FEBRUARY 2006, VOL 83, NO 2
Recommended Practices
for Maintaining
a Sterile Field
T
he following recommended practices
were developed by the AORN Recom-
mended Practices Committee and have
been approved by the AORN Board of
Directors. They were presented as proposed
recommended practices for comments by mem-
bers and others. They are effective Jan 1, 2006.
These recommended practices are intended
as achievable recommendations representing
what is believed to be an optimal level of prac-
tice. Policies and procedures will reflect varia-
tions in practice settings and/or clinical situa-
tions that determine the degree to which the
recommended practices can be implemented.
AORN recognizes the numerous settings in
which perioperative nurses practice. These rec-
ommended practices are intended as guide-
lines adaptable to various practice settings.
These practice settings include traditional
operating rooms, ambulatory surgery centers,
physicians’ offices, cardiac catheterization
suites, endoscopy suites, radiology depart-
ments, and all other areas where operative and
other invasive procedures may be performed.
PURPOSE. These recommended practices pro-
vide guidance for establishing and maintaining
a sterile field. The creation and maintenance of
a sterile field can directly influence patient out-
comes. Adherence to aseptic practices by all
individuals involved in surgical interventions
aids in fulfilling the professional responsibility
to protect patients from injury. Aseptic prac-
tices are implemented preoperatively, intraop-
eratively, and postoperatively to minimize
wound contamination and reduce patient risks
for surgical site infections.
RECOMMENDED PRACTICE I
Scrubbed persons should function within a
sterile field.
1. Before donning sterile gowns and gloves,
surgical hand antisepsis should be performed
according to AORN’s “Recommended prac-
tices for surgical hand antisepsis/hand
scrubs”1 and the manufacturer’s written
402 • AORN JOURNAL
Recommended Practices
instructions for the antiseptic. Surgical hand
antisepsis decreases the microbial counts on
the skin and will reduce the transfer of
microorganisms.
2. Personnel within the sterile field should be
attired according to both AORN’s “Recom-
mended practices for surgical attire”2 and
“Recommended practices for standard and
transmission-based precautions.”3 Personnel
should wear scrub attire, caps, masks, eye
protection, and sterile gowns and gloves to
prevent microbial transference to the sterile
field, surgical site, and patient during the
surgical procedure and to reduce risk of
occupational exposure to bloodborne
pathogens and other potentially infectious
materials.4-7
3. Scrubbed personnel should don sterile
gowns and gloves from a sterile area away
from the main instrument table to prevent
contamination of the sterile field.8-12
4. Materials for gowns should be selected
according to AORN’s “Recommended prac-
tices for selection and use of surgical gowns
and drapes”13 and according to the required
level of barrier protection as outlined in the
Association for the Advancement of Medical
Instrumentation (AAMI) guideline “Liquid
barrier performance and classification of
protective apparel and drapes intended for
use in health care facilities.”14 Surgical
gowns should be of sufficient size to
adequately cover the scrubbed person.
Surgical gowns should establish a barrier
that minimizes the passage of microorgan-
isms between nonsterile and sterile areas.12,15
5. The front of a sterile gown is considered
sterile from the chest to the level of the ster-
ile field. The sterile area of the gown front
extends to the level of the sterile field
because most scrubbed personnel work
Recommended Practices
adjacent to a sterile bed and/or table.
Gown sleeves are considered sterile from
two inches above the elbow to the cuff,
circumferentially.
The neckline, shoulders, underarms, sleeve
cuffs, and gown back are areas of friction
and, therefore, are not considered effective
microbial barriers. The gown back is consid-
ered nonsterile because it cannot be con-
stantly monitored.
Gowns of an adequate size to close com-
pletely in the back and a sleeve length ade-
quate to prevent cuff exposure outside the
glove should be selected.
6. Sleeve cuffs should be considered contami-
nated when the scrubbed person’s hands
pass beyond the cuff.9,10,12
• Cuffs of the gown should remain at or
below the natural wrist area.
• Gown sleeves should not be pulled up,
leaving cuffs exposed.
• Sleeves of the gown should be of suffi-
cient length and should cover the back of
the hand to avoid exposing the gown cuff
when the gloves slide down.
7. Scrubbed personnel should inspect gloves for
integrity after donning them. Intact gloves
establish a barrier that minimizes the passage
of microorganisms between nonsterile and
sterile areas.4,12,16 AORN’s “Recommended
practices for standard and transmission-
based precautions”3 should be followed.
