WOUND DRAIN

1. Removal of wound drainage
2. Types
1. closed drain
1. drain attached to collection system
2. uses vacuum to draw drainage into system
3. example: Jackson-Pratt, Hemovac
4. specific nursing interventions
1. maintain patency of drain
2. empty collection system and reactivate suction device
3. record amount and characteristics of drainage
4. asepsis
5. standard precautions
2. open drain
1. removes drainage from wound, deposits it on skin surface
2. example: Penrose drain
3. safety pin usually attached to outside end of drain
4. specific nursing interventions
5. prevent inadvertent removal of drain
1. protect skin
2. record characteristics of drainage
3. asepsis
4. standard precautions
6. protect skin surface from irritating effects of drainage
7. wound vacuum
1. removes and collects infectious material from wound
2. computer controlled
3. requires a seal at wound site with pressure distributing wound packing
4. client may be discharged with device 

HIGH RISK GROUPS FOR POST-OP INFECTIONS

1. Impaired immunologic system
2. Extremes of age
3. Diabetes mellitus
4. Corticosteroid therapy
5. Chemotherapy
6. Infection elsewhere in the body
7. Malnutrition
8. Presence of staphylococcus aureus on client
9. Contaminated environment where injury or trauma occurred

CLASSIFICATIONS OF SURGICAL WOUNDS RELATIVE TO RISK OF INFECTION

The higher the class, the higher the risk: a class IV wound carries much more risk than a class I.

1. Class I (clean wound)
1. No break in sterile technique
2. No inflammation encountered
3. GI, Respiratory or GU tract not entered
2. Class II (clean-contaminated wound)
1. GI, GU or respiratory tract entered with no spillage of contents
2. Minor breaks in technique
3. Operations involving the biliary tract, appendix, vagina, and oropharynx
3. Class III (contaminated wound)
1. Acute inflammation without pus
2. Spillage from a hollow viscus occurs
3. Trauma from a clean source
4. Class IV (dirty)
1. Pus or a perforated viscus
2. Trauma from a dirty source
3. Organism causing infection present before surgery
4. Surgical variables that increase risk of infection
5. Prolonged preoperative hospital stay
6. Body location of surgery
7. Surgical technique: delayed wound closure, excess blood loss, presence of drain, improper suture tension
8. Presence of bacteria at closure

Principles of Surgical Asepsis

1. A sterile object remains sterile only when touched by another sterile object.
• Sterile touching sterile remains sterile.
• Sterile touching clean becomes contaminated.
• Sterile touching contaminated becomes contaminated.
• Sterile touching questionable is contaminated.
• Only sterile objects may be placed on a sterile field.
2. A sterile object or field out of range of vision, or an object held below a person's waist, is contaminated.
3. Never turn your back on a sterile field.
4. A sterile object or field becomes contaminated by prolonged exposure to air.
5. When a sterile surface comes in contact with a wet, contaminated surface, the object or field becomes contaminated by capillary action.
6. Always hold your hands above the level of your elbows.
7. The edges of a sterile field or container are considered contaminated.