The purpose of creating a sterile field is to reduce the number of microbes present to as few as possible. The sterile field is used in many situations outside the operating room as well as inside the operating room when performing surgical cases. Sterile fields should be used outside the operating room when performing any procedure that could introduce microbes into a patient. A few examples of this would be inserting a Foley Cather, an arterial line, and a central line. Inside the operating room, sterile fields are created when practitioners identify the back table that will be used, the mayo stand that will go up to the field, and finally the patient and the surgical site itself.
Sink/automatic sink, sterile scrub brush with nail pick, antiseptic soap, and sterile gown/gloves drying towel.
Anyone that is performing an invasive procedure requires a sterile technique.
Sterile fields should always be established as close as possible to the time of the procedure and should not be left unattended. When a sterile field is opened and exposed for a long time before the procedure, the risk is higher for the items to get contaminated from airborne microbes. If left unattended the risk is higher such that someone might have accidentally contaminated the field. Both of these put the patient at risk for a hospital-acquired infection (HAI).
It is important to arrange the furniture before opening supplies when creating a sterile field in the operating room, because of kicking up microbes as you are moving around. The furniture should be 12 to 18 inches from the walls or any objects that could contaminate the field.
Place the back table, ring stand and mayo stand in their locations before opening items. Before opening any supplies, all packages must be checked to ensure the integrity of the packaging materials. There should not be any holes or tears in the outside wrappers. If the integrity is intact, then it is safe to proceed with placing the back table pack on the back table (this item is always opened first). The back table allows a large surface to open all other supplies onto it during set-up and is the main sterile field. Once the back table cover is opened, it is important to note that an imaginary 1-inch border exists along the edges of the table. This border is considered unsterile and should be avoided when tossing items onto the field; another area considered unsterile is anything below table height. Once the back table is opened, bend down and move the table closer to the wall by grasping the lower leg of the table. This allows less chance of someone contaminating the table and gets it out of the way.
The next item is the ring stand that will hold the basin sets; open the first flap away from you, then each side flap, and lastly the flap closest to you. Bend down and marry (move) the ring stand closer to the back table and close the space between them. The sterile flap will be against the back sterile table drape.
Open up sterile supplies needed for the procedure; open peel packs by checking the integrity of the package, identify there is an indicator in the package, and that the indicator has changed color. The indicator only informs us that the items have been exposed to a sterilant. Open wrapped items by performing the same method used with the basin set; open the flap away from you first, then the sides, and finally, the flap closest to you. When opening peel packed items, ensure there is an indicator and that it has turned color. Open the peel pack and do not slide any item near the edges of the wrapper, the one-inch border exits for peel pack items as previously discussed. When flipping the items into the basin or onto the back table, be careful not to extend your arm over the sterile field.
To open the instrument trays, ensure there is a plastic lock that identifies an indicator change, a label with the Julian date, and load number and make sure it is the correct set for the procedure. Look at the outside container for any moisture or condensation; if there is moisture, do not use and retrieve another set. If there is not any condensation, then proceed by grasping the latches and flip open, this will automatically break the plastic locks. Lift the lid straight up and step back before flipping the lid over; this will ensure that dust or particles will not fall into the tray. Once you flip the lid over, check again for moisture and remove the paper filter. To check the filter for any holes, lift it toward a light to ensure there are not any pin size holes. If the filter looks good then careful look into the pan for an indicator; do not lean over the pan. If you cannot see an indicator, you will look more closely after you are gowned and gloved. Until you are scrubbed in the instruments are complete for now; once you are gowned and gloved, you will carefully pick up the inside basket and hold it in front of you until the circulating nurse checks the bottom filter and checks the bottom of the tray for moisture. This is also a good time to find the inside indicator. If you cannot find an indicator, do not use the tray. Once the nurse verifies the instrument tray and you see an indicator, you can proceed to place the instruments on the back table.
Finally, open a gown and gloves for yourself on the mayo stand. The gowns’ wrapper will serve as a small sterile field to open your gloves and towel. This is where you will come to first after performing your surgical scrub and will dry, gown and glove.
Once all the necessary items are opened, it is time to complete the next step, the surgical hand scrub. Hand hygiene is the most important item you can perform to prevent infections.
The surgical hand scrub can be accomplished in one of two ways: the 5-minute scrub or the counted brush stroke method.
Hand washing is now considered an event-related practice, which is performed before and after specific tasks. Handwashing should last 15 seconds up to a minute or more if the hands get very dirty.
Always perform a hand wash before performing a surgical scrub. The surgical scrub purpose is to reduce microbes to the absolute minimum and is always completed right before gowning and gloving or any invasive procedure. It is not possible to sterilize a person’s skin, but reducing the number of microbes to a minimum is paramount.
Before starting the scrub ensure the scrub top is tucked into the scrub pants, and avoid splashing water on the scrubs. Bacteria can easily harbor in moist environments.
The Counted Scrub Method
Make sure you do not touch any surface already scrubbed, if you accidentally bump the sink or touch your skin where scrubbed, you must scrub that area for an extra minute.
After both arms are scrubbed, rinse the hands and arms by passing through the running water in a one-way direction. Once the arm has passed through the water, raise the arm to the same height as before with hands above the elbow to allow the water to drip down and off the elbow. The purpose of this is to allow the water to go from the cleanest area to the lesser clean area. If you need to pass through again with the same hand and arm, it is fine to do so to ensure all soap residuals are removed. Repeat for the other hand and arm.
Once the scrub is complete, you cannot touch any non-sterile surface, if you do you must re-scrub. Proceed to where the gown and gloves were opened by holding arms above the elbows and arms away from scrubs.
The Timed Scrub
After both arms are scrubbed, rinse the hands and arms by passing through the running water in a one-way direction. Once the arm has passed through the water, raise the arm to the same height as before with hands above the elbow to allow the water to drip down and off the elbow. The purpose of this is to allow the water to go from cleanest area to the lesser clean area. If you need to pass through again with the same hand and arm, it is fine to do so to ensure all soap residuals are removed. Repeat for the other hand and arm. Once the scrub is complete, you cannot touch any non-sterile surface, if you do you must re-scrub.
Proceed to where the gown and gloves were opened by holding arms above the elbows and arms away from scrubs.
Breaks in aseptic techniques or contamination of sterile field or supplies cause complications.
Using a sterile technique reduces the microbial count. This creates a sterile field and prevents infection.
All healthcare workers including nurses who assist physicians and surgeons should be fully aware of the importance of sterile techniques. Breaks in the technique can lead to infections in the patient, which leads to higher costs of healthcare. An infectious disease team should routinely audit all physicians and nurses involved in sterile procedures to ensure proper protocol is followed.
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