Wound Care
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Department & Location Nursing Cooperative Wide PURPOSE:
Procedure Infection Control Wound Care Procedures
Number Page 1 of 3
To prevent or minimize transmission of microorganisms during wound care procedures.
RESPONSIBILITY STATEMENT: All personnel across the continuum of care who perform wound care shall adhere to established GHC infection control principles and practices.
CONTENTS: Notify Infection Control if MRSA transmission is suspected. HAND HYGIENE A Follow Hand Hygiene Policy: http://incontext.ghc.org/about/org-pol/d-07/d-07-013.html 1 2 3
B C
When hands are soiled: Wash with chlorhexidine gluconate. Alternative to chlorhexidine when hands are soiled: Lotion soap followed by alcohol hand sanitizer. When hands are not visibly soiled: Use alcohol hand sanitizer frequently and as needed: a between the dirty/clean steps of procedure to prevent cross contamination (remove gloves, sanitize, and re-glove) b before and after gloving c just prior to setting up supplies for procedure or accessing supplies d when moving away from the patient “zone” (remove gloves and sanitize hands) Minimize jewelry. Keep natural nails no longer than ¼ inch long. No artificial nails. Use hand lotion (latex/chlorhexidine compatible) as needed to maintain skin integrity between washings.
PERSONAL PROTECTIVE EQUIPMENT D
Glove for all wound care and non-intact skin.
E
Gowns and face protection
F
G
Procedure
Isolation gown
Mask with eye protection or Mask with full face shield
Mask without eye protection
MRSA (colonized/infected) wound care
required
recommended
recommended
Wound irrigation
required
required
Dremel use
required
required
Incision & drainage
required
required
Debridement
recommended
Lengthy wound care procedure, Complex, or large sized wounds
required
recommended recommended
recommended
Masks (with or without eye protection) are recommended with all wound care to prevent a inadvertent touching of face/hair/glasses with hands or gloved hands during procedure b employee shedding of respiratory/nasal droplets into wound site during procedure Remove gloves and PPE after completion of procedure and perform hand hygiene.
INSTRUMENT USE AND HANDLING H
Use only sterile instruments and basins when performing wound care procedures.
I
Use sterile scissors (not bandage scissors unless sterile) to cut off dressings. Alcohol wipe is not adequate to disinfect scissors.
J
Wash instruments/basin in enzymatic detergent, rinse, air dry and package for autoclave after use. Keep instruments moist or submerged in water if unable to clean immediately.
K L
Transport contaminated instruments in a covered basin. Send instruments and basins to CSR for sterilization after cleaning.
Nursing Cooperative Wide
Infection Control Wound Care Procedures
Procedure # Page 2 of 3
CROSS-CONTAMINATION PREVENTION M Establish clean/dry area for supplies/home care bag/equipment. N
Establish separate clean and dirty areas for use during procedure.
O
Perform hand hygiene prior to assembling wound care supplies: tape, gauze, ointments, instrument packages, etc.
P
Set up and open supplies immediately prior to procedure.
Q
Tear tape during procedure set-up to avoid contamination of clean supplies during actual procedure or care.
R
Avoid ointment and cream contamination: 1 During procedure set up, dispense needed amount into a small plastic or paper cup by lifting ointment, cream or gel, from tube/jar with sterile cotton applicator or tongue blade with clean gloved hands. 2 Do not wipe bottle tips on skin. (i.e., ABI gel, creams, ointments). 3 Do not handle tubes or jars with contaminated gloved hands.
S
Plan your work so that you are not repeatedly entering and leaving "the patient zone”. Do not rummage in drawers or cupboards, or dressing cart with gloved hands. Prevent contamination by removing gloves, apply alcohol hand sanitizer, access needed supplies, then re-glove and return to “the patient zone.”
T
Store each individual patient's supplies in separate, clean, labeled baggie or container. Keep the supplies for those with MRSA or VRE apart from supplies of non-infected patients and separate from clean supplies.
U V
Discard any disposable cross-contaminated supplies even if unopened. Discard normal saline or sterile water within 24 hours of opening. Consider using individual 30 cc NS plastic fish.
W Nu-gauze and other dressings are single use only (one patient use only). X
Discard expired supplies and dressings.
Y
Disinfect Doppler between patients with approved environmental disinfectant.
Z
Wash contaminated BP cuffs or wipe down with approved environmental disinfectant between patients. Prevent contamination by using saran wrap on non-intact skin, then placing BP cuff when doing ABI or blood pressure.
AA In ambulatory or hospital setting remove, move, or cover unnecessary furniture and equipment in room to prevent contamination and make clean up easier. Cover clean items in close proximity (within 3-5 feet) to wound with sheet or barrier during irrigation and Dremel procedures. BB Supplies should be kept in original packages, or stored in small amounts in clean, covered containers. Clean and sterilize containers prior to refilling. Do not “top off” containers.
