Official (Closed) and Sensitive-Normal

Aseptic Dressing Techniques &

Collection of specimens: Wound swab
Learning Outcomes:

At the completion of the session, the students will be able to:

1. determine the need for performing a wound dressing from a surgicalwound.

2. perform the appropriate technique for simple dressing.
3. describe the characteristics of a wound.
4. choose appropriate dressing materials.
5. outline the nursing care of a surgical wound.
6. demonstrate the collection of wound swab.
7. report and record procedure and relevant observations correctly.
8. share group reflection on the skills learnt.

Self-Directed Learning

• Complete the lecture materials and notes in Brightspace before class.

• View the Lippincott procedures.
• Attempt the Quiz in Brightspace.

View Demonstration of Skill

The lecturer will demonstrate how to perform wound dressing using aseptic technique.

References

Carrie Sussman C. & Bates-Jensen B.M. (2012). Wound Care: A CollaborativePractice Manual
(4th ed.). Lippincott Williams & Wilkins: Philadelphia.

Lippincott Williams & Wilkins (2019). Wound specimen collection.

https://procedures-lww-com.nyp.remotexs.co/lnp/view.do?pId=1596761&disciplineId=942

Perry, A. G., Potter, P. A., & Ostendorf, W.R. (2018). Clinical nursing skills andtechniques
(9th ed.). St Louis: Mosby.

Group Practice
Divide into 4 subgroups and practice the skills you have been taught.
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Performance checklist: Aseptic dressing techniques

ASSESSMENT
1. Review doctor’s treatment order, nursing notes and wound
chart.
2. Identify location, size of wound and type of dressing.
3. Assess patient’s comfort and pain level. Serve analgesia if
necessary.
4. Assess patient’s understanding of purpose of dressing
change.
5. Assess patient’s allergy status (e.g. adhesive tape).
PLANNING
Nurse:
• Perform hand hygiene.

Patient:
• Identify right patient.
• Offer explanation as necessary.
• Provide opportunity for patient to empty bladder.
• Position the patient to facilitate theprocedure.

Equipment:
• Decontaminate trolley.
• Non-sterile gloves
• Apron/face mask
• Gather necessary equipment. Check D.I.E of sterile supplies and
cleansing solution.

Environment:
• Ensure privacy and safety.
• Where possible, dressing should be carried out after floor has been
cleaned.
• Fans to be switched off.
IMPLEMENTATION
1. Position trolley. Place disposable bag appropriately (trash bag on
receptacle) –away from the sterile field.
2. Don apron and face mask if necessary.
3. Perform medical hand wash.
4. Open the packaging of the dressing set.
5. Prepare the dressing set by pouring cleansing solutions first
followed by adding dry sterile supplies without contaminating the
sterile field (please refer the notes on preparing a sterile field and
handling of sterile items).
6. Position patient appropriately. Place protective material
under wound (if necessary).
7. Put on clean gloves and loosen wound dressing.Support
skin while doing so.
8. Observe colour, odour, consistency and amount (C.O.C.A.) of
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exudate on soiled dressing. Discard the soiled dressing into

the disposable bag and then remove the gloves.
9. Perform relevant physical examination based to the anatomic
location of the wound:
• Inspect for type and percentage of tissue in wound base,
wound size, wound exudate, presence of odour, and
colour and integrity of surrounding skin.
• Palpate for temperature, oedema, and tenderness of
the surrounding skin. Palpate pulses (when necessary).
10. Perform surgical hand wash.
11. Pick up the first forceps without contaminating the sterile field using
dominant hand, and then pick up the second forceps using the first
forceps.
12. Arrange the instruments and dressing material with forceps
within sterile field, creating maximum working space in sterile
field.
13. Using two forceps, prepare sufficient moistened cotton
swabs for cleansing the wound.
14. The drape will be used as an extension of sterile field.
15. Establish ‘clean’ and ‘dirty’ forceps (usually dominant
hand holds “dirty” forceps)
16. With “clean” forceps, pick up pre-moistened swab and transfer
swab to “dirty” forceps without forceps tips touching. The transfer
is done outside the sterile field.
17. Ensure that the clean forceps is held away from the patient’s
wound during the cleansing of the wound.
18. Clean the wound from area of the least contamination to the area
of most contamination. Use a new swab with each cleansing
stroke. Note the colour, odour, consistency and amount (C.O.C.A.)
of exudate on swabs before discarding. Also note patient’s
response to the strokes.
19. Wounds are generally cleansed this way:
• For vertical wounds: clean from top to bottom, then the 2
sides.
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• For horizontal wounds: clean from centre of wound outwards

to each side.
• For circular wounds: clean from the centre of the wound to
outer,
in full or semi-circle, overlapping strokes.
• For deep wound cavity: irrigate the wound with the
cleansing solution, using 20mls syringe.
20. Dab dry wound with gauze, and then the surrounding
skin.
21. Apply appropriate wound dressing and secure.Ensure a 2.5cm
border around the wound.
22. Position patient comfortably and safely.
23. Ensure proper handling and disposal of soiled dressing material.
24. Remove trolley and perform hand hygiene.
25. Return unused items back in its appropriate place. Ensure that
the items have not been contaminated.
26. Decontaminate trolley.

