Preventing surgical site infection: hand hygiene and dressing best practices

I didn’t plan to nerd out on surgical site infections this month, but a small moment pushed me there: watching a nurse pause, take a breath, and perform hand hygiene before touching my friend’s post-op dressing. That tiny pause felt like a force field—simple, human, and quietly powerful. I started collecting what actually works, what’s overhyped, and how I, as a layperson and a curious observer, can support safer recovery without turning into the “internet expert” nobody wants in the room.

SSIs are complicated—there’s the patient’s biology, the wound, the operating room, the ward, the home, and tiny organisms we never see. But certain behaviors consistently tilt the odds in our favor. Two of the most practical levers are also the most ordinary: clean hands at the right times and smart, low-drama dressing care. That’s where I’m focusing today, weaving in what I keep learning from established guidance (for example, the CDC SSI guideline, the WHO global guideline, and the very practical NICE recommendations).

When the lightbulb went on for me

What made this click was realizing that “hand hygiene” isn’t one big rule—it’s a set of precise moments. If you hit the moments, you change risk. Miss them, and the cleanest-looking unit can still have avoidable infections. That’s why I now pay attention to the rhythm of care: before contact, before a clean task, after exposure risk, after contact, and after touching what’s around the patient (the WHO’s “Five Moments” is a simple, memorable anchor—see a friendly explainer here).

  • High-value takeaway: The timing of hand hygiene often matters as much as the technique.
  • Ask for clarity without blame: “Is now the right moment to sanitize?” is a fair, safety-first question.
  • SSIs are multifactorial; hand hygiene and dressings are impactful but not magic. Bodies are different, and healing is never one-size-fits-all.

Hand hygiene that happens at the right moment

In the perioperative continuum—preop, intraop, and postop—the indications vary, but the gist stays steady: perform hand hygiene at the moments that interrupt germ transfer. In practice, that looks like this:

  • Before patient contact and before a clean/aseptic task (like a dressing change).
  • After body fluid exposure risk (even if gloves were used).
  • After patient contact and after touching patient surroundings.

It sounds obvious, but consistency beats intensity. A quick, well-done alcohol-based hand rub is often the fastest way to be reliable at the bedside (CDC’s practical page for clinicians is handy here).

Alcohol rub or soap and water

I used to think soap and water were automatically better. What I learned: for routine care when hands aren’t visibly soiled, alcohol-based hand rubs are highly effective and kinder to skin, which improves compliance. There are, however, clear times for soap and water.

  • Use alcohol rub (typically 60–95% alcohol) for most routine indications; rub all surfaces until dry.
  • Use soap and water when hands are visibly dirty, after restroom use, or if exposure to certain hardy organisms is suspected.
  • Technique matters: fingertips, thumbs, between fingers, backs of hands, and wrists often get missed. Take a beat to cover them.

Small details that add up:

  • No jewelry on hands/wrists during patient care. Rings and bracelets hide moisture and microbes.
  • Short, natural nails; avoid artificial nails and chipped polish in patient-facing roles.
  • Gloves are not hand hygiene. Perform hand hygiene before donning and after removal.
  • Use hospital-approved lotions to prevent dermatitis; cracked skin undermines everything.

For surgical teams, preoperative hand antisepsis follows different, stricter protocols—this post focuses on the routine moments around dressing care. If you’re curious about the deeper dive on surgical scrubs and prep, the CDC guideline and WHO chapters give helpful context (linked above).

How I now think about dressings without the drama

Dressings are both barrier and reminder. The first goal is simple: keep the incision clean, protected, and dry, especially in the early window. Here’s the mindset I use, informed by well-regarded guidance and checklists from agencies like AHRQ and NHS/NICE.

  • Respect the first 24–48 hours: unless the team instructs otherwise, keep the initial sterile dressing in place and dry.
  • Know your dressing type: plain sterile gauze, adhesive island dressings, semi-permeable transparent films, or negative-pressure devices all have different rules.
  • Avoid casual ointments on closed, clean incisions unless specifically prescribed; they can trap moisture or irritate skin.
  • Water matters: showering with a waterproof dressing is often allowed after the first day or two; soaking (baths, pools, hot tubs) usually waits much longer—ask for a timeline that fits your wound and surgery.
  • Hands first: perform hand hygiene before you touch the dressing supplies, again before touching the incision, and again after you’re done.

My step-by-step for a clean dressing change at home

When the team okays home dressing changes, a little structure keeps it calm:

  • Prep the space: clean a flat surface, lay out sterile or clean supplies as instructed, open packages without touching sterile surfaces.
  • Perform hand hygiene and, if directed, wear clean (or sterile) gloves for the aseptic parts.
  • Remove the old dressing gently; peel back adhesive low and slow. If it sticks, ask whether sterile saline or adhesive remover is appropriate.
  • Inspect the incision briefly: is there increasing redness spreading outward, thick yellow/green drainage, a gap, or a foul odor? (See the caution list below.)
  • Clean only if instructed and with what was prescribed (e.g., sterile saline); avoid improvising with alcohol, peroxide, or iodine unless your clinician specifically advised it.
  • Place the new dressing without touching the absorbent surface; smooth edges to seal. Label with date/time if that helps track changes.
  • Finish with hand hygiene and dispose of waste properly.

