A chronic wound is a one that does not does not proceed through an orderly and timely repair process requiring more than 4 weeks to heal such as vascular wounds and pressure wounds.14,19, Surgical wound. The saline kept at room temperature had undesirable levels of bacteria after 2 weeks. Accessed March 20, 2011. Wound Repair Regenerat. Based on cultures of the solutions immediately following preparation and at weekly intervals for 4 weeks, the authors concluded that saline solution prepared by patients by adding table salt to distilled water (purchased from a grocery store) remained bacteria free for a month if refrigerated. Acute and Chronic Wounds: Current Management Concepts. In colonization, microorganisms attach to the wound surface and replicate but do not impair healing or cause signs and/or symptoms of infection. There is no deﬁ nitive evidence that sterile technique is superior to clean technique, improves outcomes, or is war-ranted when changing dressings on chronic wounds.8 Insufﬁ cient evidence is available to determine if there are signiﬁ cant differences in infection rates or healing when wounds are treated using clean or sterile technique.14 When staff are instructed to use clean technique, they are being asked to at least wash their hands with soap and water, to remove all visible dirt from their hands, and to … Ostomy Wound Manag. The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Alexander D, Gammage D, Nichols A, Gaskins D. Analysis of strike-through contamination in saturated sterile dressings. Investigators in both these studies concluded that the practice of saturating gauze sponges on their wrappers was unacceptable. Clean technique involves meticulous handwashing, maintaining a clean environment by preparing a clean field, using clean gloves and sterile instruments, and preventing direct contamination of materials and supplies. Lippincott NursingCenter’s Best Practice Advisor, Lippincott NursingCenter’s Cardiac Insider, Lippincott NursingCenter’s Career Advisor, Lippincott NursingCenter’s Critical Care Insider, Chronic Obstructive Pulmonary Disease (COPD), Extracorporeal Membrane Oxygenation (ECMO), Prone Positioning: Non-Intubated Patient with COVID-19 ARDS, Prone Positioning: Mechanically Ventilated Patients, http://www.apic.org/AM/Template.cfm?Section=Topics1&CONTENTID=6376&TEMPLATE=/CM/, http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/SSI.pdf. Signs of inflammation such as a faint halo of erythema and moderate amounts of drainage might be the only signs of an infected arterial wound.17 Studies have shown that in chronic wounds, increasing pain, friable granulation tissue, wound breakdown, and foul odor have high validity for infection.17,18, Wound. Eur J Surg. 2003;49:44-53. Doughty DB, Sparks-DeFriese B. J Wound, Ostomy Contin Nurs. Angeras, Brandberg, Falk, and Seeman26 compared the use of sterile saline or tap water for cleaning acute traumatic soft tissue wounds and found that the infection rate in the tap water group was 5.4% compared to 10.3% in the group using sterile saline (p < .05) with a 50% decrease in costs for the tap water group. In 1993, Stotts and colleagues conducted a descriptive, exploratory survey of members of WOCN to obtain information regarding wound care practices in the United States.29 Two hundred and forty-two (242) members responded to the survey. Wise LC, Hoffman J, Grant L, Bostrom J. [Context Link], 29. Sterile technique is a set of procedures and operations intended to create and maintain a sterile environment in support of surgical asepsis. In acute care, sterile gloves were used more than non-sterile for packing wounds, in cases of purulence or tunneling, or for open orthopedic wounds. [Context Link], 18. The difference between sterile and aseptic technique is not properly understood. [Context Link], 32. a. Whether to use clean or sterile technique in the management of acute and chronic wounds is a question that researchers and clinicians have been asking and attempting to answer with certainty since the 1800s. Clean vs. Sterile Dressing Techniques for Management of Chronic Wounds: A Fact Sheet; Sterile Versus Clean Technique in Postoperative Wound Care of Patients With Open Surgical Wounds: A Pilot Study; Clean Technique or Sterile Technique? [Context Link]. This involves practices used to promote asepsis (free of disease-carrying micro-organisms) in a surgical or medical procedure to prevent infection or contamination. Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses. Alexander, Gannage, Nichols, and Gaskins27 reported that when gauze sponges were saturated directly in their wrapper, that contamination occurred in 100% of sponges in uncoated wrappers. Ferreira AM, de Andrade D. Integrative review of the clean and sterile technique, agreement and disagreement in the execution of dressing. I was reading another thread about protecting your license and there was mention of a nurse not using clean technique to change a dressing (which leads me to wonder what technique DID she use? The basic principles of an aseptic technique must be adopted and sterile dressing materials used: • Clean gloves rather than sterile … Clean means free of dirt, marks, or stains.3 Clean technique involves strategies used in patient care to reduce the overall number of microorganisms or to prevent or reduce the risk of transmission of microorganisms from one person to another or from one place to another. St. Louis, MO: Elsevier Mosby; 2012:289-307. It has been suggested that an assessment of patients risk for infection is an important factor in choosing the type of technique.3,34, 1. Two-thirds of those following the hospital guideline said that they used clean technique and one-third sterile technique. Kstorically, the presumed best wound dressing is a sterile dressing applied with sterile technique. Therefore in practice, clean and aseptic techniques are often used interchangeably. Identify and apply the clean, aseptic, and sterile technique required for common OMS procedures. Nurs Stand. Few national guidelines have addressed