Policies and procedures in the practice set-
ting should indicate when double-gloving is
required to reduce the potential for hand con-
tact with blood and body fluids.
8. Sterile gloves that become contaminated
should be changed as soon as possible. The
preferred method of changing gloves is
assisted gloving, whereby one member of
the sterile team assists another member.
This technique allows a gowned and
gloved team member to touch only the out-
side of the new glove when applying the
FEBRUARY 2006, VOL 83, NO 2
glove to a team member’s hand. If this
method is not possible, the contaminated
glove should be changed by the open-glove
method. If it is not possible to change the
glove at the moment the break in technique
is noted, a new glove may be donned over
the contaminated/damaged glove until it
can be changed.9,11,12
RECOMMENDED PRACTICE II
Sterile drapes should be used to establish a
sterile field.
1. Surgical drapes should be selected according
to AORN’s “Recommended practices for
selection and use of surgical gowns and
drapes”13 and the AAMI guideline “Liquid
barrier performance and classification of
protective apparel and drapes intended for
use in health care facilities.”14 Surgical drapes
should establish an aseptic barrier that mini-
mizes the passage of microorganisms
between nonsterile and sterile areas.15,17,18
2. To prevent transfer of microorganisms
from nonsterile to sterile areas, sterile
drapes should be placed on the patient, fur-
niture, and equipment to be included in the
sterile field.19
3. Sterile drapes should be handled as little as
possible. Rapid movement of draping mate-
rials creates air currents on which dust, lint,
and other particles can migrate.20,21
4. Draping material should be held in a com-
pact manner, held higher than the OR bed,
and placed from the surgical site to the
periphery to minimize contamination of
the surgical site. Some procedures may
require modified draping techniques (eg,
extremities).9,10,12
5. During draping, gloved hands should be
protected by cuffing the drape material over
the gloved hands to reduce the potential for
contamination.9,10,12
6. The portion of the surgical drape that
establishes the sterile field should not be
AORN JOURNAL • 403
FEBRUARY 2006, VOL 83, NO 2
moved after it is positioned. Shifting or
moving the sterile drape can compromise
the sterility of the field.9,10,12
RECOMMENDED PRACTICE III
Items used within the sterile field should
be sterile.
1. To ensure that only sterile items are pre-
sented to the sterile field, all items should
be inspected immediately before presenta-
tion to the field for proper packaging, pro-
cessing, seal, package container integrity,
and inclusion of a sterilization indicator.
The indicator should be inspected immedi-
ately to verify the appropriate color change
for the sterilization process selected. If an
expiration date is provided, the date should
be checked before the package is opened
and the contents are delivered to the field.
Outdated items should not be used.12,22
An event-related sterility system should be
used. Event-related sterility is based on the
concept that “sterility is not altered over
time, but may be compromised by certain
events or environmental conditions.”23
Shelf life refers to the time an item may
remain on the shelf and still maintain its
sterility. Shelf life is influenced by the type
of packaging used, storage conditions (eg,
open or closed shelves), humidity, temper-
ature, transport conditions, use of dust
covers, and the amount of handling the
item receives.12,22,23
Spaulding’s criteria are used to determine
the potential for transmission of infectious
agents.24 Within this classification, items con-
tacting the vascular system, the neurological
system, and/or sterile tissues pose the great-
est risk of infection and are classified as crit-
ical items. Using sterile items when contact-
ing sterile tissues minimizes the risk of
infection.12,25-28
2. Packaging materials should meet the crite-
ria identified in AORN’s “Recommended
practices for selection and use of packaging
systems.”29
404 • AORN JOURNAL
Recommended Practices
3. Methods of sterilization, event-related shelf
life, and handling of sterile items should be in
accordance with AORN’s “Recommended
practices for sterilization in perioperative
practice settings.”30 Sterilization provides the
highest level of assurance that surgical items
are free of viable microbes. High-level disin-
fection reduces the risk of microbial contami-
nation, but it does not ensure the same mar-
gin of safety that sterilization provides.25,26,28,31,32
RECOMMENDED PRACTICE IV
All items introduced to a sterile field
should be opened, dispensed, and trans-
ferred by methods that maintain item
sterility and integrity.
