Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [82], C).
2. 2.Show
   Check analgesia requirements, allergy status, religious beliefs and ethical considerations that may affect wound dressing choice.
   To reduce anxiety and discomfort during the procedure. Some dressings may not be suitable due to allergy, religion or ethical choices (Eriksson et al. [30], E; Sood et al. [98], C).
3. 3.Show
   Wash hands with soap and water, and put on a disposable plastic apron.
   Hands must be cleaned before and after every patient contact and before commencing the preparations for aseptic technique, to prevent cross‐infection (Fraise and Bradley [33], E).
4. 4.Show
   Clean the trolley with a detergent wipe.
   To provide a clean working surface (Fraise and Bradley [33], E).
5. 5.Show
   Place all the equipment required for the procedure on the bottom shelf of the clean dressing trolley. Check the integrity and use‐by dates of all equipment (i.e. ensure that packs are undamaged, intact and dry).
   To maintain the top shelf as a clean working surface. To ensure sterility of equipment prior to use. E
6. 6.Show
   Close the treatment room door or screen the bed area. Position the patient comfortably so that the wound area is easily accessible without exposing the patient unduly.
   To allow any airborne organisms to settle before the sterile field (and, in the case of a dressing, the wound) is exposed (Fraise and Bradley [33], E). To maintain the patient's dignity and comfort. E
7. 7.Show
   Take the trolley to the treatment room or patient's bedside, disturbing the screens as little as possible.
   To minimize airborne contamination (Fraise and Bradley [33], E).

Procedure

1. 8.Show
   Clean hands with an alcohol‐based handrub.
   To reduce the risk of wound infection and cross‐contamination (Fraise and Bradley [33], E).
2. 9.Show
   Open the outer cover of the sterile dressing pack and slide the contents onto the top shelf of the trolley.
   To ensure that only sterile products are used (Fraise and Bradley [33], E).
3. 10.Show
   Open the sterile field using only the corners of the paper. Open any other packs, tipping their contents gently onto the centre of the sterile field.
   So that areas of potential contamination are kept to a minimum. E
4. 11.Show
   Clean hands with an alcohol‐based handrub.
   Hands may become contaminated by handling outer packets, dressing and so on (Fraise and Bradley [33], E).
5. 12.Show
   Using the plastic bag in the pack as a sterile glove, arrange the sterile field. Pour cleaning solution into gallipots or an indented plastic tray.
   The time the wound is exposed should be kept to a minimum to reduce the risk of contamination. To prevent contamination of the environment. To minimize the risk of contamination the cleaning solution. E
6. 13.Show
   Attach the bag with the dressing to the side of the trolley below the top shelf on the side next to the patient.
   To avoid taking soiled dressings across the sterile area. Contaminated material should be disposed of below the level of the sterile field. E
7. 14.Show
   Apply non‐sterile gloves and then loosen the adhesive of any existing dressing and remove it. Place the dressing in the disposal bag. Remove the gloves and dispose of them in the disposal bag.
   To reduce the risk of cross‐infection. To prevent contamination of the environment (Fraise and Bradley [33], E).
8. 15.Show
   Clean hands with an alcohol‐based handrub and apply sterile gloves.
   To reduce the risk of infection to the wound and contamination of the nurse. Gloves provide greater sensitivity than forceps and are less likely to traumatize the wound or the patient's skin. E
9. 16.Show
   If necessary, gently irrigate the wound bed and peri‐wound with 0.9% sodium chloride, unless another solution is indicated.
   To reduce the possibility of physical and chemical trauma to granulation and epithelial tissue (Hess [48], E).
10. 17.Show
    Assess wound healing (see Figures 18.6 and 18.7). Obtain wound measurements and photography (with the consent of the patient) if required.
    To assess healing and evaluate wound care (Hess [48], E).
11. 18.Show
    Apply the dressing that is most suitable for the wound using the criteria for dressings (see Table 18.4).
    To promote healing and/or reduce symptoms. E
12. 19.Show
    Ensure the patient is comfortable and the dressing is secure.
    A dressing may slip or feel uncomfortable as the patient changes position. E

Post‐procedure

1. 20.Show
   Dispose of waste in orange plastic clinical waste bags and sharps in a sharps bin. Remove gloves and apron and wash hands.
   To prevent environmental contamination and sharps injury. Orange is the recognized colour for clinical waste (DH [23], C).
2. 21.Show
   Ensure the patient is comfortable and draw back the curtains (if applicable).
   To promote wellbeing and maintain dignity and comfort. E
3. 22.Show
   Clean hands with an alcohol‐based handrub. Wipe trolley with detergent wipe and return to storage.
   To prevent the risk of cross‐contamination to the next episode of care (Fraise and Bradley [33], E).
4. 23.Show
   Record the assessment in the relevant documentation at the end of the procedure (see Figure 18.5 for an example).
   To maintain an accurate record of wound healing progress (NMC [82], C).