Hand Hygiene Non-Compliance Before a Wound Dressing
You are a senior allied health practitioner observing a junior colleague prepare to change a dressing on a patient's stage 2 sacral pressure injury. The patient has a known history of MRSA colonisation in the nares and a multi-drug-resistant urinary infection. You notice the colleague removes the old dressing with bare hands, then reaches for a clean dressing pack and new gloves without performing hand hygiene. The patient's skin around the wound is red and warm, and the wound has a new odour. The colleague says, 'I'm in a rush, I'll wash after.'
1. Explain the infection prevention breaches and the correct sequence of hand hygiene and PPE for this dressing change.
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Breaches: (1) no hand hygiene after removing a contaminated dressing and before touching clean equipment - this transfers organisms from the old dressing to the clean pack and gloves; (2) bare-hand contact with contaminated material instead of gloves; (3) failure to perform hand hygiene at the WHO 'before clean/aseptic procedure' moment. MRSA and multi-drug-resistant organisms make this a high-consequence breach.
Correct sequence: perform hand hygiene (alcohol-based rub if hands not visibly soiled) → apply gloves for removal of the old dressing → dispose of dressing in clinical waste → remove gloves → perform hand hygiene → prepare the clean field and open the dressing pack → apply sterile or clean gloves as per aseptic technique → cleanse and redress the wound → remove gloves → hand hygiene again.
Key principle: hand hygiene is the single most effective measure; it must occur at every transition between contaminated and clean tasks, and before and after glove use (gloves do not replace hand hygiene).
2. The wound now looks red, warm and has a new odour. What do you do next, and how do you address the colleague's practice without undermining them in front of the patient?
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Clinical action: stop and treat the wound as potentially infected. Do not proceed with a routine dressing as if nothing has changed. Clean and dress the wound using aseptic technique, then escalate the signs of infection (redness, warmth, new odour) to the responsible clinician and document them. Swab or culture may be requested per local policy - follow orders rather than acting outside your scope.
Addressing the colleague: give immediate, private, specific feedback after the patient interaction - describe what you observed and its risk, not the person. Use a structured approach (e.g., 'I noticed X; this matters because Y; can we agree Z for next time'). Offer to model the correct sequence. Report through the appropriate channel (supervisor/incident reporting) if this is a repeated or systemic issue, and complete an incident report if a breach occurred.
Balance: protect the patient first, then support learning. Public criticism in front of the patient damages trust and does not improve safety; silence does not either.