Aseptic technique - dressings and sutures

Aseptic technique is carrying out a procedure in a way that minimises the risk of introducing contamination to a vulnerable area or device (Dougherty and Lister, 2015). Aseptic technique is crucial in preventing the spread of health care acquired infection in clinical procedures. Aseptic non–touch technique avoids contamination by not touching key elements such as the needle tip or the inside of a sterile dressing (Dougherty and Lister, 2015). This article explores the importance of aseptic technique in relation to dressings and sutures in clinical practice. It is important that nurses can apply aseptic non–touch techniques to prevent the risk of infection and complications.

Aseptic technique is a key skill undertaken every day by nurses and health care professionals (Gould et al, 2021). The standards of proficiency for registered nurses states that it is a requirement that nurses can use effective aseptic and non-touch techniques when undertaking procedures such as

Assess the wound using a wound assessment tool (e.g. TIME):

• Tissue type - assess whether the tissue is viable or non-viable
• Infection and inflammation - treat any signs and symptoms of infection
• Moisture imbalance - aim for a moist wound healing environment
• Edge - if epithelialisation is visible, continue treatment. If the edges are not advancing (e.g. rolled edges), reassess the patient and wound (Wounds UK, 2017). 

The type of wound and stage of healing will determine the required dressing to be placed on the wound and also the need for either sterile or non-sterile gloves. The technique used for applying the dressing will also be determined by the style of wound and the environment in which the injury or wound occurred. The technique can either be: clean or aseptic.

The clean technique is a modified aseptic technique, the main difference is the wound can be irrigated with or immersed

Aseptic technique requires the use of:

• sterile dressing pack containing a sterile towel, gallipot, swabs, disposable gloves, disposable bag (the contents may differ in different organisations)
• fluid for cleaning (0.9% sodium chloride)
• dressing if required and/or suture
• appropriate hand hygiene preparation (e.g. alcohol gel, hand washing)
• other equipment required for the procedure (e.g. scissors, hypo-allergenic tape)
• wipe for cleaning dressing trolley if present. 

The following procedure (Table 1) should be follow when carrying out an aseptic technique for dressings and sutures. Standard precautions should also be adhered to, which include hand hygiene, disposal of sharps, use of personal protective equipment and the use of an aseptic non–touch technique.

Infection is a risk which can cause complications for the patient if aseptic technique is not adhered to, and patients with weakened immunity are at greater risk of complications such as delayed healing and infection. Risks associated with dressings include skin injury, allergic reactions and skin tears. Similarly, risks associated with suturing include, suture erosions, infiltrates at the suture sites, infection and wound dehiscence (wound reopens) (Upton et al, 2019).

Effective patient care during application of dressings and the suturing of wounds, requires healthcare professionals to have a good understanding of the pathophysiology and healing mechanisms of the skin. Referral to specialist practitioners may be required in some cases depending on the nature of the wound. Inadequate skill or knowledge to treat can lead to failure in response to treatment and improper healing of the wound. Only staff educated and trained in aseptic technique should carry out this procedure. Adherence to the principles of asepsis is a vital in preventing the transmission of infection in any environment (NHS, 2019). Aseptic technique should be adhered to as per local policies and staff in community and hospital settings should receive training on a regular basis to ensure that safe, effective practice is being provided to patients.

References

Britto EJ, Nezwek TA, Robins M. Wound Dressings. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022

Brown A. Wound management 1: Phases of the wound healing process. Nurs Times. 2015;111(46):12-13.

Dougherty L, Lister S. The Royal Marsden Manual of Clinical Nursing Procedures. (9th edn). Wiley Blackwell: UK; 2015.

Gould D, Hawker C, Chudleigh JH et al. Survey with content analysis to explore nurses’ satisfaction with opportunities to undertake continuing professional education in relation to aseptic technique. Nurse Educ Today. 2021;98:104749. https://doi.org/10.1016/j.nedt.2021.104749
NHS. Community Infection Prevention and Control Policy for Care Home Settings: Aseptic technique. 2019. https://www.infectionpreventioncontrol.co.uk/content/uploads/2019/07/CH-02-Aseptic-technique-June-2019-Version-1.00.pdf (accessed 16 November 2022)

Nursing and Midwifery Council (NMC). Standards of proficiency for registered nurses. NMC. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/nurses/future-nurse-proficiencies.pdf (accessed 16 November 2022)

Unsworth J, Collins J. Performing an aseptic technique in a community setting: fact or fiction? Primary Health Care Research & Development., 2011;12(1):42–51. https://doi.org/10.1017/S1463423610000198

Upton P, Dunk, AM, Upton, D. Complications associated