FIGURE 18-1 Opening a sterile package. A, Opening the first flap.

B and C, Opening the side

flaps. D, Pulling the last flap by grasping the corner.
A sterile package may also be opened as follows:
1. Hold the package in one hand with the top flap opening away from the person opening the
package.
2. Pull the top flap well back and hold it away from both the contents of the package and the sterile
field. Using the free hand to hold the flap against the wrist of the hand holding the package is an
effective technique.
3. Drop the contents gently onto the sterile field from approximately 6 inches above the field and
at a slight angle.
These techniques help ensure that the package wrapping does not touch the sterile field at any
time.
Commercial packages usually have specific directions written on the package for opening. In
general, available packages include those with partially sealed corners, in which the container is
held in one hand and the flap is pulled back with the other, and those with partially sealed edges,
in which both sides of the edge are grasped, one with each hand, and gently pulled apart
FIGURE 18-2 Opening commercially prepared sterile packs to drop sponges onto a sterile field.
For a sterile field to be established, the drape is plucked with one hand by the corner and
opened. This corner is used to fold back the top. Then the drape is lifted out of the cover and
allowed to open freely without touching anything. Another corner of the drape then is picked up
carefully and laid on a clean, dry surface with the bottom farthest from the person establishing the
field (Fig. 18-3).

FIGURE 18-3 Establishing a sterile field. A, Holding the drape with one hand by the corner. B, Folding back
the top to lift the cover and laying the drape on a clean, dry surface with the bottom farthest from the person
establishing the field.

Adding Sterile Supplies to an Established Sterile Field

Necessary sterile supplies can be added to the field using the proper package-opening techniques.
Remember the following:
1. Do not reach across a sterile field.
2. Do not flip or toss objects on the sterile field.
3. A 1-inch border around the sterile field is not considered sterile.
4. Discard the outer wrapper from each sterile item.
5. Repeat this process for adding additional items to the sterile field.

Pouring a Sterile Solution

Sterile solutions are frequently poured into a metal or other container within the sterile field. Bottles
containing sterile solutions usually are considered sterile on the inside but contaminated on the
outside; thus special care is needed in pouring these solutions.
Begin with verifying the contents and expiration date on the solution. When possible, show the
name to another health care person for verification.
Always try to use the exact amount of solution. Once opened, the solution can be considered
sterile only if it is used immediately. Once the container has been set down, it is no longer
considered sterile and a new container must be opened. The procedure for pouring sterile
solutions is as follows:
1. Remove the lid or cap from the bottle; place it on an unsterile surface with the topside down
immediately to ensure the sterility of the inner surface.
2. Hold the bottle with the label uppermost so that poured solution cannot stain and obscure the
label.
3. Sterile basins into which sterile liquids will be poured are generally placed at the end of the
table to avoid splashing over the entire sterile field.
4. With as little of the bottle as possible over the field, hold it at a height of approximately 1 to 2
inches over the bowl (Fig. 18-4). Pour the solution gently so that no splashing occurs. Splashing
of liquids can destroy a sterile field by allowing microorganisms to move from the unsterile tabletop
through the wet drape that forms the bottom of the sterile field.

FIGURE 18-4 Pouring a sterile solution into a sterile bowl on a sterile field.
5. Close the bottle with the cap if appropriate. Some institutions require marking on the label of
the bottle with the date and time that the bottle was opened along with the initials of the person
that opened the bottle.