[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Procedures](https://durgical.com/en/nursing/areas/procedures/) › Wound care and dressings: cleaning and choosing a dressing # 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 Nov 5, 2026 ## Key points - Clean from least to most contaminated: the suture line first, then outward, with a new gauze for each stroke. - Around a drain, clean in circles from the drain outward. - Saline is the gentlest; avoid hydrogen peroxide, povidone-iodine and acetic acid in the bed (they are cytotoxic). - A moist bed heals better; excess exudate is absorbed so the skin does not macerate. - Deep or tunnelled wounds are packed with material that is easy to remove. ## 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) - Identify the patient, check the order and the wound plan, and explain — the right dressing depends on the plan. - Set up supplies on a clean surface; a sterile field if the protocol requires it — having everything to hand avoids breaking technique. - With clean gloves remove the outer and then the inner dressing, wrapping it in the glove — so it does not contaminate the room. - Change gloves and assess the wound: bed, exudate, size, edges and skin — the assessment guides cleaning and the dressing. - Clean with moist gauze in straight strokes from the cleanest area outward, one gauze per stroke — it does not drag germs into the bed. - If there is a drain, clean in circles from the drain outward — the drain site is the cleanest point of that area. - Pack dead space if ordered, loosely — loose packing that is easy to remove protects granulation. - Apply the sterile dressing without touching the side that faces the wound, and secure it — it keeps the bed protected and moist. - 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/wound-care-and-dressings-cleaning-and-choosing-a-dressing/) ## Connections ## Related 4 - [Wound assessment: bed, edges, exudate and signs of infection](https://durgical.com/en/nursing/wound-assessment-bed-edges-exudate-and-signs-of-infection/) - [Clean and sterile technique: medical and surgical asepsis](https://durgical.com/en/nursing/clean-and-sterile-technique-medical-and-surgical-asepsis/) - [Setting up a sterile field and putting on sterile gloves](https://durgical.com/en/nursing/setting-up-a-sterile-field-and-putting-on-sterile-gloves/) - [Removing sutures and staples](https://durgical.com/en/nursing/removing-sutures-and-staples/) [← All of nursing](https://durgical.com/en/nursing/) 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](https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Skills_(OpenRN)/10%3A_Wound_Care/10.04%3A_Wound_Therapy) (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); [Nursing Skills, 10.8: Checklist for Simple Dressing Change](https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Skills_(OpenRN)/10%3A_Wound_Care/10.08%3A_Checklist_for_Simple_Dressing_Change) (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); [Nursing Skills, 10.5: Wound Dressings](https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Skills_(OpenRN)/10%3A_Wound_Care/10.05%3A_Wound_Dressings) (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/wound-care-and-dressings-cleaning-and-choosing-a-dressing/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/wound-care-and-dressings-cleaning-and-choosing-a-dressing/