the injured arm.
3. Bend the arm at the elbow with the hand slightly elevated (four to five
inches). When possible, the fingertips should be exposed so you can monitor for
impaired circulation.
Dr Diana N. PhD
Slings
4. Bring the forearm across the chest and over the bandage.
5. Carry the lower end of the bandage over the shoulder of the injured side, and
tie a square knot at the uninjured side of the neck; make sure the knot is at
the side of the neck.
6. Twist the apex of the bandage and tuck it in or pin it at the elbow.
Dr Diana N. PhD
4. Bring the forearm across the chest and over the bandage.
5. Carry the lower end of the bandage over the shoulder of the injured side, and
tie a square knot at the uninjured side of the neck; make sure the knot is at
the side of the neck.
6. Twist the apex of the bandage and tuck it in or pin it at the elbow.
Dr Diana N. PhD
Ideal Wound Closure
Allow for meticulous wound closure
Easily and readily applied
Painless
low risk to provider
Inexpensive
Minimal scarring
Low infection rate
Dr Diana N. PhD
Allow for meticulous wound closure
Easily and readily applied
Painless
low risk to provider
Inexpensive
Minimal scarring
Low infection rate
Dr Diana N. PhD
Sutures
Non-absorbable sutures
Tinsel strength 60 days
Non-reactive
Outermost closure
Dr Diana N. PhD
Non-absorbable sutures
Tinsel strength 60 days
Non-reactive
Outermost closure
Dr Diana N. PhD
Sutures
Absorbable sutures
Synthetic > natural
Synthetic increases wound tinsel
strength
Deeper layers
Avoid in highly contaminated wounds
Avoid in adipose tissue
Synthetic & monofilament > natural
& braided
Dr Diana N. PhD
Absorbable sutures
Synthetic > natural
Synthetic increases wound tinsel
strength
Deeper layers
Avoid in highly contaminated wounds
Avoid in adipose tissue
Synthetic & monofilament > natural
& braided
Dr Diana N. PhD
Sutures
Absorbable sutures are usually used for closure of deeper structures deeper
than the epidermis
In general, synthetic sutures are less reactive and have greater tensile
strength than sutures from natural sources, such as catgut. They increase the
time during which the healing wound retains 50% of its tensile strength from
less than 1 week to as long as two years.
Chromic gut lasts for up to 2 weeks and is associated with tissue reactivity
Dr Diana N. PhD
Absorbable sutures are usually used for closure of deeper structures deeper
than the epidermis
In general, synthetic sutures are less reactive and have greater tensile
strength than sutures from natural sources, such as catgut. They increase the
time during which the healing wound retains 50% of its tensile strength from
less than 1 week to as long as two years.
Chromic gut lasts for up to 2 weeks and is associated with tissue reactivity
Dr Diana N. PhD
Sutures
Deep sutures help relieve skin tension, decrease dead space and hematoma
formation, and probably improve cosmetic outcome.
Deep sutures should be avoided in highly contaminated wounds, where they
increase the risk of infection.
Sutures through adipose tissue do not hold tension, increase infection rates,
and should be avoided
Dr Diana N. PhD
Deep sutures help relieve skin tension, decrease dead space and hematoma
formation, and probably improve cosmetic outcome.
Deep sutures should be avoided in highly contaminated wounds, where they
increase the risk of infection.
Sutures through adipose tissue do not hold tension, increase infection rates,
and should be avoided
Dr Diana N. PhD
Staples
Advantages
Rapid application
Low tissue reactivity
Disadvantages
Less meticulous closure
May interfere with some older
generation imaging techniques (CT,
MRI)
Dr Diana N. PhD
Advantages
Rapid application
Low tissue reactivity
Disadvantages
Less meticulous closure
May interfere with some older
generation imaging techniques (CT,
MRI)
Dr Diana N. PhD
Adhesive Tapes
Less reactive than staples
Use of tissue adhesive adjunct
(benzoin)
Poor outcome in areas of tension
Seldom used for primary closure
Use after suture removal
Dr Diana N. PhD
Less reactive than staples
Use of tissue adhesive adjunct
(benzoin)
Poor outcome in areas of tension
Seldom used for primary closure
Use after suture removal
Dr Diana N. PhD
Adhesive Tapes
Surgical adhesive tapes are less reactive than staples, but they require the
use of adhesive adjuncts that increase local induration and wound infection
Tape alone cannot maintain wound integrity in areas subject to tension.
