Principles and Practices of Surgical Asepsis

All objects used in a sterile field must be sterile.

  1. All articles are sterile appropriately by dry or moist heat, chemicals, or radiation before use.
  2. Always check a package containing a sterile object for intactness, dryness, and expiration date. Sterile articles can be stored for only a prescribed time; after that, they are considered unsterile. Any package that appears already open, torn, punctured, or wet is considered unsterile.
  3. Storage areas should be clean, dry, off the floor, and away from sinks.
  4. Always check chemical indicators sterilization before using a package. The indicator is often a tape used to fasten the package or contained inside the package. The indicator changes color during sterilization, indicating that the contents have undergone a sterilization procedure. If the color change is not evident, the package is considered unsterile. Commercially prepared sterile packages may not have indicators but are marked with the word sterile.

Sterile objects become unsterile when touched by unsterile objects.

  1. Handle sterile objects that come will touch open wounds or enter body cavities only with sterile forceps or sterile gloved hands.
  2. Discard or resterilize objects that come into contact with unsterile objects.
  3. Whenever the sterility of an object is questionable, assume the article is unsterile.

Sterile items that are out of vision or below the waist level of the nurse are considered unsterile.

  1. Once left unattended, a sterile filed is considered unsterile.
  2. Sterile objects are always kept in view. Nurses do not turn their backs on a sterile flied.
  3. Only the front part of a sterile gown (from the waist to the shoulder) and 2 inches above the elbows to the cuff of the sleeves are considered sterile.
  4. Always keep sterile gloved hands in sight and above waist level; touch only objects that are sterile.
  5. Sterile draped tables in the operating room or elsewhere are considered sterile only at surface level.
  6. Once a sterile field becomes unsterile, it must be set up again before proceeding.

Sterile objects can become unsterile by prolonged exposure to airborne microorganisms.

  1. Keep door closed and traffic to a minimum in areas where a sterile procedure is being performed, because moving air can carry dust and microorganisms.
  2. Keep areas in which sterile procedures are carried out as clean as possible by frequent damp cleaning with detergent germicides to minimize contaminants in the area.
  3. Keep hair clean and short or enclose it in a net to prevent hair from falling on sterile objects. Microorganisms on the hair can make a sterile field unsterile.
  4. Wear surgical caps in operating rooms, delivery rooms, and burn units.
  5. Refrain from sneezing or coughing over a sterile field. This can make it unsterile because droplets containing microorganisms from the respiratory tract can travel 1 m (3 ft). Some agencies recommend that masks covering the mouth and the nose should be worm by anyone working over a sterile field or an open wound.
  6. Nurses with mild upper respiratory tract infections refrain from carrying out sterile procedures or wear masks. When working over a sterile field, keep talking to a minimum. Avert the head from the field if talking is necessary.
  7. To prevent microorganisms from falling over a sterile field, refrain from reaching over a sterile field unless sterile gloves are worn and refrain from moving unsterile objects over a sterile field.

Fluids flow in the direction of gravity.

  1. Unless gloves are worn, always hold wet forceps with the tips blow the handles. When the tips are held higher than the handles, fluid can flow onto the handle and become contaminated by the hands. When the forceps are again pointed downward, the fluid flows back down and contaminates the tips.
  2. During a surgical hand wash, hold the hands higher than the elbows to prevent contaminants from the forearms from reaching the hands.

Moisture that passes through a sterile object draws microorganisms from unsterile surfaces above or below to the sterile surface by capillary action.

  1. Sterile moisture-proof barriers are used beneath sterile objects. Liquids (sterile saline or antiseptics) are frequently poured into containers on a sterile filed. If they are spilled onto the sterile field, the barrier keeps the liquid from seeping beneath it.
  2. Keep the sterile covers on sterile equipment dry. Damp surfaces can attract microorganisms in the air.
  3. Replace sterile drapes that do not have a sterile barrier underneath when they become moist.

The edges of a sterile field are considered unsterile.

  1. A 2.5-cm (1-in) margin at each edge of an opened drape is considered unsterile because the edges are in contact with unsterile surfaces.
  2. Place all sterile objects more than 2.5 cm (1 in.) inside the edges of a sterile field.
  3. Any article that falls outside the edges of a sterile field is considered unsterile.

The skin cannot be sterilized and is unsterile.

  1. Use sterile gloves or sterile forceps to handle sterile items.
  2. Prior to a surgical aseptic procedure, wash the hands to reduce the number of microorganisms on them.

Conscientiousness, alertness, and honesty are essential qualities in maintaining surgical asepsis.

  1. When a sterile object becomes unsterile, it does not necessarily change in appearance.
  2. The person who sees a sterile object become contaminated must correct or report the situation.
  3. Do not set up a sterile field ahead of time for future use.

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