– A set of actions aimed at healing a wound (cleaning, disinfection and protection) according to the rules of hygiene.
– All wounds do not require coverage of a dressing (eg wound sutured for several days and clean; small non-sutured wound and dry..).
Equipment:
– Sterile Instruments
• Kocher forceps or Péan
• a dissecting forceps
• a pair of surgical scissors or a scalpel to excise necrotic tissue, cut or cut compresses son
Instruments to care for a patient must be packed together in the same packaging (paper, fabric or metal case) to limit handling of aseptic faults, then autoclaved. 5-10 compresses can be included in this set.
Failing sterile instruments, the dressing can be performed using sterile gloves.
– Consumables
• sterile compresses
• non-sterile disposable gloves
• tape and / or crepe tape or gauze
• sodium chloride 0.9% sterile or sterile water
• according to the wound antiseptic (povidone iodine scrub solution, povidone iodine dermal solution), paraffin gauze, painkillers
Organization of care:
A rigorous care organization facilitates compliance with the rules of hygiene and reduces the risk of wound contamination or transmission of germs from one patient to another:
– Reserve for valid patients a special room for dressings. It must be cleaned daily and the waste removed. The treatment table must be disinfected between patients.
– Make the dressing to the patient’s bed if his health or his degree of mobility required. Use a clean and disinfected care trolley with on the top plate, the sterile equipment and / or own (set dressing, reserve compresses, etc.) and on the lower tray, septic material (container for decontamination of instruments , safety box for sharps, container or sacpoubelle for waste).
– Have all the necessary equipment, better lighting. Get help from an assistant if necessary.
– Wear eye protection if there is risk of soiling or projection from an oozing wound.
– Always proceed from clean to dirty: start with the care of patients whose wounds are not infected. When several dressings in the same patient, start with one that is cleaner.
Technique:
– Administer an analgesic medication before treatment if it may be painful and wait the time required for its effectiveness before intervening.
– Place the patient comfortably, preserving their privacy during the treatment.
– Explain to the patient the course of care and obtain his cooperation.
– Change imperative of instruments (or sterile gloves) between patients.
– Always use the same antiseptic on a patient to prevent drug interactions.
Removal of an old dressing:
– Wash hands (regular soap) or disinfect with an alcohol solution.
– Put on non-sterile gloves and remove bandage, tape and superficial compresses.
– Acting gently for the last compresses. If they adhere to the wound, inhibit the sodium chloride 0.9% sterile or sterile water before removal.
– Observe the appearance of soiled dressings. In case of large spills, greenish, foul odor, a wound infection.
– Discard the dressing and non-sterile gloves in the container provided for this purpose.
Examination of the wound:
Two situations commonly arise:
– This is an open wound, a skin defect or ulcer.
Observing the color information on the evolution of the healing process:
• = necrotic tissue black area: Dry Wet infected bedsore
• yellow or greenish area = infected tissue and presence of pus
• Red zone = granulation tissue, usually a sign of healing on track; unless it is hypertrophic. By cons, red banks indicate inflammation or even infection.
• epithelialisation = pink zone, ultimate healing phase that begins with the wound edges
– This is a wound sutured. The existence of local suppuration signs associated with pain led to the removal of one or more son to prevent the spread of infection:
• indurated red and painful banks
• pus between points, either spontaneously or by pressing either side of the wound
• lymphangite
• subcutaneous crepitus around the wound
In both cases, general signs of infection (fever, chills, poor general condition) are to be found.
Dressing technique using sterile instruments:
– Wash hands again or disinfect with an alcohol solution.
– Open the set or dressing box by checking the integrity of the packaging and sterilization date.
– Take a sterile forceps without touching anything else with your fingers.
– Take the second clip with the first.
– Grab a pad with one of the two clamps and make a buffer by bending the four.
– Clean wounds, sutured or open and budding red:
• Clean with sodium chloride 0.9% or sterile water from the cleanest to the dirtiest to remove organic residues (change buffer on each pass);
• pat dry with a sterile dressing;
• cover with a sterile gauze wound sutured and tulle fat an open wound, making them exceed the wound a few centimeters;
• maintain the dressing with tape or bandage.
– Open wounds necrotic or infected:
• Clean with povidone iodine (foam solution at 7.5%, 1 volume solution of 4 parts of sodium chloride 0.9% or sterile water) and rinse thoroughly and pat dry with a sterile dressing; failing to clean sodium chloride 0.9% or sterile water and apply an antiseptic (dermal solution povidone iodine 10%).
• Apply sterile vaseline and remove necrotic tissue at each dressing until the wound is clean.
– Eliminate sharp and cutting equipment in a specific container and the rest of the waste in the container provided for this purpose.
– Immerse the instruments in a water decontamination as soon as possible.
– Wash hands again or disinfect with an alcohol solution.
The principle remains the same when using sterile gloves failing instruments.
Dressings:
– Clean, sutured wound: dressing 5 days later if the wound is painless, odorless, and that the dressing stays clean.The decision to cover the wound or let air dry if it is often context and local customs.
– Wound sutured and infected: remove one or more son and drain pus, dressing at least once a day.
– Open wound dirty: daily cleaning and dressing.
– Open wound burgeoning: dressing every two or three days unless the bud is hypertrophic (in this case, local corticosteroid application).
