Requirements (Sterile, Pack and trolley procedure) Toy Top shelf Sterile pack containing Hand towel 3 gallipots for swabs, cleaning and dressing lotion, A pair of dissecting forceps 3 dressing forceps for removal of stained dressing, dressing the wound and Appli new dressing Gauze and cotton swabs 1 kidney dishshell Tray containing Cleaning lotion Dressing lation Scissors Adhesive plaster Container for mask Sterile gloves Clean gloves (assisting Nurse) Large covered bow! with disinfect Large lined bow for soiled dressing and swabs for used forceps Receiver for used towel ‘Cheatle forceps in a container Dressing mackintosh and towel depending onsite and nature of wound Method/Procedure Inform and explain procedure to patient Provide privacy. Put on face mask Wheel the tolley tothe patent's bedside ' ‘Open the outer cover ofthe pack (by the serub nurse) Leave pack on the top ofthe trolley Fold bed clathes neaily not exposing patient unnecessarily Fold night-gown or pyjamas by rolling it inwards. Place the dressing mackintosh and towel in position to protect Leave trolley under the care of assisting muse. Go to the tap and scrub for up to three (3) minutes forthe first dressing and one (1) ‘minutes for subsequent wound dressings (by scrub nurse) Loosen strapping and remove outer dressing over the wound leaving inner dressing (by assisting nurse) The scrub nurse retums to the trolley Dry and glove hands (by serub nurse) ‘Open the inner pack with hands touching the outside ofthe towel only Remove the soiled dressing with a dressing forceps Drop forceps into the bowl and discard soled dressing into a lined bow ‘Wash and dry hands (by assisting nurse) Pour antiseptic into a gallipot (by asisting nurse) Pick swabs with forceps and dip into the antiseptic lotion Squeeze swab to remove excess antiseptic lotion Clean the face ofthe wound from inside out once in a swipe fashion sheet 405Nate s Repeat until wound surface i clean using as man Clean skin around the wound last. apply antiseptic powder to wound if prescribed Cover the wound with sterile dressing Y swabs a8 possible and strap in postion Remove dressing mackintosh and towel Make patient comfortable Dispose soiled dressing Remove sereen ‘Wash and sterilize forceps used Retum used ilems tothe wility room ‘Wash and dry hands Document treatment AA dry wound should not be cleaned with any lotion asthe moisture will make the ‘wound soggy and micro-organisms multiply rapidly ina moist environment several dressings are to be done, the clean ones ae dressed befor the septic ones ‘Avoid unnecessary conversation during procedute so that dressing will be done fast and patient will experience only minimum discomfort and apprehension Call the attention of the head nurse if unusual factors are observed during the procedure During dressing, the ward should be closed to any form of trafic Strict Aseptic technique must be observed Prevention of Wound Infection ‘The organisms commonly responsible for wound infections are those usually present inthe ait, dust, bedding and upper respiratory tract of eariers and as such the following measures should be instituted for prevention Respiratory tract infections = Use Mask during wound dressing = Nurses with respiratory rat infections should not do dressing of wounds, ~All fans should be tured off before dressing is commenced Blankets = Cotton blankets should be used because they ean be conveniently boiled Dust Suppression = Do dressing a least one hour after sweeping, dusting and bed-making = If possible vacuum sweeping shouldbe done to preven raising up of dost Isolation = Isolate of barrier nurse all infectious patients and treated with effective, nubiotes Dressing technique = Clean wounds should be dressed before the septic wounds> At sic utc ean tenis) eile rd dessin. Ibe dress daly, tice daily oF whenever = Use Aseptic technique for 0 = The septic and diseharging wounds © the dressing is hadly sie ae = Clean and healing wounds ray be cecsed cHiy REMMI JON Ceeings undisturbed for 2-Mays 6 Disposal of soiled dressings = Soiled dressings are pat into paper ba removed fim the wound and enti! wed an Hing he Bos 6864 whey Tae an incr al DUTT 3S sy Aressing is completed. oie te dust bin or feaving ther exposed ereatey an Ping si dosing #1 ee the spread of disease, offensive odour, attracts Mis and vultures caus 7. Cleaning of a trolley for dressing = Clean the teolley top. and bottom disinfectant suet as avon, spits ik ee hiding the cross bars and Hees. with = Using clean tly cloth and dy then se an amine oto to wipe i Removal of