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Care of Acute Postoperative Surgical Incisions Approximated with Sutures or Staples (Adult) (4.25A)

Care of Acute Postoperative Surgical Incisions Approximated with Sutures or Staples (Adult) (4.25A) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Integumentary

4.25A


NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
December 26, 2016
Amended: April 4, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy 4.25A

Original
Revision

Page
1
of 6

Title: Care of Inpatient Acute Postoperative
Surgical Incisions Approximated with
Sutures or Staples (Adult)

I. PURPOSE

The purpose of this policy is to establish guidelines for sterile and clean dressings
applied to acute postoperative surgical incisions approximated with sutures or staples
in the adult inpatient population: these guidelines are consistent with Center for
Disease Control (CDC) Prevention of Surgical Site Infections.

Refer to Policy 4.23AP, Changing Sterile and Clean Wound Dressings (Adult &
Pediatrics) for open wound dressings.


II. DEFINITIONS

A. Sterile technique: Strategies are used to reduce patient exposure to
microorganisms and maintain objects and areas as free from microorganisms as
possible. Sterile technique includes meticulous hand hygiene, use of sterile field,
use of sterile gloves for application of sterile dressing, and use of sterile supplies
and instruments. Contact between sterile instruments or materials and any
nonsterile surface or product must be avoided.
B. Clean technique: Strategies are used to reduce patient exposure to the overall
number of microorganisms or to prevent/reduce the risk of transmission of
microorganisms from one person to another, or from one place to another. Clean
technique includes meticulous hand hygiene, maintaining a clean environment by
preparing a clean field, using clean (nonsterile) gloves, sterile supplies and
instruments, and prevention of direct contamination of materials and supplies.

III. POLICY

A. Center for Disease Control recommends sterile technique and sterile dressing
application to acute post-operative incisions for 48 hours to decrease chance of
surgical site infection. All acute post-operative surgical incisions approximated
with sutures or staples are included in this policy except orthopedics, burn,
plastics and ENT.
B. This policy does not apply to
1. Acute surgical incisions that are closed with surgical glue
2. Dressings used on open wounds
C. All acute post-operative intact incision care requires a provider’s order. If no
order for incision care exists, the nurse will contact the provider for an order that
contains wound care instructions.
D. After returning from the Operating Room (OR), the RN is to maintain the sterile

Page 2 of 6

incision dressing placed in the operating room for 48 hours.
E. If the original post-operative dressing requires a change prior to the 48 hour
window, sterile technique is used.
F. After 48 hours:
1. The original postoperative dressing may be removed, using clean
technique.
2. Cleansing of the intact suture line, using clean technique, is done daily.
The incision may be left open to air or covered with dry gauze, per
patient preference and/or dependent on location of the incision.
G. Dressing changes provide an opportunity for nursing staff to assess wounds.
Therefore, dressing changes on hospitalized patients shall be performed by nurses
unless otherwise specified.
H. Standard and isolation precautions shall be followed according to UWHC
Administrative Policy 13.07, Standard Precautions and Transmission-based
Precautions.
I. Hand hygiene shall be performed when indicated according to UWHC
Administrative Policy 13.08, Hand Hygiene.
J. Hand hygiene must be performed with each glove change.
K. Patients and/or families will be educated on incision care if needed prior to
discharge.

IV. EQUIPMENT

A. Sterile Dressing Change:
1. Non-sterile (clean) examination gloves
2. Appropriate tape (such as Medipore)
3. Appropriate replacement dressing (e.g. Tegaderm, Island Dressing)
4. Sterile Field (CS Item Number 1220114)
5. Sterile scissors if needed
6. Sterile 4x4 gauze X 3 (CS Item Number 1219158)
7. Sterile rolled gauze, e.g., Kerlix (optional)
8. Waterproof disposable pad (e.g., Chux [CS Item Number 1216070])
9. Sterile gloves
10. Sterile cotton-tipped applicator (optional)
11. Sterile saline
12. Aqueous Chlorohexidine Gluconate (CHG) or cleaning solution as
ordered
13. Bacteriostatic ointment if ordered
14. Overbed table or bedside stand
15. Adhesive remover (optional)
16. Skin barrier (optional)
17. Red biohazard bag (if needed)
18. Disinfecting wipe or spray
B. Clean Dressing Change
1. Non-sterile (clean) examination gloves
2. Appropriate tape (such as Medipore )
3. Appropriate replacement dressing (e.g. Tegaderm, Island Dressing)
4. Sterile scissors if needed
5. Sterile 4x4 gauze x3 (CS Item Number 1219158)
6. Sterile rolled gauze, e.g., Kerlix (optional)

