Book 03 · Page 66 / 15
Clean, Sterile, Surgical, and the Field That Fails
| MEDICAL ASEPSIS | SURGICAL ASEPSIS | THE FIELD IN PRACTICE | |
|---|---|---|---|
| Goal | Reduce the number and the spread of organisms | Absence of all microorganisms, including spores | Keep the state you created |
| Where used | Injections, routine dressing changes over intact granulating wounds, all standard care | Urinary catheter insertion, central line dressing change, invasive procedures, entry into a normally sterile cavity | Anywhere a sterile field is opened |
| Hand hygiene agent | Alcohol-based rub, or soap and water when hands are soiled | Surgical hand antisepsis before the sterile procedure | Repeat before regloving |
| Attire | Clean gloves | Sterile gloves, and for defined procedures a mask and eye protection | Sleeves above the elbow, hair contained |
| Contaminated means | Visibly soiled, or in contact with a dirty surface | Any contact with a non-sterile item, however brief | Any rule below has been broken |
| The break the exam tests | Reusing a single-use item | Touching the outer wrapper with a sterile glove | Turning away from the field |
The operational rules of the field
- The outer border band of a drape is not sterile. Current AORN guidance states the width; verify the exact figure at reprint and do not round it.
- Anything below the level of the field, or below the waist, is contaminated.
- An item out of vision is contaminated. A turned back ends the field's sterility whether or not anything touched it.
- Never reach across the field. Open the flap farthest from the body first and the flap nearest the body last.
- Sterile touches sterile only. Sterile gloves touch sterile items. Anything else transfers.
- Moisture wicks organisms upward. A wet field has strike-through and is contaminated, even if the liquid was sterile saline.
- When in doubt, contaminated. There is no partial credit and no probable sterility.
Memory hookOut of sight, out of sterile.
Margin noteSterile touches sterile only.
Watch outStrike-through is the break candidates forgive. A drape that has absorbed solution is a wick, not a barrier, and the field is set up again.
TakeawaySterility is a state, not an intention, and it ends when a rule breaks rather than when the nurse notices.