A surgical dressing is a sterile covering applied to a wound or incision site to promote healing, prevent infection, absorb exudate, and protect the area from mechanical injury. It plays a vital role in postoperative care and wound management.
Definition
A sterile protective surgical covering applied to a wound incision with aseptic technique with or without medication.
Purposes
- To promote wound granulation and healing.
- To prevent microorganisms from entering the wound.
- To decrease the presence of purulent wound drainage.
- To absorb fluid and provide a dry environment.
- To immobilize and support wound.
- To assist in removal of necrotic tissue.
- To apply medication to the wound.
- To provide comfort.
- To promote aesthetic sense.
Principles
- Microorganisms are present everywhere. These may be transmitted from the source to the host directly or indirectly.
- Bacteria travel along with the dust particles.
- Cleaning an area where there is less number of organisms before cleaning an area where there are more organisms minimizes the spread of organisms to the clean area.
- Respiratory tract harbors microorganisms that can enter the wound.
- Nutrition and oxygen are carried to the wound via blood and are essential for collagen formation.
- Moisture facilitates growth and movement of microorganisms.
Types of Surgical Dressings
| Dressing Type | Key Features & Uses |
|---|---|
| Dry-to-Dry | Absorbs drainage; used for clean wounds healing by primary intention |
| Wet-to-Dry | Debrides necrotic tissue; used for infected or untidy wounds |
| Wet-to-Wet | Maintains moisture; used on clean, granulating wounds |
| Foam | Highly absorbent; ideal for moderate to heavy exudate |
| Hydrocolloid | Gel-forming; promotes autolytic debridement and protects against contamination |
| Hydrogel | Hydrates dry wounds; reduces pain and supports autolysis |
| Alginate | Derived from seaweed; absorbs heavy exudate and conforms to wound shape |
| Transparent Film | Waterproof and breathable; allows wound observation and protects superficial wounds |
| Silver/Antimicrobial | Controls infection; used for chronic or infected wounds |
| Composite | Combines multiple materials for complex wound needs |
Instructions for the Dressing
- Use aseptic technique strictly.
- Wash hands thoroughly to minimize the wound contamination.
- Use barrier technique.
- Sweeping and dusting should be done approximately 15-30 minutes prior to changing the dressing.
- Create a sterile field around the wound by spreading sterile sheets.
- Cleaning should be done from the cleanest area to a less clean area.
- If the dressing is adherent to the wound due to drying of the secretions, wet it with normal saline.
- When drains are in place, the dressing should not be combined with the dressing on the wound line.
- The discharge from the wound must be measured carefully and the odor, color, and consistency of the drainage noted.
- Avoid meal timings for the wound care.
- Give analgesics before dressing if it is very painful
Articles
Preparation of Equipment
- A sterile dressing set containing:
- K-basin.
- Bowl.
- Artery clamps (2).
- Thumb forceps (nontoothed) (1).
- Cotton balls, gauze pieces.
- Cleaning solution and medication prescribed.
- Sterile saline.
- Sterile gloves and mask.
- Adhesive bandages, scissors.
- Waterproof bag for disposal.
- Dressing drum.
- Ether (according to the hospital policy).
- Scissors.
- Mackintosh or underpad.
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | Relieves anxiety and promotes understanding of healing process. |
| 2. | Assemble equipment on a trolley and take it to the bedside. | Prevents waste of time and chance of break in sterile technique by accidental omission of a needed supply. |
| 3. | Provide privacy; switch off the fan. | Reduces air currents that may transfer the microorganisms. |
| 4. | Position the patient comfortably and drape the patient. | Prevent the contamination of wound supplies. |
| 5. | Expose the wound area and instruct not to touch the wound. | Minimizes unnecessary exposure and provides access to wounds. |
| 6. | Perform hand hygiene in an aseptic technique. | Removes the microorganisms. |
| 7. | Wear a clean glove if needed and remove the old dressings, keeping the soiled surface away from the patient. If wound drain is present, remove only a layer at a time. | Prevents dislodging of drains. |
| 8. | If the wound is soiled, place a mackintosh or underpad under the wound before irrigation. | To prevent soiling of linen. |
| 9. | Pour sterile saline over the wound dressing if adhering gauze piece needs to be removed. | Prevents pain and bleeding from the tissue. |
| 10. | Open the dressing pack; arrange the articles; pour the solution; open the sterile glove; put it in; and close the pack without contamination. | To prevent contamination. |
| 11. | Perform surgical hand washing; wear sterile gloves. | Reduces transmission of microorganisms. |
| 12. | Using artery clamp, remove the adhered gauze. | For easy removal. |
| 13. | Observe the character of wound and amount of drainage. | Provides an estimate of the amount of drainage and assessment of wound condition. |
| 14. | Use separate gauze piece for each stroke. | Prevents transmission of microorganisms. |
| 15. | Move in progressive strokes away from incision line or wound edge; if it is a diabetic wound or infected wound, the center of the wound is considered as unclean; hence, strokes should be from periphery to center. | Prevents introduction of microorganisms. |
| 16. | Use dry gauze to clean the incision line. | Reduces moisture which harbors organisms. |
| 17. | Apply loose woven gauze as a contact layer. | Promotes proper absorption of drainage. |
| 18. | If a drain is present, clean in a circular manner; take gauze and fix it around the drain. | Secures its placement. |
| 19. | Apply an ointment if needed and apply surgical pad. | For absorption of drainage. |
| 20. | If wound is deep, gently pack gauze into wound with sterile gloved hand or forceps until wound surfaces are in contact with moist gauze. Be sure gauze does not touch periwound skin. Remove gloves. | Absorbs drainage and adheres to debris. |
| 21. | Secure dressing with bandages/dressing. Apply adhesives. | For proper placement. |
| 22. | Wash hands and replace the articles. | Prevents transmission of microorganisms. |
Special Considerations
- Ensure patient comfort and privacy
- Wear sterile gloves and prepare all equipment beforehand
- Change dressings per protocol or when saturated, loose, or contaminated
- Document wound condition, dressing type, and patient response
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