the topic of clean vs. sterile technique. A clear available work space. Topical management. J Wound, Ostomy Contin Nurs. Research is needed to provide an evidence-basis to support either "clean" or "sterile" dressing technique to manage chronic wounds. Ostomy Wound Manag. Aseptic technique is not the same as surgical asepsis, also known as sterile technique, which refers to a set of infection control practices that it is necessary to use in operating rooms. Lawson, Juliano, and Ratliff32 in a non-experimental, longitudinal study monitored infection rates and supply costs of all patients with open surgical wounds healing by secondary intention before and 3 months after implementing non-sterile wound care. 2002 Jul;29(4):173. Clean wound dressing technique, as opposed to asepsis, involves the use of a clean procedure field, clean gloves, with sterile supplies, and with avoidance of direct contamination of materials and supplies. The researchers evaluated 1,000 patients undergoing MMS using clean technique, which included the use of clean (vs. sterile) gloves, clean (vs. sterile) towels, and a "single pack" of sterile instruments for the entire wound reconstruction. Management of exudate and infection. 2010;14:14-18. The debate about sterile technique vs. clean technique has been ongoing for decades now, but there is no consensus on which approach is applicable under various given circumstances. Aziz AM. Unit Two – Clean, Aseptic, and Sterile Technique Learning Outcomes. A sterile technique minimizes the possibility of contamination, and a clean technique attempts to do the same but using a clean field and clean gloves. Clean technique or sterile technique? Let's Take a Moment to Think; CLEAN VERSUS STERILE TECHNIQUE Sterile Technique: The process is less complex and requires moderate investment compared to aseptic process. NPUAP-EPUAP (National Pressure Ulcer Advisory Panel-European Pressure Ulcer Advisory Panel). [Context Link], 19. All open wounds have some level of bacterial burden that is ordinarily cleared by the host.9-11, Colonization. Th e 2 groups were randomized into receiving dressing changes 3 times per day, with either clean or sterile technique application, depending upon their group assignment. An aseptic technique describes a set of procedures conducted to promote germ-free and sterile conditions. Wound care is provided in a variety of patient care settings including acute care, sub-acute care, long-term care, outpatient clinics, and in the home. The authors recommended further studies to confirm their findings. Principles of asepsis and clean dressing technique. A middle-aged patient who was in an automobile accident and subsequently developed a non-infected, Stage III pressure ulcer treated with hydrocolloid dressings, changed every 3-4 days, might be adequately managed using "clean" technique. Nursing wound care survey: sterile and nonsterile glove choice. Here are common characteristics of clean vs. sterile methods: Sterile technique involves hand washing with special solutions and the use of sterile instruments, gloves, towels, and dressings. Terms sterile,’ clean’ used inconsistently. All rights reserved. In 2006, Fellows and Crestodina reported that the optimal cleansing agent for wound cleaning should be sterile, noncytotoxic, and inexpensive.33 Because of the cost of sterile saline and reluctance of patients to discard unused solutions, Fellows and Crestodina conducted a small, quasi-experimental study in a home health setting to compare the bacterial content of home prepared saline made with distilled water and stored at room temperature (2 gallons) to saline stored in a refrigerator (2 gallons). Aseptic Vs Sterile. [Context Link], 15. Definition: Clean Technique. Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: a pilot study J Wound Ostomy Continence Nurs . change technique (clean vs sterile) in open abdominal surgi-cal wounds and studied 2 groups of patients for 3 to 9 days postoperatively (n = 30). Stotts NA, Barbour S, Slaughter R, Wipke-Tevis D. Wound care practices in the United States. Sterile environments include in acute hospital care settings, surgery centers, pharmaceuticals, and around patients at a high risk of infection. J Wound Care. When used on a patient, the area immediately around them is … 2001. http://www.apic.org/AM/Template.cfm?Section=Topics1&CONTENTID=6376&TEMPLATE=/CM/. It is important to know the difference between clean and sterile, especially if you are in the health, food, or pharmaceutical industry. Position Statement. [Context Link], 23. Some of the other factors affecting glove choice included type of dressing, type of drainage, time since surgery, licensure (i.e., registered nurse vs. licensed vocational nurse), agency policy, physician preference, and what they were taught in school. [Context Link], 3. Some authors have made a distinction between surgical asepsis or "sterile technique" used in surgery and medical asepsis or "clean technique" that involves procedures to reduce the number and transmission of pathogens.4, No touch technique. However, clean technique is… And your rationale for whichever way you perform the care. Nurses must learn to select clean or aseptic technique, and therefore clean or sterile gloves, using a risk assessment protocol. Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: a pilot study. Date Approved by the WOCN Society Board of Directors: Join NursingCenter on Social Media to find out the latest news and special offers. 3rd ed. Clin Nurs Res. Complexity of the process. Infection. 2003;49:56-60. Rationale: Although the World Health Organization recommends not using sterile technique for low-risk delivery and literature doesn't report a significant association between clean delivery and higher risk for infection, sterile technique remains a prevalent practice. * Use and maintenance may be based on likelihood of exposure to organisms in the care setting. Contamination is the presence of non-replicating microorganisms on the surface of the wound. 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