For high-risk incisions—think obesity, diabetes, immunosuppression, long operations, or incisions near moist skin folds—teams may use closed-incision negative-pressure therapy. It’s not for everyone, but when chosen, it can protect the wound environment and collect fluid under a sealed dressing. If you see one of these devices, don’t open it casually; follow the exact instructions you’re given.

Showering, activity, and the “when can I…” questions

I try to keep these rules-of-thumb humble and physician-led:

  • Showering: often allowed after 24–48 hours if the dressing is waterproof; pat dry, don’t rub. Replace compromised dressings.
  • Exercise and lifting: early walking is usually good; heavy lifting, bending, or stretches that tug on the incision often wait. Ask for a clear weight limit and duration.
  • Pets, gardens, gyms: great for the soul, tricky for wounds. Keep the incision covered and protected in messy environments; clean afterward.
  • Travel: plan for extra dressing supplies, hand sanitizer, and a copy of discharge instructions. Long car or plane rides? Build in walk-and-stretch breaks.

In the hospital, I love seeing checklists. On the patient side, a simple home checklist works too. The NICE SSI guidance and CDC pages offer clear, non-dramatic language that matches what most teams teach.

Signals that tell me to slow down and call

Not every ache is an emergency, but certain patterns are worth attention. My personal “amber and red” lights:

  • Amber: mild, localized redness that isn’t spreading; a small amount of clear or blood-tinged drainage; low-grade warmth near the incision in the first 48 hours. I monitor, photograph, and ask at the next check-in.
  • Red: redness spreading outward, increasing pain after a period of improvement, fever as defined by your team, thick yellow/green drainage, a bad odor, the incision separating, or any concern about drains or devices. I call sooner rather than later.
  • Systemic feeling “off”: chills, weakness, lightheadedness—trust your gut and escalate.

I keep a short log: date/time of dressing changes, what I saw, questions that came up, and pain levels. It makes follow-up more useful and reduces “I forgot to mention…” moments.

A few myths I’ve let go of

Collecting these helped me stop arguing with reality:

  • Myth: “Soap and water are always superior.” Reality: alcohol rubs are excellent for routine moments, which makes them more consistently used.
  • Myth: “If a little cleaning is good, more is better.” Reality: more scrubbing isn’t always safer; over-cleaning can irritate skin and disturb edges.
  • Myth: “Antibiotic ointment prevents all infections.” Reality: on closed, clean incisions, routine ointments are usually not needed and may cause issues.
  • Myth: “Gloves replace hand hygiene.” Reality: gloves are a barrier, not a disinfectant; you still need hand hygiene at the right moments.

What I’m keeping front and center

Three principles I write at the top of my notebook:

  • Timing beats intensity: hit the hand hygiene moments and keep dressings clean and intact early on.
  • Simple > flashy: choose the least complicated dressing that protects the incision and fits your context.
  • Clarity lowers risk: know exactly when to shower, when to change the dressing, and what “call-us-now” looks like. Ask, write it down, post it on the fridge.

If you want a quick way to go deeper without drowning in tabs, I recommend starting with the CDC and WHO for the big picture, then using NICE (or your local equivalent) for the “what do I actually do” details. For implementation checklists, AHRQ has practical toolkits that are designed for teams but are readable for informed patients and family members too.

FAQ

1) Do I need to wash with soap and water before every dressing change?
Answer: Perform hand hygiene every time, but the product depends on the situation. An alcohol-based hand rub is effective and quick when hands aren’t visibly soiled; use soap and water if they are. Your care team’s protocol should lead.

2) When can I shower after surgery?
Answer: Many people can shower after 24–48 hours if a waterproof dressing is in place and the team has okayed it. Pat dry—no scrubbing or soaking. If the dressing gets wet or loose, replace it as instructed.

3) Should I put antibiotic ointment on the incision?
Answer: Not routinely for closed, clean incisions unless your clinician specifically prescribes it. Ointments can irritate skin or trap moisture; follow your surgeon’s guidance.

4) How often should the dressing be changed at home?
Answer: It depends on the dressing type, the incision, and your surgeon’s instructions. Some dressings are meant to stay several days if clean and dry; others are changed more frequently. Ask for a written schedule.

5) What are the early signs of an SSI?
Answer: Worsening redness spreading outward, increasing pain after earlier improvement, fever per your team’s threshold, thick yellow/green drainage, a bad odor, or the wound gaping. When in doubt, call—sooner is usually better.

Sources & References

This blog is a personal journal and for general information only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Always seek the advice of a licensed clinician for questions about your health. If you may be experiencing an emergency, call your local emergency number immediately (e.g., 911 [US], 119).