This document provides guidelines for maintaining sterile technique. Some key points are: - Items must be either sterile or contaminated, there is no in-between. Green indicates sterile and red indicates contaminated. - Personnel working in sterile fields must perform surgical hand antisepsis to reduce microorganisms. - Sterile items and packages must be handled cleanly and stored in dry areas to maintain sterility. Moisture can compromise sterility. - The integrity of sterile packaging and drapes must not be breached through punctures, tears or moisture passing through layers.

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
I. Scrubbed persons should function within a
sterile field.
II. Sterile drapes should be used to establish a
sterile field.
III. Items should be used within the sterile field
should be sterile.
IV. All items introduced to a sterile field should be
opened, dispensed, and transferred by methods
that maintain sterility & integrity
V. A sterile field should be maintained &
monitored constantly

14. AORN (CONTINUED)
I. A sterile field should be maintained &
monitored constantly
II. All personnel moving within or around a sterile
field should do so in a manner that maintains
the sterile field.
III. 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