What happens if a sterile item touches something non-sterile?

If a sterile item contacts any non-sterile surface, person, or item, it is immediately considered contaminated and must be removed from the sterile field and replaced. This rule applies without exception. Even brief contact with a non-sterile surface can transfer microorganisms.

What parts of the surgical gown are considered sterile?

Only the front of the gown from chest level to waist level and the sleeves from 2 inches above the elbow to the cuffs are considered sterile. The back of the gown, the neckline, the area below the waist, and the underarms are all considered non-sterile, regardless of how the gown is fastened.

Why is moisture on the sterile field a concern?

Moisture can act as a wick, drawing bacteria through fabric barriers (drapes, gown material) from non-sterile surfaces to the sterile side. This is called strike-through contamination. Keeping the sterile field dry is essential for maintaining the barrier function of surgical drapes.

Sterile Technique: Maintaining the Sterile Field in Surgery

What Is Sterile Technique?

Sterile technique (aseptic technique) is a set of practices designed to prevent contamination during surgical procedures. The goal is to maintain a microorganism-free environment around the surgical site, minimizing the risk of postoperative infection. In ophthalmic surgery, even a small number of organisms introduced into the eye can cause devastating endophthalmitis.

The Sterile Field

The sterile field is a defined area that has been prepared and maintained free of microorganisms. It includes the surgical drapes covering the patient, the instrument tray, and the area immediately surrounding the surgical site.

Rules governing the sterile field:

Only sterile items may be placed on the sterile field
If a sterile item contacts a non-sterile surface, it is contaminated and must be replaced
Sterile-gowned personnel should only touch sterile items and other sterile-gowned personnel
The edges of any sterile wrapper or container are considered non-sterile
If there is any doubt about an item's sterility, consider it contaminated
The sterile field is established as close to the procedure start time as possible

The Surgical Scrub

The surgical hand scrub reduces the number of microorganisms on the hands and forearms to the lowest possible level. Two methods are commonly used:

Traditional scrub: Using antimicrobial soap and a brush, scrubbing each finger, hand, and forearm for a prescribed time (typically 3-5 minutes)
Alcohol-based surgical hand rub: Applying an alcohol-based antiseptic to clean, dry hands and forearms, rubbing until dry

After scrubbing, hands must be held above waist level with fingers pointed upward to prevent water from the non-scrubbed forearms from running down onto the clean hands.

Gowning and Gloving

After the surgical scrub, the team member dons a sterile gown and sterile gloves using specific techniques to avoid contamination:

The gown is considered sterile only on the front from chest to waist level and on the sleeves from 2 inches above the elbow to the cuffs
The back of the gown is considered non-sterile regardless of closure method
Closed gloving is preferred, where gloves are applied while hands remain inside the gown sleeves, preventing bare skin from contacting the outer glove surface

If a glove is punctured or torn during a procedure, it must be changed immediately. The compromised glove provides a direct path for microorganisms to enter the sterile field. Stop, remove both contaminated gloves, and re-glove using proper technique.

Common Contamination Scenarios

Reaching over the sterile field: Non-scrubbed personnel should never reach over the sterile field to hand off items
Turning your back: Sterile-gowned personnel should face the sterile field at all times and never turn their back to it
Dropping items: Items dropped below waist level or off the sterile field are contaminated
Wet barriers: Moisture can wick bacteria through drapes, contaminating the field ("strike-through")

Allowing non-scrubbed personnel to lean over the sterile field to adjust equipment or monitors. Any time a non-sterile item or person passes over the sterile field, contamination risk increases. Rearrange the room setup so equipment is accessible without crossing the sterile field.

Key Takeaways

Sterile technique prevents introduction of microorganisms into the surgical site
The sterile field is established and maintained with strict rules; any breach means contamination
The surgical scrub reduces hand flora to the lowest possible level before gowning and gloving
Only the front of the gown (chest to waist) and sleeves (above elbow to cuff) are considered sterile
When in doubt about sterility, treat the item as contaminated and replace it