ENVIRONMENTAL BARRIERS CC Use blue incontinent pad (chux) or plastic bag as protective barrier to prevent environmental contamination from wound site and to make clean up easier. DD Saran wrap or plastic bag may also be used to protect equipment (BP cuff, Doppler) from wound site. EE Use exam light sheath covers when available. Change sheaths between patients or disinfect exam light. FF Discard soiled dressings in plastic bag. GG Disposable wound drainage canisters 1 Home Care discard in home trash after sealing 2
In ambulatory or inpatient settings, discard in biohazardous waste.
ENVIRONMENTAL DISINFECTION HH To disinfect environmental surfaces, clean the item, then spray/wipe the item with an environmental disinfectant and allow to air-dry. Disinfect all items touched by employees and patient during procedure. 1 Wipe all areas in "patient zone" that were touched during the procedure 2 Wipe exam table, chair armrests, and lamp
3
Don't forget phones, keypads, doorknobs, light switches, pagers, if cross contamination occurred
Gwenda Felizardo, Infection Control [email protected]
10/10/09
Nursing Cooperative Wide 4
Infection Control Wound Care Procedures
Procedure # Page 3 of 3
Don’t forget bedside tables/stands, bed rails, wheelchairs, drawer handles.
Gwenda Felizardo, Infection Control [email protected]
10/10/09
Nursing Cooperative Wide
Infection Control Wound Care Procedures
Procedure # Page 4 of 3
REFERENCES: APIC Text of Infection Control and Epidemiology (2000). Garner, JS. Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996; 17: 53-80. CDC. Guideline for environmental infection control in health-care facilities: recommendation of the CEC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003; 52 (No. RR-10): 1-48.
Written by:
Gwenda Felizardo RN, BSN, CIC, Infection Control Pat Vivolo, RN, BSN, CIC, Infection Control
Written by:
Gwenda Felizardo, BSN, CIC, RN, Infection Control
Original date:
March 2002
Reviewed by:
Jan Crosman, MN, ARNP, ONC, RN, Orthopedics Barb Fugleberg, MN, RN, Puget Sound Regional Division Administration Ruth Gregersen, PhD, RN, Home and Community Services Karen Severson, MSN, RN, Hospital System Practice and Process Improvement Carmen Suazo, MN, RN, Nursing Operations
Reviewed/Revised date(s): 1/2003, 1/05 Administrative Approval: ______________________________________________ Director, Nursing Resources
Gwenda Felizardo, Infection Control [email protected]
10/10/09
Procedure Infection Control Wound Care Procedures
Number Page 1 of 3
To prevent or minimize transmission of microorganisms during wound care procedures.
RESPONSIBILITY STATEMENT: All personnel across the continuum of care who perform wound care shall adhere to established GHC infection control principles and practices.
CONTENTS: Notify Infection Control if MRSA transmission is suspected. HAND HYGIENE A Follow Hand Hygiene Policy: http://incontext.ghc.org/about/org-pol/d-07/d-07-013.html 1 2 3
B C
When hands are soiled: Wash with chlorhexidine gluconate. Alternative to chlorhexidine when hands are soiled: Lotion soap followed by alcohol hand sanitizer. When hands are not visibly soiled: Use alcohol hand sanitizer frequently and as needed: a between the dirty/clean steps of procedure to prevent cross contamination (remove gloves, sanitize, and re-glove) b before and after gloving c just prior to setting up supplies for procedure or accessing supplies d when moving away from the patient “zone” (remove gloves and sanitize hands) Minimize jewelry. Keep natural nails no longer than ¼ inch long. No artificial nails. Use hand lotion (latex/chlorhexidine compatible) as needed to maintain skin integrity between washings.
PERSONAL PROTECTIVE EQUIPMENT D
Glove for all wound care and non-intact skin.
E
Gowns and face protection
F
G
Procedure
Isolation gown
Mask with eye protection or Mask with full face shield
Mask without eye protection
MRSA (colonized/infected) wound care
required
recommended
recommended
Wound irrigation
required
required
Dremel use
required
required
Incision & drainage
required
required
Debridement
recommended
Lengthy wound care procedure, Complex, or large sized wounds
required
recommended recommended
recommended
Masks (with or without eye protection) are recommended with all wound care to prevent a inadvertent touching of face/hair/glasses with hands or gloved hands during procedure b employee shedding of respiratory/nasal droplets into wound site during procedure Remove gloves and PPE after completion of procedure and perform hand hygiene.
INSTRUMENT USE AND HANDLING H
Use only sterile instruments and basins when performing wound care procedures.
I
Use sterile scissors (not bandage scissors unless sterile) to cut off dressings. Alcohol wipe is not adequate to disinfect scissors.
J
Wash instruments/basin in enzymatic detergent, rinse, air dry and package for autoclave after use. Keep instruments moist or submerged in water if unable to clean immediately.