EVALUATION
1. Condition of wound, surrounding skin, description of pulses (where
necessary), amount and nature of exudate and type of dressing
applied.
2. Patient’s condition and tolerance of the procedure.
3. Perform relevant physical examination when necessary, such as
peripheral vascular, abdominal, musculoskeletal assessment.
4. Report abnormalities to doctor.

DOCUMENTATION
1. Nursing notes and wound chart:
• Date and time of dressing.
• Condition of wound, surrounding skin, C.O.C. A and type of
dressing applied and cleansing solution used.
• Size of wound.
• Frequency of dressing change.
• Patient’s condition and tolerance of procedure. (eg. pain score)
• If applicable, physical assessment data (eg. peripheral vascular
assessment)
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Performance checklist: Collection of wound swabs

ASSESSMENT
1. Check the doctor’s treatment order.
2. Identify the type of specimen be collected.
3. Review nursing notes and wound chart.
4. Assess patient’s understanding of the procedure.
5. Assess patient’s pain score.
PLANNING
Nurse:
• Perform hand hygiene

Environment:
• Ensure privacy and safety.
• Switch off fan.

Patient:
• Explain and steps of procedure purpose.

Equipment:
• specimen container (Sterile swab).
• equipment for wound dressing.
• laboratory biohazard transport bag
IMPLEMENTATION
1. Perform medical hand wash.
2. Prepare the dressing set (please refer to the notes on
preparing a sterile field and handling of sterile items).
3. Place the sterile packed swab in the sterile field.
(Omit this step if the swab is not sterile packed).

Please seek help from another staff to obtain the wound

swab if using a non-sterile packed swab.

4. Position patient appropriately. Place protective material under

wound (if necessary).
5. Don clean gloves and loosen wound dressing. Support skin
while doing so.
6. Observe exudates on soiled dressing. Discard the soiled
dressing into the disposable bag and then remove the gloves.
7. Perform relevant wound assessment based on the anatomic
location of the wound:
• Inspect for type and percentage of tissue in wound
base, wound size, wound exudate, presence of
odour, and colour and integrity ofsurrounding skin.
• Palpate for temperature, oedema, and tenderness
of the surrounding skin if indicated. Palpate pulses
(when necessary).
8. Remove the soiled gloves.
9. Perform surgical hand wash.
10. Don sterile gloves if needed.
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11. Clean wound and surrounding skin with normal saline to

remove old exudate or medications.
12. Pick up the sterile swab, taking care not to touch the cotton
tip. If wound bed is dry, moisten the swab with sterile normal
saline solution.
13. Using the swab, apply light pressure to the identified area;
then rotate the swab to try to produce exudate.
14. Remove the swab from the wound and immediately place it
in the aerobic culture tube.
15. Care must be taken to swab the wound instead of the
wound edges to prevent contamination by skinflora and
contaminated debris.

NOTE: Be sure the quantity of specimen obtained is adequate

for a culture and Gram stain. Note that the culture must come
from the cleanest tissue possible, not pus, slough, eschar, or
necrotic material.

16. Insert swab into culture tube.

17. Clean wound as doctor’s order.
18. Position patient comfortably and safely.
19. Ensure proper handling and disposal of soiled
dressing material.
20. Place correct specimen label on culture tube together
with laboratory requisition from in a laboratory biohazard
transport bag.
21. Send specimen to laboratory immediately.
22. Decontaminate trolley.
23. Perform hand hygiene.
EVALUATION
1. Condition of wound, surrounding skin, description of pulses
(where necessary), amount and nature of exudate and type
of dressing applied.
2. Patient’s condition and tolerance of the procedure.
3. Obtain laboratory report for results of cultures when it is
ready.
4. Report abnormalities to doctor.

DOCUMENTATION
1. Nursing notes and wound chart:
• Date, time and site of specimen collection
• Time specimen was sent to lab
• Date and time of dressing.
• Condition of wound, surrounding skin, C.O.C. A and type
of dressing applied and cleansing solution used.
• Size of wound.
• Frequency of dressing change.
• Patient’s condition and tolerance of procedure. (eg. pain
score)
• If applicable, physical assessment data
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SAMPLE DOCUMENTATION

Date/Time Progress Notes Reported by

XX/XX/202X Abdominal wound dressing was performed. Wound was -------------

1000hrs cleansed with normal saline. Dry gauze dressing was applied. -------------
Suture line is clean, no signs of wound infection observed. -------------
Sutures are intact. Patient tolerated the procedure well.------------ SN Alice Ming

Date/Time Progress Notes Reported by

XX/XX/202X Abdominal wound has slight redness with small amount of --------------------
1100hrs yellowish exudate. Staples are intact. Wound swab was --------------------
taken and simple wound dressing was done. Patient --------------------
tolerated the procedure well. Pain score was 3/10. --------------------
Wound swab was despatched to laboratory immediately. SN Remmy
Cruz
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