Skill 1-4

Preparing a Sterile Field Using a Packaged Sterile Drape

A sterile field is created to provide a surgically aseptic workspace. It should be considered a restricted area. A sterile drape may be used to establish a sterile field or to extend the sterile working area. The sterile drape should be waterproof on one side, with that side placed down on the work surface. After establishing the sterile field, add other sterile items, as needed, including solutions. Sterile items and sterile-gloved hands are the only objects allowed in the sterile field. Prepare the sterile field as close as possible to the time of use (AORN, 2018). Refer to Fundamentals Review 1-2 to review basic principles of surgical asepsis.

Delegation Considerations

Procedures requiring the use of a sterile field and other sterile items are not delegated to assistive personnel (AP). Depending on the state's nurse practice act and the organization's policies and procedures, these procedures may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Sterile-wrapped drape
Additional sterile supplies, such as dressings, containers, or solutions, as needed
PPE, as indicated

Assessment

Assess the situation to determine the necessity for creating a sterile field. Assess the area in which the sterile field is to be prepared. Move any unnecessary equipment out of the immediate vicinity. Assess that the sterile, packaged drape is dry and unopened. Assess the package expiration date, making sure that the date is still valid.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or needs may require the use of this skill as part of related interventions. An appropriate health problem or need may include:

Infection risk
Risk for Cross Infection

Outcome Identification and Planning

The expected outcomes to achieve when preparing a sterile field is that the sterile field is created without contamination, and the patient remains free of exposure to pathogens.

Implementation

Action	Rationale
1. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
2. Identify the patient. Explain the procedure to the patient.	Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect.
3. Check that the packaged sterile drape is dry and unopened. Also note expiration date, making sure that the date is still valid.	Moisture contaminates a sterile package. Expiration date indicates period that package remains sterile.
4. Select a work area that is waist level or higher.	Work area is within sight. Bacteria tend to settle, so there is less contamination above the waist.
5. Open the outer covering of the drape. Remove sterile drape, lifting it carefully by its corners. Hold away from body and above the waist and work surface.	The outer 1 inch (2.5 cm) of drape is considered contaminated. Any item touching this area is also considered contaminated.
6. Continue to hold only by the corners. Allow the drape to unfold, away from your body and any other surface (Figure 1).	Touching the outer side of the wrapper maintains the sterile field. Contact with any surface would contaminate the field.
7. Position the drape on the work surface with the moisture-proof side down (Figure 2). This would be the shiny or blue side. Avoid touching any other surface or object with the drape. If any portion of the drape hangs off the work surface, that part of the drape is considered contaminated.	Moisture-proof side prevents contamination of the field if it becomes wet. The moisture penetrates the sterile cloth or paper and carries organisms by capillary action to contaminate the field. A wet field is considered contaminated if the surface immediately below it is not sterile.
8. Place additional sterile items on field as needed. Refer to Skill 1-6. Continue with the procedure as indicated.	Sterility of the field is maintained.
9. When procedure is completed, remove PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms.

Evaluation

The expected outcomes have been met when the sterile field has been prepared without contamination, and the patient has remained free of exposure to pathogens.

Documentation

It is not usually necessary to document the preparation of a sterile field. However, document the use of sterile technique for any procedure performed using sterile technique.

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

A part of the sterile field becomes contaminated: When any portion of the sterile field becomes contaminated, discard the sterile field and any items on the field, and start over.
You realize a supply is missing after setting up the sterile field: Call for help. Do not leave the sterile field unattended. If the nurse is not able to directly see the sterile field at all times, it is considered contaminated.
The patient touches the sterile field: If the patient touches the sterile field, discard the supplies and prepare a new sterile field. If the patient is confused, have someone assist by holding the patient's hands and/or provide reassurance and explanation of the procedure.

EVIDENCE FOR PRACTICE

AORN Guideline Quick View: Sterile Technique

Association of periOperative Registered Nurses (AORN). (2018). AORN guideline quick view: Sterile technique. AORN Journal, 108(6), 705-710. https://doi.org/10.1002/aorn.12458

This AORN guideline Quick View provides key points for implementation of sterile technique from the AORN Guideline Essentials. These guidelines provide evidence-based recommendations to guide implementation of sterile technique to promote safety and optimal outcomes for patients. Access to the full set of Guidelines for Perioperative Practice is included with AORN membership and can be accessed at https://www.aorn.org/guidelines

section name header

Skill 1-4

EVIDENCE FOR PRACTICE