Infection Control
Establishing and Maintaining a Sterile Field
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- » Establishing and Maintaining a Sterile Field
- » Adding Items to a Sterile Field
- » Pouring A Sterile Solution
- » Using a Prepackaged Sterile Kit
- » Performing Sterile Gloving
Take the Review Test:
Safety
- It is the nurse’s responsibility to stop a procedure when a break in sterile technique occurs.
- Gain the patient’s full cooperation in order to minimize contamination of your work area.
- Explain to the patient how you will perform the procedure and what he or she can do to avoid contaminating sterile items, such as avoiding sudden body movements, refraining from touching sterile supplies, and avoiding coughing or talking over a sterile area.
- Teaching the patient before you perform a sterile procedure minimizes the need to talk during the procedure, which can cause air droplet contamination of a sterile area.
- Traffic or movement can increase the potential for contamination by spreading microorganisms on air currents.
Equipment
(Roll cursor over items to see labels)
Sterile Kit
Sterile drape or kit
Sterile gloves
PrintableDelegation
The skill of preparing a sterile field cannot be delegated to nursing assistive personnel (NAP). However, NAP may assist in positioning patients and obtaining extra supplies. Be sure to inform NAP of the following:
- Explain how to assist with patient positioning.
- Direct NAP to hand you any necessary supplies.
Preparation
- Verify that the procedure requires surgical aseptic technique.
- Assess the patient’s comfort, oxygen requirements, and elimination needs before preparing for the procedure.
- Check the integrity of sterile packages for punctures, tears, discoloration, moisture, or any other signs of contamination. If you are using commercially packaged supplies or those prepared by the agency, check the package for a sterilization indicator, which is a marker that changes color when exposed to steam or another heat source.
- Ask visitors to step out briefly during the procedure. Discourage movement by any staff that might be assisting with the procedure.
- Position the patient comfortably for a specific procedure to be performed. If a body part is to be examined or treated, position the patient so that the area is accessible. Have NAP assist you with positioning the patient as needed.
- Explain to the patient the purpose of the procedure and the importance of using a sterile technique.
Follow-up
- Observe for any breaks in sterile technique. Such a break requires that you set up a new sterile field.
Documentation
- No recording or reporting is required for establishing a sterile field.
- Record the type of sterile procedure performed and the patient’s status.
Review Questions
1. The nurse is preparing to perform a sterile procedure for a patient. Which action will best minimize the risk of infection during the procedure?
Administer a prophylactic antibiotic before the procedure, as prescribed.
Follow sterile technique during the procedure.- Ensure proper hand hygiene before the procedure.
- Educate the patient in order to minimize movement and talking during the procedure.
INCORRECT. Antibiotics are not given to prevent infection during sterile procedures.
CORRECT. Sterile technique is intended to prevent the introduction of pathogens into the body.
INCORRECT. This action should be taken but is not as important as following sterile technique in minimizing the risk of infection during the procedure.
INCORRECT. Movement by the patient can create turbulent air flow that carries pathogens onto the field. Talking over the sterile field can also spread airborne microorganisms. Teaching the patient to move or talk as little as possible during the procedure, however, is not as important as following sterile technique.
2. While preparing a sterile field, the nurse determines that additional supplies are needed. What will the nurse do to ensure that the sterile field is maintained?
- Cover the field with a sterile drape before leaving the room.
- Collect the necessary supplies after preparing a new sterile field.
- Retrieve the supplies, but instruct the patient not to touch anything on the field.
- Ask the assistant who has been helping with the procedure to bring the necessary supplies.
INCORRECT. Covering the field with a sterile drape will not ensure that asepsis is maintained.
INCORRECT. Any action that prevents the nurse from having constant visual contact with the field constitutes a break in sterile technique. The nurse would need to leave the field and begin again after collecting the necessary supplies.
INCORRECT. Responsibility for maintaining the sterile field cannot be delegated to the patient.
CORRECT. An assistant may be present while performing a procedure that requires maintaining a sterile field, and the assistant may add items to the field, provided correct technique is observed.
3. What direction would the nurse provide to nursing assistive personnel (NAP) while establishing and maintaining a sterile field?
- “This work surface is too low. Choose a surface that’s above your waist.”
- “Begin to establish the sterile field here on the overbed table.”
- “Be careful to touch only the outer 1-inch edge of the sterile drape.”
- “Remember, reaching over the sterile field constitutes a break in sterile technique.”
INCORRECT. The nurse cannot delegate the establishment of a sterile field to NAP.
INCORRECT. The nurse cannot delegate the establishment of a sterile field to NAP.
INCORRECT. The nurse cannot delegate the establishment of a sterile field to NAP.
CORRECT. In assisting the nurse during the procedure, the NAP might reach over the field if not reminded that doing so would constitute a break in sterile technique.
4. While preparing a sterile field, the nurse notes that a portion of the sterile drape has come into contact with the patient’s gown. Which action is most appropriate in this situation?
- Place the sterile supplies only on the portion of the drape that did not touch the gown.
- Collect the supplies necessary and establish a new sterile field.
- Determine if the contact occurred within the outer 1-inch perimeter of the drape.
- Establish the sterile field on the opposite side of the drape.
INCORRECT. If sterile technique is broken, the sterile field must be reestablished.
CORRECT. Any breach in sterile technique requires the nurse to establish a new sterile field. The sterile drape must not touch anything as it is opened over the work surface.
INCORRECT. If sterile technique is broken, the sterile field must be reestablished.
INCORRECT. If sterile technique is broken, the sterile field must be reestablished.
5. Why might the nurse offer the patient a bedpan before establishing a sterile field?
- Anticipating what the patient might need during a lengthy sterile procedure will minimize patient movement.
- A patient’s becoming incontinent constitutes a breach in sterile technique.
- Refocusing the patient’s attention on a task decreases anxiety.
- Assessing the patient’s ability to follow instructions will help the nurse maintain the sterile field.
CORRECT. Some procedures that require asepsis are lengthy, and it is helpful to anticipate the patient’s needs.
INCORRECT. A patient's becoming incontinent does not constitute a breach in sterile technique.
INCORRECT. Although refocusing the patient’s attention may decrease anxiety, a patient would not be asked use a bedpan as a means of distraction.
INCORRECT. Asking the patient to follow a few simple commands usually yields enough information for the nurse to determine how well the patient can follow instructions. The patient would not be asked to use a bedpan for that purpose.
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