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Definition of terms Sterile means while asepsis means microorganisms disease.

methods operating free absence of of

Drapes, with

basins, a sterile packages.

sponges stock room The

are obtained from microorganisms including the pores that inside to of cause the

instruments used are sterilized and are placed in a sterile table. Any person who holds should the be sterile very in equipments important

Sterile techniques are employed room prevent organisms

cautious to maintain sterility. One consideration implementing sterility is this: IF YOU ARE IN DOUBT ABOUT THE STERILITY OF A CERTAIN OBJECT, CONSIDER IT UNSTERILE. Any suspected or known unsterile items should not be placed the sterile field.


throughout the surgical procedure. It is very important for nurses to know and understand the principles governing safety of operation. When are sterile for techniques an invasive sterility the to promote during patient

Any sterile package found in an unsterile or contaminated area is considered unsterile. If the actual timing or is

used or applied? 1. Preparation procedure 2. In preparation of the sterile team to handle sterile supplies and contact to the surgical site (gowning, scrubbing) 3. Skin preparation and draping of the patient 4. Sterility maintenance throughout the operation Principles of Sterility



undetermined and the nurse is unsure about the sterilization process, sterilized procedure the with the are equipments suspected considered



contaminated. A sterile table which has been touch or rubbed accidentally by an unsterile person or vice versa is no longer considered sterile. If the packaging material is broken or has missing pieces it is no longer sterile.

Principle Number 1: Only sterile items are used within the sterile field.

Microorganisms is damp or

can wet.


Principle Number 3: Tables are only sterile at Table Level

packed sterile package when it Thus, damppackages are unsterile.

Edges and sides of the table drape level is are also considered considered contaminated. Below the table unsterile.

A sterile package dropped on a floor is considered contaminated.

Any sterile person who touches a part of the drape hanging below the table level is considered unsterile. Any object or equipment that drops below the table surface is considered contaminated. In unfolding and placing a

Principle When

Number a

2: Sterile gown, the

persons are gown and gloved. wearing considered sterile area is the part where you can see in front down to the level of the sterile field. Thus, gowns are only considered sterile in front of the chest, sleeves above the elbow to the cuffs down to the level of the sterile field. Certain methods should be employed in the OR:

sterile drape any portion of that falls below the table surface is unsterile and should not be moved or touched or brought back up to the level of the table.

Gowning is not done on the sterile table to avoid dripping water onto the sterile equipments. Gloving and selfgowning should be done in a distinct sterile surface. Stockinette cuffs of the gowns are absorbent and may retain moisture, thus making to it a in. be suitable area for bacteria or microorganisms stockinette inserted gloves. thrive should the because of the said principle, cuffs beneath sterile

To prevent cords and tubing from sliding to the edge of the table, it should be fastened with a non-sharp device or object.



4: Sterile

Persons Touch ONLY Sterile Items while Unsterile OR Personnel Touch Only Unsterile Items

Sterile OR personnel comes in direct contact with persons who wears gowns and gloves only. The items that they will touch are the sterile equipments. Any supply brought by an unsterile

staff should transfer the item in a sterile manner.






unsterile table the scrub person personnel drops the sterile drape at the center of the table while holding the fan-folded drape high and standing back from the table to protect the sterile gown. 5: Unsterile avoid an Sterile gloves are protected by cuffing a drape. The sterile OR personnel should place the gloved hands inside the sterile part of the drape.



(circulator), should not directly come in contact with a gowned and gloved person. Principle field and Number sterile or

persons avoid reaching over sterile persons touching leaning over

unsterile area.

In cases where a solution has to be basin, poured the into a unsterile sterile OR

The scrub person unfolds the drape towards him or herself first to allow him or her to move closer to the table when working on the opposite side of the table since the first part of the unfolded drape now protects the sterile gown.

personnel should only hold the lip of the bottle over the basin to prevent any contact with the sterile area.

