Evidence-Based Nursing: Clean vs. Sterile Wound Dressing Techniques

This nursing assignment report investigates the effectiveness of clean versus sterile wound dressing techniques in acute care settings, addressing the clinical uncertainty surrounding wound care practices. The student formulates a research question, employing the PICO framework, and conducts a search in the CINAHL database, using relevant keywords and inclusion criteria. The report evaluates several research papers, assessing their level of evidence and discussing their findings regarding infection prevention and wound healing. The analysis includes a systematic review and randomized controlled trials, comparing the two techniques and highlighting the need for more evidence-based research to determine the superiority of either method. The conclusion emphasizes the challenges of wound care, the importance of infection control, and the inconclusive nature of current research, advocating for further studies to guide clinical practice. The report includes references to key papers and an appendix.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

1NURSING ASSIGNMENT
Introduction
A large variation and several controversies exist regarding the methods of wound care,
especially in the context of the wound cleansing, pain relief, dressing choice, patient instructions
and the type of wound care options. There had been a difference in opinions about the type of
wound care carried out by the nurses. Some of the papers has described the effectiveness of the
sterile techniques, whereas some finds clean dressing technique is the best way to prevent
infections. There is no effective evidences to prove that sterile technique is more effective than
the clean dressing techniques. There are few national guidelines that have addressed the topic of
clean vs sterile techniques. Sterile technique and recommended dressing has been recommended
for the post-operative management of wound and this has been set as the standard by the centers
for the disease control and prevention. However, no recommendation has been provided after 48
hours for the wounds having primary closure. On the other hand, the Agency for the Health Care
Policy and Research has recommended the usage of clean dressings and clean protective
equipment till the dressing procedure is being completed. In order to remove the ambiguity and
research question has been formulated.
Research question
Is clean wound dressing more effective than sterile technique in managing wounds in acute care
settings.
The formulated research question could have been written in the PICO format.
Problem: Wound management
Intervention: Clean dressing of wounds

2NURSING ASSIGNMENT
Comparison: Comparison between sterile or aseptic technique and clean dressing of wound.
Outcome: Easy healing of wound and to prevent infections
A search strategy has been conducted in CINAHL database. Appropriate keywords has been
used to find out proper articles within the topic. The keywords that has been used are “wound
management” AND “aseptic” and “Clean dressing” . Boolean operators has been used properly
for filtering the search. The inclusion criteria was English articles between the publication years
2013-2020. Grey literatures and editorials were discarded from the search results. The reliability
and the validity of the articles that has been found was assessed or evaluated by using the
hierarchy of evidence (Burns, Rohrich & Chung 2011). Papers were chosen on the basis of the
impact factors and level of evidence. The level of evidence has been given below:
Papers Level of evidence
Kent, D.J., Scardillo, J.N., Dale, B. & Pike,
C., 2018. Does the Use of Clean or Sterile
Dressing Technique Affect the Incidence of
Wound Infection?. Journal of Wound,
Ostomy and Continence Nursing, no. 45,
vol. 3, pp.265-269.
Level 2
Based on the results of a level 1 of mixed
findings from more than one level 1 studies
Huang, X.L., Zhang, J.Q., Guan, S.T. &
Liang, W.J., 2016. Comparison of sterile
and clean dressing techniques in post-
operative surgical wound infection in a
chinese healthcare facility. Tropical
Journal of Pharmaceutical Research,
vol.15,no. 2, pp.415-419.
Level 1
Randomized control trials.
Huang, X.L., Zhang, J.Q., Guan, S.T. & Level 2

3NURSING ASSIGNMENT
Liang, W.J., 2016. Comparison of sterile
and clean dressing techniques in post-
operative surgical wound infection in a
chinese healthcare facility. Tropical
Journal of Pharmaceutical Research,
vol.15,no. 2, pp.415-419.
A randomized control trial
Walter, C.J., Dumville, J.C., Sharp, C.A.
and Page, T., 2012. Systematic review and
meta‐analysis of wound dressings in the
prevention of surgical‐site infections in
surgical wounds healing by primary
intention. British Journal of Surgery, 99(9),
pp.1185-1194.
Level 1
Systematic review consists of three RCTs.
Discussion
The paper by Kent et al. (2018) have provided recommendations and evidence regarding
the use of sterile and clean techniques with the application of dressing for the prevention of
wound infection. It has been stated that clean dressing techniques involves the use of a clean
procedure field, clean personal protective equipment and the avoidance of direct contamination
of the supplies and the materials. On the other hand sterile dressing technique involved the use of
sterile procedure field, sterile supplies and sterile instruments. Meticulous hygiene is required for
both the techniques. This paper has conducted a systematic review consisting of 4 articles. Three
of them are randomized control trial and one of the study is quasi-experimental. The paper has
provided about the fact how both clean dressing and sterile technique can be used to prevent
infections. But no such valid statement has been provided stating that any of these techniques are

