The purpose of a sterile dressing change is to prevent healthcare-associated infections, particularly surgical site infections, which can significantly increase patient morbidity and mortality. This procedure requires the application of surgical asepsis, a set of practices designed to eliminate all microorganisms from an area or object. When a student performs this high-risk skill, it demands direct and continuous supervision by a registered nurse. This supervisory presence ensures patient safety is maintained while the student develops technical proficiency and adherence to sterile principles.
The Supervising Nurse’s Critical Responsibilities
The supervising registered nurse is accountable for all care the student provides. The nurse must establish intervention readiness, meaning they are positioned to immediately stop the procedure if a break in sterile technique occurs. This direct observation is continuous, requiring the nurse to be physically present and focused solely on the student’s actions and the sterile field.
Before the procedure begins, the supervisor must verify the student’s theoretical knowledge of the rationale behind sterile technique and the specific procedure steps. This includes confirming the student understands potential risks, such as wound contamination leading to infection, and can articulate the correct “stop points” for intervention. The student should be able to identify a contaminated item or a lapse in hand hygiene and know to immediately pause and correct the error. The nurse guides the student’s clinical judgment and ensures procedural integrity.
Essential Patient and Environmental Preparation
Effective preparation reduces the risk of contamination before the sterile pack is opened. The procedure begins with the confirmation of patient identity using two unique identifiers, followed by an allergy check concerning dressing materials or cleansing solutions. Assessing the patient’s pain level is important, and pre-medication should be administered and allowed sufficient time to take effect, ensuring the patient can remain still and comfortable throughout the procedure.
The environment must be controlled to minimize airborne contaminants and external distractions. The nurse should ensure doors are closed, traffic flow is limited, and any air-moving devices, like fans, are turned off to prevent air currents from carrying dust or microbes onto the sterile field. All necessary supplies, including the correct type and size of dressing, cleansing solutions, and waste receptacles, must be gathered and organized on a clean, disinfected surface before the student begins to open the sterile kit. This organization allows the student to proceed smoothly without having to leave the bedside or reach over the sterile field.
Technique for Maintaining the Sterile Field
The sterile dressing change relies on surgical asepsis to prevent microorganisms from entering the wound. The student must first perform meticulous hand hygiene before applying non-sterile gloves to remove the old, soiled dressing. This removal must be done gently to avoid causing pain or disturbing the wound bed. This step should be followed by immediate removal of the contaminated gloves and a second, thorough hand hygiene step.
Opening the Sterile Pack
When opening the sterile pack, the student must unfold the wrapper flaps in a specific sequence—the furthest flap first—to avoid reaching over the sterile contents, which would compromise the field. The sterile field is considered contaminated if any part of it falls below the student’s waist level or if the one-inch border around the perimeter is touched.
Handling Solutions and Gloving
Pouring sterile solutions requires the student to lip the bottle by pouring a small amount into a waste receptacle before dispensing the solution into the sterile basin without allowing the bottle to touch the sterile field. The student must don sterile gloves carefully, touching only the inside of the first glove with the bare hand and the outside of the second glove with the gloved hand. Throughout the cleansing process, the student should cleanse from the least contaminated area, typically the incision line, outward to the most contaminated skin, using a fresh sterile swab for each stroke to prevent transferring microbes back into the wound.
Final Steps: Documentation and Patient Assessment
Once the new sterile dressing is secured, the student must reassess the patient for comfort, pain, or any adverse reactions, such as dizziness or bleeding. All biohazardous waste and sharps must be disposed of correctly to prevent accidental exposure and maintain a safe environment. Comprehensive documentation of the procedure is required.
The record must detail the assessment of the wound’s appearance, including its size, the color and volume of any drainage observed, and the type of cleansing solution and dressing material applied. Crucially, the documentation must explicitly state that the procedure was performed by the student nurse and under the direct supervision of the registered nurse. This notation provides a clear legal record of the supervisory oversight and confirms adherence to professional practice standards.