Preparing a Sterile Field Using a Commercially Prepared Sterile Kit or Tray

Skill 1-5

Preparing a Sterile Field Using a Commercially Prepared Sterile Kit or Tray

A sterile field is created to provide a surgically aseptic workspace. Consider it a restricted area. Commercially prepared sterile kits and trays are wrapped in a sterile wrapper that, once opened, becomes the sterile field. Sterile items and sterile-gloved hands are the only objects allowed in the sterile field. If the area is breached, the entire sterile field is considered contaminated. 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

Commercially prepared sterile package
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 commercially prepared package 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 opening a commercially packaged sterile kit or tray is that a sterile field is created without contamination, the contents of the package remain sterile, 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 kit or tray 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 outside cover of the package (Figure 1) and remove the kit or tray. Place in the center of the work surface, with the topmost flap positioned on the far side of the package. Discard outside cover.	This allows sufficient room for sterile field.
6. Reach around the package and grasp the outer surface of the end of the topmost flap, holding no more than 1 inch from the border of the flap. Pull open away from the body, keeping the arm outstretched and away from the inside of the wrapper (Figure 2). Allow the wrapper to lie flat on the work surface.	This maintains sterility of inside of wrapper, which is to become the sterile field. The outer surface of the wrapper is considered unsterile. The outer 1-inch border of the wrapper is considered contaminated.
7. Reach around the package and grasp the outer surface of the first side flap, holding no more than 1 inch from the border of the flap. Pull open to the side of the package, keeping the arm outstretched and away from the inside of the wrapper (Figure 3). Allow the wrapper to lie flat on the work surface.	This maintains sterility of the inside of the wrapper, which is to become the sterile field. The outer surface of the wrapper is considered unsterile. The outer 1-inch border of the wrapper is considered contaminated.
8. Reach around the package and grasp the outer surface of the remaining side flap, holding no more than 1 inch from the border of the flap. Pull open to the side of the package, keeping the arm outstretched and away from the inside of the wrapper (Figure 4). Allow the wrapper to lie flat on the work surface.	This maintains sterility of the inside of the wrapper, which is to become the sterile field. The outer surface of the wrapper is considered unsterile. The outer 1-inch border of the wrapper is considered contaminated.
9. Stand away from the package and work surface. Grasp the outer surface of the remaining flap closest to the body, holding not more than 1 inch from the border of the flap. Pull the flap back toward the body, keeping arm outstretched and away from the inside of the wrapper (Figure 5). Keep this hand in place. Use other hand to grasp the wrapper on the underside (the side that is down to the work surface). Position the wrapper so that when flat, edges are on the work surface, and do not hang down over sides of work surface (Figure 6). Allow the wrapper to lie flat on the work surface.	This maintains sterility of the inside of the wrapper, which is to become the sterile field. The outer surface of the wrapper is considered unsterile. The outer 1-inch border of the wrapper is considered contaminated.
10. The outer wrapper of the package has become a sterile field with the packaged supplies in the center (Figure 7). Do not touch or reach over the sterile field. Place additional sterile items on field as needed. Refer to Skill 1-6. Continue with the procedure as indicated.	Sterility of the field and contents are maintained.
11. 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, the contents of the package remained sterile, 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, do 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 you are unable 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 Refer to details in Skill 1-4, Evidence for Practice.

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Skill 1-5

EVIDENCE FOR PRACTICE