NCM 112 OR PROCEDURES

The center of the sterile field is the patient, which also includes the areas of the patient, the operating
table, and furniture covered with sterile drapes and the personnel wearing the OR attire. More
importantly, strict adherence to principles of sterile technique must be observed for the safety of the
patient. This adherence reflects one's surgical conscience. The principles of sterile technique are
applied in the;
1. Preparation for operation by proper sterilization of needed materials and supplies.
2. Preparation of the operating team to handle sterile supplies and intimately contact wound.
3. Creation and maintenance of the sterile field, including the preparation and draping of the patient
to prevent contamination of the surgical wound;
4. Maintenance of sterility and asepsis throughout the operative procedure
5. Terminal sterilization and disinfections at the conclusion of the operation.

Principles
Sterile persons have scrubbed and are gowned and gloved; unsterile persons have not.

1. Only sterile items are used within the sterile field.

- Proper packaging, sterilizing, and handling should be observed
- If you are in doubt about the sterility of anything, consider it not sterile
- If sterilized package is found in a nonsterile area, considered it unsterile
- If unsterile person comes into close contact with a sterile table
- If sterile table is not in constant observation
- If sterile package falls to the floor, it must be discarded

2. Tables are sterile only at table level.

- Edges and sides of drape extending below table level are considered unsterile.

3. Persons who are sterile touch only sterile items or areas; persons who are not sterile touch only
unsterile items or areas;
For example:
- sterile team members maintain contact with sterile field by means of gowns and gloves
- nonsterile circulating nurse does not directly come in contact with the sterile field.
- Additional supplies needed for sterile team members must be open by circulating nurse and
pass to scrub nurse maintaining safe distance from the sterile field.
4. Unsterile persons avoid reaching over a sterile field; persons avoid leaning over an unsterile area.
- Unsterile circulating nurse never reach over a sterile field to transfer sterile items
NCM 112 OR PROCEDURES

- In pouring solution into sterile basin, circulating nurse holds only lip of bottle over basin to
avoid reaching over a sterile area
- Circulating nurse stands at a distance from the sterile field to adjust light over it to avoid
microbial fallout over field
- Surgeon turns away sterile field perspiration removed from brow
- Scrub nurse drapes a nonsterile table towards self first to protect gown
- Scrub nurse stands back from nonsterile table when draping it to avoid leaning over an unsterile
area
5. Edges of anything that encloses sterile contents considered unsterile.
The following precautions should be taken;
a. In opening sterile packages, a margin of safety is always maintained. Ends of flats are secured
in hand so they do not dangle loosely. The last flat is pulled toward the person opening package
thereby exposing package, contents away from nonsterile hand
b. Sterile person lift contents from packages by reaching down a lifting item straight up, holding
elbows high.
c. Steam reaches only the area within gaskets of a sterilizer. Instrument trays should not touch
the edge of the sterilizer outside the gasket.
d. Flaps on peel - open packages should be pulled back, not torn, to expose sterile contents.
Contents should be flipped or lifted upward and not permitted to slide over edges. Inner edge of the
heat seal is considered the line of demarcation between sterile and sterile portion.
e. If a sterile wrapper is used as a table cover, it should simply cover the entire surface. Only the
interior surface level of the covered are considered sterile.
f. After a sterile bottled is opened, contents must be used or discarded. Cap cannot be replaced
without contaminating pouring edges.

6. Sterile field is created as close as possible to time of use.

- Degree of contamination is proportionate to length of time sterile items are uncovered and
expose to the environment, precaution must be taken as follows:
1. Sterile table are set up just prior to the operation
2. It is difficult to uncover a table of sterile contents without contamination. Covering sterile
tables for later use is not recommended.

7. Sterile areas are continuously kept in view.

- Unintentional contamination of sterile areas must be readily visible. To ensure this principle:
7.1 Sterile persons face sterile areas
7.2 When sterile packs are opened in a room, or a sterile is set up, someone must remain in
the room to maintain vigilance.
NCM 112 OR PROCEDURES

8. Sterile persons keep well within the sterile area.

Allow a wide margin of safety when passing unsterile areas and follow these rules:
1. Sterile persons stand back at a safe distance from the operating table in draping the patient
2. Sterile persons pass each other back-to-back
3. Sterile persons turn back to sterile person or area when passing
4. Sterile persons face sterile area to pass it
5. Sterile person asks nonsterile individual to step aside rather than risks contamination
6. Sterile persons stay within and around a sterile field. They do not walk around or go outside
room
7. Movement within and around a sterile area is kept to a minimum to avoid contamination
of sterile items or persons.
8. Sterile persons keep contact with sterile areas to a minimum.
The following rules are observed:
8.1 Sterile persons do not lean on sterile tables and on draped patient
8.2 Sitting or leaning against a nonsterile surface is a break in technique. If the sterile team sets
to operate, they do so without proximity to nonsterile areas

9. Unsterile persons avoid sterile areas

- a wide margin of safety must be maintained when passing sterile areas by following these rules:
1. Unsterile persons maintain at least one-foot distance from any area of sterile field
2. Unsterile persons face and observed a sterile area when passing it to be sure that they do
not touch it
3. Unsterile persons never walk between 2 sterile areas
4. Circulating nurse restrict to a minimum all activity near sterile field
10. Destruction of integrity of microbial barriers results in contamination
- Integrity of a sterile package of sterile drape is destroyed by perforation, puncture or strike
through
- The integrity of a sterile package, its expiration, date and appearance of process monitor must
be checked for sterility just prior to opening.
To ensure sterility:
- Sterile packages are laid on dry surfaces
- If sterile package becomes wet, it is re-sterilized or discarded
- If solutions soak through sterile drape to nonsterile area the wet area is covered with
impervious sterile drapes
- Sterile items are stored in clean dry areas
NCM 112 OR PROCEDURES

- Undue pressure on sterile packs is avoided to prevent forcing sterile tie out and pulling unsterile
air into the pack

11. Microorganisms must be kept to an irreducible minimum

- All microorganisms cannot be eliminated but this does not hinder or prevent necessity for strict
sterile technique
To prevent entrance of microorganisms into wound:
- Transient and resident flora are removed from skin and operative site by mechanical hand
washing and chemical asepsis
- Gowning and gloving of operating team is accomplished without contamination of sterile
exterior of gowns and gloves
- Sterile gloved hands do not directly touch skin
- If globe is pricked or punctured by needle, gloves are changed immediately.