Does the Use of Clean or Sterile Dressing Technique Affect the Incidence of Wound Infection?

Purpose: The purpose of this article is to examine the evidence and provide recommendations for the use of clean or sterile dressing technique with dressing application to prevent wound infection.

Question: In all persons with acute or chronic wounds, does the use of clean or sterile dressing technique affect incidence of wound infection?

Search Strategy: A search of the literature was performed by a trained university librarian, which resulted in 473 articles that examined any age group that dealt with application of a wound dressing using either sterile or nonsterile technique. A systematic approach was used to review titles, abstracts, and text, yielding 4 studies that met inclusion criteria. Strength of the evidence was rated using rating methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine, adapted by Gray and colleagues. Johns Hopkins Nursing Evidence-Based Practice Nursing Research Appraisal Tool was used to rate the quality of the evidence.

Findings: All 4 studies reported no significant difference in the rate of wound infection when using either clean or sterile technique with dressing application. The strength of the evidence for the identified studies was identified as level 2 (1 level A, 3 level B). The study sizes were variable, and the wounds included do not represent the continuum of wounds clinically encountered across the board.

Conclusion/recommendation: Evidence indicates that the use of clean technique for acute wound care is a clinically effective intervention that does not affect the incidence of infection. There is no recommendation that can be made regarding type of dressing technique for a chronic wound due to the lack of evidence in the literature.