Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient and check analgesia requirements.
   To ensure that the patient understands the procedure and gives his or her valid consent, and to reduce anxiety (NMC [108]). C
2. 2.Show
   Wash hands with soap and water; put on a disposable plastic apron.
   Hands must be cleaned before touching a patient and prior to a procedure to prevent cross‐infection and reduce the risk of healthcare‐associated infection (WHO [148]). C Clothing may become contaminated with pathogenic micro‐organisms, blood/body fluids (Loveday et al. [84]). C
3. 3.Show
   Clean trolley with a detergent wipe.
   To provide a clean working surface and reduce the risk of the environment providing a reservoir for cross‐infection (Guizhen [57]). C
4. 4.Show
   Place all the equipment required for the procedure on the bottom shelf of the clean dressing trolley. Check integrity and use‐by dates of all equipment (i.e. packs are undamaged, intact and dry).
   To maintain the top shelf as a clean working surface.

   To ensure sterility of equipment prior to use (Fraise and Bradley [43], E).
5. 5.Show
   Screen the bed area and provide privacy. Position the patient comfortably so that the area to be dealt with is easily accessible without exposing the patient unduly.
   Maintain the patient's dignity and comfort (NMC [108], C).
6. 6.Show
   Take the trolley to the treatment room or patient's bedside; minimize the movement of bedding and screens as much as possible prior to dressing change.
   To allow any airborne organisms to settle before the sterile field and the wound is exposed, to minimize airborne contamination (Bache et al. [11]). C

Procedure

1. 7.Show
   Clean hands with a bactericidal alcohol handrub.
   To reduce the risk of wound infection and cross‐contamination (WHO [148]). C
2. 8.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 [43], C).
3. 9.Show
   Open the sterile field using only the corners of the paper.
   So that areas of potential contamination are kept to a minimum. E
4. 10.Show
   Loosen the dressing tape (if necessary). If contamination on outer dressings, gloves should be worn.
   To make it easier to remove the dressing. E

   For personal protection (Loveday et al. [84], C).
5. 11.Show
   Clean hands with a bactericidal alcohol handrub.
   Hands may become contaminated by handling outer packets and dressings (WHO [148]). C
6. 12.Show
   Using the plastic bag in the pack, 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 risk of contamination of cleaning solution. C
7. 13.Show
   Remove dressing by placing a hand in the plastic bag, lifting the dressing off and inverting the plastic bag so that the dressing is now inside the bag. Thereafter use this as the ‘dirty’ bag. Use gloves if there is difficulty removing dressing.
   To reduce the risk of cross‐infection. To prevent contamination of the environment (Fraise and Bradley [43], C).
8. 14.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. C
9. 15.Show
   Assess wound healing (see Table 18.1)
   To evaluate wound care (Dealey [28], E; Hampton and Collins [63], E; Hess [67], E).