They are seldom recommended for primary wound closure, but are often used
after suture removal to decrease tension on the wound until they fall off.
Dr Diana N. PhD
Surgical adhesive tapes are less reactive than staples, but they require the
use of adhesive adjuncts that increase local induration and wound infection
Tape alone cannot maintain wound integrity in areas subject to tension.
They are seldom recommended for primary wound closure, but are often used
after suture removal to decrease tension on the wound until they fall off.
Dr Diana N. PhD
Adhesive Tapes
Advantages
Least reactive
Lowest infection rate
Rapid application
Patient comfort
Low cost
No risk of needle stick
Disadvantages
Frequently falls off
Lower tensile strength than sutures
Highest rate of dehiscence
Requires use of toxic adjuncts
Cannot be used in areas of hair
Cannot get wet
Dr Diana N. PhD
Advantages
Least reactive
Lowest infection rate
Rapid application
Patient comfort
Low cost
No risk of needle stick
Disadvantages
Frequently falls off
Lower tensile strength than sutures
Highest rate of dehiscence
Requires use of toxic adjuncts
Cannot be used in areas of hair
Cannot get wet
Dr Diana N. PhD
Tissue Adhesives
Dermabond, Ethicon
Topical use only
Outcome equal to 5-0 and 6-0
facial repairs
Less pain and time
Slough off in 7-10 days
Act as own dressing
No antibiotic ointment
Dr Diana N. PhD
Dermabond, Ethicon
Topical use only
Outcome equal to 5-0 and 6-0
facial repairs
Less pain and time
Slough off in 7-10 days
Act as own dressing
No antibiotic ointment
Dr Diana N. PhD
Tissue Adhesives
Advantages
Rapid application
Patient comfort
Resistant to bacterial growth
No need for removal
Low cost
No risk of needle stick
Disadvantages
Lower tensile strength than sutures
Dehiscence over high tension areas
(joints)
Not useful on hands
Cannot bathe or swim
Dr Diana N. PhD
Advantages
Rapid application
Patient comfort
Resistant to bacterial growth
No need for removal
Low cost
No risk of needle stick
Disadvantages
Lower tensile strength than sutures
Dehiscence over high tension areas
(joints)
Not useful on hands
Cannot bathe or swim
Dr Diana N. PhD
Post-procedural Care
Dressing for 24-48 hours
Topical antibiotics
Start cleansing in 24 hours
Suture/staple removal
Face 3-5 days
Non-tension areas 7-10 days
Tension areas 10-14 days
Dr Diana N. PhD
Dressing for 24-48 hours
Topical antibiotics
Start cleansing in 24 hours
Suture/staple removal
Face 3-5 days
Non-tension areas 7-10 days
Tension areas 10-14 days
Dr Diana N. PhD
The Interrupted Stitch
Dr Diana N. PhD
Dr Diana N. PhD
The Interrupted Stitch
Instrumentation
Hemostat
Scissors
Forceps with teeth
Plain forceps
Control syringe
Tub for saline
Gauze
Sterile towels
Syringe and splash shield
Dr Diana N. PhD
Instrumentation
Hemostat
Scissors
Forceps with teeth
Plain forceps
Control syringe
Tub for saline
Gauze
Sterile towels
Syringe and splash shield
Dr Diana N. PhD
The Interrupted Stitch
Finger tip grip
Palm grip
Grip needle one-third of way from thread
Dr Diana N. PhD
Finger tip grip
Palm grip
Grip needle one-third of way from thread
Dr Diana N. PhD
The Interrupted Stitch
Curl needle into dermis of 1st side
Dr Diana N. PhD
Curl needle into dermis of 1st side
Dr Diana N. PhD
The Interrupted Stitch
Curl needle into dermis of 1st side
Curl needle trough parallel opposite
subcutaneous side
Dr Diana N. PhD
Curl needle into dermis of 1st side
Curl needle trough parallel opposite
subcutaneous side
Dr Diana N. PhD
The Interrupted Stitch
Curl needle into dermis of 1st side
Curl needle trough parallel opposite
subcutaneous side
Tie square knot with at least two braids
Dr Diana N. PhD
Curl needle into dermis of 1st side
Curl needle trough parallel opposite
subcutaneous side
Tie square knot with at least two braids
Dr Diana N. PhD
The Interrupted Stitch
Curl needle into dermis of 1st side
Curl needle trough parallel opposite
subcutaneous side
Tie square knot with at least two braids
Repeat three to four throws
Dr Diana N. PhD
Curl needle into dermis of 1st side
Curl needle trough parallel opposite
subcutaneous side
Tie square knot with at least two braids
Repeat three to four throws
Dr Diana N. PhD
Dr Diana N. PhD
Visit www.cetl.org.uk/learningfor tutorial with video of dressing steps.
