Sterile technique is essential in surgical settings. Key aspects of maintaining sterility include properly scrubbing and gloving personnel, ensuring sterile packaging and items are handled appropriately, defining boundaries of the sterile field, and having clear roles and procedures for scrubbed and unscrubbed team members. Any break in sterile technique must be addressed immediately to minimize risk to the patient. Professional organizations like AORN provide guidelines for standard practices to establish and maintain a sterile surgical field.

1. STERILE TECHNIQUE Remember: It’s either sterile or it is not !

2. THE BASICS Green = Sterile Red = Contaminated

3. SCRUBBED PERSONNEL Scrubbed persons should function within a sterile field. Before putting on gloves (and gown, if needed) surgical hand sepsis should be performed. Surgical hand antisepsis decreases microbial counts on the skin and decreases transfer of microorganisms

4. ENSURING STERILITY Sterile goods are stored in clean, dry areas. Sterile items are handled with clean, dry hands. Sterile packages are laid on dry surfaces. If a sterile package becomes damp or wet, it is considered nonsterile and therefore, cannot be used.

5. STERILE PACKAGING The integrity of a sterile package or sterile drape is destroyed by perforation, puncture, or strike through. Strike-through is the soaking of moisture through nonsterile layers to sterile layers or vice versa. Package expiration date for sterility must be checked just prior to opening it.

6. DEFINING THE STERILE FIELD It is not easy to define the boundaries between sterile and nonsterile areas; therefore, the following precautions should be taken: In opening sterile packages, a margin of safety is always maintained. The LAST flap is pulled TOWARD the person opening the package, away from the non-sterile hand. Flaps on peel-open packages should be pulled back, not torn, to expose sterile contents: Contents should be flipped or lifted upwards, and not permitted to slide over the edges. Only the interior and surface level of the cover are considered sterile.

7. SCRUBBED VS. UNSCRUBBED TEAM MEMBERS Supplies for scrubbed personnel: obtain sterile items by opening them onto the sterile field before donning sterile gloves or with assistance from a unscrubbed team member. Team members who are not scrubbed should face the sterile field on approach, not walk between two sterile fields, and maintain a safety margin of at least six inches.

8. TEAM MEMBERS Unscrubbed people NEVER reach over a sterile field to transfer sterile items. When pouring solutions into a sterile basin, the assistant holds only the lip of the bottle over the basin, to avoid reaching over a sterile area. The scrubbed person sets cups or basins, to be filled, at the edge of the sterile table. The assistant stands near this edge of the table to fill them.

9. POURING SOLUTIONS After opening a bottle of sterile solution, the contents must be used or discarded. The edge of the bottle is considered contaminated after the contents have been poured; therefore the sterility of the contents cannot be ensured if the cap is replaced.

10. RULES FOR PASSING Unscrubbed personnel face and observe a sterile area when passing it to ensure they do not touch it.

11. TABLES Only the top of a sterile, draped table is considered sterile. The edges and sides of the drape extending below the table level are considered unsterile. Anything that drops below the level of the table surface is considered unsterile and must be discarded.

12. BREAK IN STERILE TECHNIQUE Corrective action should occur immediately unless patient safety is compromised. If patient is at risk, correct the break in technique as soon as possible. Each institution should determine how break in technique should be reported and recorded, and the wound classification should be adjusted accordingly and documented in the record.

13. AORN (ASSOCIATION OF OPERATING ROOM NURSES) RECOMMENDED PRACTICES FOR MAINTAINING A STERILE FIELD Scrubbed persons should function within a sterile field. Sterile drapes should be used to establish a sterile field. Items should be used within the sterile field should be sterile. All items introduced to a sterile field should be opened, dispensed, and transferred by methods that maintain sterility & integrity A sterile field should be maintained & monitored constantly

14. AORN (CONTINUED) A sterile field should be maintained & monitored constantly All personnel moving within or around a sterile field should do so in a manner that maintains the sterile field. P&P’s for maintaining a sterile field should be developed, reviewed periodically, revised as necessary, and readily available in the practice setting. Association of Operating Room Nurses (2006). AORN, 83(2),402-416