Maintaining Asepsis Within a Sterile Field in Surgery

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In order to advance in our knowledge of nursing practice we must keep in mind the basic information of the daily tasks that we perform which truly make a difference. One such basic but extremely important task in the perioperative setting is maintaining asepsis within a sterile field. Perioperative nursing practice is in part guided by the American Nurses Association (ANA)’s Code of Ethics. Maintaining asepsis is a fundamental skill in accepting responsibility and being accountable within this framework of ethics. The AORN Explications for Perioperative Nursing outline this framework in Appendix A of the AORN Perioperative Standards and Recommended Practices, 2008 edition.

The American Heritage Dictionary of the English Language gives us two definitions of asepsis. The first is: The state of being free of pathogenic microorganisms. A second definition that applies to surgical asepsis as well is: The process of removing pathogenic microorganisms or protecting against infection by such organisms. The state of being free of pathogenic microorganisms is truly the most accurate of the two definitions when applied to the surgical field, the second definition speaks to the process leading to asepsis..

The Association of periOperative Registered Nurses (AORN) provides guidance in maintaining a sterile field within the 2008 Perioperative Standards and Recommended Practices. “Recommended Practices (RPs) for Maintaining a Sterile Field" is the specific RP pertaining to maintaining a sterile field and asepsis. This document is intended to be a guideline for establishing and maintaining a sterile field. Within this recommended practice are seven recommendations for maintaining asepsis within a sterile field.

The first of the seven recommendations speaks to the fact that scrubbed persons should function within a sterile field. The process of maintaining the sterile field begins with the scrub person’s hand antisepsis at the scrub sink. Surgical hand antisepsis should be performed according to the antiseptic manufacturer’s instructions, so that the product is used in the most efficient manner. The purpose of hand antisepsis is to reduce the microbial count and decrease the chance that microbes will be transferred. The scrub person then enters the operative suite, dries hands and arms in an aseptic manner and dons a sterile gown and gloves from a table that has been separated from the main instrument table. This is done to prevent contamination of the sterile field.

Sterile field draping is addressed in the second recommendation. Sterile drapes should be used to establish a sterile field. The selection of draping materials should be done by consulting AORN and AAMI guidelines. The purpose of sterile surgical drapes is to establish a sterile aseptic barrier between sterile and unsterile areas and to prevent microbe transfer between these areas. Drapes should be placed on the patient, equipment and furniture that is to be included in the sterile field. The scrub person should place the drape at the surgical site and unfold the drape with fanning or moving it from the area in which it is placed, since this movement may compromise the sterile field.

Items used within the sterile field should be sterile. While opening sterile supplies onto the sterile field, all packages should be inspected for integrity and quality before opening. In order to assure quality control each sterile item or tray of sterile items must include a sterilization indicator. The indicator must be inspected before opening to note whether the indicator color has changed to the appropriate color for the indicator type. An appropriate color change will verify that the sterilization process was completed. The package being opened should be intact with no evidence of water stains. If water stains are present, the item must be considered contaminated, and is not to be introduced to the sterile field.

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