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Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619)563-0274 Voice/FAX
jmarx@concentric.net
Q. What determines a sterile dressing vs. a clean one?
A. Sterile dressings are appropriate for central lines. All other dressing changes, including pressure ulcers, G-tube sites, and surgical sites are clean. A sterile dressing may be ordered when reimbursement for dressing changes is required.
Q. What solutions are used to clean a wound?
A. According to the most recent published guidelines, normal saline is the only solution that should be used on a healing wound. Fresh wounds, such as a cut, skin tear or abrasion should be cleaned with soap and water or an antiseptic (such as hydrogen peroxide or betadine). Wounds are most suspectable to infection during the first 24 hours.
Q. When should gloves be worn during a dressing change?
A. Gloves should be worn when contact with non-intact skin or any body fluid is anticipated. Therefore gloves would be worn while removing a dressing and doing a treatment. Gloves are not always needed when applying the new dressing or taping the dressing to the skin.
Q. How often should I wash my hands?
A. This question still remains controversial. According to the CDC recommendations for Universal Precautions, hands should be washed after removing gloves. There is nothing in the guidelines which makes an exception. However, I believe that handwashing may not be necessary if the gloves are removed during the same procedure. For example, after the treatment is complete, the nurse can remove the gloves and apply the new dressing and tape without washing their hands. Of course, the hands would be washed at the end of the procedure.
Q. Is alcohol hand washing solution an adequate substitute for handwashing?
A. Yes. Alcohol handwashing is both effective and saves time. If hands are visible soiled, soap and water will remove the gross debris.
Q. Do all dressings need go into in a red bag?
A. No, in fact most dressings do not need special disposal. See article on Biohazardous Waste.
Q. Can I bring the treatment cart into the room? A. Yes, however the cart should be closed and you should not access it during the treatment without first washing your hands. Never set up your supplies and work from the cart. A clean surface should be established at the bedside. Bring all items needed for the dressing change to the bedside. Do not return unused items to the cart.
If you have other questions, please call us!>
In San Diego County, the Medical Waste Ordinance of 1989, was one of the first to be created. The following is a list of items which require special handing by a health care facility:
* Sharps require a special container which is puncture resistant.
Biohazardous waste can usually only be stored for 7 days, unless it is frozen. Storage begins when the container is closed and sealed. However, if you can reduce the amount of waste your facility produces to less than 20 pounds per month, you may qualify for a special permit. This would extend the pick-up time to every 30 days. Facilities have save $200-$1200 per year by changing their waste handling practices. For an evaluation for your facilities waste disposal please contact us.
All other wastes that are generated during resident care are classified as medical waste, which requires no special containers or handing except it must be kept lock and non-accessible during storage.
Finally, do not forget recyclable waste, such as paper, cans and glass!
Biohazardous Waste
Medical Waste laws are not common. Several States and counties now have their own definition of medical waste. Keep in mind that OSHA and the EPA also have definitions of medical wastes. This has lead to much confusion over which laws apply in which situations.
James Marx © 1997