Practising asepsis during dressing changes in community settings

The term ‘aseptic technique’ means free from pathogenic microorganisms and is the deliberate prevention of the transfer of organisms from one individual to another by keeping the microbial count to an irreducible minimum (Rowley et al, 2010). On the other hand, clean technique is a slightly less sterile technique, but the term still indicates free of dirt, marks or stains. The technique involves care delivery using methods that prevent the transmission of microorganisms, such as by meticulous handwashing; maintaining a clean environment by preparing a clean field; using personal protective equipment, such as clean gloves and sterile instruments; and preventing direct contamination of materials and supplies. The main difference between the two is that, unlike aseptic technique, clean technique does not require ‘sterile-to-sterile’ (Rowley et al, 2010). This means that sterile technique requirements, such as wearing clean sterile gloves before touching any sterile surface, for example, a dressing field, do not apply. Clean technique would involve clean hands and clean—but not necessarily sterile—latex gloves. The sterile-to-sterile policy means that only sterile gloves that are clean and new out of their packet can be used before touching any sterile surface. Minimal transference is used in both cases, where gloves do not repeatedly go from the wound or patient, back to a sterile pack and then back again to the wound. Wound dressings would be opened onto the sterile field in a sterile-to-sterile technique. Clean technique is considered most appropriate for long-term and home care, and so is applicable most commonly as the most aseptic way of changing a dressing in community nursing practice. This is especially true in the case of large wounds that require many dressings, including packing of the wound for heavy exudate. Sterile packing should still be applied, as well as a sterile dressing, but clean technique would generally apply in this case, which is more appropriate for the cleansing of a heavily exuding wound Thus, it is appropriate, for example, for patients who are not at high risk for infection and for patients who require routine dressings for chronic wounds such as venous ulcers, or wounds healing by secondary intention with granulation tissue (Wooten and Hawkins, 2001; Kent et al, 2018).