One of the most important responsibilities of the perioperative nurse is the ability to recognize common breaks in sterile technique. Understanding the most common breaks in sterile technique may prevent future breaks and promote extra vigilance.
Common breaks in sterile technique that can increase a patient's risk of infection often occur during sterilization, opening and setting up the sterile field, delivering solutions to the sterile field, moving draped tables, setting up sterile supplies, and draping.1
Sterilization
Ensure that all sterile packages and trays are inspected prior to opening them on a sterile field. Inspect packages for wet spots or tears. Check the sterilization indicator in the sterile package to confirm the distinctive color pattern ensuring the sterilization process is adequate.1,2 Any problems with the sterile packages or trays should be reported to the central processing department as it may indicate a larger issue.
Opening and setting up
The process of opening and setting up requires concentration and should never be hurried. All items introduced to the sterile field should be opened, dispensed, and transferred by methods that maintain both sterility and integrity.2 Unsterile individuals should not touch or reach over a sterile field, and all items delivered to the sterile field should follow this directive. A good rule of thumb is to hand the item directly to a scrub person to avoid inadvertently contaminating the field.1
Delivering solutions onto the sterile field
Delivering solutions onto the sterile field may not be easy. The scrub person should place the labeled container near the edge of the table, while the circulating nurse slowly pours the solution to avoid splashing. The label should face the scrub person.2 Any remaining fluid should be discarded as the edge of the container is considered contaminated after the contents have been poured.2
Moving draped tables
Only the top surface of a draped table is considered sterile.2 The circulating nurse should always move the table by grasping below the sterile drape. If the scrub person needs to move the table, he or she should push on the top of the table with gloved hands and not the underside of the table.1
Leaving sterile supplies open
Due to the risk of contamination, sterile fields should not be covered.2 This raises the question, how long is it safe to leave the setup open? There is no specified amount of time that a setup can remain open and unused and still be considered sterile. The sterility of an open field is event-related, and the field requires continuous observation.2
Draping
Draping is very important for minimizing the chance of breaks in sterile technique.1 The principle is simple: sterile drapes are used to establish a sterile field to operate.2 All personnel moving in or around a sterile field should do so in a way that maintains the sterile field without contaminating it. Nonscrubbed personnel should maintain a distance of at least 12 in (30.5 cm) from all parts of the sterile field and sterile staff members.2
Next steps
There are many ways in which breaks in sterility may occur even with the most conscientious perioperative practitioners. Perioperative nurses can prevent these breaks, however when they remain vigilant of best practices.
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