Wound care and Aseptic Flashcards
Three zones of the operating theatre?
- outer zone
- main access corridor, transfer area, documentation area and patient holding area
- clean/semi restricted zone
- clean corridor, sterile equipment, storage and anaesthesia/recovery
- restricted zone
- scrub sinks and operating room
aseptic technique
= Aseptic technique is a process or procedure used to achieve asepsis to prevent the transfer of potentially pathogenic micro-organisms to a susceptible site that may result in the development of infection
- Refers to knowledge and application of skills required when developing and maintaining a sterile field using aseptic technique
• Area immediately surrounding the draped patient
• Sterile surgical personnel
• Sterile draped instrument tables and equipment
Surgical handwash
- technique
- duration
- drying
- what needed
Technique
• Remove jewellery
• Keep fingernails short
• Inspect skin for intactness
• Wash hands, nails & forearms thoroughly & apply a TGA approved hand disinfectant &/or antiseptic
• Rinse carefully, keeping hands above elbows
• No touch techniques apply
Durration
- first wash of the day = 5 mins
- subsequent was = 3 mins
Drying - with sterile towels
When needed - before any invasive surgical procedure
Three layers of the skin?
- epidermis
- dermis
- subcutis
Epidermis layer
• Epidermis, is the outer most layer, mainly consisting of keratinocytes, is continuously produced by the basal cell layer - a zone between dermis and epidermis.
- The new epidermal cells (keratinocytes) rising to the surface of the skin, become loaded with keratin and are eliminated by desquamation after 8-10 days.
Dermis layer
• Thickest tissue layer of the skin
• Dermal thickness ranges from 2-4 mm
• Major proteins found in the dermis are collagen and elastin
- Other cells found in the dermis are mast cells, macrophages and lymphocytes
•Beneath the dermis is the hypodermis or subcutaneous fatty tissue
Subcutis layer
• Layer of adipose tissue or fat that:
- attaches the dermis to the underlying muscles and bone
- delivers the blood supply to the dermis, provides insulation and has a cushioning effect
Function of the skin
Skin as a barrier protects against
o Chemical and mechanical damage
o Bacterial and viral pathogens
o Ultraviolet radiation
o Also prevents excessive loss of fluids and electrolytes to maintain the homeostatic environmentFactors affecting the bodys ability to maintain intact and healthy skin
o Wounds are disruptions that may occur in the skin’s integrity, leading to a loss of the skins normal functioning
o Factors that lead to the development of wounds and delays in wound healing include vascular disease, diabetes, malnutrition, medications, excessive moisture, external forces and the aging process
what is a wound
= a break in the epidermis of the skin that can lead to infection and sepsis
Types of wounds
- acute
- chronic
Chronic wounds
- Arterial and venous leg ulcers
- Pressure ulcers
- Neuropathic ulcers
- Malignant ulcers
- Chronic wounds are in principle acute wounds where the healing process has stopped or has been interrupted somewhere in the normal sequence
Acute wounds
- Burns
- Donor sites
- Aberrations - Traumatic abrasions are caused by a moving surface rubbing against the skin or by dragging along a rough surface
- Incisional/surgical wounds
- Trauma
- An acute wound occurs when healthy tissue is damaged by traumatic means, such as surgery, heat, electricity, chemical or abrasions
- The continuity of the skin surface loss
Types of wound healing
Primary = Clean, straight line, edges well approximated with sutures, rapid healing
Secondary = Larger wounds with tissue loss, edges not approximated, heals from the inside out, granulation tissue fills in the wound, longer healing time, larger scars
Tertiary = Delay 3-5 days before injury is sutured, greater access from pathogens to invade, greater inflammation, more granulation, larger scars
Phases of wound healing (4)
- immediate = haemostasis
- inflammation phase - increased blood flow
- debridement (phagocytosis
- removal of cellular debris/devitalised tissue and cleaning of wound
- macrophages adn leukocytes are dominating cells
- 2-3 days
- proliferation
- macrophages attract endothelial cells
- new capillaries are formed
- fibroblast amount increase
- collagen produced
- granulation - red appearance
- epithelialisation
- maturation
- transformation of the produced collagen will increase the strength of the connective tissue
- some of the capillaries formed during granulation will disappear thereby normalising the blood supply
- duration - longer than a year
Surgical wound healing
- Wounds that heal by primary intervention should be left covered for the first 48 hours and will normally seal and dry out within this period
- These wounds will usually heal within eight to 14days depending on the type of surgery
- Healing should coincide with the removal of clips or staples
Surgical wound types
- clean
• Elective, not emergency, non-traumatic, primarily closed
• No acute inflammation
• No break-in technique
• Respiratory, gastrointestinal, biliary and genitourinary tracts not entered - clean- contaminated
• Urgent or emergency case that is otherwise clean
• Elective opening of respiratory, gastrointestinal, biliary or genitourinary tract with minimal spillage not encountering infected urine or bile
• Minor technique break - contaminated
• Non-purulent inflammation
• Gross spillage from gastrointestinal tract: entry into binary or genitourinary tract in the presence of infected bile or urine
• Major break-in technique
• Penetrating trauma < 4 hours old
• Chronic open wounds to be grafted or covered - dirty
- Purulent inflammation (e.g. abscess)
• Pre-operative perforation of respiratory, gastrointestinal, biliary or genitourinary tract
• Penetrating trauma
>4 hours old
Principles of wound management?
