Infection Control
Adding Items to a Sterile Field
Select a Skill:
- » Establishing and Maintaining a Sterile Field
- » Adding Items to a Sterile Field
- » Pouring A Sterile Solution
- » Using a Prepackaged Sterile Kit
- » Performing Sterile Gloving
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Safety
- Once you create a sterile field, you are responsible for performing the procedure without contaminating the field.
- It is the nurse’s responsibility to stop a procedure when a break in sterile technique occurs.
- Traffic or movement can increase the potential for contamination by spreading microorganisms on air currents.
- Reaching over a sterile field contaminates it.
- A sterile object below a person’s waist is considered contaminated. Items placed below the waist level are considered contaminated.
- The outer surface of any package is considered unsterile. There is a 2.5-cm (1-inch) border around any sterile drape or wrap that is considered contaminated. Gloves are not necessary to pick up a drape if only this area of the drape is touched.
- A sterile object remains sterile only when touched by another sterile object. If a sterile object touches any nonsterile object, it becomes contaminated.
- If a sterile item falls off of the sterile field, open a new, sterile package containing the item and add the item to the field, unless the field itself has been contaminated.
- Do not flip or toss objects onto the sterile field.
Equipment
(Roll cursor over items to see labels)
Sterile drape or kit that is to be used as a sterile field
Sterile drape or kit that is to be used as a sterile field
Sterile procedure-specific equipment
Sterile procedure-specific equipment
PrintableDelegation
The skill of adding items to 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.
- Explain how to assist with keeping the patient from contaminating the sterile field.
- 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.
- Position the patient for maximum comfort and ease of breathing.
- 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.
- Anticipate the number and types of supplies you will need for the procedure.
- Complete all other priority tasks, such as medication administration or suctioning the patient, before beginning the procedure.
- Ask visitors to step out briefly during the procedure. Discourage movement by any staff that might be assisting with the procedure.
- Prepare equipment to be used at the bedside.
- 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 the 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 placing supplies on a sterile field that is being prepared for a dressing change. Which action is likely to contaminate the field?
Placing a role of sterile tape on the field - Holding a prepackaged sterile item in the nondominant hand while opening it
- Adding supplies that will expire in 2 days
Placing the needed supplies near the back of the sterile field
INCORRECT. Placing a sterile item on the sterile field will not contaminate the field.
INCORRECT. Holding a prepackaged sterile item in the nondominant hand while opening it will not contaminate the field.
INCORRECT. Adding supplies that have not expired will not contaminate the field.
CORRECT. Placing the needed supplies near the back could cause the nurse to reach across the sterile field, which would be a breach in sterile technique.
2. A patient requires all of the following interventions. Which one would the nurse perform last?
- Change the dressing on the patient’s newly established suprapubic catheter.
- Administer the patient’s prescribed medication.
- Offer the patient a bedpan.
- Position the patient for maximum comfort and ease of breathing.
CORRECT. Since this a sterile procedure, the nurse will address the patient’s oxygen requirements and his or her comfort and elimination needs prior to completing the procedure. The nurse will also complete priority tasks such as medication administration before establishing a sterile field.
INCORRECT. The nurse will complete priority tasks such as medication administration before establishing a sterile field.
INCORRECT. The nurse will address the patient’s elimination needs before undertaking any procedure that requires establishment of a sterile field.
INCORRECT. The nurse will address the patient’s comfort and oxygen requirements before undertaking any procedure that requires establishment of a sterile field.
3. Which direction to nursing assistive personnel (NAP) would help to maintain a sterile field while conducting a sterile procedure?
- “Please see to it that nothing contaminates this sterile field while I get some additional supplies.”
- “I’d like you to make sure that the patient doesn’t reach toward the sterile field while I’m changing the dressing.”
- “Hand me the item closest to the edge of the sterile field.”
- “Place a sterile drape over these supplies for a moment while I answer my other patient’s call light.”
INCORRECT. Responsibility for establishing or maintaining a sterile field cannot be delegated to NAP. The nurse cannot leave the sterile field once it is established.
CORRECT. The nurse may delegate to NAP the responsibility for monitoring the patient’s behavior during a sterile procedure in order to minimize the risk that the patient’s actions will contaminate the field.
INCORRECT. Handing an item to the nurse from the sterile field would contaminate the entire sterile field.
INCORRECT. Responsibility for establishing or maintaining a sterile field cannot be delegated to NAP. In addition, placing a sterile drape over a sterile field is inconsistent with sterile technique. The nurse cannot leave the sterile field once it is established.
4. While preparing supplies on a sterile field, a gauze pad falls off the sterile field. What should the nurse do?
- Nothing
- Create a new sterile field
- Use sterile forceps to move the gauze pad toward the center of the sterile field
- Dispose of the gauze before continuing the procedure
CORRECT. The gauze fell outside the sterile field, and the field has not been contaminated. The nurse can leave the gauze where it is and discard it with the other used supplies at the conclusion of the procedure.
INCORRECT. Creating a new sterile field is not needed. The gauze fell outside of the sterile field and can be discarded after the procedure.
INCORRECT. Using forceps to move the gauze pad back onto the sterile field would contaminate the field. The nurse can leave the gauze where it fell because it was off the sterile field.
INCORRECT. Disposing of the gauze would cause the nurse to break sterile field. Leave the gauze in place because it fell off of the sterile field and continue with the procedure.
5. Which action would minimize the risk of infection when placing prepackaged supplies on an established sterile field?
- Wear clean treatment gloves.
- Collect supplies with sterile gloves to avoid contamination.
- Do not allow the wrapper to touch the sterile field.
- Place the supplies in the 1-inch perimeter of the sterile field.
INCORRECT. Wearing gloves is not necessary when adding prepackaged supplies to an established sterile field.
INCORRECT. Wearing gloves is not necessary when collecting supplies.
CORRECT. This is the correct option because allowing contact of the prepackaged wrapper with the sterile field would result in contamination.
INCORRECT. Supplies are to be placed well inside the 1-inch border of the sterile field. Placing items on the 1-inch perimeter would contaminate the supplies.
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