K L
Transport contaminated instruments in a covered basin. Send instruments and basins to CSR for sterilization after cleaning.
Nursing Cooperative Wide
Infection Control Wound Care Procedures
Procedure # Page 2 of 3
CROSS-CONTAMINATION PREVENTION M Establish clean/dry area for supplies/home care bag/equipment. N
Establish separate clean and dirty areas for use during procedure.
O
Perform hand hygiene prior to assembling wound care supplies: tape, gauze, ointments, instrument packages, etc.
P
Set up and open supplies immediately prior to procedure.
Q
Tear tape during procedure set-up to avoid contamination of clean supplies during actual procedure or care.
R
Avoid ointment and cream contamination: 1 During procedure set up, dispense needed amount into a small plastic or paper cup by lifting ointment, cream or gel, from tube/jar with sterile cotton applicator or tongue blade with clean gloved hands. 2 Do not wipe bottle tips on skin. (i.e., ABI gel, creams, ointments). 3 Do not handle tubes or jars with contaminated gloved hands.
S
Plan your work so that you are not repeatedly entering and leaving "the patient zone”. Do not rummage in drawers or cupboards, or dressing cart with gloved hands. Prevent contamination by removing gloves, apply alcohol hand sanitizer, access needed supplies, then re-glove and return to “the patient zone.”
T
Store each individual patient's supplies in separate, clean, labeled baggie or container. Keep the supplies for those with MRSA or VRE apart from supplies of non-infected patients and separate from clean supplies.
U V
Discard any disposable cross-contaminated supplies even if unopened. Discard normal saline or sterile water within 24 hours of opening. Consider using individual 30 cc NS plastic fish.
W Nu-gauze and other dressings are single use only (one patient use only). X
Discard expired supplies and dressings.
Y
Disinfect Doppler between patients with approved environmental disinfectant.
Z
Wash contaminated BP cuffs or wipe down with approved environmental disinfectant between patients. Prevent contamination by using saran wrap on non-intact skin, then placing BP cuff when doing ABI or blood pressure.
AA In ambulatory or hospital setting remove, move, or cover unnecessary furniture and equipment in room to prevent contamination and make clean up easier. Cover clean items in close proximity (within 3-5 feet) to wound with sheet or barrier during irrigation and Dremel procedures. BB Supplies should be kept in original packages, or stored in small amounts in clean, covered containers. Clean and sterilize containers prior to refilling. Do not “top off” containers.
ENVIRONMENTAL BARRIERS CC Use blue incontinent pad (chux) or plastic bag as protective barrier to prevent environmental contamination from wound site and to make clean up easier. DD Saran wrap or plastic bag may also be used to protect equipment (BP cuff, Doppler) from wound site. EE Use exam light sheath covers when available. Change sheaths between patients or disinfect exam light. FF Discard soiled dressings in plastic bag. GG Disposable wound drainage canisters 1 Home Care discard in home trash after sealing 2
In ambulatory or inpatient settings, discard in biohazardous waste.
ENVIRONMENTAL DISINFECTION HH To disinfect environmental surfaces, clean the item, then spray/wipe the item with an environmental disinfectant and allow to air-dry. Disinfect all items touched by employees and patient during procedure. 1 Wipe all areas in "patient zone" that were touched during the procedure 2 Wipe exam table, chair armrests, and lamp
3
Don't forget phones, keypads, doorknobs, light switches, pagers, if cross contamination occurred
Gwenda Felizardo, Infection Control [email protected]
10/10/09
Nursing Cooperative Wide 4
Infection Control Wound Care Procedures
Procedure # Page 3 of 3
Don’t forget bedside tables/stands, bed rails, wheelchairs, drawer handles.
Gwenda Felizardo, Infection Control [email protected]
10/10/09
Nursing Cooperative Wide
Infection Control Wound Care Procedures
Procedure # Page 4 of 3
REFERENCES: APIC Text of Infection Control and Epidemiology (2000). Garner, JS. Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996; 17: 53-80. CDC. Guideline for environmental infection control in health-care facilities: recommendation of the CEC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003; 52 (No. RR-10): 1-48.
Written by:
Gwenda Felizardo RN, BSN, CIC, Infection Control Pat Vivolo, RN, BSN, CIC, Infection Control
Written by:
Gwenda Felizardo, BSN, CIC, RN, Infection Control
Original date:
March 2002
Reviewed by:
Jan Crosman, MN, ARNP, ONC, RN, Orthopedics Barb Fugleberg, MN, RN, Puget Sound Regional Division Administration Ruth Gregersen, PhD, RN, Home and Community Services Karen Severson, MSN, RN, Hospital System Practice and Process Improvement Carmen Suazo, MN, RN, Nursing Operations
Reviewed/Revised date(s): 1/2003, 1/05 Administrative Approval: ______________________________________________ Director, Nursing Resources
Gwenda Felizardo, Infection Control [email protected]
10/10/09
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