Wound Dressing
Definition
A dressing is a sterile pad or compress applied to wound to promote healing and protect the wound
from further harm. Dressing is used to have direct contact with a wound but bandage is used to hold a
dressing in place.
GENERAL INSTRUCTIONS FOR THE WOUND DRESSING
1. Practice strict aseptic technique to prevent cross infection to the wound and from the
wound. Dressing a wound is surgical procedure which should be carried out with the precision and
care of an operation. All materials touching the wound should be sterile.
2. All articles should be disinfected thoroughly to make sure that they are free from
pathogens. Special care must be taken when there is any reason to suspect the presence of
pathogenic spores particularly those causing the dreaded wound infections of gas gangrene and
tetanus. These spores are destroyed only be the sterilization with steam under pressure.
3. Wash hands thoroughly before and after the procedure.
4. Instruments used for one dressing cannot be used for another until they have been re-
sterilized.
5. Use masks, sterile gloves and gowns for large dressings to minimize the wound
contamination.
6. Dressings are not changed for atleast 15 minutes after the room has been swept or
cleaned. Sweeping and dusting of the room will raise the dust and the wound will be contaminated.
7. Use individually wrapped sterile dressings and equipments for the greatest safety of the
wound. The practice of storing dressings and instruments in large trays and drums and opening them
every now and then should be condemned.
8. Create a sterile field around the wound by spreading sterile towels.
9. Avoid talking, coughing and sneezing when the wound is opened.
10. During the procedure the nurse works carefully to avoid contaminating the patient’s skin,
clothing and bed linen with soiled instruments and dressings. All the soiled dressings and
contaminated instruments should be carefully collected and disposed safely.
11. Cleaning the wound should be done from the cleanest area to the less clean area.
Consider the wound area cleaner than the skin area even if the wound is infected. Therefore clean the
wound from its centre to the periphery. When cleaning a circular wound, start from the centre of the
wound and go to the periphery. When cleaning a linear wound, the first swab cleanses the wound
line; the subsequent swabs cleanse the skin on either side of the wound.
12. If the dressings are adherent to the wound due to the drying of the secretions or blood,
wet it with physiologic saline before it is removed from the wound.
13. When dressing the wound, keep the wound edges are near as possible to promote
healing.
14. When drains are in place, anticipate drainage and re-enforce the dressing accordingly.
The dressings over the drains should not be combined with the dressings on the wound line. This
enables the nurse to change the dressings over the drains without disturbing the wound dressings
and thereby minimize the wound infections.
15. The amount of discharge from the wound should be accurately measured by recording
the number and size of the dressings changed. Note the color, odor, amount and consistency of the
drainage.
16. When the wound drainage is diminished the drains are to be shortened. This should be
done in consultation with the doctor. Usually the doctor gives a written order.
17. Before doing the dressing, inspect the wound for any complications such as dehiscence
and evisceration. If present, report it immediately to the surgeon and immediate steps are to be
taken.
18. Avoid meal timings.
19. Give an analgesic prior to the painful dressings.
NURSE’S RESPONSIBILITY IN THE WOUND DRESSING
Preliminary Assessment
1. Check the diagnosis and the general condition of the patient.
2. Check the purpose for which the dressing is to be done.
3. Check the condition of the wound – the type of the wound, the types of suturing applied,
the type of dressings to be applied etc.
4. Check the physician’s orders for the type of dressing to be applied and the specific
instructions, if any, regarding the cleansing solutions, removal of sutures, drains and the application of
medications etc.
5. Check the patient’s name, bed number and other identifications.
6. Check the nurse’s records to find out the general condition of wound.
7. Check the abilities and limitations of the patient.
8. Check the consciousness of the patient and the ability to follow instructions.
9. Check the articles available in the unit.
Preparation of the Articles
Articles
A sterile tray containing:
1. Artery forceps – 1
Purpose: to clean the wound
2. Dissecting forceps – 2
3. Scissors – 1
Purpose: for the debridement of the wound, if necessary or to cut the gauze pieces to fit around the
drainage tubes etc.
4. Sinus forceps – 1
Purpose: to open the sinus tract or to pack the sinus tract, if necessary
5. Probe – 1
Purpose: to open the sinus tract or to pack the sinus tract, if necessary
6. Small bowl – 1
Purpose: to take the cleaning solutions
7. Safety pin – 1
Purpose: to fix the drain, in case the drains are cut short
8. Gloves, masks and gowns
Purpose: to use when large wounds are dressed
9. Cotton balls, gauze pieces cotton pads etc as necessary
Purpose: to clean and dress the wound
10. Slit or dressing towels
Purpose: to create a sterile field around the wound
An Unsterile Tray containing:
1. Cleaning solutions as necessary
Purpose: to clean the wound and the surrounding skin area
2. Ointment and powders as ordered
Purpose: to apply on the wound
3. Vaseline gauze in sterile containers
Purpose: to prevent the dressing adhering to the wound
4. Ribbon gauze in sterile containers
Purpose: to pack a sinus tract or penetrating wound
5. Swab sticks in a sterile container
Purpose: to apply the medications if necessary
6. Transfer forceps in a sterile container
Purpose: to handle the sterile supplies
7. Bandages, binders, pins, adhesive plaster, and scissors
Purpose: to fix the dressing in place
8. A large bowl with disinfectant solution
Purpose: to discard the used instruments
9. Kidney tray and paper bag
Purpose: to collect the wastes
10. Mackintosh and towel
Purpose: to protect the bed garments.
