Sterile Field

What is asepsis?

Absence of pathogenic microorganisms that cause infection

What is the difference between asepsis and sterility?

Asepsis: absence of disease-causing microorganisms; sterility: absence of all living microorganisms, including spores

What is sterile conscience?

The commitment of surgical personnel to follow aseptic technique, recognize contamination risks, and maintain environmental hygiene

What are the main ways to maintain an aseptic surgical environment?

Proper cleaning and disinfection, handwashing, surgical scrubbing, patient prep, and sterile techniques

What is aseptic technique?

Steps taken to prevent contamination, including cleaning, instrument sterilization, scrubbing, and draping

What is exogenous contamination?

Contamination from external sources, such as air, instruments, supplies, skin, or the surgical team

What is endogenous contamination?

Contamination originating within the patient, such as bacteremia

How does the length of surgery affect contamination risk?

Contamination risk increases with procedure length and doubles every hour

Should aseptic techniques still be followed during contaminated procedures?

Yes, aseptic protocols must still be followed even during procedures involving abscesses

How should an OR be maintained?

Simple, uncluttered, stock, and cleaned according to daily, weekly, and monthly schedules

Why should dry dusting be avoided in the OR?

It creates airborne particles that can take hours to settle, increasing contamination risk

Why should OR traffic be limited?

To minimize air currents and potential airborne contamination

When is surgical clipping normally performed, and what blade is used?

After the patient is anesthetized, using a #40 clipper blade

What is the proper technique for surgical clipping?

Clip with hair growth first, then against it for a closer shave. Work from clean to dirty areas

Why should razor burn be avoided during surgical clipping?

It causes microabrasions in the skin, increasing infection risk

What determines the size of the clipped surgical area?

The surgical procedure and the margins required around the surgical site

What are clipping boundaries for abdominal surgery?

Cranial: xiphoid, caudal: past the pubis, lateral: nipples

What area should be clipped for orthopedic surgery?

The entire circumference of the affected limb, from the paw to the body

How is hair removed for feline castration?

Hair is plucked rather than shaved

How should paws be prepared for surgery?

Clip and soak the entire foot

How should an open wound be protected during surgical clipping?

Apply sterile lubricant to prevent loose hair from entering the wound

Why is removing loose hair from wounds with pocketing especially important?

Hair can become trapped in wound pockets extending beneath the skin

What is the correct surgical scrubbing pattern?

Start at the intended incision and site and scrub outward in a spiral, never returning toward the center

Why should scrub materials never return toward the incision site?

To prevent transferring microorganisms from the surrounding skin back to the cleaner incision area

What solutions are alternated during the presurgical scrub?

Antiseptic scrub with alcohol or sterile saline

How many times should the surgical site be scrubbed?

At least 3 times, usually 3-5 times, until no visible dirt remains

Where should alcohol NOT be used during surgical prep?

Open wounds, in or around the eyes, or on MM

What additional prep is required for male dogs?

Flush the prepuce using 0.05% chlorhexidine gluconate solution

When is the final surgical scrub performed?

After the patient has been transported to the surgical site and positioned

What is required for the final surgical scrub?

Sterile gloves, sterile gauze, and 5 mins of contact time

What is an alternative to the traditional final surgical scrub?

A one-step prep sponge containing antiseptic and alcohol

What are the application and drying times for a one-step prep sponge?

30 secs of application followed by 2-3 mins of drying

Why should one-step prep sponges not be used after chlorhexidine or povidone-iodine scrubs?

Their ingredients may become deactivated

What safety precautions apply to one-step prep sponges?

They are flammable and cannot be used on open wounds or around eyes and MM

What are the three common surgical positions?

Dorsal, lateral, and sternal recumbency

What should be considered before positioning a patient for surgery?

The procedure, positioning equipment, and access to the IV catheter and monitoring equipment

Why is the affected limb suspended during orthopedic prep?

To allow circumferential aseptic prep and manipulation during surgery

In what direction is a suspended orthopedic limb prepared?

Distal to proximal in a circumferential pattern

What is a sterile field?

Any area covered by a sterile barrier

What areas of a surgical gown are considered sterile?

The front from chest to sterile field level and sleeves from 2 inches above the elbow to the top of the cuffs

What areas of a surgical gown are considered NONSTERILE?

Neckline, shoulders, back, and cuffs

Why are surgical gown cuffs considered nonsterile?

Because the hands have passed through them

What is the purpose of surgical drapes?

To create a barrier between sterile and nonsterile areas because the patient cannot be completely sterilized

What is strike-through contamination?

When liquid soaks through a sterile barrier, allowing contamination between sterile and nonsterile areas

What are examples of strike-through contamination?

Urination, bladder expression, or saline soaking through surgical drapes

What are important rules for maintaining the sterile field?

Never leave it unattended, nonsterile personnel must not touch or reach over it, keep sterile items above table level, avoid contamination from wet drapes

How should quarter drapes be handled during placement?

Float them above the patient without dragging them across the body or contaminating the gown

Why should a drape never be advanced toward the incision after placement?

It can transfer contamination toward the surgical site

What is the correct order for applying quarter drapes?

Lateral side closest to you, lateral side away from you, cranial side, caudal side

How are ground drapes secured?

Using penetrating towel clamps placed near intersecting corners to prevent bunching

When should the opening in a fenestrated drape be made?

Before the drape touches the patient

How is a fenestrated top drape secured?

Using nonpenetrating Edna/Lorna towel clamps

What happens to the underside of a drape after it touches the patient?

It is considered nonsterile

What may be done if a surgical drape becomes contaminated?

In some situations, an additional sterile drape may be placed over the contaminated area

What should always be checked before opening sterile packs or pouches?

Sterilization indicator, packaging seal, expiration date, and holes or tears

How should sterile packs be opened by a circulating assistant?

Open the four edges one at a time without reaching over the pack or contaminating its contents

Who opens the inner wrap of a double-wrapped sterile pack?

The surgeon or sterile assistant

Are the edges of sterile packaging considered sterile?

No, they are nonsterile and must be kept away from sterile contents

How should a peel-away pouch be opened?

Slowly peel the edges apart while preventing the nonsterile packaging from contacting the sterile item

How should sterile fluids be poured?

Carefully to prevent splashing, with the sterile basin positioned away from the field or at the table edge

Can the cap of an opened sterile fluid container be replaced?

No, the cap is considered contaminated, and remaining fluid should be discarded

How should sterile and nonsterile personnel pass each other?

Sterile personnel: face to face, nonsterile: back to back

What are the primary responsibilities of a circulating nurse?

Opening sterile supplies, pouring fluids, retrieving supplies, and preventing contamination of the sterile field

What should be done if a break in sterility occurs?

Immediately acknowledge and report it, then take the necessary steps to correct the contamination