Module 6: The Unifying Principles of Aseptic Technique

Introduction

This section outlines the foundational principles and practices of aseptic technique in the surgical environment. Mastery of these concepts is essential for preventing infection and ensuring patient safety during operative procedures.

Objectives of Aseptic Technique

• Describe the principles of establishing the sterile field.

• Explain the steps for preparing an operating room.

• Describe the use of the surgeon’s preference card.

• Explain the principles of opening and presenting sterile items.

• Explain the steps for organizing the back table.

• Describe the process of spatial awareness during the opening process.

• Demonstrate the process of organizing the sterile field.

• Demonstrate the principles of economy of motion.

• Demonstrate the principles of spatial awareness when organizing the sterile field.

• Demonstrate the finalization of the sterile field.

• Demonstrate modifications to setting up the sterile field that must be taken when a special circumstance occurs.

Principles of Asepsis

Principle 1: The Sterile Field is Created for Each Surgical Procedure

The sterile field is a designated area that is maintained free of microorganisms to prevent infection during surgery. It is established using sterile instruments, drapes, and supplies.

• Definition: The sterile field includes the area covered by sterile drapes, the sterile portions of gowns and gloves, and any sterile instruments or supplies.

• Question of Sterility: If sterility is in doubt, the item is considered unsterile and should be discarded. "When in doubt, throw it out!"

• Distance to Other Items: Sterile draped items should be a minimum of a few inches from a wall or other unsterile item (exact distance may vary by protocol).

• Package Integrity: Always check the integrity of the package before opening any sterile item. Look for tears or punctures.

• Chemical Indicators: Used to confirm that instruments have been exposed to the sterilization process.

• Timing: The sterile field should be created as close as possible to the time that it is going to be used.

• Areas of Sterility:

  • Draped Tables: Only the top portion is considered sterile. Any area below the table edge is non-sterile.

  • Wrapped Items: If a wrapped item is opened, only the portion above the sterile field is considered sterile. If part of a sterile glove falls below the table edge, it is no longer sterile.

  • Patient Drapes: Only the area above the draped table is considered sterile. Repositioning drapes may compromise sterility.

Principle 2: Sterile Team Members Must Be Appropriately Attired Prior to Entering the Sterile Field

• Sterile Attire: Includes gown, gloves, mask, eye protection, hair cover, and shoe covers.

• Self-Gowning: Team members must gown and glove themselves in a sterile manner, covering from 2 inches below the neck line to the table edge and from sleeve gloves to 2 inches beyond the elbow.

• Gloving:

  • Closed-Gloving: Gloves are donned by ungloved individuals using the gown cuffs to prevent contamination.

  • Double Gloving: Recommended for all sterile team members to provide an extra barrier against infection.

  • Hand Position: Hands should remain well below waist level and should not be raised above mid-chest.

• Sitting While Sterile: Only if the entire surgical procedure will be performed sitting.

Principle 3: Movement in and Around the Sterile Field Must Not Compromise the Sterile Field

• Touching the Sterile Field: Only sterilely attired individuals may touch the sterile field.

• Walking Between Sterile Fields: Non-sterile personnel should never walk between two sterile fields.

• Changing Positions Within the Sterile Field: Sterilely attired team members should pass each other face to face or back to back to avoid contamination.

• Distance from Sterile to Non-Sterile Items: Maintain at least 12 inches of separation.

• Talking in the OR: Should be kept to a minimum to prevent airborne contamination.

Surgical Conscience

• Definition: The strict adherence to sterile technique, even when no one is observing. Any break in sterile technique must be immediately corrected, whether anyone else sees it or not.

• Application: Stimuli recognized and corrected immediately to prevent infection risk.

Summary Table: Key Principles of Aseptic Technique

Additional info:

• These principles are foundational for all surgical team members and are critical for infection control in the operating room.

• Understanding and applying aseptic technique is a core competency in both surgical technology and perioperative nursing.