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What Is the Effective Way for The Management of The Surgical Wound- Sterile Technique or Clean Wound Technique?

Introduction

The wound of the surgical site should be adequately managed so that it closes appropriately without any complications (Vowden and Vowden 2017). In a hospital setting, it is important that the surgical site is taken care of such that the chance of hospital-acquired infections are reduced and it is one of the standards that is given in national safety and quality standards for health services (Australian Commission on Safety and Quality in Health Care 2014). There are many options that are used by the nurses to maintain and manage the cleanliness and sterility of the surgical wounds like the use of clean wound dressing and sterile technique. The aim of the present assessment is to create a literature search in medical and nursing databases which are based on the PICO that will be identified. Also, to identify, select and analyze the evidence that is available with justification for the level of evidence for the articles selected and gives conclusive information related to the research question that has been identified.

The research question that is formulated for the given information is: what is the effective way for the management of the surgical wound- sterile technique or clean wound technique? On the basis of this research question the following PICO was identified:

Participants: Nurses

Intervention: clean wound care

Comparator: sterile techniques

Outcome: surgical wound care

From the PICO that has been identified their synonyms were used to create an effective search strategy and further MeSH keywords were identified. It is important that the MeSH keywords are identified so that the effective search strings can be made in the platforms chosen for literature search. Keywords that were used for the literature search are Nurse, nurses, nursing staff, clean wound care, sterile techniques, and surgical wound care. Boolean operators are simple words that can be used for creating various combinations for the literature search and the words used are AND, OR and NOT (Olaussen et al. 2017). Nur* is used with truncation so the variation in the second half can be detected without having to create another search.

There are various databases that are present only for the publications from the field of medicine and nursing and the databases are CINAHL, PubMed, Medline, Biomed central and Google scholar. For the present literature search, PubMed was used as it provides the option of advanced search and Boolean operators can be used. The search strategy that was used in for the literature search is Nurses AND Sterile techniques AND clean wound care AND surgical wound. The other Boolean operators can be used for more relaxation or restriction of the search. To include a wide range of evidence no search limitations were applied.

As per the hierarchy of the evidence that is available it is seen the best level of evidence that is available is a systematic review which consists of randomized controlled and meta-analysis (Del Fabbro et al. 2019). The next best level of evidence that is available is a randomized controlled trial which is good because of the robust methodology which includes randomization. These are quantitative studies which give statistical data while qualitative studies give information related to the one’s perception (Waters and Rankin 2019). The choice of the articles is dependent on the research question and the aspect being explored.

Discussion

The search results gave a few articles but four articles were selected which were relevant to the PICO of the research question. The CASP guidelines are a set of questions that are available for various study designs are used as per the study design of the given article to extract the information and analyze it.

An integrative review was conducted with an aim to analyze the articles which were related to the description of articles related to the clean and sterile techniques of the surgical wound care (Ferreira and Andrade 2008). The authors provided the background that the conflict between the use of clean wound care and sterile technique is long existence in the field of healthcare. In the surgical technique of sterile technique, there is the use of various things like tweezers, sterile gloves, and the solution or the dressing materials used have always raised many questions (Ferreira and Andrade 2008). Clean wound care is related to the aseptic technique of care where the microbial load of the wound is reduced.

For the review, the articles were included from various nursing and medical databases. The theoretical framework that was adopted is evidence-based practice so that the information obtained can be used in clinical practice. The results of the present integrative review included seven articles which ranged from cross-sectional studies to randomized control trial and the setting varied but all were surgical wound care. The authors concluded that the result of the review was inconclusive that is it did not report if clean wound care was better than sterile technique or not (Ferreira and Andrade 2008).

Walters et al. (2012) conducted a systematic review and meta-analysis which consisted of randomized controlled trials. The study was conducted with the aim to evaluate the results of randomized controlled trials to see the effectiveness of dressing at the site of surgery. The effectiveness was evaluated by the healing of the wound for primary intention, comparison of pain, the formation of scar, and the acceptability of dressing by the patients. The interventions of the randomized controlled trials that were included had clean wound care, sterile techniques and letting the wound be open (Walters et al. 2012).

The systematic review was conducted first which was followed by meta-analysis. A total of sixteen controlled trials were included which had 2594 participants. The results of the study reflected that there was no statistically significant difference between the wound infections in different types of wound care which was the primary outcome. When the secondary outcome was compared it was seen that there was no significant difference in pain, scar formation and acceptability between sterile techniques and clean wound care (Walters et al. 2012).

