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STERILE TECHNIQUE

ENSURING STERILITY

Sterile goods are stored in clean, dry areas.

Sterile items are handled with clean dry hands.

Sterile packages are laid on dry surfaces.

If a sterile package wrapped in absorbent material becomes damp or wet, it


is discarded. The package is considered unsterile if any part of it comes in
contact with moisture.

STERILE PACKAGING

The integrity of sterile package is destroyed by perforation; puncture or


soaking of moisture through non-sterile layers to sterile layers or vice versa.

Package expiration date for sterility must be checked just prior to opening it.

In opening sterile packages a margin of safety is always maintained.

The last flap is pulled toward the person opening the package away from the
non-sterile hand.

The inside of a wrapper is considered sterile. The circulating nurse opens top
flap away from self, then turns the sides under. The ends of the flaps are
secured in the hand so they do not dangle loosely. The last flap is pulled
toward the person opening the package, thereby exposing the package
contents away from the unsterile hand.

The flaps on peel-open packages should be pulled back, not torn, to expose
the sterile contents. The contents should not be permitted to slide over the
edges.

Sterile persons lift contents from packages by reaching down and lifting them
straight up, holding their elbows high.

Only the interior surface level of the cover is considered sterile.

Items should be used within the sterile field should be sterile.

Supplies for scrubbed personnel; obtain sterile items by opening them onto
the sterile field before donning sterile gloves or with assistance from a
unsubscribed team member.

THE STERILE FIELD

Only the top of a sterile, draped table is considered sterile.

The edges and sides of the drape extending below the table level are
considered unsterile.

Anything that drops below the level of the table surface is considered
unsterile and must be discarded.

If solutions soak through a sterile drape to an unsterile area, the wet area is
covered with impervious sterile drapes or towels.

Team members who are not scrubbed should face the sterile field and
maintain a safety margin

of at least six inches and observe a sterile area when passing it to ensure
they do not touch it.

Unscrubbed team members should never reach over a sterile field to transfer
sterile items.

When pouring solutions into a sterile basin, the circulating hold only the lip of
the bottle over the basin, to avoid reaching over a sterile area.

The scrubbed person sets basins to be filled at the edge of the sterile table.
The assistant stands near this edge of the table to fill them.

A sterile field should be maintained and monitored constantly.

Sterile persons stand back at a safe distance from operating bed when
draping the patient.

Sterile persons pass each other back to back at a 360-degree turn.

Sterile persons turn their backs to an unsterile person or area when passing.

Sterile persons face a sterile area to pass it.

Movement within and around a sterile area is kept to a minimum to avoid


contamination of sterile items or persons.

Sterile persons do not lean on sterile tables or on the draped patient.

Sitting or leaning against an unsterile surface is a break in technique.

The circulating nurse restricts to a minimum all activity near the sterile field.

The SURGINAL SCRUB


The surgical scrub is the process of removing as many microorganisms as
possible from the hands and arms by mechanical washing and chemical
antisepsis before participating in a surgical procedure. Despite the
mechanical action and the chemical antimicrobial component of the scrub
process, skin is never sterile.
SURGICAL SCRUB PROCEDURE
1.

Wet the hands and forearms

2.

Apply antiseptic agent from the dispenser to the hands.

3.

Wash the hands and arms thoroughly to 2 inches above the elbows,
several times. Rinse thoroughly under running water with the hands upward,
allowing water to drip from the flexed elbows.

4.

Take a sterile brush or sponge (from a package or dispenser) and apply


an antiseptic agent ( if it is not impregnated in the brush). Scrub each
individual finger, including the nails, and the hands, a half minute for each
hand.

5.

Hold the brush in one hand and both hands under running water, and
clean under the fingernails with a disposable plastic nail cleaner. Discard the
cleaner after use.

6.

Again scrub each individual finger, including the nails and the hands
with the brush, half a minute for each hand.

7.

Be sure to keep both arms in the upright position (careful not to touch
the faucet!) so that all water flows off the elbows and not back down to the
freshly scrubbed hands. Bring arm through the water once, starting with the
fingers, then pull the arm straight out. Do not let water run down to hands,
must drip off elbow.
DRYING THE HANDS AND ARMS

1.

Reach down to the opened sterile package containing the gown, and
pick up the towel. Be careful not to drip water onto the pack. Be sure no
one is within arms reach.
2.
Open the towel full-length, holding one end away from the nonsterile
scrub attire. Bend slightly forward.
3.
Dry both hands thoroughly but independently. To dry one arm, hold the
towel in the opposite hand and, using the oscillating motion of the arm, draw
the towel up to the elbow.
4.
Carefully reverse the towel, still holding it away from the body. Dry the
opposite arm on the unused end of the towel

GOWNING AND GLOVING TECHNIQUES


1.

Reach down to the sterile package and lift the folded gown directly
upward.

2.

Step back away from the table into an unobstructed area to provide a
wide margin of safety while gowning.

3.

Holding the folded gown, carefully locate the armhole.

4.

Holding the inside front of the gown just below the neckline with both
hands, let the gown unfold, keeping the inside of the gown toward the body.
Do not touch the outside of the gown with bare hands.

5.

Holding the hands at shoulder level, slip both arms into the armholes
simultaneously.

6.

The circulating nurse brings the gown over the shoulders by reaching
inside to the shoulder and arm seams. The gown is pulled on, leaving the
cuffs of the sleeves extended over the hands. The back of the gown is
securely tied or fastened at the neck and waist, touch the outside of the
gown at the line of ties or fasteners in the back only.

CLOSE GLOVING TECHNIQUE


1.

Using the right hand and keeping it within the cuff of the sleeve, pick
up the left glove from the inner wrap of the glove package by grasping the
folded cuff.

2.

Extend the left forearm with the palm upward. Place the palm of the
glove against the palm of the left hand, grasping in the left hand the top
edge of the cuff, above the palm. In correct position, glove fingers are
pointing toward you and the thumb of the glove is down

3.

Grasp the back of the cuff in the left hand and turn it over the end of
the left sleeve and hand. The cuff of the glove is now over the stockinet cuff
of the gown, with the hand still inside the sleeve.

4.

Grasp the top of the left glove and underlying gown sleeve with the
covered right hand. Pull the glove on over the extended right fingers until it
completely covers the stockinet cuff.

5.

Glove the right hand in the same manner, reversing hands. Use the
gloved left hand to pull on the right glove.