Clean Technique vs. Sterile Technique for Nurses

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1 Clean Technique vs. Sterile Technique for Nurses Dressing changes and other nursing procedures Jen Agosti RN, CWCA, FACCWS, CFCN, DAPWCA

2 Accredita8on Nurse Sharks, Inc. is an approved provider of Continuing Education, for nurses in the United States, through the CA State Board of Nursing, CEP # This course is approved from 9/1/14-9/1/16 for 0.5 CEU's

3 Objec8ves 1.Define clean vs. sterile dressing techniques 2.Identify two examples of wounds appropriate for each technique 3.Demonstrate understanding of procedures for clean vs. sterile dressing changes 4.Have knowledge of CMS guidelines related to clean and sterile dressing changes

4 Clean Dressing Technique 1.Definition: Intention is to prevent or reduce the risk of transmission of micro-organisms from one person to another person, place, or thing 2.Procedures are completed after usual hand-washing (soap & water) ; using non-sterile gloves; in a patient s room or treatment room 3.Used for procedures involving intact skin; intact mucous membranes; non-acute wounds; and when handling contaminated items (old dressings)

5 When To Use Clean Technique 1.Non-invasive nursing procedures 2.Examples: Taking vital signs Physical examinations Feeding Dressing changes of wounds

6 Sterile Technique 1.Definition: procedures are completed after antiseptic hand-washing (surgical scrub); using sterile gloves; antiseptic on patient s skin; and with a sterile field/dedicated room 2.Used for brief invasive procedures; contact with non-intact skin and mucous membranes

7 When To Use Sterile Technique 1.Invasive nursing procedures 2.Examples: Urinary catherization Initiation of intravenous catheter Suctioning Dressing changes for acute: infected, dehisced, and eviscerated wounds

8 So.. Clean procedures Packaged primary and secondary dressing supplies are sterile Technique is not sterile Sterile procedures Supplies, instruments, and gloves are sterile Technique is sterile (field or room is sterile)

9 Summary of Differences: Clean Technique Sterile Technique Clean gloves Sterile gloves Usual handwashing Clean field Sterile washing Sterile field or room No patient antisepsis Patient skin

10 When Can I Use Hand Sani8zer? 1.Hand sanitizer may be used between patients (up to five patients) during non-invasive procedures, such as, medication passes, PROVIDED that: Hands are not visibly soiled A soap and water washing occurs prior to and after every 5 th patient and before and after dressings changes WHEN IN DOUBT. USE SOAP AND WATER!!!!

11 Intervention WOCN Suggested Techniques for Wound Care Handwashing Gloves Supplies Instruments Wound cleansing Soap and water Clean Sterile cleansers and supplies Irrigation use sterile device; maintain clean procedure Routine dressing change without debridement Soap and water Clean Sterile cleansers and supplies Sterile devices; maintain clean procedure Dressing change with mechanical, chemical, or enzymatic debridement Soap and water Clean Sterile cleansers and supplies Sterile devices; maintain as clean procedure Dressing change with sharp, conservative bedside debridement Sterile scrub with antiseptic Sterile Sterile cleansers, supplies, and field Sterile devices; setup sterile field

12 Sterile Supplies 1.Dressings in sealed packages 2.Instruments in sealed packages 3.Cleansers 4.Ointments Therefore..your supplies and instruments are always sterile - but - that doesn t mean that your technique is always sterile

13 Invasive Procedures 1.Definition: a medical procedure that invades (enters) the body, cutting; puncturing; or inserting instruments into the body 2.Examples: sharp debridement; blood draws; inserting an intravenous device

14 Personal Protec8ve Equipment Clean procedure Clean gloves (required) Gown, mask, goggles (optional, use clinical judgment) Clean field Sterile procedure Sterile gloves (required) Sterile gown, show covers, goggles, mask, glasses (required) Sterile field (required)

15 Regulatory Considera8ons CMS Guidance to surveyors State Operations Manual Facility Expectations Treatment procedures based on current Standards of Practice Policies/procedures developed and approved by Medical Director Facility staff have understanding of clean vs. sterile technique

16 CMS Posi8on Statement Re: Clean Dressing Technique 1.Present literature suggests that pressure ulcer dressing procedures may use clean technique rather than sterile; however, appropriate technique may be needed for those wounds that are recently debrided MEANING: 2.You need to use sterile supplies for all dressing changes AND you may need to setup sterile fields and use sterile gloves for recently debrided or surgically created wounds

17 Ques8ons?? 1.Complete post test and course evaluation to earn 0.5 CEU for this course 2.THANK- YOU!

18 References 1. Ostomy-Wound Management Journal. Accessed at 2. Wound Ostomy Continence Society; Position Statement on Clean versus Sterile Technique. Accessed at 3. Centers for Medicare Services. downloads/r4som. Guidance to surveyors on clean versus sterile dressing changes. 4. Wikipedia. 5. Centers for Disease Control. 6. Nursing Health Professionals Lab. 7. Surgical Encyclopedia. Aseptic-Technique

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