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10. Medical and minor surgical procedures
Technique for cleaning and dressing of the wound
– W ash hand s again o r d isinfect them with an alco ho l-based hand rub.
– O p en th e d ressing set o r bo x after ch eck ing th e d ate o f sterilisatio n and that th e
wrap p ing is intact.
– P ick up o ne o f the sterile fo rcep s being careful no t to to uch any thing else.
– P ick up th e seco nd fo rcep s with the help o f the first o ne.
– M ak e a swab by fo ld ing a co m p ress in 4 using the fo rcep s.
– Clean sutured wound or clean open wound with red granulation:
• clean with 0 .9 % so d ium chlo rid e o r sterile water to rem o ve any o rganic resid ue;
wo rk fro m the cleanest to the d irtiest area (use a clean swab fo r each stro k e);
• d ab d ry with a sterile co m p ress;
• re-co ver a sutured wo und with sterile co m p resses o r an o p en wo und with p araffin
co m p resses; the d ressing sho uld extend a few cm bey o nd the ed ges o f the wo und ;
• k eep the d ressing in p lace with ad hesive tap e o r a band age.
– Necrotic or infected open wounds:
• clean with p o ly vid o ne io d ine (7 .5 % scrub so lutio n, 1 p art o f so lutio n + 4 p arts o f
sterile 0 .9 % so d ium chlo rid e o r sterile water). Rinse tho ro ughly then d ab d ry with a
sterile co m p ress; o r if no t available, sterile 0 .9 % so d ium chlo rid e o r sterile water
and ap p ly an antisep tic (1 0 % p o ly vid o ne io d ine d erm al so lutio n).
• ap p ly sterile vaseline and rem o ve all necro tic tissue at each d ressing change until
the wo und is clean.
– D iscard any sharp m aterials used in an ap p ro p riate sharp s co ntainer and the rest o f
the waste in a waste co ntainer.
– A s quick ly as p o ssible, so ak the instrum ents in d isinfectant.
– W ash hand s again o r d isinfect them with an alco ho l-based hand rub.
T h e p rincip les rem ain the sam e if the d ressing is d o ne using instrum ents o r sterile
glo ves.
Subsequent dressings
– C lean, sutured wo und : rem o ve the initial d ressing after 5 d ay s if the wo und rem ains
p ainless and o d o urless, and if th e d ressing rem ains clean. T he d ecisio n to re-co ver o r
to leave the wo und unco vered (if it is d ry ) o ften d ep end s o n the co ntext and lo cal 10
p ractices.
– Infected , sutured wo und : rem o ve o ne o r m o re sutures and evacuate the p us. C hange
the d ressing at least o nce d aily .
– O p en, d irty wo und : d aily cleaning and d ressing change.
– O p en granulating w o und : ch ange th e d ressing every 2 to 3 d ay s, excep t if th e
granulatio n is hy p ertro p hic (in th is case, ap p ly lo cal co rtico stero id s).
255
Technique for cleaning and dressing of the wound
– W ash hand s again o r d isinfect them with an alco ho l-based hand rub.
– O p en th e d ressing set o r bo x after ch eck ing th e d ate o f sterilisatio n and that th e
wrap p ing is intact.
– P ick up o ne o f the sterile fo rcep s being careful no t to to uch any thing else.
– P ick up th e seco nd fo rcep s with the help o f the first o ne.
– M ak e a swab by fo ld ing a co m p ress in 4 using the fo rcep s.
– Clean sutured wound or clean open wound with red granulation:
• clean with 0 .9 % so d ium chlo rid e o r sterile water to rem o ve any o rganic resid ue;
wo rk fro m the cleanest to the d irtiest area (use a clean swab fo r each stro k e);
• d ab d ry with a sterile co m p ress;
• re-co ver a sutured wo und with sterile co m p resses o r an o p en wo und with p araffin
co m p resses; the d ressing sho uld extend a few cm bey o nd the ed ges o f the wo und ;
• k eep the d ressing in p lace with ad hesive tap e o r a band age.
– Necrotic or infected open wounds:
• clean with p o ly vid o ne io d ine (7 .5 % scrub so lutio n, 1 p art o f so lutio n + 4 p arts o f
sterile 0 .9 % so d ium chlo rid e o r sterile water). Rinse tho ro ughly then d ab d ry with a
sterile co m p ress; o r if no t available, sterile 0 .9 % so d ium chlo rid e o r sterile water
and ap p ly an antisep tic (1 0 % p o ly vid o ne io d ine d erm al so lutio n).
• ap p ly sterile vaseline and rem o ve all necro tic tissue at each d ressing change until
the wo und is clean.
– D iscard any sharp m aterials used in an ap p ro p riate sharp s co ntainer and the rest o f
the waste in a waste co ntainer.
– A s quick ly as p o ssible, so ak the instrum ents in d isinfectant.
– W ash hand s again o r d isinfect them with an alco ho l-based hand rub.
T h e p rincip les rem ain the sam e if the d ressing is d o ne using instrum ents o r sterile
glo ves.
Subsequent dressings
– C lean, sutured wo und : rem o ve the initial d ressing after 5 d ay s if the wo und rem ains
p ainless and o d o urless, and if th e d ressing rem ains clean. T he d ecisio n to re-co ver o r
to leave the wo und unco vered (if it is d ry ) o ften d ep end s o n the co ntext and lo cal 10
p ractices.
– Infected , sutured wo und : rem o ve o ne o r m o re sutures and evacuate the p us. C hange
the d ressing at least o nce d aily .
– O p en, d irty wo und : d aily cleaning and d ressing change.
– O p en granulating w o und : ch ange th e d ressing every 2 to 3 d ay s, excep t if th e
granulatio n is hy p ertro p hic (in th is case, ap p ly lo cal co rtico stero id s).
255
