The Association of periOperative Registered Nurses (AORN) introduced the 2013 Perioperative Standards and Recommended Practices in March, featuring an enhanced focus on infection prevention through the practice of sterile technique. Perioperative nurses should be aware of which sterile technique practices are new, clarified, or reinforced.
* Recommendation I: Implement practices that reduce the spread of transmissible infections when working in the OR, an invasive procedure room, and when performing or assisting with operative or invasive procedures. Emphasis is on wearing clean surgical masks, head covers, or hoods that cover all hair and scalp, including facial hair, sideburns, and the hair at the nape of the neck.
* Recommendation II: Surgical gowns, gloves, and drape products should be evaluated and selected for safety, efficacy, and cost. Key emphasis includes clarifying and reinforcing the importance of wearing the appropriate gown sizes and sleeve lengths to ensure adequate coverage.
* Recommendation III: Perioperative personnel should use sterile technique when donning and wearing sterile gowns and gloves. The closed gloving technique is recommended for the initial person entering the sterile field. All other members of the scrubbed surgical team should be assisted in gowning and closed assisted gloving. Assisted open gloving techniques should be used if closed assisted isn't possible or practical. Key emphasis includes a stronger position for double gloving and the use of a perforation indicator system. In addition, it's now recommended to change gloves every 90 to 150 minutes.
* Recommendation IV: Sterile drapes should be used to establish a sterile field. When draping a sterile field, a plastic adhesive incise drape isn't recommended.
* Recommendation V: A sterile field should be prepared for patients undergoing surgical or other invasive procedures. Perform a surgical hand scrub, and don sterile gown and gloves when setting up supplies. Key emphasis includes reinforcing the practice of setting up two sterile fields on cases that involve the abdominal and perineal area. Isolation technique should be used for bowel and gastrointestinal (GI) surgery.
* Recommendation VI: Sterile fields should be monitored continuously. The recommendation emphasizes proper care and handling of instrumentation containing organic debris. If the case is delayed after the sterile field is set up, the sterile field should be covered using two sterile cuffed drapes.
* Recommendation VII: All personnel moving within and around a sterile field should do so in a manner that prevents contamination. A new recommendation includes keeping conversations to a minimum in the presence of a sterile field.
* Recommendation VIII: Perioperative team members should receive initial and ongoing education as well as competency validation on their understanding of the principles and performance of the processes for sterile technique. A new recommendation includes perioperative education to address human factors related to the principles and processes of sterile technique.
Elizabeth M. Thompson, MSN, RN, CNOR
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]
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