4NURSING ASSIGNMENT
better than the other. The main limitation of the study is the small sample size of the study. It has
been clearly recommended by the author, that there is a need for good quality of multisite RCTs
with clean vs sterile technique in wound care.
Huang, Zhang, Guan & Liang (2016) on the other hand have also brought about a
comparison between sterile and clean techniques of wound care. The RCT was made with 130
patients with 70 males and 60 females who had underwent a surgery. These two types of
dressing types were considered as independent variables. It was found that sterile environment,
gloves and instruments have been found to be more effective in comparison to clean dressings.
Additionally it has also been mentioned that the cost of sterile dressings has been relatively
higher in comparison to the dressings that are required for the clean procedures. In this paper no,
significant differences has been found between the clean and sterile dressing procedures.
Dumville et al. (2018) has conducted a Cochrane systematic review, where randomised
controlled trials has been selected as the secondary researches. Papers were chosen, where
wounds dressing has been compared wound dressing with almost no wound dressing. Most of
the studies have stated that film dressings, silver dressings and hydrocolloid dressings has been
generally used dressing of the wounds. Various techniques has been compared such as the
hydrocolloid dressings compared with basic wound dressings, aseptic techniques compared to
clean dressing , silver containing dressing with the basic wound contact dressing. However, it
was uncertain, whether any dressing reduces or increases the risk of infections compared to the
other options that has been investigated.
With respect to wound cleaning Walter et al. (2012), have stated that surgical wounds are
healed by clean and proper wound dressing. It has been stated that the surgical site infections are

5NURSING ASSIGNMENT
the major reason for the morbidity and the cost. Hence, a randomised controlled trial has been
conducted to evaluate effect of dressing on the infection rate of the surgical site. Sixteen
controlled trials has been taken for the examination of the range of the wound contamination that
takes place in a setting. However, not much significance can be found between the statuses of the
surgical wounds that has been covered with different dressings. No difference could be seen the
scar, pain or the acceptability of the dressings.
Conclusion
Wound care is an important as well as challenging task for the health care professional
due to the occurrence of the large scale of infections in the acute care wards. Infection can occur
due to the presence of bacteria or other microorganisms present in sufficient quality in the
damaged tissue and they tend to impair healing. Infected chronic wounds can cause pain, fever,
oedema, as well as an elevated blood count. The techniques used for preventing any wound
associated infections vary across a large number of settings. Various kinds of dressings are
available for dressing of each types of wounds. Similarly, the concerned scenario 1, it has been
stated that there had been an inconsistent care between clean dressing technique and the aseptic
technique chosen. However, very few papers could be found addressing the comparison between
a clean dressing technique and an aseptic technique. The four papers that has been found
contained very small sample sizes, decreasing the validity and the reliability of the research.
Additionally, none of the papers could actually found any statistically significant difference
between the adoption of aseptic technique and the use of clean dressings and personal protective
equipment in preventing infections. Hence, although clean wound dressing can be considered as
a safe option, but its effectiveness in comparison to the other types of dressing or techniques

6NURSING ASSIGNMENT
cannot be decided upon. More evidence based Randomised controlled trials are required clearly
adopting or refuting the idea.

7NURSING ASSIGNMENT
References
Burns, P.B., Rohrich, R.J. & Chung, K.C., 2011. ‘The levels of evidence and their role in
evidence-based medicine’. Plastic and reconstructive surgery, vol. 128, no. 1, p.305.
Dumville, J.C., Gray, T.A., Walter, C.J., Sharp, C.A., Page, T., Macefield, R., Blencowe, N.,
Milne, T.K., Reeves, B.C. and Blazeby, J., 2016. ‘Dressings for the prevention of surgical site
infection’. Cochrane Database of Systematic Reviews, (12).
Huang, X.L., Zhang, J.Q., Guan, S.T. & Liang, W.J., 2016. ‘Comparison of sterile and clean
dressing techniques in post-operative surgical wound infection in a chinese healthcare facility.’
Tropical Journal of Pharmaceutical Research, vol.15,no. 2, pp.415-419.
Kent, D.J., Scardillo, J.N., Dale, B. & Pike, C., 2018. ‘Does the Use of Clean or Sterile Dressing
Technique Affect the Incidence of Wound Infection?’. Journal of Wound, Ostomy and
Continence Nursing, no. 45, vol. 3, pp.265-269.
Walter, C.J., Dumville, J.C., Sharp, C.A. and Page, T., 2012. ‘Systematic review and meta‐
analysis of wound dressings in the prevention of surgical‐site infections in surgical wounds
healing by primary intention’. British Journal of Surgery, 99(9), pp.1185-1194.

8NURSING ASSIGNMENT
Appendices

9NURSING ASSIGNMENT

10NURSING ASSIGNMENT

11NURSING ASSIGNMENT