Dr Diana N. PhD
Dr Diana N. PhD
WASTE MANAGEMENT
What are Wastes?
Waste (rubbish, trash, refuse, garbage, junk, litter) is unwanted or useless
materials.
It is any of the many unwanted substances or toxins that are expelled from
living organisms, metabolic waste; such as urea and sweat.
“substances or objects which are disposed of or are intended to be disposed
of or are required to be disposed of by the provisions of the law”
Waste (rubbish, trash, refuse, garbage, junk, litter) is unwanted or useless
materials.
It is any of the many unwanted substances or toxins that are expelled from
living organisms, metabolic waste; such as urea and sweat.
“substances or objects which are disposed of or are intended to be disposed
of or are required to be disposed of by the provisions of the law”
Definition
Medical waste includes all infectious waste, hazardous (including low-level
radioactive wastes), and any other wastes that are generated from all types
of health care institutions, including hospitals, clinics, doctor’s (including
dental and veterinary) offices and medical laboratories.
Medical waste includes all infectious waste, hazardous (including low-level
radioactive wastes), and any other wastes that are generated from all types
of health care institutions, including hospitals, clinics, doctor’s (including
dental and veterinary) offices and medical laboratories.
Disposal “any operation which may lead to resource recovery, recycling,
reclamation, direct re-use or alternative uses”
reclamation, direct re-use or alternative uses”
Purpose of proper waste management
1.Protect people who handle waste items from accidental injury
2.Prevent the spread of infection to patients, clients, and HCWs
3.Prevent the spread of infection to the local community
4.Safely dispose of hazardous materials
1.Protect people who handle waste items from accidental injury
2.Prevent the spread of infection to patients, clients, and HCWs
3.Prevent the spread of infection to the local community
4.Safely dispose of hazardous materials
Kinds of Wastes
Solid wastes: wastes in solid forms, domestic, commercial and industrial
wastes.
Examples: plastics, styrofoamcontainers, bottles,cans, papers, scrap iron, and
other trash
Liquid Wastes: wastes in liquid form
Examples: domestic washings, chemicals, oils, waste water from ponds,
manufacturing industries and other sources
Solid wastes: wastes in solid forms, domestic, commercial and industrial
wastes.
Examples: plastics, styrofoamcontainers, bottles,cans, papers, scrap iron, and
other trash
Liquid Wastes: wastes in liquid form
Examples: domestic washings, chemicals, oils, waste water from ponds,
manufacturing industries and other sources
Classification of Wastes according to
their Properties
Bio-degradable: can be degraded (paper, wood, fruits and others)
Non-biodegradable: cannot be degraded (plastics, bottles, old machines,
cans, styrofoamcontainers and others)
their Properties
Bio-degradable: can be degraded (paper, wood, fruits and others)
Non-biodegradable: cannot be degraded (plastics, bottles, old machines,
cans, styrofoamcontainers and others)
Classification of Wastes according to
their Effects on Human Health and the
Environment
Hazardous wastes
Substances unsafe to use commercially, industrially, agriculturally, or
economically and have any of the following properties-ignitability,
corrosively, reactivity & toxicity.
Non-hazardous
Substances safe to use commercially, industrially, agriculturally, or
economically. These substances usually create disposal problems.
their Effects on Human Health and the
Environment
Hazardous wastes
Substances unsafe to use commercially, industrially, agriculturally, or
economically and have any of the following properties-ignitability,
corrosively, reactivity & toxicity.