Page 3 of 6

7. Waterproof disposable pad (e.g., Chux [CS Item Number 1216070])
8. Sterile cotton-tipped applicator (optional)
9. Sterile saline
10. Aqueous Chlorohexidine Gluconate (CHG) or cleaning solution as
ordered
11. Bacteriostatic ointment if ordered
12. Overbed table or bedside stand
13. Adhesive remover (optional)
14. Skin barrier (optional)
15. Red biohazard bag (if needed)
16. Disinfecting wipe or spray

V. PROCEDURE

A. Pre-Procedure Review:
1. Provider’s orders regarding incisional care
2. Type, size and location of incision
3. Time of last pain medication
4. Patient’s level of pain
5. Allergies to tape or solution used for cleaning
6. Need for patient or family member to participate in incision care
7. Pre-medicate patient for pain if needed. Wait for medication to take
effect before beginning dressing change.
B. Sterile Dressing Change
1. Gather the necessary supplies and bring into the patient’s room.
2. Obtain any assistance that may be needed with the dressing change,
close door to room, close window shade or curtains as appropriate.
3. Identify the patient and explain procedure to the patient and family.
4. Perform hand hygiene according to UWHC Administrative Policy 13.08,
Hand Hygiene. Apply appropriate personal protective equipment
(gloves, goggles/mask or face shield, gown according to UWHC
Administrative Policy 13.07, Standard Precautions and Transmission-
based Precautions).
5. Place bedside table close to area being dressed. Wipe table with
disinfecting solution or wipe.
6. Perform hand hygiene and don nonsterile gloves.
7. Position patient to allow access to incision and place waterproof pad
under wound area.
8. Remove old dressing: loosen the tape using adhesive remover as needed
for patient comfort and/or prevention of skin stripping and place soiled
dressing in the appropriate waste receptacle. If dressing is heavily
saturated with body fluids, place in red biohazard bag.
9. If dressing adheres to incision soak it with sterile saline, then gently
remove.
10. Note odor and appearance of incision and drainage on dressing. Assess
need for frequency of dressing changes. Based on assessment, if more
frequent dressing changes are needed or a different type of dressing is
needed, discuss with the provider.
11. Assess integrity of skin and effect of tape on skin. Use Montgomery
straps or skin barrier to optimize skin integrity.

Page 4 of 6

12. DISCARD GLOVES by pulling them inside out AND PERFORM
HAND HYGIENE. Hand hygiene must be performed with each glove
change.
13. Perform sterile dressing change:
a. Prepare supplies
i. Place supplies on bedside table
ii. Lay out supplies
• Open sterile field.
• Open replacement dressing and place on sterile
field.
• Open several sterile cotton-tipped swabs and
place on sterile field.
• Open three (3) plastic containers of gauze-pads
and place to the side of the sterile field.
• Open sterile saline and pour into one gauze pad
container.
• Open Aqueous CHG, or ordered cleaning solution
and pour into second gauze pad container.
b. Don sterile gloves.
c. Pick up saline-soaked gauze and use to remove debris and drainage
from incision; move from least-contaminated area to most-
contaminated area. Discard pads away from sterile supplies.
d. Wipe incision with gauze soaked with Aqueous CHG, or ordered
cleaning solution, moving from least-contaminated area to most-
contaminated area.
e. Use dry gauze to blot dry; move from least-contaminated area to
most-contaminated area.
f. Apply dressing over wound or incision in the following manner:
• Pick up replacement dressing by edge using sterile
gloved hand.
• Place replacementdressing over incision site until
site is covered.
14. Dispose of materials and then remove and dispose of gloves.
15. Perform hand hygiene.
16. Position client for comfort with call light within reach.
17. Perform hand hygiene prior to exiting room.
18. Document incisional cares/ dressing change and assessment in the
patient’s clinical record.
C. Clean Dressing Change:
1. Gather the necessary supplies and bring into the patient’s room.
2. Obtain any assistance that may be needed with the dressing change,
close door to room, close window shade or curtains as appropriate.
3. Identify the patient and explain procedure to the patient and family.
4. Perform hand hygiene according to UWHC Administrative Policy 13.08,
Hand Hygiene. Apply appropriate personal protective equipment
(gloves, goggles/mask or face shield, gown according to UWHC
Administrative Policy 13.07, Standard Precautions and Transmission-
based Precautions).
5. Prepare supplies:

