What is Surgical Asepsis?
• Procedures that maintain an
area or object free of
• Define Sterile:
• Define Contaminated:
• No room for error!!
• Work area must be clean, dry and
• Sterile items:
• Above your waist
• Always in your vision
• Held in front of your body (not touching
clothing or any thing else)
What is a sterile field? Why do you need it?
• An area free of
• May be a sterile
towel or a sterile tray
• May be the inside of
a sterile wrap
WHY DO WE NEED IT
Sterile Field RULES:
• Never work across the sterile field
• Always keep sterile items above waist and
• Never turn back to sterile tray/item
• Two inch border around tray is considered
• Move slowly and deliberately
13:7A Opening an sterile package
• Three methods of adding a sterile item to a
• Drop technique
• Mitten technique
• Sterile gloves
• To open a sterile package:
• Ascertain the package is sterile
• Hold with sealed edge TOWARD YOU
• Only touch exterior of wrap (Tabs)
• While performing drop technique the wrap is opened
maintaining sterility of inside of wrap and item. The item
is dropped onto sterile field without touching you, exterior
of wrap of the outside perimeter of sterile field. Used
most commonly for gauze pads, dressings and small
• With mitten technique, a mitten is formed with the
wrapper around the hand holding the item. Special care
to maintain sterility of item and inside of wrap. DO NOT
let the wrap drag onto the sterile field. Commonly used
for bowls,drapes, linen and odd shaped items.
• You can also correctly open items maintaining sterility of
inside of wrap and then don sterile gloves . Then you just
pick up item and place on field. Caution to only touch
inside of wrap.
Preparing a sterile tray
• Once there is a sterile tray it must be
maintained as sterile. So…..
• Contaminated items stay off the tray
• Solutions are poured without touching
bowl or working over sterile field.
• Drop, mitten and sterile gloves are used.
• Dressings that are used last are applied
to the tray first.
• Follow all the “rules”
• If contamination occurs….start over.
13:7 A & B Opening Sterile Package,
Preparing Sterile Tray
• These check offs can be given by
Supervisor and/or Head Nurses.
• If contamination occurs…..you start over.
• The item is either sterile or it is not
sterile……there is no room for error.
Donning and Removing Sterile gloves
• How in the heck do you put two sterile
gloves on two non-sterile hands and keep
the exterior of the gloves sterile?????
• And why???
• Once gloves are correctly on your hands
you may ONLY touch sterile items.
• What if you need to move the tray? Or get
more dressings (still wrapped) ?? Or your
• Assemble sterile glove and ascertain
• Remove jewelry, wash & dry hands
• Open inner wrap handling only
OUTSIDE of wrap.
• Don first glove by grasping cuff
(inside of glove)
• Don second glove by grasping under
• Pull on second glove with extreme
care not to touch exterior of second
glove. (FLY your thumb)
• Only touch sterile surfaces
• If not in use keep fingers together in
“prayer position” and away from
DHO 13:7 CHECK OFF
• ONLY TO BE DONE BY MRS. NELSON
• THERE IS NO ROOM FOR ERROR. THIS
MUST BE A 100%
13:7 D Changing a Sterile Dressing
• Surgeon change the dressing the first time. After that a
doctors order is necessary to change the dressing.
• If drainage is saturating the original dressing, additional
dressings are added and surgeon is notified.
• Exam gloves are used to remove the dressing. Only
touching the exterior of dressing. Place dressing in bio
• Using a prepared sterile tray and having donned sterile
gloves clean the area around the wound.
• Observe wound for S&S of infection or healing, color,
amount, type of drainage.
Cleaning a circular or linear wound/incision
Changing a Sterile Dressing cont.
• Remember to follow the “rules”. Such as when you toss
the gauze pads in the bio bag you need to keep sterile
gloves above waist. Do not turn back to tray.
• If contamination occurs you start over.
• Apply tape so it runs opposite the body movement.
Blue or black ink
Procedure and location
Amount, color, type of drainage
How well patient tolerated procedure
Your first initial, last name and title
Leave no blank area
10/21/2013 1440 Abdominal dressing changed. Small
amount of clear serosanguineous drainage noted. Pt
tolerated procedure well and states “feels much better
J. Nelson RN,CMA
13:7D Changing a Sterile Dressing
• Check off can be done with supervisor
and/or head nurse.
• If tray contamination occurs you start
• There is no room for error!!
• Charting in the charts in required with this