1. All invasive surgical procedures should be
performed using sterile instruments and
supplies, and the surgical team should prac-
tice aseptic technique for all surgical patients.
The mucous membranes of the mouth, uri-
nary tract, and intestinal tract are effective
bacterial barriers when intact. However, ear,
nose, and throat procedures, hemorrhoidecto-
my, and other procedures are invasive and
impair the integrity of the mucosal barrier.
The normal flora found in these areas is not
infectious to the individual in question, but it
may be pathogenic when transferred to other
tissues by contaminated surgical instruments.
Health care-acquired surgical infections are
a leading cause of patient morbidity and
mortality in the United States. Rigorous
adherence to the principles of asepsis is the
foundation of surgical site infection pre-
vention and should never be circumvented
to save time or money. A sterile field should
be prepared and maintained for every sur-
gical patient.4,25,26
2. Unscrubbed individuals should open
wrapped sterile supplies by opening the
wrapper flap farthest away from them first,
to prevent contamination from passing an
unsterile arm over a sterile item. Next, they
should open each of the side flaps. The near-
est wrapper flap should be opened last.9-11
Recommended Practices
3. All wrapper edges should be secured when
supplies are presented to the sterile field.
Securing the loose wrapper edges prevents
them from contaminating the sterile field or
a sterile item.9,10
4. Sterile items should be presented to the
scrubbed person or placed securely on the
sterile field. Items tossed onto a sterile field
may roll off the edge, create a hole in the
sterile drape, or cause other items to be dis-
placed, leading to contamination of the ster-
ile field.9,10
• Sharps and heavy objects should be pre-
sented to the scrubbed person or opened
on a separate surface. These heavy items
may penetrate the sterile barrier if
dropped onto the sterile field.9,10
• Peel pouches should be presented to the
scrubbed person to prevent contamina-
tion of the contents. The edges of the
package may curl and the contents may
slide over the unsterile edge, contaminat-
ing the contents of the package.
• Rigid container systems should be
opened on a separate surface. The
external indicator should be verified for
appropriate color change. Locks should
be inspected for security to verify there
has not been a breach of the container
seal prior to use. The lid should be lifted
toward the person opening the container
and away from the container. The filter
should be checked and changed accord-
ing to the manufacturer’s written
instructions.
5. All items should be delivered to the surgi-
cal field in a manner that prevents nonster-
ile objects or people from extending over
the sterile field. Skin is a source of bacteria
and scurf shedding; therefore, maintaining
distance from the sterile field can decrease
the potential for contamination when items
are passed from a nonsterile area to a ster-
ile area.9,10,19
6. When solutions are dispensed, the labeled
solution receptacle on the sterile field
FEBRUARY 2006, VOL 83, NO 2
should be placed near the table’s edge or
held by the scrubbed person. The entire
contents of the container should be poured
slowly to avoid splashing. Splashing can
cause strike-through and splash-back from
nonsterile surfaces to the sterile field.
Placing the solution receptacle near the
edge of the sterile table allows the
unscrubbed person to pour fluids without
contaminating the sterile field. Any
remaining fluids should be discarded. The
edge of a container is considered contami-
nated after the contents have been poured;
therefore, the sterility of the contents can-
not be ensured if the cap is replaced. Reuse
of open containers may contaminate solu-
tions due to drops contacting unsterile
areas and then running back over container
openings.9,10
7. Medications should be delivered to the
sterile field in an aseptic manner. Stoppers
should not be removed from vials for the
purpose of pouring medications. Sterile
transfer devices (eg, sterile vial spike, filter
straw, plastic catheter) should be used to
dispense medications to the sterile field.
Medications should be delivered to the
sterile field according to AORN’s “Recom-
mended practices for safe care through iden-
tification of hazards in the surgical environ-
ment,”33 AORN’s “Guidance statement: Safe
medication practices in perioperative prac-
tice settings,”34 the “AORN latex guide-
line,”35 and the policies and procedures of
the practice setting.
RECOMMENDED PRACTICE V
A sterile field should be maintained and
monitored constantly.
1. The sterile field should be prepared in the
location in which it will be used. Moving
tables stirs air currents that can contaminate
the sterile field.36
2. Sterile supplies should be opened for only
one patient at a time. Opening several cases
in a room at one time increases the risk of
cross-infection.
