Sterile Technique Study Guide PDF

**Page Title** **Content You Should Know** Module Outcome & Objectives **Outcome** On successful completion of the Sterile Technique module, 80% of nurses will be able to demonstrate knowledge related to how to prepare and maintain a sterile field, as evidenced by passing the posttest with a s...

**Page Title** **Content You Should Know** Module Outcome & Objectives **Outcome** On successful completion of the Sterile Technique module, 80% of nurses will be able to demonstrate knowledge related to how to prepare and maintain a sterile field, as evidenced by passing the posttest with a score of 80% or higher.  **Objectives** 1. Define surgical conscience.  2. Summarize the principles of sterile technique.  3. Describe how to open sterile items including containers, wrapped packages, and peel-pack items.  4. Describe the practices that recognize, address, and correct contamination of the sterile field.  Sterile Technique Principles - Prepare the sterile field in the location where it will be used. - Prepare the sterile field as close to the time of use as possible. - Open the sterile field for only one patient. - Use sterile items within the sterile field. - When in doubt about an item's sterility, consider the item to be contaminated. - A sterile field is contaminated when unsterile items come in contact with it. - A sterile gown is considered sterile from the chest to the sterile field and 2 inches above the elbow to the cuff. - Consider areas below the level of the instrument tabletop and the OR bed to be contaminated. - Cover the sterile field if it will not be used immediately or during periods of increased activity (eg, patient positioning). - Use surgical drapes to establish a sterile field. - Limit movement around and within the sterile field. For procedures with more than one surgical wound classification, prevent cross-contamination by keeping sterile fields and instrumentation separate. Hand Hygiene Hand hygiene is the single most effective measure to prevent the transmission of pathogenic microorganisms. Opening Sterile Items An item's packaging is inspected to verify that the package is intact and conditions for sterility have been met. Key indicators include: - Sterility - Package and product integrity - The expiration date - The expected chemical indicator changes How to Open a Rigid Container Perform the following steps when opening a rigid container: - Verify the container has intact external locks, secure latch filters, valves, and tamper evidence devices, and verify the correct color change to the external chemical indicators. - Lift the lid up and toward yourself while moving the lid away from the container. - The scrubbed person lifts the basket(s) out of the container without contacting the unsterile surfaces of the table or container with their sterile gown. - Before placing the instruments on the instrument table, the scrubbed person examines the internal chemical indicator for the correct color change and the inside of the container for debris, moisture, or contamination. - If there are filters at the bottom of the container, the unscrubbed person should inspect their integrity. How to Open a Small Wrapped Item - Inspect the wrapped package for intact tape and the correct color change for external chemical indicators. - Open the wrapper flap that's away from you and secure the flap in the hand that is holding the item. - Open the side flaps one at a time and secure the flaps in the hand that is holding the item. - Open the closest flap and present the item to the scrubbed team member. Inspect the wrapper for integrity (eg, no holes, tears, punctures) before the item is placed on the sterile field. Opening Techniques Peel packs are opened by doing the following: - Inspect the package and chemical indicator. - Release the corners of the peel pack at the chevron end. - Firmly hold each side of the peel pack at the chevron end and gently pull them apart. - Present the contents to the scrub person. - The contents do not touch the unsterile sides of the peel pack. Shelf-Life and Sterility are Event-Related Factors that affect event-related sterility include: - Packaging material quality - Storage conditions - How an item is transported from storage or immediate use steam sterilization to the point of use - The number of times and the way the item is handled - Environmental conditions of item storage Surgical Hand Antisepsis - Surgical hand antisepsis is performed to reduce the skin's resident and transient microbes. - A surgical hand scrub or surgical hand rub is performed before a sterile gown and gloves are put on. - **The product manufacturer's instructions for use are followed.** When Should Gloves be Changed? Gloves should be changed: - Every 60 to 150 minutes - When a visible or suspected perforation occurs or contamination is suspected - After touching a helmet hood or visor - After direct contact with bone cement - After touching microscope optics or fluoroscopy equipment - During use of hazardous medications - After a glove is caught on a wire or a drill bit Contamination and Mitigation If an instrument has any type of debris or retained organic material on it, the whole set is contaminated. When a contaminated item is discovered on the sterile field: - Remove all contaminated items from the sterile field. - Sterile gloves are changed by all members who touched the contaminated item(s). - Add drapes to the sterile field. - Replace instruments if needed. - Create a new setup. Covering a Sterile Field Open the sterile field as close as possible to the time of use. - Cover the sterile field if it is opened and will not be used immediately or during times of increased activity. - Cover and uncover the field in a manner that prevents contamination. - Portions of a sterile field can be covered when items will not be used immediately. How to Cover a Sterile Field Two-"cuffed" drape method - The first drape is placed with a cuff at the halfway point. - The second drape is placed from the opposite side and completely covers the cuff of the first drape. Traffic Rules Scrubbed Team Members - Face the sterile field. - Stay within the sterile field; avoid changing levels. - Always keep hands and arms above waist level and avoid placing hands in the axillary area. - Use the face-to-face or back-to-back methods of moving around the sterile field. - Keep conversation to a minimum. Unscrubbed Team Members - Face the sterile field. - Stay as far away from the sterile field and scrub person as possible. - Do not reach over the sterile field. - Do not walk between sterile fields. - Keep conversation to a minimum. **PRACTICE QUESTIONS** +-----------------------------------+-----------------------------------+ | **QUESTIONS** | **YOUR ANSWER** | +===================================+===================================+ | What is the name of the infection | | | preventionist(s) at your | | | facility? | | | | | | Describe a circumstance in which | | | you would need to contact them. | | +-----------------------------------+-----------------------------------+ | What is a PAPR? | | | | | | Which policy and procedure | | | addresses the use of the PAPR in | | | your facility? | | +-----------------------------------+-----------------------------------+ | What is the process for | | | medication transfer to the | | | sterile field? | | | | | | What type of sterile transfer | | | device is used? | | +-----------------------------------+-----------------------------------+ | Does your facility use a blue | | | wrap that has a different color | | | on its opposite side? | | | | | | Is the different color used for a | | | specific reason, for example, as | | | an indication that the set or | | | item is a loaner? | | +-----------------------------------+-----------------------------------+