In a short follow-up study which was conducted with an aim to investigate the effectiveness of sterile techniques and clean wound care in the management of surgical site wounds (Huang et al. 2016). This study was conducted in a single hospital care setting in china. The outcome that was compared was the impact of both the dressing techniques on wound healing and at the same time cost-effectiveness of the materials used. In the study a total of 130 patients between 2012 and 2014 were enrolled in the study, the patients were the ones who underwent surgery in the hospital. Other patients who attended the hospital just for the change of dressing were also included in the study (Huang et al. 2016).

The dressing of the patients was changed four times a day and the patients were followed up until the time they were discharged from the hospital. The results reflected that 18.5% of the patients acquired infection related to the wound site which not specific to one kind of dressing. There was an initial statistically significant difference between the sterile technique and clean wound care. There was no difference in infection rate and wound size but the wound volume was statistically significant. The authors concluded that in terms of effectiveness neither was superior or inferior while the sterile technique was costlier compared to clean wound care (Huang et al. 2016).

Kent et al. (2018) conducted a review with an aim to examine the evidence that is available in terms of infection prevention in surgical wounds with the use of clean wound care and sterile techniques. The research question that was formulated was: in all persons with acute or chronic wounds does the use of clean or sterile technique have an effect on the wound infection? A total of 473 articles were obtained after the initial search and after application of inclusion and exclusion criteria, only four articles were used for the review. The results of the review reflected that there was no significant difference between the rates of wound infection which the surgical wound care was performed using sterile techniques or use clean wound care. Though based on the level of evidence the authors concluded that no recommendation can be made regarding the type of dressing used (Kent et al. 2018).

Conclusion

Infection at the surgical site is one of the main concerns and challenges that the healthcare faces. The incidence of infection at the wound of the surgical site can be reduced if the healthcare professionals maintain hand hygiene and appropriate wound care can be given to the patient. there are various methods of wound care which are seen in the surgical care that the nurses take. In the present assessment, a literature search was conducted and analysis of relevant literature was done to find out which is better the sterile technique or clean wound care.

After the review, it can be concluded that in terms of prevention of infection both the techniques are equally effective and the user can be based on the experience and comfort of the patient and nurse. One of the studies revealed that when both the techniques were compared sterile technique was costlier. Recommendation- though both are equally effective in a single setting it is better to use one single technique so that there is similarity throughout.

References

Australian Commission on Safety and Quality in Health Care 2014. NSQHS Standards.

Del Fabbro, G., Bzovsky, S., Thoma, A. and Sprague, S. 2019. Hierarchy of Evidence in Surgical Research. In Evidence-Based Surgery (pp. 37-49). Springer, Cham.

Ferreira, A.M. and Andrade, D.D. 2008. Integrative review of the clean and sterile technique: Agreement and disagreement in the execution of dressing. Acta Paulista de Enfermagem, 21(1), pp.117-121.

Huang, X.L., Zhang, J.Q., Guan, S.T. and Liang, W.J. 2016. Comparison of sterile and clean dressing techniques in post-operative surgical wound infection in a chinese healthcare facility. Tropical Journal of Pharmaceutical Research, 15(2), pp.415-419.

Kent, D.J., Scardillo, J.N., Dale, B. and Pike, C. 2018. Does the use of clean or sterile dressing technique affect the incidence of wound infection?. Journal of Wound, Ostomy and Continence Nursing, 45(3), pp.265-269.

Olaussen, A., Semple, W., Oteir, A., Todd, P. and Williams, B. 2017. Paramedic literature search filters: Optimised for clinicians and academics. BMC Medical Informatics and Decision Making, 17(1), p.146.

Vowden, K. and Vowden, P. 2017. Wound dressings: Principles and practice. Surgery (Oxford), 35(9), pp.489-494.

Walter, C.J., Dumville, J.C., Sharp, C.A. and Page, T. 2012. Systematic review and meta‐analysis of wound dressings in the prevention of surgical‐site infections in surgical wounds healing by primary intention. British Journal of Surgery, 99(9), pp.1185-1194.

Waters, N. and Rankin, J.M. 2019. The hierarchy of evidence in advanced wound care: The social organization of limitations in knowledge. Nursing Inquiry, 26(4), p.e12312.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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