AORN JOURNAL • 407
FEBRUARY 2006, VOL 83, NO 2
3. One patient at a time should occupy the OR.
Concurrent cases performed on two patients
in the same room at the same time may
expose patients to a variety of hazards and
increase the risk of contamination and infec-
tion. The transmission of infectious diseases
can occur by airborne, contact, and droplet
methods. The risk of cross-contamination
may be increased significantly when two
sterile fields, two surgical teams, and two
open surgical wounds are confined to one
OR. Operating rooms in the United States
are not designed to accommodate the addi-
tional personnel and equipment necessary
to care for two patients simultaneously. In
the United States, general ORs built to the
standards of the American Institute of
Architects (AIA) are 400 sq ft.37 Some ORs
may be as small as 360 sq ft. This square
footage minimum is intended to accommo-
date the equipment and personnel neces-
sary for one surgical field. To move around
the sterile field without contaminating it,
nonsterile personnel (eg, the circulating
nurse) should maintain a distance of at least
12 inches from the sterile field. When two
patients and two sterile fields occupy an
area designed to accommodate one patient
and one sterile field, contamination of the
sterile field is likely.
4. Sterile fields should be prepared as close as
possible to the time of use. The potential for
contamination increases with time because
dust and other particles present in the ambi-
ent environment settle on horizontal surfaces
over time. Particulate matter can be stirred
up by movement of personnel when open-
ing the room and can settle on opened sterile
supplies.4,12,21,36,38,39 The OR environment can
be breached by other vectors, such as insects,
that could potentially come into contact with
open sterile fields, unobserved, unless the
sterile field is monitored.
There is no specified amount of designated
time that a room can remain open and not
used and still be considered sterile. The
sterility of an open sterile field is event-
408 • AORN JOURNAL
Recommended Practices
related. An open sterile field requires con-
tinuous visual observation. Direct observa-
tion increases the likelihood of detecting a
breach in sterility.12,39-41
5. Sterile fields should not be covered. Although
there are no research studies to support or
discount the practice, removing a table cover
may result in a part of the cover that was
below the table level being drawn above the
table level or air currents drawing microor-
ganisms from a nonsterile area to the sterile
field. It is important to continuously monitor
all sterile areas for possible contamination.12,21
6. Conversations in the presence of a sterile
field should be kept to a minimum to reduce
the spread of droplets. Air contains microor-
ganisms on airborne particles, such as respi-
ratory droplets. The primary source of air-
borne bacteria is health care personnel.7,12,21,31
7. Surgical equipment (eg, cables, tubing)
should be secured to the sterile field with
nonperforating devices. Perforations in a
barrier provide portals of entry and exit for
microorganisms, blood, and other potential-
ly infectious body fluids.
8. Nonsterile equipment (eg, Mayo stands,
microscopes, C-arms) should be covered
with sterile barrier material(s) before being
introduced to or brought over a sterile field.
Only sterile items should touch sterile sur-
faces. The equipment should be covered with
a barrier material on the top, bottom, and all
sides. Sterile barrier material also should be
applied to the portion of the Mayo stand or
other equipment that will be positioned
immediately adjacent to the sterile field.11
RECOMMENDED PRACTICE VI
All personnel moving within or around a
sterile field should do so in a manner that
maintains the sterile field.
1. Scrubbed personnel should remain close to
the sterile field.9,10 Walking outside the ster-
ile field’s periphery or leaving the OR in
sterile attire increases the potential for
FEBRUARY 2006, VOL 83, NO 2
contamination. Using a closed container sys-
tem for flash sterilization and transport of
items eliminates the need for the scrubbed
person to leave the sterile field to retrieve
instruments from a sterilizer. Scrubbed per-
sonnel should avoid leaving the sterile field
when x-rays are taken. Protective devices for
reducing radiological exposure should be
provided to personnel who cannot leave the
room or who cannot stand approximately 6
ft away from the source of radiation.42
2. Scrubbed personnel should move from ster-
ile areas to sterile areas to prevent contami-
nation. If they must change position, they
should turn back to back or face to face
while maintaining safe distances from each
other and the sterile field.
3. Unscrubbed personnel should face sterile
fields on approach, should not walk
between two sterile fields, and should be
aware of the need for distance from the ster-
ile field. By establishing patterns of move-
ment around the sterile field and keeping
sterile areas in view, accidental contamina-
tion can be reduced.