Page 5 of 6

a. Place waterproof pad on bedside table as clean field.
b. Open replacement dressing and leave in container.
c. Open several sterile cotton-tipped swabs and leave in packages.
d. Open three (3) plastic containers of gauze-pads.
e. Open saline and pour into gauze container.
f. Open Aqueous CHG, or ordered cleaning solution and pour into
second gauze container.
6. Don non-sterile gloves.
7. Pick up saline-soaked dressing pad and use to remove debris and
drainage from incision; move from least-contaminated area to most-
contaminated area. Discard pads away from sterile supplies.
8. Wipe incision with gauze soaked with Aqueous CHG, or ordered
cleaning solution, moving from least-contaminated area to most-
contaminated area.
9. Use dry gauze to blot dry; move from least-contaminated area to most-
contaminated area.
10. Apply dressing over incision in the following manner:
a. Pick up replacement dressing by edge using gloved hand.
b. Place dressing over wound or incision site until site is covered.
11. Dispose of materials and then remove and dispose of gloves.
12. Perform hand hygiene.
13. Position client for comfort with call light within reach.
14. Perform hand hygiene prior to exiting room.
15. Document incisional cares/ dressing change and assessment in the
patient’s clinical record.

VI. UWHC CROSS REFERENCES

A. UWHC Administrative Policy 13.07, Standard Precautions and Transmission-
based Precautions (Isolation) for Inpatient Settings
B. UWHC Administrative Policy 13.08, Hand Hygiene
C. Nursing Patient Care Policy 4.23 AP, Changing Sterile and Clean Wound
Dressings (Adult and Pediatric)

VII. REFERENCES

A. Anderson, D., Kaye, K., Classen, D., Arias, K., & et al. (2008). Strategies to
prevent surgical site infections in acute care hospitals. J Hosp Infect Control
Epidem, 29(Supp 1), S51-S61.
B. Centers for Disease Control and Prevention (2002). Recommendations of the
Healthcare Infection Control Practices Advisory Committee and the
HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR, 51(No. RR-16),
32-34.
C. Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., Jarvis, W. R., & The
Hospital Infection Control Practices Advisory Committee. Guideline for
prevention of surgical site infection, 1999. Accessed at
http://www.cdc.gov/hicpac/pdf/SSIguidelines.pdf on December 4, 2016
D. Perry, A. G., & Potter, P. A. (2017). Fundamentals of Nursing (8
th
Ed.). St. Louis,
MO: Elsevier


Page 6 of 6

E. Wound Ostomy and Continence Nurses Society, Clean vs Sterile Dressing
Techniques for Management of Chronic Wounds: A Fact Sheet. J Wound Ostomy
Continence Nurse. 2012; 39(2S) S30-S34

VIII. WRITTEN BY

UWH Surgical Site Infection (SSI) Committee


IX. REVIEWED BY

Clinical Infection Control Practitioners, Infection Control
Clinical Nurse Specialists, Wound/Skin
Clinical Nurse Specialist, Nursing Quality and Safety
Nursing Patient Care Policy and Procedure Committee, December 2016

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive