Sterile Technique Gail M. Maier, Ph.D., R.N. Associate Director, ED&R The Ohio State University Wexner Medical Center Hello, my name is Gail Maier. I am a nurse who is currently serving as Associate Director of the Department of Education, Development and Resources at the Medical Center. In the handwashing module, you learned about asepsis with a focus on medical asepsis, or clean technique. In this module, you will be learning about surgical asepsis or sterile technique. You will utilize sterile technique in a number of clinical procedures that will be performed throughout your medical education and career. Understanding principles of sterile technique and a comfort level with the use of it is critical to safe patient care.

Objectives for this program Describe the difference between medical and surgical asepsis. Describe the basic principles of sterile technique. Demonstrate the following skills: Opening a sterile field Add an item onto a sterile field Donning and removing sterile gloves The objectives of this program are that you will be able to: Describe the differences between medical and surgical asepsis. Describe the basic principles of sterile technique. Demonstrate opening a sterile field, adding an item onto a sterile field and donning and removing sterile gloves.

Medical and Surgical Asepsis Asepsis: a state of being free from pathogenic microorganisms Medical asepsis: “clean technique” Practices used to reduce and prevent the spread of pathogens Handwashing, use of clean gloves, cough etiquette Surgical asepsis: “sterile technique” Practices used to eliminate all microorganisms from an object or area Handling sterile instruments Invasive procedures Asepsis is a general term that signifies a state of being free from pathogenic (that is disease causing) microorganisms. There are 2 types of asepsis, medical and surgical. Medical asepsis, or “clean technique” include practices used to reduce and prevent the spread of pathogens. You will be practicing medical asepsis with each patient encounter when you use hand hygiene or when you don clean gloves prior to coming into contact with blood or other body fluids. Surgical asepsis, or “sterile” technique, consist of practices used to eliminate all microorganisms, pathogenic and nonpathogenic, from an object or area. Sterile technique is required when handling sterile equipment or performing invasive type procedures on a patient, such as inserting a sterile urinary catheter.

Principles of Sterile Technique If in doubt of sterility, assume it is not sterile All items within the sterile field must be sterile A one inch border surrounding the sterile field is considered non-sterile Anything below the waist is considered non-sterile Many students can become confused about when to use sterile technique and what can and cannot be touched during a sterile procedure. There are a number of important principles that can help guide your practice. If in doubt of sterility, assume it is not sterile. If you have any doubt of the sterility of a piece of equipment or a package that you are to use for a procedure, request a new package or piece of equipment. This is the best way to assure patient safety. All items within the sterile field must be sterile. Any piece of equipment that you place on a sterile field must also be sterile. When performing a sterile procedure on a patient, always remember to have a waste basket or plastic bag available to throw nonsterile items. On every sterile field, a one inch border surrounding the sterile field is considered non-sterile. There will be many times that you must set up a sterile field prior to donning sterile gloves. You may touch the one inch border with your ungloved hands. Anything below the waist is considered non-sterile. After donning sterile gloves, always keep your hands above your waist. Any sterile items that drops to the floor must remain there until the procedure is completed.

Principles of Sterile Technique Never turn your back on a sterile field Never reach over a sterile field Sterile objects can become non-sterile by prolonged exposure to airborne microorganisms Moisture passing through a sterile object contaminates the sterile field The skin cannot be sterilized and is non-sterile. Assure sterility of packages Check to see “sterile” on label Check for signs of contamination 5. Never turn your back on a sterile field. Always keep the sterile field in your field of vision so that you can be assured that sterility has been maintained constantly. 6. Never reach over a sterile field. This makes the entire field non-sterile. If you must reach for an item, you must go around the sterile field to retrieve it. 7. Sterile objects can become non-sterile by prolonged exposure to airborne microorganisms. Sterile fields should be set up shortly before they are to be used or covered by a sterile drape to reduce exposure to air. 8. Moisture contaminates the sterile field. Any type of moisture that is found on the sterile field contaminates the field. It is important that fluids for use in a sterile procedure are poured so that droplets do not contaminate the field. 9. The skin can never be sterilized so it is always considered non-sterile. You must touch the 1 inch border of the sterile field or the outside of a sterile package, but sterile gloves are required when touching sterile equipment. 10. Always assure sterility of sterile packages prior to using them. Packages, such as sterile surgical instruments will have a unique color of tape to signify sterility. Sterile packages that are not reusable, must be sealed prior to their opening. If the package has appeared to be opened, do not use it.  

