Going into the OR (Operating Room) or approaching a sterile procedure at bedside can be nerve wracking if you’re new to sterile field etiquette. Let’s go over what the sterile field is, why we do it, and it’s best practices to make sure you’re prepared when the time comes!
What is a Sterile Field?
Sterile field is the area needed to do a procedure that must be germ free. We do this in the medical field so our patients are not at an increased risk for infection. Sterile fields can include sterile instruments, sterile surfaces, sterile PPE (aka personal protective equipment like gowns, masks, and gloves), and medical professionals who have ‘scrubbed in’.
How to ‘Scrub In’ to the Sterile Field
Scrubbing into the sterile field means that the healthcare worker has performed proper hand hygiene and donned the proper PPE. In the OR, or operating room, there are very strict rules when scrubbing in. This means that you have washed your hands, and arms, with the proper antibacterial soap for the necessary amount of time. This time will be posted above the scrub station but is usually about 2 minutes long. In the OR you will be wearing surgical scrubs under a sterile gown with sterile gloves, a mask, and eyewear.
For more information on how to don PPE properly, visit How to Don and Doff PPE for Medical Professionals.
For procedures that are done at bedside, scrubbing in is going to look a little different. You are going to be wearing normal scrubs and you may want to gown up depending on the procedure, but you yourself are not going to be as sterile as you would be in the OR. Hand hygiene is a must for beside procedures. You will still don sterile gloves, a mask, and eyewear if needed but that’s all. You will create your own sterile field depending on the procedure, but this field will be either on the patient or the bedside table rather than in its own sterile room.
Why is the Sterile Field Important?
It is important to keep the sterile field sterile due to infection prevention for our patients. As we know, the skin is the first line of defense. So when we are cutting through the patients skin to do an operation, we are putting the patient at an increased risk for infection. Because of this, we need to take every precaution to ensure infection prevention.
When doing bedside procedures like central access device care or Foley insertion, it is also important to create a sterile field. However these fields can be set up at bedside. Even though we aren’t cutting the skin, we are going straight into the body where we have increased risk of infection. Which is why even some bedside procedures need to be done with a sterile field present.
For more information on infection prevention, visit Nursing Fundamentals: A Guide to Infection Control.
Sterile Field Practices
When working in or on a sterile field, there are some strict rules that need to be followed so that the sterility is not ‘broken’. Meaning the risk for infection goes up significantly because of some sort of contamination.
First off, you can never turn your back on the sterile field. When turning your back, you cannot visualize the field. The patient may bump it or something may fall on it without you knowing, which would compromise the sterility.
Second, never let your sterile hands go below your waist. Anything below the waist is deemed non-sterile.
Third, do not reach over the sterile field. If you do this, you may be running your arm or sleeve, both of which are considered non-sterile, through the field, leading to contamination. In addition to not reaching over the sterile field, it is important to note that the field has a one-inch border that is also considered not sterile. So never set instruments onto the field outside of that one-inch border.
Fourth, do not open your mouth over the sterile field. Turn your head if you need to cough, sneeze, or talk to prevent infection.
Fifth, all sterile instruments and objects should be carefully wrapped so as to maintain sterility. If any object does not look properly sealed or wrapped, then it is no longer considered sterile as it could have been exposed to microbes. The same thing goes if a sterile object falls onto the ground. Do not pick the object up! The object is now contaminated and if you reach down to pick it up, you are breaking multiple sterile field rules.
Practice
Because there are so many rules when coming in contact with a sterile field, and the repercussions can be great, it is in your best interest to practice. Practice setting up a sterile field and observing other nurses and healthcare workers from outside the field. Remember that practice makes perfect. Even if you’re struggling with simply putting on sterile gloves now, just know that with practice, you will be great!
Do you work with sterile fields? Comment below!
Be sure to check out the rest of the Nursing Fundamentals Series here!
Are you interested in becoming an OR Nurse? Visit Specialty Nursing: What Makes a Good OR Nurse?