Non-hazardous
Substances safe to use commercially, industrially, agriculturally, or
economically. These substances usually create disposal problems.
Categories of health care waste
Infectious: Infectious waste is material suspected to contain pathogens
(bacteria, viruses, parasites or fungi) in sufficient concentration or quantity
to cause disease in susceptible hosts.
This category includes:waste contaminated with blood or other body fluids,
cultures and stocks of infectious agents from laboratory work, waste from infected
patients in isolation wards;dressings, bandages and other material contaminated
with blood or other body fluids
Infectious: Infectious waste is material suspected to contain pathogens
(bacteria, viruses, parasites or fungi) in sufficient concentration or quantity
to cause disease in susceptible hosts.
This category includes:waste contaminated with blood or other body fluids,
cultures and stocks of infectious agents from laboratory work, waste from infected
patients in isolation wards;dressings, bandages and other material contaminated
with blood or other body fluids
Categories of health care waste
Sharps: Used or unused sharps
e.g. hypodermic, intravenous or other needles; auto-disable syringes; syringes
with attached needles; infusion sets; scalpels; pipettes; knives; blades;
broken glass
Pathological: Human tissues, organs or fluids; body parts; foetuses; unused
blood products
Pharmaceutical: Pharmaceuticals that are expired or no longer needed;
items contaminated by or containing pharmaceuticals; Cytotoxic waste
containing substances with genotoxic properties waste containing cytostatic
drugs (often used in cancer therapy) genotoxic chemicals)
Sharps: Used or unused sharps
e.g. hypodermic, intravenous or other needles; auto-disable syringes; syringes
with attached needles; infusion sets; scalpels; pipettes; knives; blades;
broken glass
Pathological: Human tissues, organs or fluids; body parts; foetuses; unused
blood products
Pharmaceutical: Pharmaceuticals that are expired or no longer needed;
items contaminated by or containing pharmaceuticals; Cytotoxic waste
containing substances with genotoxic properties waste containing cytostatic
drugs (often used in cancer therapy) genotoxic chemicals)
Categories of health care waste
Chemical: Waste containing chemical substances (e.g. laboratory reagents;
film developer; disinfectants that are expired or no longer needed; solvents;
waste with high content of heavy metals, e.g. batteries; broken
thermometers and blood pressure gauges).
Radioactive: Waste containing radioactive substances (e.g. unused liquids
from radiotherapy or laboratory research; contaminated glassware, packages,
or absorbent paper; urine and excreta from patients treated or tested with
unsealed radionuclides; sealed sources).
Chemical: Waste containing chemical substances (e.g. laboratory reagents;
film developer; disinfectants that are expired or no longer needed; solvents;
waste with high content of heavy metals, e.g. batteries; broken
thermometers and blood pressure gauges).
Radioactive: Waste containing radioactive substances (e.g. unused liquids
from radiotherapy or laboratory research; contaminated glassware, packages,
or absorbent paper; urine and excreta from patients treated or tested with
unsealed radionuclides; sealed sources).
Major components of waste
management
1.Generation of waste
2.Segregation of waste
3.Waste minimization
4.Reducing use of hazardous substances or processes
5.Waste Audit
management
1.Generation of waste
2.Segregation of waste
3.Waste minimization
4.Reducing use of hazardous substances or processes
5.Waste Audit
Treatment
1.Autoclave
2.Chemical disinfection
3.Incineration
1.Autoclave
2.Chemical disinfection
3.Incineration
Incineration
Combustible waste turned to ash at temps >800 C
Reduces volume and weight
Residues are transferred to final disposal site
Not all wastes can be incinerated
Costs vary greatly according to type of incinerator
Produces combustion gases
Combustible waste turned to ash at temps >800 C
Reduces volume and weight
Residues are transferred to final disposal site
Not all wastes can be incinerated
Costs vary greatly according to type of incinerator
Produces combustion gases
DO NOT incinerate the following:
Plastics especially halogenated plastics (e.g. PVC)
Pressurized gas containers
Large amounts of reactive chemical waste
Radioactive waste
Radiographic waste
Mercury or cadmium
Ampoules of heavy metals
Plastics especially halogenated plastics (e.g. PVC)
Pressurized gas containers
Large amounts of reactive chemical waste
Radioactive waste
Radiographic waste
Mercury or cadmium
Ampoules of heavy metals
IMPROPERLY
PACKAGED MEDICAL
WASTE
PACKAGED MEDICAL
WASTE
REGULAR
GARBAGE DOES
NOT BELONG IN
BIO HAZARD
CONTAINER
GARBAGE DOES
NOT BELONG IN
BIO HAZARD
CONTAINER
General Tips for Waste Disposal
Use heavy-duty utility gloves and appropriate PPE when handling wastes.