Examination/ assessment
- wound appearance (colour, depth, position, pain and exudate) surround skin
History
- diet, smoking, medications, issues, surgeries
investigations
4 stages of wound management?
- define the aetiology
- identify and control factors affecting wound healing
- select the appropriate wound dressing
- maintain wound healing
Wound management : defining aetiology
- Vascular: chronic venous insufficiency arterial mixed vasculitis
- Mechanical: pressure, friction, shear, trauma, neuropathic, surgical infection
Wound management: Control factors inhibiting the healing process
- health status
- age
- body build/obesity
- immune function
- poor nutritional status
- peripheral vascular disease (atherosclerosis)
- diabetes
Wound management: local factors that can affect healing extrinsic
- drying/maceration
- wound temp
- mechanical stress; pressure, friction and shearing force
- chemical stress
- foreign bodies
- infection
Wound management: principles of wound healing (maintain wound healing)
- moisture
- exudate control
- temp control
- infection free
- controlling inflammation
- nutrition
- wound dressing clean
infection diagnostic criteria:
- abscess
- cellulitis
- discharge
- delayed healing
- discolouration
- bleeding granulation tissue
- unexpected pain, tenderness, erythema
- abnormal smell, wound breakdown
preventing surgical site infection
Pre-operative prevention
• Length of preoperative stay (patients being admitted for planned elective surgery should be admitted as close to the date of surgery as
• possible to reduce the risk of infection)
• Optimal hand hygiene
• Prophylactic antibiotics should always be given for clean-contaminated, contaminated and dirty/infected wounds. They should be administered
Preoperative prevention of infection
- hand hygiene
- appropriate theatre wear
- skin preparation
- wound irrigation
- wound closure techniques
- glucose control
Post operative prevention of infection
- HH
- use of drains
- use of interactive dressings
- recognition of infection and appropriate use of antibiotics
- education pt
Wound dehiscence?
= partial or total separation of previously approximated wound edges, due to a failure of proper wound healing
Causes of wound dehiscence?
- Infection
- A failure to achieve haemostasis with subsequent haematoma development
- Poor nutritional intake
- Excessive exudate caused by an infection or localised oedema
- Poor quality vascular supply caused by a chronic or acute medical condition, an emboli, oedema, anaemia, obesity or smoking
Wound assessment
- Wound etiology
- Pain and odour assessment
- Wound site/anatomical location
- Would bed and surrounding skin appearance
- Measurement of wound depth and undermining
- Rationale for dressing regime
Classifications of wounds
Red - yellow - black
Red = mainly red granulation tissue
yellow = Covered with sloughy material consisting of necrotic tissue and fibrin it remains yellow, brown or grey while it is moist
• It may be adherent to the wound bed or edges or loosely adherent and stringy
Black = covered with necrotic tissue
Wound exudate
= ecaudate is an accumulation of fluids in the wound, may contain serum, cellular debris, bacteria and leukocytes
types of wound exudate
• Serous-clear, watery plasma
- Sanguineous/haemorrhagic-indicates fresh bleeding
- Serosanguineous/haemoserous-mixture of serous and sanguineous
- Purulent-thick yellow, green or brown fluid indicative of infection
Aseptic non touch technique (ANTT)
- Aseptic technique: aims to prevent pathogenic organisms in sufficient quality to cause infection from being introduced to susceptible sites by hands, surfaces and equipment
- Non-touch technique: not touching key parts directly or indirectly
surgical hand was = 2 % and 60 secs
Compare Moist healing Vs Dry healing
Moist - wound healing is twice as fast as dry wound healing
* By keeping the wound moist you provide optimal environment for the body's own wound healing system * Prevents the formation of scab * Provides optimal conditions for the body’s own would healing system * Speeds up healing process * Saves time, money and suffering
Dry healing
- drying out the wound
- scab form
- mechanical injury to the granulating tissue
- longer healing time
