Surgical Asepsis and Wound Care

1. Surgical Asepsis and Wound Care Fundamentals Unit 8

2. Surgical Asepsis and Wound Care • Terms • Preoperative • Intraoperative • Postoperative • Skin prep • Shave prep • What is surgical asepsis? • Free from all microorganisms • Only as good as the most careful person • If sterility is doubt, consider contaminated!

3. Surgical Asepsis and Wound Care • Pathogen evolution and antibiotic resistance • Sterile technique is used for… • Use sterile technique when entering sterile interior of the body • Bladder • Wounds • Veins • Lower airways • Rules for sterile technique…

4. Surgical Asepsis and Wound Care • The surgical scrub… • The stroke method • The timed method • Up the arm to 2 inches above elbow • Keep hands above the elbows • Rinse in one direction only, fingers first • Dry each hand with a separate sterile towel • Sterile gloving • Let’s do it!

5. Surgical Asepsis and Wound Care • The 3 types of wound healing are… • First intention – skin edges close together • Second intention – adhesion of two granulated surfaces • Third intention – left open and closed later

6. Surgical Asepsis and Wound Care • Factors which affect wound healing… • Age • Nutrition • Metabolism • Medication • Edema • Foreign bodies • Radiation • Dressing technique • Drains • Stressors • Closures

7. Surgical Asepsis and Wound Care • Purposes for a dressing… • Purposes for leaving wounds open to air… • Some dressing change guidelines are… • Removing the dressing • Some safety factors in wound care

8. Surgical Asepsis and Wound Care • Sterile dressing changes • Nursing actions • Types of drains • Penrose drain • Jackson Pratt wound suction • Hemovac or Porta-Vac • T-tubes • Wound VAC

9. Surgical Asepsis and Wound Care • How do I care for a patient with a suction device? • Discontinuing the drainage device • Check the order! • Do with dressing change • Relieve the suction! • Cut suture prn • Pull firmly and place in towel. Inspect! • Proceed with dressing change • Document

10. Surgical Asepsis and Wound Care • What are the types of drainage? • Serous • Sanguineous • Serosanguineous • Purulent • Mucopurulent • Bile • Fecal

11. Surgical Asepsis and Wound Care • Wound infections • S and Sx • Interventions • Wound cultures • Dehiscence • Evisceration

12. Surgical Asepsis and Wound Care • Removal of sutures • Removal of staples • Wound irrigation • Care of the deep wound, with review Let’s practice!

13. Surgical Asepsis and Wound Care Bandages and Binders • Purposes for bandages and binders are… • To apply pressure to control bleeding or edema • To immobilize a part • To serve as a support • To hold splints in place • To hold surgical dressings in place

14. Surgical Asepsis and Wound Care • Types of binders • Abdominal binder – application may take two people • T-binder – suspending bandage • Double T-binder – used for the male • Classifications of bandages according to shape • Triangular – used as a sling • Roller – gauze or ace wraps • Types of roller bandages • Circular • Oblique • Spiral • Spiral reverse • Figure of eight • Recurrent

15. Surgical Asepsis and Wound Care • Applying bandages • Position patient • Clean part to be bandaged • Use pillows prn to elevate • Wrap distal to proximal • Never let two skin surfaces touch under bandage • Never apply a wet or damp bandage tightly • Overlap ½ the previous bandage turn width • Apply with even tension • Note edema present before application • Secure the bandage ends

16. Surgical Asepsis and Wound Care • Circulatory and neurovascular checks are… • Documentation is important • Type of bandage • Area applied to • Neurovascular assessments • How tolerated

17. Surgical Asepsis and Wound Care • Removal • Wash hands, use clean scissors • Untape or cut bandage to the side of the wound • Unroll bandage, do not allow to fall to floor • Special types • Mitten • Clavicle strap • TEDS Now we’ll practice bandaging.

18. Surgical Asepsis and Wound Care Hot and Cold Applications Terms- Compress Ischemia Maceration Suppuration Tepid Vasodilation Vasoconstriction

19. Surgical Asepsis and Wound Care • Heat is used for • Tissue healing • Reduce edema • Relieve pain • Increases the inflammatory response • Cold is used for • Prevent edema • Control bleeding • Relieve pain

20. Surgical Asepsis and Wound Care Hot and Cold Applications • Effects of hot and cold • Effects of moist and dry • Patients at risk for hot and cold tx • Children • Elderly • Unconsciousness • Peripheral vascular disease • Damage to the nervous system • Broken areas of skin • Fragile areas of skin

21. Surgical Asepsis and Wound Care • Safety guidelines to follow • Equipment • Amount of time • Adaptation • Skin • Types of heat applications • Aquathermia pad • Warm, wet compress • Whirlpool or soak • Sitz bath

22. Surgical Asepsis and Wound Care • Types of cold applications • Ice pack • Chemical cold pack • Cold, moist compress • Tepid sponge bath • Temperature ranges Done with unit 8! We are done with unit 8!