Principles of Sterile Technique Maria Hrubes NUR 402, Spring 2014

ASEPTIC/STERILE TECHNIQUE

Categories of Breaks in Sterile Technique Type 1 – the break is recognized immediately Type 2 – the break is recognized shortly after it occurs Type 3 – the break is recognized later Type 4 – the break is not recognized at all

Principles of Sterile Technique (2013 AORN Recommended Practices) Recommendation 1 – Proper Attire Scrub attire – hospital laundered Long-sleeved jacket snapped closed w/ cuffs down to the wrists Surgical head covers that cover all hair & scalp skin, including facial hair, sideburns, and the hair at the nape of the neck

2013 AORN Recommended Practices Recommendation II – Selecting Gowns of Appropriate Size and Sleeve Length Gown large enough to adequately wrap around the body and completely cover the back Lower sleeves and gown cuffs should conform to the shape of the wearer’s body

2013 AORN Recommended Practices Closed Assisted Gloving Used at the initial gowning and gloving

2013 AORN Recommended Practices Recommendation III – Donning Sterile Gloves Open Assisted Gloving Used when closed assisted gloving is not possible

2013 AORN Recommended Practices Recommendation III – Donning Sterile Gloves Wear 2 pairs of surgical gloves, one over the other during cases with the potential for exposure to blood, body fluids or other infectious materials. Use perforation indicator system using colored pair worn beneath a standard pair of surgical gloves Changing the outer pair every 2 hours

2013 AORN Recommended Practices Recommendation III – Changing Sterile Gloves After each patient procedure When suspected or actual contamination occurs After touching surgical helmet system hood & visors After adjusting microscope When gloves begin to swell, expand, and become loose on hand as a result of fluids and fats

2013 AORN Recommended Practices Recommendation IV – Sterile Drapes Only the top surface of the sterile, draped area should be considered sterile. Items that fall below the sterile area should be considered contaminated

2013 AORN Recommended Practices Recommendation IV – Sterile Drapes Did you know? The upper portion of the C-arm drape should be considered contaminated

2013 AORN Recommended Practices Recommendation V – Sterile fields should be constantly monitored Once created, a sterile field should not be left unattended until the operation is completed. Observation increases the likelihood of detecting a breech in sterility.

2013 AORN Recommended Practices Recommendation V – Sterile fields should be constantly monitored The doors in the OR should not be taped closed as alternative to monitoring the sterile field

2013 AORN Recommended Practices Recommendation V – Covering sterile field, use 2 sterile “cuffed” drapes The 1st drape is placed with the cuff at the halfway point. The second drape is placed from the opposite side and completely covers the cuff of the 1st drape.

2013 AORN Recommended Practices Recommendation VI – Limit of movement within or around the sterile field Scrubbed team members should not leave the sterile field to retrieve items from the sterilizer. Scrubbed team members should wear lead apron when x-rays are needed so they will not leave the room.

2013 AORN Recommended Practices Recommendation VI – Limit of movement within or around the sterile field Scrubbed team members should keep their hands and arms above waist level at all times Arms should not be folded with the hands in the axillary area.

2013 AORN Recommended Practices Recommendation VI – Limit of movement within or around the sterile field Scrubbed team members should avoid changing levels and should be seated only when the entire procedure will be performed at that level.

2013 AORN Recommended Practices Recommendation VI – Limit of movement within or around the sterile field Unscrubbed personnel should face the sterile field on approach Should not walk between sterile fields or scrubbed persons Should maintain a distance of at least 12 inches from the sterile filed and scrubbed persons at all times

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