Journal Article

Guideline Quick View: Sterile Technique

2024

Overview

PUTTING ON GOWNS AND GLOVES * Select a surgical gown that provides adequate barrier protection as determined by the: - team member's role - type of procedure (minimally invasive versus open) - anticipated blood loss - anticipated volume of irrigation - anticipated patient contact - length of the procedure - probability of handling hazardous medications * Select a surgical gown that wraps around the body and completely covers the wearer's back. * Perform surgical hand antisepsis before putting on a surgical gown and sterile gloves. * Prevent contamination when donning a sterile gown by: - following the manufacturer's instructions for use (IFU) - placing and opening the surgical gown away from the sterile field - avoiding putting sterile gloves on top of the open surgical gown - ensuring hands and arms are dry before putting on the surgical gown - only touching the inside of the gown when putting it on - only touching the sterile glove wrapper after the surgical gown has been put on * Wear two pairs of sterile gloves and use a perforation indicator system when scrubbed into the sterile field. * Cover the surgical gown cuffs with the gloves. * Change surgical gloves: - every 60 to 150 minutes - when known or suspected contamination occurs - when a defect or perforation is identified or suspected - after touching » methyl methacrylate » a C-arm » drapes used to protect the sterile field from contamination during lateral movement of the C-arm » a surgical helmet or visor » optic eyepieces on a microscope * Avoid using penetrable materials (eg, sterile towels) to manipulate or hold unsterile items (eg, cell phones). * Surgical gowns are tested by the manufacturer for liquid barrier protection and labeled with barrier level properties (ie, levels 1 [lowest] to 4 [highest]) based on the anticipated risk of exposure. PREPARING THE STERILE FIELD AND DRAPING * Prepare the sterile field as close as possible to the time of the procedure. * Avoid moving the sterile field to another room once it is set up. * Keep sterile fields and instrumentation separate for procedures that involve more than one wound classification (eg, clean, clean-contaminated, contaminated, dirty). * Prepare sterile fields according to the health care organization's process when using isolation technique. * Place sterile drapes as close as possible to the time of the procedure and in accordance with the manufacturer's IFU. * Avoid leaning or reaching across an unsterile area when placing surgical drapes. * Shield gloved hands by cuffing the sterile drape. * Avoid moving the drapes once they are placed. * Use a nonperforating device when securing surgical equipment (eg, tubing, cords) to the drapes. * Consider any item that falls below the level of the sterile field to be contaminated. * Several different kinds of sterile drapes are used in the perioperative environment. OPENING AND HANDLING STERILE ITEMS * Inspect the packaging of sterile items for: - sterility of the contents, as noted on the packaging - package and product integrity - the expiration date, when applicable - chemical indicator changes (eg, color change) * Present sterile items directly to the scrubbed person or place them securely on the sterile field. * Present heavy or sharp items directly to the scrubbed person or place them on a separate surface. * Inspect rigid sterilization containers for intact, secure latch filters; intact external locks, valves, and tamper-evident devices; and the correct color change to external chemical indicators. * Examine wrapped sterile packages for intact tape and the correct color change for the external chemical indicator before opening. * Examine paper-plastic pouches (ie, peel pouches) for intact seals and chemical indicators. * Prevent items from sliding over the unsterile edges of the pouch by pulling back on the flaps without touching the inside of the package. * Inspect instruments for retained bioburden and debris after they are opened to the sterile field. * Consider instruments to be contaminated if debris, moisture (except when immediate-use sterilization cycles are used), or damage is present. * When a contaminated instrument is found, consider the entire instrument set to be contaminated. * Transfer medications and solutions to the sterile field by: - opening them as close as possible to the time of use - transferring them in a slow, controlled manner using a sterile transfer device (eg, sterile vial spike) and in accordance with the manufacturer's IFU - only removing the medication vial stopper if it is designed for removal - pouring them in a container that is near the sterile table's edge or held by the scrubbed person - pouring them only once * Inspecting items (eg, peel packed items, wrapped sterile packages) before they are presented to the sterile field helps determine if the item is sterile or if its damaged or compromised. MAINTAINING THE STERILE FIELD * Cover the sterile field with a drape in a way that prevents contamination if the sterile field will not be used immediately (eg, procedural delay). * Refer to the organization's standard procedure regarding circumstances that might necessitate the sterile field being covered, how it is covered, and the length of time it should be covered. * If the OR has a unidirectional air delivery system, position the surgical site and instrument tables within the airflow curtain. * Place heater-cooler devices (HCDs) outside the air curtain of the unidirectional air delivery system and direct the airflow exhaust away from the sterile field. * Educate perioperative team members on the safe use of HCDs and the interventions to decrease the risk of infections associated with those devices. * Implement isolation technique as part of a surgical site infection bundle during colorectal surgeries. * Use a wound protector for open or hand-assisted abdominal procedures in which the gastrointestinal or biliary tract is accessed. * Prevent the risk of cross contamination when using a C-arm by: - considering the top of the C-arm drape to be contaminated immediately after draping - maintaining sterility of

• Publisher: John Wiley & Sons, Inc
• Subject: Gloves / Guidelines as Topic / Hands / Humans / Packaging / Perioperative / Practice Guidelines as Topic / Sterilization / Sterilization - methods / Sterilization - standards / Surgery