Aseptic Technique

1. Purpose

Direction and knowledge and application of skills required when developing

and maintaining sterile field using aseptic technique.

The principles of surgical sepsis are based on sound scientific values and
logical thought and are carried out to prevent the transmission of
microorganisms that can cause infection.

Aseptic technique refers to the activities of preparing creating and

maintaining a sterile field. The sterile field is defined as the area
immediately surrounding the draped patient, the sterile surgical personnel
and the sterile draped instrument tables/trolleys/equipment.

2. Application

This procedure is to be adhered to by all members of the Operating

Team in the WCDHB Operating Theatres.

3. Definitions

There are no definitions associated with this Procedure.

4. Responsibilities

For the purposes of this Procedure:

Staff Members are required to:

ensure they abide by the requirements of this Procedure.

5. Resources Required

This Procedure requires no specific resources.

6. Process

6.1. Personal within a sterile field shall wear sterile gowns and gloves

The nurse and other scrubbed personal shall

- complete an acceptable method of surgical hand wash
- complete and acceptable method of gowning and gloving
- immediately change gloves if the integrity of those gloves has been
compromised, or
the gloves have become contaminated
 - immediately change sterile gowns which have become
contaminated.

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 Aseptic Technique

6.2. Items used within a sterile field shall be sterile

The nurse and other members of the surgical team shall

- apply principles of event related sterility to the transport
storage handling and
dispensing of sterile items
- check the integrity of packaged items
- check the external and internal indicator and expiry date
of packaged items
- treat sterile articles which have a suspected lack of
integrity or leak of sterilization
indication to be unsterile
- consider that drapes or surgical supplies which fall
below the horizon surface of the
patient or instrument table to be unsterile
- consider sterile items dropped onto the floor and upon
other non sterile surfaces to be
unsterile
Note: Cleaning, packaging sterilization handling and
storage of sterile articles shall be in
accordance with the appropriate standards.
Note: Expiry dates placed on items by the manufacturers
must be checked

6.3. All items introduced onto a sterile field shall be opened

dispensed and transferred by methods
that maintain sterility and integrity

The nurse in the circulation role shall

- Inspect all sterile items prior to opening, to verify the
integrity of the packaging and
that the appropriate sterilisation process has been
completed
- present sterile items to be taken by the instrument nurse
- refrain from leaning over the sterile field to dispense
items or fluids
- consider the edges of sterile packaging to be non sterile
once the package is opened
- place and open large items and rigid containers on an
appropriate surface when
opening
- when opening a wrapped item, open the wrapper fold
furthest away first, the sides next
 and the nearest last
- with hand held items, secure all open wrapper edges to
avoid contamination when
sterile items are presented to the sterile field
- when dispensing fluids, pour slowly into receptacles
placed near the edge of the
instrument trolley or held by the instrument nurse
- pull open and not tear, peel pack items to expose
contents

The nurse in the instrument role shall

- remove items from packages that are presented by
lifting items straight up
- where appropriate, use an instrument to receive items
onto the sterile field thereby
maintaining sterility
- flipping items onto a sterile field is not an accepted
practice.

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 Aseptic Technique

6.4. Sterile drapes shall be used to create and maintain a sterile

field

The nurse in the instrument role shall

- establish an effective aseptic barrier by the correct
positioning of sterile drapes and
- ensure sterile drapes be placed on the patient, furniture
and equipment to be included
in the sterile field
- ensure that equipment introduced to, or over, the sterile
field shall be covered
appropriately with sterile drapes
- prevent contamination and strike though from fluid by
using impervious drapes
- ensures that surgical drapes are handled appropriately
by minimizing drape handling during the draping
procedure
by carrying folded drapes to the operative site holding
them above the waist to avoid
contamination
by unfolding drapes from operative site to the
periphery
by forming a cuff of the sterile drape over the
gloved hands to reduce the risk of
potential contamination
by ensuring positioned drapes are not moved, and are
secured to prevent movement
by securing drapes and surgical equipment with non
perforating devices

- discard contaminated drapes into a suitable receptacle

positioned close to the sterile
field utilizing standard precautions.

6.5. The sterile field, once established, shall be constantly

monitored

The nurse shall

- ensure that sterile fields are prepared as close as
possible to the time of use
- maintain direct observation of the sterile field to monitor
for possible contamination
- not leave a sterile field unattended
 - not use a cover as a means of maintaining an unattended
sterile field.

6.6. Movement of personal and equipment within or around the

sterile field shall be minimal and
deliberate in order to maintain the integrity of the sterile
field

Scrubbed personnel shall

- remain close to the sterile field
- touch only sterile draped surfaces
- be aware that the draped sterile field incorporates only
the horizontal surfaces of the
patient or instrument trolleys/tables
- move draped table/trolleys by placing hands on the
horizontal surfaces only
- face the sterile field at all times: if movement is to occur
within the sterile field,
scrubbed personnel shall pass back to back or front to
front
- avoid altering levels at the sterile field
- be seated only when the operative procedure is to be
performed at that level

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 Aseptic Technique

- consider the surgical gown sterile only in the areas from

mid chest to waist level in the
front and from elbows to glove cuffs
- consider neckline shoulders underarms and the back to
be unsterile
- keep gloved hands within the levels of the sterile field

Unscrubbed personnel shall

- face the sterile field on approach
- refrain from leaning over the sterile field
- maintain an appropriate distance from the sterile field at
all times
( approximately
30cms)
- refrain from moving between two sterile fields
- move sterile draped equipment by holding vertical
uprights below the level of the
drape.

6.7. All movement with in the operating room shall be kept to a

minimum

The nurse shall

- monitor activity in the operating room
- ensure that all doors to the operating room remain
closed except for the movement of
staff, equipment and the patient
- limit the number of personnel in the operating room to
only those required to safely
undertake the procedure.

6.8. The flow of clean and sterile supplies and equipment shall
be separated from contaminated
supplies, equipment and waste

The nurse shall

- ensure that the flow of supplies moves through a
predetermined route, from clean area
to a decontamination area
- ensure that soiled supplies, instruments and equipment,
are not moved back into a
clean area
- place soiled supplies, instruments and equipment, within
 covered containers or vehicles
for movement to the designated decontamination area
- ensure that the decontamination area, soiled linen and
rubbish areas are separated from
personnel and patient traffic areas.

7. References

Perioperative Standards and Recommended practices AORN

2012-2013
Reprocessing of reusable items, cleaning packaging
sterilization and storage of sterile supplies AS/NZ
4187:2014.

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8. Related Documents

Guidelines for Safe practice in the Operating Theatres of New

Zealand
WCDHB Infection Control Policies and Procedures
WCDHB Infection Prevention Policy
WCDHB Theatre Attire Policy
WCDHB Skin preparation of patients
WCDHB Surgical scrubbing gowning and gloving

Version: 1
Developed By: Operating Theatre
REVISION Authorised By: Operating Theatre
HISTORY Date Authorised: April 2012
Date Last February 2015
Date Of Next February 2017
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Document Owner: Theatre
Number OpTheat14, Version 1 , Issued: 12/02/15 Master Copy is
UNCONTROLLED DOCUMENT - WEST COAST DISTRICT HEALTH BOARD