4. Scrubbed personnel should keep their arms
and hands above the level of their waists at
all times. Hands should remain in front of
the body above waist level so the hands
remain visible. Contamination may occur
when arms and hands are moved below
waist level. Arms should not be folded with
the hands in the axilla. This area has the
potential to become contaminated by perspi-
ration, allowing for strike-through of the
gown and, ultimately, contamination of the
gloved hands. The gown at the axilla also is
an area of friction and, therefore, is not con-
sidered an effective microbial barrier.
5. Scrubbed personnel should avoid changing
levels and should be seated only when the
entire surgical procedure will be performed
at that level. When changing levels, expo-
sure of the nonsterile portion of the surgical
gown is likely.
410 • AORN JOURNAL
Recommended Practices
6. The number and movement of individuals
involved in a surgical procedure should be
kept to a minimum per AORN’s “Recom-
mended practices for traffic patterns in the
perioperative practice setting.”36 Bacterial
shedding increases with activity. Air currents
can pick up contaminated particles shed
from patients, personnel, and drapes and
distribute them to sterile areas.12,21,31,43
7. When a break in sterile technique occurs,
corrective action should be taken immediate-
ly unless the patient’s safety is at risk. If the
patient’s safety is at risk, correct the break in
technique as soon as it is safe to do so.
8. When a break in sterile technique occurs and
cannot be corrected immediately, the organi-
zation should determine how it should be
reported and recorded, and the wound clas-
sification should be adjusted accordingly
and documented on the operative record.
RECOMMENDED PRACTICE VII
Policies and procedures for maintaining a
sterile field should be developed, reviewed
periodically, revised as necessary, and
readily available in the practice setting.
1. Policies and procedures for maintaining a
sterile field should be developed by each
facility and should include, but not be limit-
ed to,
• aseptic technique, including handling
sterile supplies and monitoring a sterile
field;
• surgical hand antisepsis;
• gowning and gloving with sterile gown
and gloves;
• masks, head coverings, and scrub attire;
• draping;
• event-related sterility;
• traffic patterns; and
• monitoring of environmental conditions,
including OR air exchange rate and pres-
sure, temperature, and humidity.
2. These recommended practices should be
used as a guideline for developing policies
and procedures in the perioperative practice
Recommended Practices
setting. Policies and procedures serve as
operational guidelines and establish author-
ity, responsibility, and accountability within
the facility.
3. Personnel and observers should be knowl-
edgeable about the procedures involved in
developing and maintaining a sterile field.
An introduction and review of policies and
procedures for maintaining the sterile field
should be included in orientation to the
perioperative setting for personnel and
observers. Continuing education should be
provided when new technologies (eg, sterili-
zation containers, barrier materials) are intro-
duced. Ongoing education of perioperative
personnel facilitates the development of
knowledge, skills, and attitudes that affect
surgical patient outcomes. Policies and proce-
dures also assist in the development of quali-
ty assessment and improvement activities.
4. The Perioperative Nursing Data Set (PNDS)
should be used in the development of poli-
cies and procedures and documentation of
nursing interventions related to maintenance
of the sterile field. The expected outcome of
primary importance to this recommended
practice is outcome O10, “The patient is free
from signs and symptoms of infection.” This
outcome falls within the domain of Physio-
logical Responses (D2). The associated nurs-
ing diagnosis is X28, “Risk for infection.” The
associated interventions that may lead to the
desired outcome may be I21, “Assesses sus-
ceptibility for infection”; I70, “Implements
aseptic technique”; and I98, “Protects from
cross-contamination.”44
GLOSSARY
ASEPSIS: Process for keeping away disease-
producing microorganisms.
ASEPTIC TECHNIQUE: Methods by which contami-
nation with microorganisms is prevented.
ASSISTED GLOVING: Method by which a gowned
and gloved person assists another gowned per-
son to don sterile gloves.
CLOSED GLOVING METHOD: Used when wearing a
sterile gown to prevent exposure of bare skin
FEBRUARY 2006, VOL 83, NO 2
during gowning and donning of sterile gloves,
thereby lessening the chance of contamination.
CRITICAL ITEM: An item that contacts the vascu-
lar system or enters sterile tissue, posing the
highest risk of transmission of infection.
