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ssings
– A lway s p ro ceed fro m clean to d irty : start with p atients with uninfected wo und s. If
there are m ultip le d ressings fo r o ne p atient, start with the cleanest wo und .
Technique
– If the p ro ced ure m ay be p ainful, give an analgesic and wait the necessary tim e fo r the
d rug to tak e effect befo re starting the p ro ced ure.
– S ettle the p atient co m fo rtably in an area where his p rivacy is resp ected thro ugho ut
the p ro ced ure.
– E xp lain the p ro ced ure to the p atient and o btain his co -o p eratio n.
– Instrum ents (o r sterile glo ves) m ust be changed between p atients.
– T o p revent d rug interactio ns, use the sam e antisep tic fo r all care o f o ne p atient.
Removal of an old dressing
– W ash hand s (o rd inary so ap ) o r d isinfect them with an alco ho l-based hand rub.
– P ut o n no n- sterile glo ves and rem o ve th e ad h esive tap e, band age and sup erficial
co m p resses.
– P ro ceed gently with the last co m p resses. If they stick to the wo und , lo o sen them with
0 .9 % so d ium chlo rid e o r sterile water befo re rem o val.
– O bserve the so iled co m p resses. I f there is significant d ischarge, a greenish co lo ur o r a
fo ul o d o ur, a wo und infectio n is lik ely .
– D iscard the d ressing and the no n-sterile glo ves in the waste co ntainer.
Observe the wound
– I n th e case o f an o p en wo und , lo ss o f cutaneo us tissue o r ulcer, th e co lo ur is an
ind icato r o f the stage in the healing p ro cess:
• black area = necro sis, wet o r d ry infected eschar
• yellow o r greenish area = infected tissue and p resence o f p us
• red area = granulatio n, usually a sign o f h ealing ( unless th ere is h y p ertro p h y ),
ho wever, red ed ges ind icate inflam m atio n o r infectio n
• pink area = p ro cess o f ep ithelisatio n, the final stage o f healing that begins at the
ed ges o f the wo und
– In the case o f a sutured wo und , the existence o f lo cal signs o f sup p uratio n and p ain
requires the rem o val o f o ne o r m o re sutures to avo id the infectio n sp read ing. L o cal
signs includ e:
• red , ind urated and p ainful ed ges
• d rainage o f p us between th e sutures, either sp o ntaneo usly o r wh en p ressure is
ap p lied o n either sid e o f the wo und
• ly m p hangitis
• sub-cutaneo us crep itatio ns aro und the wo und
I n any case, if lo cal signs o f infectio n are o bserved , lo o k fo r general signs o f infectio n
(fever, chills, changes in the o verall co nd itio n).
254
– A lway s p ro ceed fro m clean to d irty : start with p atients with uninfected wo und s. If
there are m ultip le d ressings fo r o ne p atient, start with the cleanest wo und .
Technique
– If the p ro ced ure m ay be p ainful, give an analgesic and wait the necessary tim e fo r the
d rug to tak e effect befo re starting the p ro ced ure.
– S ettle the p atient co m fo rtably in an area where his p rivacy is resp ected thro ugho ut
the p ro ced ure.
– E xp lain the p ro ced ure to the p atient and o btain his co -o p eratio n.
– Instrum ents (o r sterile glo ves) m ust be changed between p atients.
– T o p revent d rug interactio ns, use the sam e antisep tic fo r all care o f o ne p atient.
Removal of an old dressing
– W ash hand s (o rd inary so ap ) o r d isinfect them with an alco ho l-based hand rub.
– P ut o n no n- sterile glo ves and rem o ve th e ad h esive tap e, band age and sup erficial
co m p resses.
– P ro ceed gently with the last co m p resses. If they stick to the wo und , lo o sen them with
0 .9 % so d ium chlo rid e o r sterile water befo re rem o val.
– O bserve the so iled co m p resses. I f there is significant d ischarge, a greenish co lo ur o r a
fo ul o d o ur, a wo und infectio n is lik ely .
– D iscard the d ressing and the no n-sterile glo ves in the waste co ntainer.
Observe the wound
– I n th e case o f an o p en wo und , lo ss o f cutaneo us tissue o r ulcer, th e co lo ur is an
ind icato r o f the stage in the healing p ro cess:
• black area = necro sis, wet o r d ry infected eschar
• yellow o r greenish area = infected tissue and p resence o f p us
• red area = granulatio n, usually a sign o f h ealing ( unless th ere is h y p ertro p h y ),
ho wever, red ed ges ind icate inflam m atio n o r infectio n
• pink area = p ro cess o f ep ithelisatio n, the final stage o f healing that begins at the
ed ges o f the wo und
– In the case o f a sutured wo und , the existence o f lo cal signs o f sup p uratio n and p ain
requires the rem o val o f o ne o r m o re sutures to avo id the infectio n sp read ing. L o cal
signs includ e:
• red , ind urated and p ainful ed ges
• d rainage o f p us between th e sutures, either sp o ntaneo usly o r wh en p ressure is
ap p lied o n either sid e o f the wo und
• ly m p hangitis
• sub-cutaneo us crep itatio ns aro und the wo und
I n any case, if lo cal signs o f infectio n are o bserved , lo o k fo r general signs o f infectio n
(fever, chills, changes in the o verall co nd itio n).
254
