Wound Dressing Change Guidelines

Step-by-Step Guide for Dressing Removal and Reapplication

This guide provides clear instructions for safely removing and reapplying a primary and secondary dressing while monitoring the wound for signs that may require medical attention. Always follow your healthcare provider’s recommendations, including changing dressings as prescribed or when certain situations arise.

1. Preparation

  1. Follow Your Provider's Schedule:

    • Change the dressing as often as prescribed by your healthcare provider.
    • Be prepared to change the dressing sooner if necessary (e.g., if it becomes loose, soiled, or there is drainage strike-through).

  2. Gather Supplies:

    • Non-sterile gloves
    • Normal saline solution or wound cleanser
    • Clean wound dressings (primary and secondary)
    • Disposable drape or clean towel
    • Disposable bag for soiled dressings
    • Dimethicone skin wipes (if recommended)
    • Camera (for wound photos, if instructed by your provider)

  3. Prepare the Environment:

    • Choose a clean, well-lit area.
    • Lay out the disposable drape or clean towel for clean supplies.

  4. Hand Hygiene:

    • Wash your hands thoroughly with soap and water for at least 20 seconds.
    • Dry hands with a clean towel or air dry.

2. Removing the Old Dressing

  1. Put on Non-Sterile Gloves:

    • Protects against contamination and exposure to wound drainage.

  2. Assess the Dressing Before Removal:

    • Check for Strike-Through Drainage: If drainage has soaked through the secondary dressing, it's important to change it promptly.
    • Inspect for Loose or Unattached Dressings: If the dressing is peeling off or has become unattached, it should be replaced.

  3. Carefully Remove the Secondary Dressing:

    • Gently peel away the outer layer without pulling on the skin.
    • Dispose of the dressing in the prepared disposable bag.

  4. Remove the Primary Dressing:

    • Loosen the edges gently; if it sticks, moisten with normal saline to prevent skin damage.
    • Dispose of the primary dressing in the bag.

  5. Observe the Wound and Surrounding Skin:

    • Wound Bed:
      • Note the size, depth, color, and appearance.
      • Look for signs of healing or deterioration.
    • Peri-Wound Skin (Skin Around the Wound):
      • Check for redness, warmth, swelling, or signs of irritation.
      • Assess for skin erosion or breakdown.

  6. Bag and Seal the Waste:

    • Place all soiled dressings and gloves into the disposable bag.
    • Seal the bag securely and dispose of it according to local guidelines.

  7. Hand Hygiene (Again):

    • Wash your hands thoroughly after removing the gloves.

3. Cleaning the Wound

  1. Prepare to Clean:

    • Have your normal saline or wound cleanser ready.

  2. Clean the Wound:

    • Gently flush the wound bed with normal saline or wound cleanser.
    • Use gauze or a clean dressing pad to gently pat the area dry.

  3. Assess the Wound After Cleaning:

    • Look for REPAIR Signs (see below).

  4. Protect the Surrounding Skin:

    • Apply Dimethicone Skin Wipes:
      • Gently wipe the skin around the wound (not the wound itself) with dimethicone skin wipes.
      • This helps to protect the skin from moisture and reduce tissue erosion.

  5. Take a Photo (If Advised):

    • Capture a clear image of the wound to share with your healthcare provider.
    • Ensure the photo is well-lit and focused on the wound area.

4. Applying the New Dressing

  1. Hand Hygiene:

    • Wash your hands again before putting on new gloves.

  2. Put on New Non-Sterile Gloves:

    • Maintain cleanliness during dressing application.

  3. Apply the Primary Dressing:

    • Place the prescribed primary dressing directly over the wound bed.
    • Ensure it covers the wound completely without excessive overlap.

  4. Apply the Secondary Dressing:

    • Secure the primary dressing with the secondary dressing to keep it in place.
    • Use medical tape or adhesive as instructed, avoiding tightness that could impair circulation.

  5. Ensure Dressing Integrity:

    • Check that the dressing is fully attached with no gaps or loose edges.
    • Make sure it is comfortable and does not restrict movement.

5. Final Steps

  1. Dispose of Used Materials:

    • Place gloves and any other waste into the sealed disposable bag.
    • Dispose of the bag as per local regulations.

  2. Hand Hygiene (Final Time):

    • Wash your hands thoroughly after completing the procedure.

  3. Monitor the Wound and Dressing:

    • Regular Checks:
      • Inspect the dressing regularly for signs of strike-through drainage or if it becomes unattached.
      • Change the dressing promptly if either occurs, even if it's ahead of schedule.

  4. Look for REPAIR Signs and Report to Your Provider: Use the acronym REPAIR to remember when to contact your provider:

    • R: Redness – Increased redness or warmth around the wound.
    • E: Excessive Drainage – Increase in amount, color changes (yellow, green, brown).
    • P: Pain – New or worsening pain at or around the wound.
    • A: Appearance – Wound getting larger, deeper, or showing signs of delayed healing.
    • I: Infection Signs – Odor or swelling indicating potential infection.
    • R: Response – Lack of progress in healing after following prescribed care.

  5. Communicate with Your Provider:

    • Share Photos and Updates:
      • Send wound images and observations as instructed.
    • Immediate Reporting:
      • Contact your provider promptly if you notice any REPAIR signs.

Key Notes:

  • Adhere to the Prescribed Schedule:

    • Changing dressings as prescribed promotes optimal healing and reduces infection risk.

  • Respond to Dressing Issues Promptly:

    • If the dressing becomes soiled, loose, or unattached, change it even if it's ahead of schedule.

  • Protect the Skin Around the Wound:

    • Using dimethicone skin wipes can help prevent skin breakdown and irritation caused by moisture or adhesive dressings.

  • Maintain Hygiene Throughout:

    • Proper hand washing before and after the procedure is crucial.
    • Use gloves appropriately to prevent contamination.

  • Stay Observant and Communicative:

    • Monitoring the wound and promptly reporting concerns to your provider ensures timely interventions.

By following this process and keeping REPAIR in mind, you can support wound healing effectively while addressing potential complications early.