EVENT-RELATED STERILITY: Shelf life of a packaged
sterile item depends on the quality of the
wrapper material, the storage conditions, the
conditions during transport, and the amount of
handling.
NONCRITICAL ITEM: An item that comes in con-
tact with intact skin but not with mucous mem-
branes, sterile tissue, or the vascular system.
OPEN-GLOVING METHOD: Used when changing a
glove during a surgical procedure. A method of
donning sterile gloves in which the everted
cuff of each glove allows the gowned person to
touch the inner side of the glove with ungloved
fingers and the outer side of the glove with
gloved fingers.
SCURF: A bran-like desquamation of the epi-
dermis.
SEMICRITICAL ITEM: An item that comes in con-
tact with mucous membranes or with skin that
is not intact.
STERILE: The absence of all living microorgan-
isms.
STERILE FIELD: Area around the site of the inci-
sion into tissue or the site of introduction of an
instrument into a body orifice that has been
prepared for the use of sterile supplies and
equipment. This area includes all furniture
covered with sterile drapes and all personnel
who are in sterile attire.
STERILE TECHNIQUE: Methods by which contami-
nation with microorganisms is prevented to
maintain sterility throughout the surgical pro-
cedure.
STERILIZATION: Processes by which all patho-
genic and nonpathogenic microorganisms,
including spores, are killed.
STRIKE-THROUGH: Contamination of a sterile
surface by moisture that has originated from a
nonsterile surface and penetrated the protec-
tive covering of the sterile item.
TIME-RELATED STERILITY: Expiration dates are
established to indicate the maximum duration
of time within which a sterile item is consid-
ered sterile and safe to use.
AORN JOURNAL • 413
FEBRUARY 2006, VOL 83, NO 2
NOTES
1. “Recommended practices for surgical hand
antisepsis/hand scrubs,” in Standards, Recom-
mended Practices, and Guidelines (Denver: AORN,
Inc, 2005) 377-385.
2. “Recommended practices for surgical attire,” in
Standards, Recommended Practices, and Guidelines
(Denver: AORN, Inc, 2005) 299-305.
3. “Recommended practices for standard and
transmission-based precautions in the periopera-
tive practice setting,” in Standards, Recommended
Practices, and Guidelines (Denver: AORN, Inc, 2005)
447-451.
4. A J Mangram et al, “Guideline for prevention
of surgical site infection,” American Journal of
Infection Control 27 (April 1999) 97-134.
5. W A Rutala, D J Weber, “A review of single-use
and reusable gowns and drapes in health care,”
Infection Control and Hospital Epidemiology 22 (April
2001) 248-257.
6. H Laufman, N L Belkin, K K Meyer, “A critical
review of a century’s progress in surgical apparel:
How far have we come?” Journal of the American
College of Surgeons 191 (November 2000) 554-568.
7. Association for Professionals in Infection
Control and Epidemiology, APIC Text of Infection
Control and Epidemiology (Washington, DC:
Association for Professionals in Infection Control
and Epidemiology, 2002) 27-1 – 27-4.
8. J S Heal et al, “Bacterial contamination of
surgical gloves by water droplets spilt after scrub-
bing,” Journal of Hospital Infection 53 (February
2003) 136-139.
9. D M Fogg, “Infection prevention and control,” in
Alexander’s Care of the Patient in Surgery, 12th ed, J C
Rothrock, ed (St Louis: Mosby, 2003) 97-158.
10. N F Phillips, Berry & Kohn’s Operating Room
Technique, 10th ed (St Louis: Mosby, 2004) 247-323.
11. P A Mews, “Establishing and maintaining a
sterile field,” in Patient Care During Operative and
Invasive Procedures, second ed, M Phippen, M Wells,
eds (Philadelphia: W B Saunders Co, 2000) 61-93.
12. B Gruendemann, S Mangum, Infection
Prevention in Surgical Settings (Philadelphia: W B
Saunders Co, 2001) 47-49, 88-97, 119-219, 250-257,
266-281, 365-371.
13. “Recommended practices for selection and use
of surgical gowns and drapes,” in Standards,
Recommended Practices, and Guidelines (Denver:
AORN, Inc, 2005) 371-375.
14. Association for the Advancement of Medical
Instrumentation, Liquid Barrier Performance and
Classification of Protective Apparel and Drapes Intended
for Use in Health Care Facilities, ANSI/ AAMI PB70
(Arlington, Va: Association for the Advancement of
Medical Instrumentation, 2003).
