FUNCTION:  Surveillance, Prevention, Control of Infection
 
TITLE:  Aseptic Technique in the Operating Room, Principles of
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PURPOSE:
 
All persons working in the Operating Room must be alert to contamination and
aid in maintaining aseptic conditions.
 
POLICY:
 
I.   All articles used in a surgical procedure are sterile.
 
     A.   Sterile articles may be added to sterile articles.
     B.   Wrapped sterile supplies are stored in an area where they can remain
          sterile.
 
II.  If in doubt about the sterile quality of any article or area, consider
     the article nonsterile.
 
     A.   Uncertain about timing of sterilizer.
     B.   If sterile package is found in unsterile area.
     C.   If sterile table or sterile articles are left unguarded or
          uncovered.
     D.   If sterile package is dropped to floor.
 
III. The sterile field can become contaminated.
 
     A.   By becoming wet if underlying area is nonsterile.
     B.   By dropping a nonsterile object onto a sterile field.
     C.   By infectious wound material.
     D.   By dust in the air or droplet nuclei, airborne germs from sponges,
          excessive traffic in the operating room.
 
IV.  Sterile areas should be protected to avoid accidental contamination.
 
     A.   Nonsterile persons should never walk between sterile fields.
     B.   Nonsterile persons avoid reaching over a sterile field.
 
          1.   Pouring solutions-scrub nurse sets basins or glasses to be
               filled at the edge of the sterile table. Circulator stands near
               edge of table, without touching, to fill containers.
          2.   Adjusting lights-circulator stands at a distance from the
               sterile field to adjust light over it.
          3.   For the circulator to wipe perspiration from the surgeon's
               brow, surgeon turns away from sterile field.
 
     C.   Sterile persons avoid leaning over unsterile areas. They remain well
          within the sterile area to avoid contact with the nonsterile.
          Sterile nurses:
     
          1.   Turn back to unsterile areas.
          2.   Face sterile areas or persons when passing.
          3.   Avoid squeezing through narrow spaces.
 
               a.   If a sterile person is obstructing the way, he or she
                    should move.
               b.   If the obstruction is due to equipment, a nonsterile
                    person should move it.
 
          4.   A sterile person should be told that someone nonsterile is
               behind him or her.
          5.   Sterile persons pass each other back to back or front to front,
               keeping well within the sterile areas.
 
     D.   Tables are sterile only at table level.
 
          1.   Scrubbed persons stand a safe distance from the
               operating table while patient is being draped.
          2.   A nonsterile back does not touch a sterile table or
               sterile areas.      
 
V.   Gowns and gloves.
 
     A.   Gowns are considered sterile from the waist to shoulder level in
          front, including sleeves and back of sleeves to elbow.
     B.   Sterile person keeps gloved hands resting on sterile drapes. They
          are never dropped below the waist level.
     C.   Arms are never folded with hands in axilla area. Perspiration in
          this will contaminate gown.
 
VI.  Sterile articles. Sterile persons keep contact with sterile articles at
     an absolute minimum. Excessive handling of instruments increases the
     chance of contamination.
 
VII. Sterilizer. When unwrapped articles are removed, the tray must not come
     in contact with the nonsterile edge of the sterilizer or door.
 
VII. Wrapper.
 
     A.   The outer side of the wrapper or other means of enclosing sterile
          contents is not considered sterile.
     B.   The innermost side of a wrapper is sterile except for one (1) inch
          around the border, which is considered nonsterile.
 
IX.  All doors leading into the operating room are kept closed.