# A nurse is preparing to change a sterile dressing on a postoperative chest incision. Which action demonstrates proper sterile technique during the dressing change procedure?

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> subject: Fundamentals

## 문제

A nurse is preparing to change a sterile dressing on a postoperative chest incision. Which action demonstrates proper sterile technique during the dressing change procedure?

## 보기

1. Opening sterile packages by tearing the corners and allowing the contents to fall onto the sterile field
2. Reaching across the sterile field to retrieve supplies from the opposite side of the table
3. Using clean gloves to remove the old dressing, then applying new sterile gloves without hand hygiene
4. Opening sterile packages away from the body and dropping contents onto the sterile field without touching **✔ 정답**

**정답: 4**

## 해설

Opening sterile packages away from the body and dropping contents without touching maintains sterility. Other actions, like reaching across or using contaminated gloves, break sterile technique.

## 심화 해설

Analysis of Sterile Technique in Dressing Change

Maintaining a sterile field is a critical nursing competency to prevent surgical site infection (SSI), a common healthcare-associated infection that leads to prolonged hospitalization, readmission, and increased costs [1]. Postoperative wound care practices require strict adherence to aseptic principles, as the wound remains a portal for pathogen entry until epithelialization is complete . The nurse must integrate knowledge of microbiology and surgical wound healing into every step of the procedure.

Evaluation of Options

**Option 1: Opening sterile packages by tearing the corners and allowing the contents to fall onto the sterile field.**

This is incorrect. The edges of a sterile package are considered contaminated once the package is opened. Allowing contents to brush against these edges during removal introduces microorganisms to the item, which then contaminates the sterile field. Items must be carefully lifted out without touching the package borders.

**Option 2: Reaching across the sterile field to retrieve supplies from the opposite side of the table.**

This is incorrect. Reaching across the sterile field violates a core principle: any item that passes over a sterile field is considered contaminated because non-sterile particles, including skin flora and dust from the nurse's sleeve, can fall onto the field. The nurse must move around the field to access items, keeping the sterile field in view and never turning their back on it.

**Option 3: Using clean gloves to remove the old dressing, then applying new sterile gloves without hand hygiene.**

This is incorrect. Wearing clean gloves during removal of a soiled dressing creates a moist, warm environment under the glove that promotes rapid microbial proliferation. Removing the gloves does not eliminate the transient flora that multiplied on the hands. Hand hygiene must be performed immediately after glove removal and before donning sterile gloves to reduce bacterial load and prevent contamination of the new sterile gloves during application.

**Option 4: Opening sterile packages away from the body and dropping contents onto the sterile field without touching.**

This is the correct answer. The technique of opening packages away from the body and dropping items onto the sterile field follows the principle of maintaining a barrier between contaminated and sterile objects. By holding the package away from the body, the nurse prevents contact with the uniform, which is not sterile. Dropping without touching ensures that the nurse's hands, which are not yet sterile or are covered by gloves that may have contacted non-sterile surfaces, do not contaminate the item. The item falls directly onto the sterile field, preserving its sterility. This method is a standard practice in establishing and maintaining a sterile field for wound care procedures . In resource-constrained settings, strict adherence to such basic aseptic steps is fundamental to SSI prevention bundles, as workflow variability can significantly increase infection rates .References (research sources)

- [1]Perioperative nursing process-oriented bundled interventions and digital monitoring for the prevention of surgical site infections.Research articleYang Y, Yao S, Pu M, Zhao X, Li Y, Shu Z, Xu L, Kang L, He Z. (2026) · DOI: 10.3389/fmed.2026.1837050

## 임상 시나리오

Clinical Practice Guide: Sterile Dressing Change for Postoperative Chest Incision

1. Preparation and Setup

- Perform hand hygiene thoroughly before gathering supplies.

- Assess the patient's pain level and pre-medicate if needed; ensure privacy.

- Open sterile packages away from the body, ensuring the inner contents do not touch the outer 1-inch border considered contaminated.

- Drop sterile items gently onto the center of the sterile field from a safe height without the hand crossing over the field.

2. Procedure Steps

- Don clean gloves to remove the old dressing, lifting it away from the wound and discarding it immediately into a biohazard bag.

- Remove gloves, perform hand hygiene, and don sterile gloves using closed-gloving technique if the sterile field is large.

- Never reach across the sterile field; move around the table to access supplies while keeping the field in constant view.

- Cleanse the wound from the incision line outward using a new sterile swab for each stroke, never returning to the center with a used swab.

3. Key Safety Principles

- Any item that passes over a sterile field is considered contaminated due to potential fallout of skin flora or dust.

- Sterile objects become contaminated by prolonged exposure to air; minimize traffic and talking near the field.

- If a breach in sterility is suspected, discard the compromised item and restart the setup with new supplies.

## 핵심 개념

- **Sterile Field** — A specified area that is considered free of all microorganisms, maintained by using sterile drapes and strict aseptic technique.
- **Surgical Site Infection (SSI)** — An infection that occurs after surgery in the part of the body where the surgery took place, a common healthcare-associated infection.
- **Aseptic Technique** — A set of specific practices and procedures performed to prevent contamination from pathogens, aiming to maintain sterility.
- **Cross-Contamination** — The unintentional transfer of microorganisms from one object or person to another, potentially causing infection.
- **Hand Hygiene** — The act of cleaning hands with soap and water or an alcohol-based hand rub to remove dirt, organic material, and microorganisms.

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