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Wound care and dressings: cleaning and choosing a dressing

  • Procedure

The wound is cleaned from cleanest to dirtiest and dressed with something that keeps it moist without macerating the skin.

Updated

What it is

Wound care protects the wound from germs, cleans it and creates an environment that helps it heal. Saline is the gentlest cleaning option; hydrogen peroxide, povidone-iodine and acetic acid are avoided in the wound bed because they damage cells. The dressing is chosen by the wound type, its cause and its exudate: it should keep the bed moist, absorb the excess, fill deep spaces and protect the surrounding skin. For chronic wounds, the wound care team should be consulted.

Indications

  • A surgical or traumatic wound with a soiled, wet or loose dressing, or at the ordered frequency.
  • Chronic wounds (pressure injuries, venous or diabetic foot ulcers) following the wound team's plan.
  • A wound with new signs of infection: cleaning, assessment and a culture if ordered.
  • Wounds with a drain, to keep the exit site clean.

Contraindications and precautions

  • Assess pain and give the ordered analgesia before the dressing change if the wound is painful.
  • Use sterile or clean technique according to the wound type and the institution's protocol.
  • Stable, dry eschar on the heel is left in place until the vascular status is known.
  • Highly absorbent dressings (alginate, hydrofibre) are not used on dry wounds, because they injure the bed.
  • An opened bottle of saline is for one patient only; it is dated and discarded per protocol.

Equipment

  • Clean and sterile gloves, and eye protection if splashing is likely.
  • Sterile gauze, saline or wound cleanser, and a syringe for irrigation if ordered.
  • The ordered dressing: gauze, non-adherent dressing, foam, alginate or hydrofibre, or another per the plan.
  • Sterile forceps, tape or securement and a waste bag.
  • A barrier product for the surrounding skin if exudate is heavy.

Step by step (and why)

  1. Identify the patient, check the order and the wound plan, and explain — the right dressing depends on the plan.
  2. Set up supplies on a clean surface; a sterile field if the protocol requires it — having everything to hand avoids breaking technique.
  3. With clean gloves remove the outer and then the inner dressing, wrapping it in the glove — so it does not contaminate the room.
  4. Change gloves and assess the wound: bed, exudate, size, edges and skin — the assessment guides cleaning and the dressing.
  5. Clean with moist gauze in straight strokes from the cleanest area outward, one gauze per stroke — it does not drag germs into the bed.
  6. If there is a drain, clean in circles from the drain outward — the drain site is the cleanest point of that area.
  7. Pack dead space if ordered, loosely — loose packing that is easy to remove protects granulation.
  8. Apply the sterile dressing without touching the side that faces the wound, and secure it — it keeps the bed protected and moist.
  9. Discard waste, perform hand hygiene and record the assessment and care — the record allows comparison between changes.

Complications

  • Wound infection, which can progress to systemic infection and sepsis.
  • Maceration of the surrounding skin from excess moisture or the wrong dressing.
  • Damage to granulation tissue when removing an adherent dressing or dry packing.
  • Haematoma or dehiscence in surgical wounds.
  • Pain during the dressing change, which can be prevented with analgesia beforehand.

Next step: when to call for help

  • Report new purulent exudate, odour, spreading redness or fever.
  • Report if a surgical wound opens, bleeds actively or shows deep tissue.
  • Report pain that increases between dressing changes: it may mean infection or dehiscence.
  • Ask if the ordered dressing does not match the current exudate or if the wound is not improving.

Test yourself

Think of the answer, then tap the question to see it.

In what order is a surgical wound cleaned?

From the least to the most contaminated area: the suture line first and then outward, with a new gauze for each stroke.

Why are hydrogen peroxide and povidone-iodine avoided in the wound bed?

Because they are cytotoxic: they damage the cells that build new tissue. Saline is the gentlest option.

How is a drain site cleaned?

In circles, starting next to the drain and moving outward, with a new applicator or gauze for each circle.

Why is an alginate not used on a dry wound?

Because it is highly absorbent: it is meant for wounds with a lot of exudate and can injure the bed of a dry wound.

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Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Skills, 10.4: Wound Therapy (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); Nursing Skills, 10.8: Checklist for Simple Dressing Change (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); Nursing Skills, 10.5: Wound Dressings (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021).

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Representative model, for educational purposes only.