In the course of your clinical placement in a surgical ward, you noted inconsistency in wound care. While some nurses use a sterile technique others employ a clean dressing change technique.
Is clean wound dressing a safe option for the dressing of surgical wounds?
The dressing is done to avoid contamination and infections that can affect the surgical site. Many nurses and health care professional's uses sterile techniques while some prefer to use sterile dressing. Researchers suggest that even if the wound is already infected dressing should be done to protect the surgical wound from further infections. The research question according to the scenario is clean wound dressing is a safe option for the dressing of surgical wounds or not? Pico question helps in formulating the search strategy for the clinical question and identifies the key concepts needed to be in the articles that answer the clinical question (Palaskar, 2017). Also, it aims to identify target group, intervention, comparison and outcomes.
I-clean wound dressing
C- Sterile wound dressing and other techniques for surgical wound dressing
O- Safe option for surgical wound dressing
The search strategy used for the clinical question is the use of Boolean operators for checking the adequate databases. Thedatabases include Medline, PubMed and CINAHL. These databases are used to classify the articles for clean surgical wounds and other wound techniques. There are many research articles presented on the chosen clinical question but only the authentic, peer-reviewed and relevant sources are used for the analysis. The keywords used for choosing articles are clean wound dressing, surgical wound dressing, wound dressing, postoperative surgical wound dressings, use of clean wound dressing, techniques for surgical wound dressing, the importance of clean wound dressing and safe clean wound dressing. The systematic review is the procedure used to evaluate information. A systematic review is an efficient tool to endorse evidentiary activities and health care initiatives. It is a straightforward and reproducible way of drawing the inference from the different evidence available.Pertaining to the clinical question Boolean operations will have opted for the relevancy and authentic search. The exclusion criteria will include eliminating all the articles that do contain the selected keywords. the total number of research articles chosen are four and the inclusion criteria are that they should have at least two to three chosen keywords. This method is adequate for positive outcomes and the CASP tool used for this objective.
Huang et al. (2016) have conducted a study on the comparison between clean dressing wound techniques and sterile wound dressing. The control group methodology is used for the comparison of dressing techniques. Cancio et al. (2017) is a descriptive study on the wound care for burns and the use of dressing techniques. Also, it compared the dressing techniques and their effectiveness. Next, Kent et al. (2018) conducted a randomized control trial for the comparison of the sterile and clean dressing for wound prevention of wound infections. Further, Khudhair et al. (2018) have conducted a descriptive study on postoperative clean wound dressing and its efficacy along with nursing practice.
Research conducted byHuang et al. (2016) aimed to find out the effect of clean and sterile dressing techniques for the management of wounds. The study was conducted in a Chinese hospital and the impact of the dressing techniques was evaluated to know how they can affectduring the process of wound healing. Researchers selected a control group with 60% males and 40% females. The dressings of the patients were changed after a time span of every 4 hours and till the time of discharge. The results indicate that patients with sterile and clean dressings had an infection, but reduced wound size. Also, researchers have asserted that the cost of the strategy of sterile dressing is more expensive than that of clean dressing procedure although the effect is almost the same.So it can be concluded both the dressing technique are effective in patient safety and helps in reducing the wound size.
Further, Kent, Scardillo, Dale and Pike (2018) conducted a study on the comparison of the dressing techniques and with evidence based research and also gave recommendations of the use of sterile techniques. Moreover, the authors examined whether sterile or clean dressing have any significant effect on the wound or not. The findings indicate that there was no difference found on the wound infection after using either clean or sterile. Authors also put forth that evidence indicates that the use of the clean dressing technique is a clinically effective treatment that does not influence the incidence of acute wound management infections.There is no suggestion which can be given for a chronic wound about the method of dressing procedure due to a lack of research in the literature.
Khudhair, (2018), conducted a descriptive study at the surgical wards. The aim of the study was to assess the nursing practice in the postoperative surgical ward for clean wound dressing. The nurses were selected by non-probability sampling technique and direct observation was used as a strategy for the data collection. Data analysis tool was a descriptive statistical analysis including percentage and frequency. The results revealed that nurses experience have a great impact on postoperative wound care. Special training should be given to the nurses for the clean dressing technique so that patient safety is ensured. Clean dressing procedure is best suited for long-term care, for patients in-home care for acute wound care.
Cancio et al. (2019) is a descriptive study that tells about the wound care for burn wounds and effective dressing technique that can be used for such wounds. Different kinds of old and new dressing techniques can be used for nursing care of surgical wounds. Authors have chosen silver-based dressings, clean wound dressing, sterile dressing and silver-impregnated dressing. Authors conclude that the forms and quantities of materials may vary greatly after a surgical wound. Materials caches often include dressing’s specific to burns. Authors recommend that clean wound dressing are an effective way for acute wounds and minimises the wound size in adequate time. Using bandages and dressings available that are readily available rather than costly ones is useful, and use clean dressing is a critical resource for acute burns. Keep the wound clean and change dressings at least every 24 hours, for eliminating infection and contamination.
From the above findings and research evidence, it can be concluded that clean wound dressing is an effective procedure for surgical wound dressing. It has been found that both sterile and non-sterile dressing techniques have the same effect on the wound and minimises the size of the wound at the same time. Moreover, the cost of the sterile procedure of the wound dressing is also costlier than the clean wound dressing. As the cost of the sterile dressing is relatively high clean wound dressing is preferred in most of the developing countries and hence the demand for their clinical practice has been increased. The clean wound dressing is efficient for acute wounds and burned wounds. In addition to this clean wound dressing is a simple technique and can be performed adequately by nurses with practice and experience. Clean dressing procedure is considered best suited for long-term care, for patients not at high risk of infection, home care, and also some hospital settings and patients undergoing daily dressings for a chronic wound like secondary purpose healing or venous ulcers of wounds with granulation. This technique minimizes the chances of infection and contamination is eliminated if used in the right way that is changed after a required period of time. Nurses need to continuously monitor the wound to ensure patients safety.
Cancio, L.C., Barillo, D.J., Kearns, R.D., Holmes IV, J.H., Conlon, K.M., Matherly, A.F., Cairns, B.A., Hickerson, W.L. and Palmieri, T., 2017. Guidelines for burn care under austere conditions: surgical and nonsurgical wound management. Journal of Burn Care & Research, 38(4), pp.203-214.
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.
Khudhair, A.S., 2018. Nurses Practice Concerning Postoperative Clean Wound Dressing. Indian Journal of Public Health, 9(6), p.252.
Palaskar, J. (2017). Framing the research question using PICO strategy. Journal of Dental and Allied Sciences, 6(2), 55-55.
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