15. Association for the Advancement of Medical
Instrumentation, Selection of Surgical Gowns and
Drapes in Health Care Facilities, AAMI TIR no
414 • AORN JOURNAL
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11:1994 (Arlington, Va: Association for the
Advancement of Medical Instrumentation, 2000.)
16. J Tanner, H Parkinson, “Double gloving to
reduce surgical cross-infection,” (Cochrane
Review) in The Cochrane Library, issue 2
(Chichester, UK: John J Wiley & Sons, 2004).
Abstract available at http://www.cochrane.org
/cochrane/revabstr/AB003087.htm (accessed 26
Aug 2005).
17. A Lipp, “An assessment of the clinical effec-
tiveness of surgical drapes,” Nursing Times 99 (Dec
9, 2003) 28-31.
18. N Belkin, “Selecting surgical gowns and
drapes for today’s surgery,” SSM 9 (December
2003) 41-44.
19. J Pournoor, “New scientific tools to expand
the understanding of aseptic practices,” Surgical
Services Management 6 (April 2000) 28-32.
20. F Memarzadah, A P Manning “Comparison of
operating room ventilation systems in the protec-
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Competency & Credentialing Institute New Board Members
T wo new board members and two new officers have
been elected to the Competency & Credentialing
Institute (CCI) board of directors. The two new board
members are Larry L. Asplin, RN, MS, CNOR, clinical
director, surgery and central processing at St Cloud
Hospital, St Cloud, Minn; and Michelle Byrne, RN,
PhD, CNOR, associate professor of nursing at North
Georgia College & State University, Dahlonega, Ga.
The new CCI president-elect is Robin Lazenby,
In Memory of Audrey N. Bell, RN
A ORN past President Audrey N. Bell, RN, died
from heart and lung failure on Monday, Sept
26, 2005, in Wichita Falls, Tex. Bell, an AORN
member for more than 40 years, served as
President from 1967 to 1969. She also served on
the AORN Board of Directors from 1962 to 1966
and as Vice President from 1966 to 1967. In her
presidential address at the 1969 AORN Congress, Bell
defined the practice of professional nursing as being
involved in care, cure, and coordination, explaining
that a truly professional OR nurse constantly strives
to improve patient care.
Bell graduated from the Parkland Hospital School
of Nursing, Dallas, where she started her nursing
career. She was the supervisor of the OR at Children’s
Medical Center of Dallas for many years and was the
OR supervisor there when President Kennedy’s body
was brought in after his assassination in 1963.
Bell completed postgraduate study in OR nurs-
ing at the Graduate Hospital of the University of
416 • AORN JOURNAL
Recommended Practices
Originally published March 1978, AORN Journal,
as “Recommended practices for aseptic tech-
nique.” Format revision July 1982.
Revised March 1987, October 1991.
Revised June 1996; published November 1996,
AORN Journal.
Revised and reformatted; published February
2001, AORN Journal.
RN, BSN, MS, CNOR, director of perioperative services,
Day Kimball Hospital, Putnam, Conn. Connie Moser,
central area territory vice president, McKesson Pro-
vider Technologies, is the new secretary/treasurer.
The board members and officers will take their
new positions in March 2006. Lazenby’s president-
elect term will begin in March 2006 and will be
followed by her presidential term from March 2007
to March 2008.
Pennsylvania, Philadelphia. She was a clinical asso-
ciate professor of OR management, Department of
Surgery, at the University of Texas Southwestern
Medical School at Dallas. She wrote many articles
and made national and international presentations.
After retiring from nursing, Bell volunteered for
many years at the American Red Cross and the
Wilbarger General Hospital Auxiliary, Dallas.
Recently, the Wilbarger General Hospital Auxiliary
dedicated the Audrey N. Bell Pavilion and Memorial
Garden in her honor.
Services for Bell were held in Vernon, Tex, in
September 2005. The AORN Board of Directors and
staff members express their sincere condolences to
Bell’s family members and to those who worked
closely with her during her long career. Donations in
Bell’s honor may be sent to the AORN Foundation,
2170 S Parker Rd, Suite 300, Denver, CO 80231 or
made by calling Nancy Harbin, AORN Foundation
senior project manager, at (303) 755-2676 x 366.