Wound Stitehes Stitches are generally used in surgical and broken skin together and promote healing Removal of stitches depends on the nature of the wound and the diseretion of the Sargeon and could be within 3-7 days post cxher extensive wommds 10 ring the elges of the Extra requirements = Stitch scissors = Mitchell's clip remover ifused = Other requirements (as in wound dressing) Methou/Procedure = The same a for surgical dressing. = Count stitches on the wound before and afer removal = One end of the sfitch is picked up with dressing Forceps and one blade of the stiteh scissors i slipped beneath the suite = Stitch is cut close tothe skin in such a way that in withdrawing i, no par ofthe stitch which was exposed to the air is dragged through the tissue. Ensure that the cot is ‘made in such a way that no piece of stich i et in the tissues = The stitch is pulled through by the nurse with the foreeps and placed on the gauze square and inspected to see that it is complete. To prevent the skin being pulled when the sltch is withdrawn gently lay the forceps held inthe right hand over the skin area imthe same plane as the skin. ‘When all the sutures are removed, they ace counted.Saretng worl wed siren elie Aressing At nstrumens = Use Aseptic techie or 04 ily, twiee daily oF whenever ging wows 2 The speach the dressing shay sie = Clean and tating wens may be dese! daly taistue fr 2° Mays 6. Dignosal of soiled dressings = Soiled dressings ne pu 0 P fe wou adem removed fo th Aressing seompere i in the dst bin ig them expel teste an ee ae ‘causing the spread of disease, ‘offensive exdour, attests ties and wares 1. Cleaning of a trolley for dressing = Clean the trolley. top_and hotter avon, iit ik anal dy, then se mnliding the ctons Bars al Leys wath lsinfestant sch as = Using a clean trolley etoth sures an annseptic thon 0 pe a Removal of Wound Stitehes Stitches are generally used in surgical ‘broken skin together and promote healing Removal of stitches depends on the 1 and coal he within 3 ~ 7 days post-surecty and other extensive wounds 1 bring the ele ofthe re of the wound andthe Uisereton othe Surgeon = Stitch seissors = Mitchells = Other requizements (as in wound des ip remover sFused Method Procedure = The same as for surgical dressing = Count stitches on the wound before and afer removal = One end of the stitch is picked up with dressing Foreens scissors is slipped Beneath the suture: ~ Stitch is eutelose tothe skin in such a way that in withdrawing it part ofthe site ‘ragged through the tissue, Ensure thatthe cutis fone Blade othe site which was exposed t0 the made in such a way that no picce of stich is left inthe tissues = The stitch is pulled through by the nurse with the forceps and placed on the gauze square and inspected to soe that itis complete. To prevent the skin being pulled when the stitch is withdrawn gently lay the foreps held in the right hand over the skin area inthe same plane asthe skin. = When all the sutures are removed, they are counted___ With cotton wool swabs, the scars lightly pressed to sce if th sf wound is completely healed and all sutures removed. f Femoved, gentian violet can be appli sitet eve tales eta et and secured with tapping, also check prescription order if wound shold fe Ien open. Make patient comfortable ere is any discharge Stee and ret used items to the tity room Wash and dry hands _z_ Document the date and numberof sutures removed in patients chan “= Document condition ofthe wound care of Drainage Tube (10 Shorten a Drain) ruira requirements = Siefile safety pin = Sierile bandage and scissors = Sterile stitch scissors if necessary Method/ Procedure = Same a for surgieal dressing = Use the foreeps and open the sterile safety pin and place it on the sterile area ready for = Clean the skin around the drain using the sab = Remove any stitch holding the drain in position = Genily tur the drain within the wound to loosen tifa tubular dain = Grasp the protruding end of the drain with a par of artery forceps and gently ease the drain out ofthe wound forthe prescribed distance eg. | inch (2.Sem = Pick another pair of artery forceps and pick up the sterile safety pin, Grasp the pin firmly in the forceps; pas it through the tube and ou the ater side, as ‘near tothe skin surface as posible (take eare not to injure the patent), The pi should be directed ina slighily upward ditection away from the skin, = Use the second pair of forceps to steady the tubing = Close the pin using two pair of forceps = Cut excess tubing oT using sterile Bandage scissors = Apply dry dressing,