What is the most appropriate intervention when a nurse witnesses a colleague using non-sterile technique during a wound dressing change, increasing the risk of infection?

Appropriate Intervention When Witnessing Non-Sterile Technique During Wound Dressing

The most appropriate intervention when witnessing a colleague using non-sterile technique during a wound dressing change is to immediately intervene during the procedure to correct the technique safely.

Rationale for Immediate Intervention

Surgical site infections (SSIs) represent a significant clinical problem with substantial morbidity and mortality. When a breach in sterile technique is observed, immediate action is necessary to protect the patient from potential harm.

Evidence Supporting Immediate Intervention

The CDC guidelines for prevention of intravascular catheter-related infections emphasize maintaining aseptic technique during insertion and care of catheters 1. While this specifically addresses catheter care, the principle applies to all sterile procedures, including wound dressings.

When a site infection is suspected or diagnosed, the ESPEN guideline recommends antimicrobial treatment, and if the infection cannot be resolved, removal of devices may be necessary 1. This underscores the serious consequences of improper sterile technique.

Proper Approach to Intervention

When intervening during a non-sterile dressing change:

1. Address the issue immediately but professionally
2. Focus on patient safety rather than colleague criticism
3. Demonstrate proper technique
4. Document the intervention and patient assessment afterward

Infection Control Principles

The following infection control principles should be maintained during wound dressing changes:

• Hand hygiene before and after patient contact 1
• Proper use of personal protective equipment (PPE) including clean or sterile gloves 1
• Aseptic technique throughout the procedure 1
• Immediate replacement of PPE if it becomes soiled 1

Why Other Options Are Less Appropriate

• Recording the event secretly: This fails to prevent immediate harm to the patient and violates professional ethics of direct communication
• Discussing concerns privately post-shift: While important for follow-up, this allows the current breach in technique to continue, potentially causing patient harm
• Requesting transfer of patient: This doesn't address the immediate risk to the current patient and doesn't prevent future incidents with other patients

Prevention of Future Incidents

After the immediate intervention, follow-up actions should include:

• Educational reinforcement about proper sterile technique
• Review of institutional policies and procedures
• Monitoring for signs of infection at the surgical site
• Documentation of the incident according to institutional protocols

Common Pitfalls to Avoid

1. Confrontational approach that embarrasses the colleague
2. Failing to document the intervention and patient assessment
3. Not following up with appropriate education and monitoring
4. Allowing concern about professional relationships to override patient safety

The evidence clearly supports that immediate intervention is necessary when sterile technique is breached, as the risk of surgical site infection significantly increases with improper technique 2. The primary obligation of healthcare providers is to protect patients from harm, making immediate intervention the only appropriate response when witnessing a breach in sterile technique.