To prevent the circulator from reaching over a sterile area when pouring solutions, the

Principle anything

Number that

6: Edges


scrub person places the basin and glasses or any container for solutions near the edge of the table. This prevents the circulator from reaching over the sterile area by just standing nearthe edge of the table to fill the container with the liquid solution.



contents are considered unsterile

Sterile supplies are packed. In opening sterile packages, the area within 1 inch from the edges is considered unsterile. Supplies are handled by the circulator. The upper portion of the package is flapped away from the self and turns the side under. In doing so, the end of the flaps is the it secured from by the to band of prevent circulator





their brows, he or she should to turn away from the sterile field and have the sweat removed by the circulator.


loosely. The other flap is pulled towards the circulator; hence, the contents are exposed yet away from the unsterile hands.

environment, The practice

the of

higher covering

the a

possibility of contamination. sterile set-up does is not in the best interest of the patient. Sterility cannot be guaranteed by just covering a sterile setup, unless it is under a a the constant

To open a sterile package, the flaps sterile on peel-open packages be should be pulled not torn. The contents should flipped and lifted upward. The circulator should prevent the sterile contents to slide over the unsterile edges. When lifting contents from

surveillance. and uncovering contaminate

Covering table


sterile items. personnel Principle Number 8: Sterile areas are continuously kept in view.



should lift the object straight up while holding their elbows high.

Sterility cannot be guaranteed by just covering a sterile setup, unless it is under a constant surveillance.





wrapper is used as a table cover instead of a drape, it should cover the entire table surface. surface Sterile cannot Only of the the interior is

Sterile persons should face the sterile area. While waiting for the patient to come inside the OR, someone must stay in the sterile area to maintain vigilance on the sterile set-up. Direct sterility. observation ensures

wrapper when

considered sterile.

bottles be

opened without pouring

recap the


edges. Thus, all contents must be used or in cases where there is still a solution left, it should be discarded. Principle Number 7: Sterile field is set-up just before a surgical procedure

Principle area.


9: Sterile

persons keep well within sterile In draping the patient, sterile persons stay at a safe distance from the operating table to to air and maintain sterility.

The longer a sterile item is exposed

Movements in a sterile area are done by passing with each other back to back at a 360 degree turn. When a sterile person passes by an unsterile person or area, he or she should turn back to maintain sterility. When sterile persons pass by a sterile field or area, they face towards it.

Unsterile personnel should have the knowledge on the proximity to the sterile field. They must be aware of their distance to the sterile area or field to A prevent contamination.

distance of at least 1 foot or 30 cm from a sterile field should be maintained and observed by the unsterile staff.

Unlike the sterile persons who turn their back towards the unsterile surface, unsterile personnel (circulator) face the sterile area (within 1 foot) when passing by to observe any and maintain the distance and to avoid objects. touching sterile

To the

prevent sterile

contamination asks to the step sterile

during movements in an area, person unsterile aside.

personnel inside



area is kept at a minimum to avoid contamination.

Sterile persons stay inside the sterile field or area.

All activity of a circulator should be kept to a minimum.



10: Sterile

Principle 12: Destruction microbial A sterile contamination packages by the of barriers

Number integrity result integrity of in is

persons keep in contact with sterile areas to minimum. Inside the operating room or within a sterile field the following are strictly observed:

destroyed instances:


Sterile persons avoid leaning over sterile tables or drapes. Sterile personnel who lean over or sit on an unsterile area is considered contaminated.

Perforation Puncture Strike-through soaking of moisture through unsterile or sterile layers or vice versa.



11: Unsterile

Before opening a sterile package to be used in a certain procedure or

persons avoid sterile areas

operation the package should be checked should thoroughly also be before in opening. The following principles employed handling packages:

Sterilization removing including be

is ALL




microorganisms bacterial The spores. following


However, not all things or area can sterilized. principles are employed to employ sterile technique in:

To prevent strike-through all sterile packages should placed on a dry surface. If any part be

Skin be very good source of

of the package

Skin cannot be sterilized thus, it can contamination in any operation. To prevent entrance of microorganism to the patients wound the following are done: 1. Surgical hand washing 2. Chemical antisepsis of the skin around the surgical site 3. Gowning and gloving 4. Application of sterile draping.

becomes damp or wet it is considered unsterile and should be discarded or re-sterilized.





should be dried before draped.

If the sterile drape is soaked with a solution the be covered wet with area an should drape.

impermeable sterile towels or Sterile items should be placed not only in clean but also in dry areas.

Air contains dust, droplets and that may cause Environmental


shedding sterile packages, also Thus, cause undue

In Air

handling can


the hands should be dried first.

control measures include: 1. Movement around the sterile field is kept to a minimum. 2. Drapes dusts. 3. Talking inside the operating room is kept to a minimum because moisture droplets are are not flipped and fanned to avoid the spread of


pressure on sterile packs should be avoided. This prevents the ejection of sterile air and the entry of unsterile air into the pack. Principle to irreducible minimum Number




into the

13: Microorganisms must be kept

mask when a person is talking.