Sterile Technique - Preparation The following steps should be taken prior to the start of any sterile procedure: Verify the procedure requires sterile technique Wash hands Identify the patient, inform the patient of the procedure and assure patient comfort Assemble equipment (assure sterility) Prepare equipment at bedside Prior to any procedure, verify that the procedure requires sterile technique. Most procedures that you will perform do not require sterile technique. Any procedure that is considered invasive almost always requires sterile technique.

Setting Up a Sterile Field Process

To review… To review the principles and practices just learned, please view the short video. Video Link: http://mns.elsevierperformancemanager.com/Content/Videos/Establishing%20and%20maintaining%20a%20Sterile%20Field/Player.html

Pouring a sterile solution onto the sterile field It is common for sterile solutions to be added to the sterile field. Keep bottle held away from the sterile field and bottle lip 2 inches above the inside of sterile container. Label of the bottle should be facing the ceiling Pour solution slowly to prevent spillage onto the sterile field Some procedures require the use of a sterile solution such as sterile saline. These solutions may be included in the sterile package. For example, the solution used in cleansing the patient prior to urinary catheter insertion, is included in the sterile kit. However, there may be other procedures where sterile solution must be added to a sterile container on the sterile field. The container of the sterile solution is non-sterile, so must be kept at least 2 inches above the sterile container. The 2 inch requirement keeps the bottle sufficiently away from the sterile container and also assures that there is no splashing of fluid onto the sterile field. The label of the bottle must be facing the ceiling. For patient safety purposes, the label of a container must always be clear and readable. Solution that would run down the container will smudge the writing on the container. Keeping the label face up will eliminate this problem. Pour the solution slowly into the container to prevent spills on the sterile field.

Applying/Removing Sterile Gloves One of the most common procedures you will perform is applying and removing sterile gloves. Obtain the correct sized gloves for your hands. Excessively smaller gloves will be difficult to apply risking contamination Excessively larger gloves will make it difficult to manipulate sterile objects Remember these basic rules: Sterile to sterile = sterile Sterile to unsterile = unsterile Sterile to unsure = contaminated In a previous module you learned about donning and removing clean gloves and other personal protective equipment. When a procedure requires sterile technique, you will don sterile gloves. It is vital that the sterility of the gloves be maintained so that the procedure remains sterile. Using the correct sized gloves for your hands is important as gloves that are too small will be difficult to don and run the risk of contamination. Gloves that are too large will make it difficult to manipulate sterile equipment which also run the risk of contamination. Typically medium size gloves are found within pre-packaged sterile containers. If you wear a different size, you will need to ask nursing or clinic staff for the correct size. To keep yourself from being contaminated remember: Sterile only touches sterile Clean only touches clean Contaminated only touches contaminated. Sometimes the trick is to remember what part of the glove is sterile, what is clean and what is contaminated. With practice, you will become more proficient.

Donning Sterile Gloves

Applying sterile gloves – A review To view an animation applying gloves, please watch: (will appear shortly in separate browser) Link: http://mns.elsevierperformancemanager.com/Content/Animations/GN_09_3/AnimationPlayer.html

Removing Sterile Gloves Process

In summary Many procedures in the ambulatory setting require the use of surgical asepsis. Surgical asepsis are the practices used to eliminate all microorganisms from an object or area Surgical asepsis will be used for all invasive procedures and when coming into contact with a sterile field or body system. Maintaining sterility of a sterile environment is only possible through following the correct principles of surgical asepsis. In summary, many procedures require the use of surgical asepsis. It is vital that you understand and follow the principles of surgical asepsis in order to deliver quality and safe patient care.

Thank you for completing this module If you have any questions, please contact me: Gail.Maier@osumc.edu

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