Aseptic versus sterile procedures 

When we treat chronic wounds, we usually do not need to work in a sterile manner because chronic wounds are not sterile. Almost all chronic wounds are contaminated with different bacterial strains. It is, for example, quite common to find Staphylococcus aureus or enterococci in chronic wounds.  

 

However, we want to avoid introducing new bacteria into the wound. Therefore, we must always wear clean ( non-sterile) gloves when treating a wound. The gloves also protect our own hands from getting contaminated. We also have to wear a face mask to avoid small aerosol particles with bacteria transferring from our mouths to the patient's wound. When we work in a non-sterile yet clean manner, we call this an aseptic procedure as opposed to a sterile procedure. 

Most types of dressings are sold in sterile packages. For chronic wounds, we don't need sterile dressings. Non-sterile dressings are usually cheaper because the sterilization process ( usually gamma radiation) is very costly.

There are, however, situations in wound care where we have to work in a sterile manner. An example of this is in the treatment of burns, where infections are a real concern. Other examples are surgical procedures where we might close a wound with sutures or procedures like split skin grafts.  

 

What equipment do we need to carry out an aseptic procedure?

Note that we usually also need sterilized instruments when working in an aseptic manner with chronic wounds. If we are going to debride a wound with a scalpel or curette, these instruments must be sterilized beforehand. Please refer to our chapter on " sterilization of equipment" for further information. If you have scissors used exclusively for cutting dressings, they may be disinfected with alcohol between uses.

As we mentioned earlier, we do not need sterilized dressing for treating chronic wounds. Under all circumstances, however, should you avoid touching the inside part of the dressing with your bare fingers. For example, always wear clean (non-sterile) gloves when cutting up dressings. 

You will need the following equipment to do a dressing change in an aseptic manner:

  • Absorbent pad placed under the patient

  • An apron or a coat to protect your work clothes from contamination

  • Non-sterile single-use gloves

  • Face mask

  • A small bowl and cotton swabs

  • Irrigation fluid for rinsing the wound

  • Disinfected scissors for cutting dressings

  • Sterile forceps,scalpel, curette

Procedure:

  1. Avoid long-sleeved working clothes. Doctors have to take off their coats before starting a sterile procedure.

  2. Take off all jewelry from the hands, including watches

  3. Disinfect your hands

  4. Put on the face mask

  5. Put on a protective gown or apron

  6. Put on non-sterile gloves and remove the old dressing

  7. Inspect the wound and make a plan for all the equipment you will need

  8. Take off the non-sterile gloves

  9. Disinfect your hands

  10. Go to the storage and get all the equipment you will need. Double-check that you have everything.

  11. Disinfect your hands again

  12. Put on new non-sterile gloves

  13. Do the procedure

  14. Clean up after yourself and put contaminated waste into designated waste bins

  15. Remove the non-sterile gloves

  16. Disinfect your hands

  17. Put on new non-sterile gloves

  18. Do surface disinfection of the working area using an appropriate surface disinfectant.

  19. Remove the gloves

  20. Disinfect your hands

What equipment do we need to perform a sterile procedure?

As we have mentioned several times now, we rarely need to do a dressing change or debridement of a chronic wound in a sterile manner. The aseptic technique is sufficient here. We should use the sterile technique for burns or procedures like suturing or split skin grafting. When changing a dressing on a postoperative wound that is more recent than <72 hours, we should use a sterile procedure. In postoperative wounds which involve surgery where there has been used an implant ( like a metal hip implant or a stent), we recommend changing the dressing in a sterile manner as long as there is some secretion from the wound. Here our own recommendations are stricter than most international recommendations. Globally we see an increase in postoperative wound infections, and prolonging the need for sterile dressing change > 72 hours may be one measure to counteract this.  

You will need the following equipment to do a sterile dressing change:

Non-sterile gloves to remove the old dressing

Sterile gloves

Face mask

Sterile bowl with sterile cotton gauze

Skin disinfectant

Sterile dressing

Protective gown ( for most procedures in wound care, the gown does not need to be sterile)

 

 

Procedure:

 

  1. Avoid long-sleeved working clothes. Doctors have to take off their coats before starting a sterile procedure.

  2. Take off all jewelry from the hands, including watches

  3. Disinfect your hands

  4. Put on the face mask

  5. Put on the protective apron or gown

  6. Put on non-sterile gloves and remove the old dressing

  7. Take off the non-sterile gloves

  8. Disinfect your hands

  9. Put on the sterile gloves

  10. It is easiest if you have an assistant who can open the equipment you need at this stage. If you do not have an assistant, you should have opened the equipment at an earlier stage. 

  11. If you are doing a dressing change on a postoperative wound, you will usually not have to wash or disinfect the skin surrounding the operation wound. In fact, washing with saline may only make things worse as you can easily smear bacteria across the sutured wound, causing an infection. If you have to wash the skin because it is bloody, do so in a controlled manner. Wash the skin, starting with a fresh swab near the operation wound and moving away from it. Never wash in the opposite direction. There is no documentation that cleaning a postoperative wound with skin disinfectant will reduce the rate of infection. 

  12. If you are going to do a surgical procedure like a delayed skin suture or a split-thickness skin graft, you should, of course, disinfect the skin beforehand using iodine- or alcohol- or chlorhexidine products. 

  13. Put on the new dressing with the sterile gloves

  14. Take off the sterile gloves

  15. Disinfect your hands

  16. Document that you have done a sterile dressing change/procedure in the patients' journal