Healthcare and Medicine Reference
In-Depth Information
Preparing your sterile fi eld/trolley for the
All sterile equipment is double wrapped. Packs containing sterile
equipment must be unopened and the seals must be intact. The
pack must be within the expiry date printed on the packaging.
All trolleys and surfaces must have been wiped or washed each
day thoroughly with detergent solution. They should additionally
be cleaned before each use using an alcohol-based disinfectant.
Wash your hands before handling the equipment and don a dis-
posable apron and non-sterile gloves.
Touch only the outside layer of packaging - open the outer packs
away from your body, and tip the contents onto your proposed
work surface (trolley).
The outside of the inner wrapper is not part of the sterile fi eld
Least missed
Sometimes missed
Most missed
and may be touched with the hands. To open the pack, hold the
corners of the wrapper only. Pull the corners out and down to
expose the contents. Ensure that you do not reach across the
opened pack or touch the contents.
The opened pack now becomes part of your sterile fi eld.
Figure 3.3 Missed areas in hand hygiene.
Table 3.1 Summary of the three levels of hand hygiene.
Any additional sterile equipment can be tipped or dropped
onto this sterile fi eld, ensuring that the sterile surfaces are not
The operator can now perform a surgical scrub and don sterile
gown and gloves.
Some procedures require the operator to wear a surgical mask.
This must be worn before the scrub to avoid contamination of the
hands. Local policy should be adhered to.
When wearing a sterile gown and gloves, always keep your
hands within view and above the waistline to prevent accidental
Liquid soap
and water
Surgical scrub
Level 1
Level 2
Level 3
Removal of physical
contaminants: dirt,
organic matter
Killing of transient
fl ora on physically
clean hands
Disinfection and
removal of transient
and resident fl ora
from hands
When hands are
physically dirty and
after using the toilet
Between patients
Before applying
gloves for
procedures such
as venepuncture,
lumbar puncture,
joint aspiration, etc
Prior to surgical
Before applying sterile
gloves to carry out a
procedure where an
implantable device is
to be inserted such
as central venous,
epidural and cardiac
catheters, and
Extending the sterile fi eld
The sterile fi eld can now be extended to include the area between
the operator and the patient and surrounding the procedure site.
The skin is decontaminated using a bactericidal preparation of
2% chlorhexidine in 70% isopropyl alcohol, and allowed to dry.
Sterile drapes are opened by the operator, and held by the cor-
ners away from the body and any surfaces that will contaminate
Apply the drapes around the procedure site, also covering the
The sterile fi eld
area between the operator and the patient: leave only the decon-
taminated area of skin exposed.
Drapes are placed from the back to the front to avoid contami-
The sterile fi eld is the sterile area that can be used as a work area
when carrying out a sterile procedure. It is essential that this area is
kept free from microorganisms and spores.
nating the operator's gown or gloves.
Gloves must be changed if they touch a non-sterile area.
The environment
Any sterile procedures should be carried out in a clean area, free
from airborne contamination. All surfaces to be used must be clean,
dry, fl at and stable. Any activities that will cause environmental
disturbances or an increase in airborne contamination (dusting,
bed-making etc.) should not be carried out immediately before an
aseptic procedure. Curtains or fabric screens should be closed for
10 minutes to allow the airborne contaminates to settle. Ensure that
the patient is aware of the need to maintain sterility during the pro-
cedure, as he/she may accidentally touch the sterile fi eld.
Skin preparation solutions
Skin antisepsis before a percutaneous procedure
2% chlorhexidine in 70% isopropyl alcohol has been shown to
provide very effective skin preparation. It has the dual benefi ts of
rapid action and excellent residual activity, reducing subsequent
Povidine iodine solution can be used if the patient has a history
of chlorhexidine sensitivity.
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