Decontaminate and clean gloves between uses.
Handle wastes carefully to avoid spills or splashes and wear a complete PPE
set.
Always wash your hands after removing gloves and handling contaminated
wastes.
Avoid transferring contaminated waste from one container to another.
Use heavy-duty utility gloves and appropriate PPE when handling wastes.
Decontaminate and clean gloves between uses.
Handle wastes carefully to avoid spills or splashes and wear a complete PPE
set.
Always wash your hands after removing gloves and handling contaminated
wastes.
Avoid transferring contaminated waste from one container to another.
General Tips for Waste Disposal
Incineration is the preferred method for waste disposal
If incineration is not possible, then careful burial is the next best
alternative.
Dispose of used toxic chemicals or medicine containers properly:
Rinse glass containers thoroughly with water. Glass containers may be
washed with detergent, rinsed, dried, and reused.
Incineration is the preferred method for waste disposal
If incineration is not possible, then careful burial is the next best
alternative.
Dispose of used toxic chemicals or medicine containers properly:
Rinse glass containers thoroughly with water. Glass containers may be
washed with detergent, rinsed, dried, and reused.
Colour coding
Red –highly infectious waste
Yellow -infectious waste
Black –non-infectious waste
White –food waste
Purple –radioactive waste
Red –highly infectious waste
Yellow -infectious waste
Black –non-infectious waste
White –food waste
Purple –radioactive waste
Sharps management
General Policies for Sharps
Do not pick up a handful of sharp instruments simultaneously.
Position the sharp end of instruments away from self and others.
Exercise caution when rotating instruments are in use.
Wear heavy-duty or strong utility gloves while decontaminating, cleaning, and
disinfecting instruments.
Dispose of used sharps immediately in designated puncture-and leak-proof
containers labeled with a biohazard symbol.
Prevent access to used needles and syringes, and other sharps while awaiting
transport for final disposal.
If injured by sharps, contact the supervisor immediately.
Do not pick up a handful of sharp instruments simultaneously.
Position the sharp end of instruments away from self and others.
Exercise caution when rotating instruments are in use.
Wear heavy-duty or strong utility gloves while decontaminating, cleaning, and
disinfecting instruments.
Dispose of used sharps immediately in designated puncture-and leak-proof
containers labeled with a biohazard symbol.
Prevent access to used needles and syringes, and other sharps while awaiting
transport for final disposal.
If injured by sharps, contact the supervisor immediately.
Tips for injection safety
Practices that can harm recipients and should be avoided
Changing the needle but reusing the syringe.
Loading the syringe with multiple doses and injecting multiple doses.
Applying pressure to the bleeding sites using a finger.
Leaving the needle in the vial to withdraw additional doses.
Touching the needle.
Reusing a syringe or needle.
Practices that can harm recipients and should be avoided
Changing the needle but reusing the syringe.
Loading the syringe with multiple doses and injecting multiple doses.
Applying pressure to the bleeding sites using a finger.
Leaving the needle in the vial to withdraw additional doses.
Touching the needle.
Reusing a syringe or needle.
Tips for injection safety
Practices that can harm the health care worker and should be avoided
Recapping, bending, breaking, and cutting needles.
Placing needles on a surface or carrying them any distance prior to disposal.
Practices that can harm the community and should be avoided
Leaving used syringes in areas with public access.
Giving or selling used syringes to vendors who resell them.
Providing used syringes to patients for personal reuse.
Practices that can harm the health care worker and should be avoided
Recapping, bending, breaking, and cutting needles.
Placing needles on a surface or carrying them any distance prior to disposal.
Practices that can harm the community and should be avoided
Leaving used syringes in areas with public access.
Giving or selling used syringes to vendors who resell them.
Providing used syringes to patients for personal reuse.
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