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Principles of Asepsis

  1. A sterile field is created for each surgical procedure
  2. Only sterile items are used in the sterile field. If an item is of questionable sterility, it should not be used. Any moisture present on an item, means the item is not sterile.
  3. Destruction of integrity of a microbial barrier results in contamination. Moisture that gets through a barrier, renders the item NOT sterile.
  4. The sterile field is located within the operating room as far as possible from doors and high traffic areas.
  5. The sterile field is created as close to the time of surgery as possible. Sterile items should not be covered for later use. Policy of the institution will dictate the timeframe for use of opened items/field.
  6. The sterile field is kept in view. All OR team members, sterile and nonsterile, will not turn their backs on the sterile field.
  7. Edges of wrappers are contaminated up to a 2 inch perimeter.
  8. Wrapper edges or drape edges that are below the table level, MUST NOT be brought back up.
  9. Table edges define the sterile area. Items below or beyond that table surface are nonsterile.
  10. Once placed, a sterile item or sterile drape may not be repositioned.
  11. Sealed edges of a peel pack are considered contaminated or nonsterile.
  12. A sterile package is opened away from the nonsterile individual.
  13. Nonsterile individuals and items (walls, furniture) must maintain a 12-18” distance from nonsterile items or areas. Preferably 18”.
  14. Nonsterile individuals or items may not touch, reach across, or pass over the sterile field.
  15. Nonsterile individuals or items may not pass between or be placed between two sterile fields.
  16. Sterile team members must be appropriately attired prior to entering the sterile field.
  17. Sterile persons must be properly attired, including PPE and scrub attire.
  18. Self-gowning is performed on a separate sterile surface to prevent contamination of the back table when entering the sterile field.
  19. Closed gloving is recommended when gowning and gloving yourself.
  20. The stockinette cuff of the gown is enclosed in the glove cuff.
  21. The sterile gown is considered sterile from the waist or table level to the mid-chest or nipple line in front of the gown. Hands and arms are considered sterile to 2 inches above the elbow. This is the “sterile-zone” of the surgical sterile gown.
  22. The back of a wrap around gown is NOT considered sterile.
  23. Sterile persons must keep their hands in sight at all times, within the sterile zone. Elbows are kept close at the sides and hands are never folded or placed in the underarm of the gown.
  1. Movement in and around the sterile field must not compromise the sterile field.
  2. Talking and movement within and around the sterile field are kept to a minimum.
  3. Sterile individuals must remain within the sterile area.
  4. Sterile individuals pass each other face-to-face or back-to-back, rotating 360º.
  5. Sterile individuals keep their backs to a nonsterile individual or area and allow at least 12 to 18” of space.
  6. Sterile individuals always face the sterile field.
  7. Sterile individuals are allowed to sit only when the entire procedure will be performed in the sitting position.
  8. Tubing and cords are secured to the sterile field with non-penetrating devices to prevent slippage and perforation or penetration of the sterile barrier or drape which would create contamination.
  9. Sterile individuals or items may only touch sterile items and reach or pass over the sterile field.
  10. Addition of sterile items to the sterile field is accomplished by a nonsterile team member. The item may be placed directly on the sterile field or secured by the surgical technologist in the scrub role.
  11. When transferring sterile solutions to the sterile field, only the lip of the bottle is positioned over the sterile container. The receiving sterile container will be placed at the edge of the sterile field. The bottle is held by the nonsterile person at least 12” above the receiving sterile container.
  12. Sterile team members must avoid leaning over the sterile field.
  13. When assisting a team member entering the sterile field, a safe distance is maintained, the gloved hands are protected by cuffing the towel, and gown over the hands to prevent contact with the nonsterile individual.
  14. Nonsterile surfaces that will have sterile drapes applied are draped first toward the sterile individual to avoid contamination of the gown and avoid reaching over the nonsterile area. The gloved hands are protected by cuffing the drape of the hands to prevent contact with the nonsterile area. Until the sterile drape is applied, the sterile individual must maintain a safe distance.

Breeching or Contaminating a Sterile Field

Three options:

  1. Ignore or disregard. Only an option if the patient’s life is at risk. Must be reported to the surgeon at appropriate time so that measures can be implemented, (i.e. prophylactic antibiotics). May not be a truly sterile case, but a “clean” case, (colonoscopy).
  2. Remove the contaminated item form the sterile field and replace it with a sterile one. Any item contaminated must be removed or covered (gloves). The circulator will generally assist with glove removal or removal of a contaminated item. The circulator or nonsterile person removing the soiled, contaminated item should have on appropriate PPE.
  3. Cover the contaminated item or area. Some items may not be removable. An impervious drape may be placed over the contamination to recreate a sterile field.