Infection Control
Using a Prepackaged Sterile Kit
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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
- To minimize contamination of your work area, gain the patient’s full cooperation by explaining the procedure and advising him or her to avoid sudden movements, refrain from touching supplies, and talk as little as possible (to avoid air droplet contamination).
- Assess the patient's comfort, oxygen requirements, and elimination needs before preparing for the procedure.
- 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.
- Remain organized and prepare the sterile field as close as possible to the time of use, to reduce the potential for contamination.
- Be aware that once you create a sterile field, you are responsible for performing the procedure without contaminating the field and for stopping the procedure if a break in sterile technique occurs.
Equipment
(Roll cursor over items to see labels)
Commercially prepared sterile pack
Sterile kit to be used as a sterile field
Sterile gloves
Waist-high/countertop surface
PrintableDelegation
The skill of using a prepackaged sterile kit 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.
- Check the integrity of the solution for 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 heat or steam.
- Anticipate and prepare the number and types of equipment and supplies you will need for the procedure.
- Ask visitors to step out briefly during the procedure. Discourage movement by any staff that might be assisting with the procedure.
Follow-up
- Observe for any breaks in sterile technique. A break in the sterile field requires you to set up new sterile field.
Documentation
- No recording or reporting is required for establishing a sterile field.
- Record the type of sterile procedure performed in your nurses’ progress notes and the patient’s status.
Review Questions
1. What is the best reason for a nurse to select a prepackaged sterile kit for a sterile procedure?
Sterile prepackaged kits do not have expiration dates.
The wrapper of the sterile kit can be used as a sterile field.- Adding supplies to the sterile field takes less time than using a prepackaged kit.
- The prepackaged sterile kit will take up less space on the bedside table.
INCORRECT. Sterile kits do expire and the nurse should check the date prior to use. The kit may be outdated or its integrity compromised.
CORRECT. The container is designed to provide a readily accessible sterile field.
INCORRECT. This is not true. Adding supplies to a sterile field can be time consuming and there is a high risk of contamination.
INCORRECT. Although a prepackaged kit may be more compact, space usage on the bedside table is not the top priority.
2. Which action is the most important step the nurse can take to keep the field sterile when using an overbed table as the work surface for a sterile field?
- Position the table out of the patient's reach
- Assess the table for stability
- Position the height of the table to be above waist level
- Assemble ahead of time any supplies and equipment not included in the kit.
INCORRECT. Although positioning the table out of the patient's reach is prudent, it is not the most important step the nurse can take to keep the field sterile.
INCORRECT. Although assessing the stability of the table is prudent, doing so pertains to safety, not sterile technique.
CORRECT. To remain sterile, the field must be above the level of the waist. Anything below the waist is considered contaminated.
INCORRECT. Although assembling the necessary additional supplies ahead of time is prudent, this step is unrelated to the use of the overbed table as the work surface for the sterile field.
3. While opening a prepackaged sterile kit, a package of sterile 4 x 4s falls to the floor. What will the nurse ask ancillary staff to do to ensure the quality of the sterile field?
- "I will have to set up another sterile field; please take these items away."
- "Please go to the clean utility room and get me a package of sterile 4 x 4s."
- "Please watch that nothing contaminates this sterile field while I go and get a replacement item."
- "Explain to the patient the importance of remaining still during this procedure so no other items are contaminated."
INCORRECT. Another sterile field does not need to be established. A replacement item can be obtained and placed on the sterile field.
CORRECT. This action reflects appropriate delegation of ancillary staff when working with a sterile field.
INCORRECT. Ancillary staff cannot be delegated the responsibility of the maintenance of the sterile field.
INCORRECT. Ancillary staff cannot be delegated the responsibility of educating the patient regarding an invasive nursing intervention.
4. When preparing a sterile field using a prepackaged sterile kit, what will influence the nurse’s placement of the kit on the overbed table?
- Tips of the flaps are easily accessible.
- Kit is positioned in the center of the table.
- Sterile contents of the kit are readily available.
- Outermost flap can be opened away from the nurse's body.
INCORRECT. This is not appropriate sterile technique.
INCORRECT. This is not necessarily true because the kit may or may not need to be centered on the table. It will depend upon the size of the kit and the location where the contents will be used.
INCORRECT. This is not necessarily true because the contents will depend upon the purpose of the procedure.
CORRECT. This will influence the nurse’s decision where to place the kit on the overbed table. The outermost flap needs to be opened away from the nurse’s body.
5. Prior to setting up a sterile field for a sterile procedure in a patient’s room, why would the nurse ask any visitors to please leave the patient’s bedside?
- Ensures that no unnecessary movement occurs that could contaminate the sterile field
- Limits distractions while setting up the sterile field
- Ensures a quiet environment during the procedure
- Provides privacy for the patient
CORRECT. Asking visitors to leave the bedside of a patient prior to setting up a sterile field will ensure that no unnecessary movement occurs that could contaminate the sterile field.
INCORRECT. Asking visitors to leave the bedside of a patient prior to setting up a sterile field will ensure that no unnecessary movement occurs that could contaminate the sterile field. This is not done to limit distractions while setting up the sterile field.
INCORRECT. Asking visitors to leave the bedside of a patient prior to setting up a sterile field will ensure that no unnecessary movement occurs that could contaminate the sterile field. This is not done to ensure quiet during the procedure.
INCORRECT. Asking visitors to leave the bedside of a patient prior to setting up a sterile field will ensure that no unnecessary movement occurs that could contaminate the sterile field. This is not done to provide privacy for the patient.
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