This article focuses on how to create and maintain a sterile field, including best practices, which are important to know both for your exams and for clinical practice.
The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Fundamentals of Nursing - Flashcards
What is a sterile field?
A sterile field is a designated area which is free of microbes and other pathogens that can infect someone. The sterile field can include surfaces, instruments, and people. Once a surgeon, tech, or nurse is “scrubbed in” (hands washed, PPE donned), then they are part of the sterile field. Once you are scrubbed in and enter a sterile field, you should consider yourself part of the field; that means you must follow specific protocols so as not to contaminate it.
When is a sterile field used?
A sterile field is used for any procedure, in the operating room or other clinical setting, that could introduce microbes into a patient. Procedures that require a sterile field are usually invasive and include surgery, starting a central line or a PICC (peripherally inserted central catheter), inserting a urinary catheter (quick straight catheter or indwelling one), tracheostomy care (cleaning and caring for a hole that goes directly into the patient’s lungs), or inserting an arterial line or CVC (central venous catheter).
A sterile field is not required for administering medications or taking a patient’s vital signs. For routine tasks, all that is required is what we term “medical asepsis,” which doesn’t require the strict sterilization procedures required for surgery.
Medical asepsis vs. surgical asepsis
Medical asepsis simply means performing routine cleaning or washing in order to prevent pathogen transmission to reduce the number of organisms and prevent their spread. Washing hands, wearing clean gloves, or wearing a mask are examples of medical asepsis.
Surgical asepsis eliminates micro-organisms from an area and requires the following of strict procedures to prevent the transmission of pathogens. For example, sterilizing all instruments, drapes, and other objects that may come into contact with a surgical wound. Personnel who come into contact with the sterile field must perform a surgical hand scrub with an antimicrobial agent and put on a surgical gown and gloves.
Sterile field best practices
The following protocols must be followed to maintain a sterile field and keep it from being contaminated.
Never turn your back or leave the field unattended. If you turn your back, you are no longer looking at the sterile field, which means you don’t know if anything has touched it or fallen onto it.
Do not reach over a sterile field. Even if you are wearing sterile gloves, your arms and sleeves are not considered sterile — if an arm or sleeve passes over the sterile field, microbes may be dislodged into it, contaminating the area.
Do not talk, cough, or sneeze over the sterile field.
Always check the integrity of any packaged items for holes, damage, or moisture. Any of these is a sign that the package contents are no longer sterile.
What contaminates a sterile field?
When setting up a sterile field, you should imagine that there is a one-inch border surrounding it. This sterile border allows just enough room to work safely. Anything outside the border is considered to be non-sterile, so do not allow anything to touch beyond the border.
Objects held below the waist are considered non-sterile. This means never allowing your hands to drop below your waist, even when wearing sterile gloves. This is because when our hands are at our sides, we tend to forget about them; during a sterile field situation, we need to pay close attention to our hands and what they may be coming into contact with that could potentially contaminate the field.
If an object becomes wet, it is no longer sterile. For example, when pouring a sterile solution into a sterile container, if any splashes onto a sterile item, that item is no longer considered sterile. Bacteria can grow rapidly in areas that become wet.
How to prepare a sterile field
Sterile fields should always be established as close as possible to the time of a procedure and, once established, should not be left unattended. When opening sterile packages, follow this protocol:
- Position all packages so that the top flap will open away from your body.
- Open the top flap of the package first; open it away from you.
- Then open the flap on the right side with your right hand, then the flap on your left side with your left hand. This is to keep you from reaching over the sterile field.
- Open the last flap toward your body.
- To put an item into a package, open the package and drop the item from six inches above the field.
How to pour sterile solutions
As part of your sterile field setup, you may need to pour a sterile solution, such as an antiseptic solution when preparing for surgery. There are specific steps to follow when pouring sterile solutions to help maintain the integrity of the sterile field.
Remove the bottle cap and place it so that the inside of the cap is facing up on a non-sterile surface.
Hold the bottle so that the label is in the palm of your hand. This is to protect the label from being damaged due to a splash, which could make it difficult to read its contents.
When pouring, hold the bottle two inches above the receptacle. Pour slowly to avoid splashing, which would contaminate the sterile field.
Practice
It is important to practice these skills over and over again until they become muscle memory and you can do them by rote.
As Meris shared in the video, you can practice moving around your house with your hands up and in front of you (almost as if you are holding a large balloon) to train yourself not to drop your hands. The more you practice, the easier it will be to work in a sterile field without having to think about it!
1 comment
according to ATI placing the palm of your hand on the label doesn’t keep sterile.