Best Practices in Maintaining the Sterile

Field

Lets face it, maintaining a sterile field is no easy task. The

definition of sterile the absence of all living microorganisms
is in itself about as far-reaching as it can get. But combine that with
a room full of organism-laden people, surfaces, instruments, and
machinery, and this tall order becomes an ever-increasing
challenging demand for todays surgical teams.

Have you heard the ongoing buzz over allowing a parent to accompany a
child in the operating room (OR) while the child receives anesthesia? The
caring parent and often the surgical team of course wants nothing more
than to reduce the anxiety a child may feel in such situations, but at what
price? The pros: the child may remain calmer. The cons: the parent
donned in street clothes just entered a sterile field.

The number of people in the OR is a critical factor in maintaining a sterile

field, according to Carol Petersen, RN, BSN, MAOM, CNOR, a perioperative
nursing specialist at the Association of periOperative Registered Nurses
(AORN) Center for Nursing Practice. Aside from the above-mentioned
parental saga, Petersen says that even the surgical team should not be
passing through the sterile field. In other words the back table and the
patient, she explains. They should be walking out around the periphery of
the sterile field. You need to keep the number of people in the room to a
minimum.

Ramona Conner, RN, MSN, CNOR, a perioperative nursing specialist, also with
AORNs Center for Nursing Practice, says controlling the number of people in
the room is a big challenge for a lot of organizations, particularly teaching
organizations, because there are a lot of people who want to observe the
procedures. Although we have an obligation to teach, we have a higher
priority to protect the patient, she asserts.

This aspect relates well to event-related sterility (ERS). ERS means that once
an item has been sterilized, it remains sterile until something occurs that
contaminates it. If somebody touches it or an unsterile surface touches it or
another vector comes in contact with the sterile item, it becomes
contaminated, Conner explains. Air currents can contain airborne
contaminants.

The more people in the room, the more likely you are going to have airborne
contaminants because people are the most common cause of contamination
in the environment, she points out. This is because we shed skin cells, we
breathe and exhale bacteria. Were just pretty dirty. So the item is sterile
until something comes in contact with it to contaminate it.

She continues, People need to be aware that part of maintaining the sterile
field includes maintaining the environment. People need to be aware that if
they leave the OR doors open or frequently open them they are impeding the
air exchange system in the OR. The HVAC system is designed to maintain a
minimum of 15 air exchanges per hour in the OR. If they leave that door
open or frequently open and close it, the system cant maintain 15 air
exchanges per hour. It also changes the directional air flow. The OR pressure
is supposed to be maintained as positive pressure. When they open that
door, that equalizes the pressure between the OR and the outside corridor,
so they are allowing airborne contaminates potentially to enter the OR.

Other environmental recommended practices (RPs) Conner offers involve

movement techniques within and around the sterile field. When somebody
is passing a sterile field, you should always face it, not have your back to it.
You do this so you can keep an eye on it and not accidentally brush up
against it with your back. She says a common question AORN receives
involves people sitting while in sterile attire. You shouldnt be below the
level of the sterile field, she answers. When you sit, your hands are often
on your lap or near your lap. We recommend that you only sit when the
entire procedure is going to be performed in the sitting position. Also, she
warns, if there is a delay in the case, the person maintaining the sterile field
should not sit while awaiting the procedure to begin.
(http://www.infectioncontroltoday.com/articles/2006/11/best-practices-in-
maintaining-the-sterile-field.aspx)