A Nurse Is Performing A Sterile Dressing Change. Which Action Contaminates The Sterile Field?

4.iv Sterile Fields

Open up Resources for Nursing (Open RN)

A sterile field is established whenever a patient's skin is intentionally punctured or incised, during procedures involving entry into a torso crenel, or when contact with nonintact pare is possible (e.g., surgery or trauma). Surgical asepsis requires adherence to strict principles and intentional actions to preclude contagion and to maintain the sterility of specific parts of a sterile field during invasive procedures. Creating and maintaining a sterile field is foundational to aseptic technique and encompasses practice standards that are performed immediately prior to and during a procedure to reduce the risk of infection, including the post-obit:

Handwashing
Using sterile barriers, including drapes and appropriate personal protective equipment
Preparing the patient using an canonical antimicrobial production
Maintaining a sterile field
Using aseptically safe techniques

There are basic principles of asepsis that are critical to understand and follow when creating and maintaining a sterile field. The near basic principle is to allow merely sterile supplies within the sterile field one time information technology is established. This means that prior to using any supplies, outside packaging must be checked for whatever signs of damage, such every bit previous exposure to moisture, holes, or tears. Packages should not exist used if they are expired or if sterilization indicators are non the appropriate color. Sterile contents within packages are dispensed onto the sterile field using the methods outlined below. See Figure iv.16^{^[ane]} for an image of a nurse dispensing sterile supplies from packaging onto an established sterile field.

Figure iv.16 Dispensing Sterile Supplies onto a Sterile Field

When establishing and maintaining a sterile field, there are other important principles to strictly follow:

Disinfect whatsoever piece of work surfaces and allow to them thoroughly dry earlier placing whatever sterile supplies on the surface.
Be enlightened of areas of sterile fields that are considered contaminated:
- Whatsoever function of the field within 1 inch from the edge.
- Any part of the field that extends below the planar surface (i.east., a drapery hanging downwards below the tray tabletop).
- Any office of the field below waist level or higher up shoulder level.
- Any supplies or field that you lot take not directly monitored (i.due east., turned away from the sterile field or walked out of the room).
- Within 1 inch of whatsoever visible holes, tears, or moisture wicked from an unsterile area.
When treatment sterile kits and trays:
- Sterile kits and trays mostly have an outer protective wrapper and four inner flaps that must be opened aseptically.
- Open sterile kits away from your body get-go, touching only the very edge of the opening flap.
- Using the aforementioned technique, open each of the side flaps one at a fourth dimension using merely one mitt, being conscientious not to allow your torso or arms to be directly above the opened drape. Take intendance not to allow already-opened corners to flip back into the sterile expanse again.
- Open the terminal flap toward you, being careful to not allow whatever office of your body to be directly over the field. See Figure 4.17^{^[2]}for images of opening the flaps of a sterile kit.
- If you must remove parts of the sterile kit (i.east., sterile gloves), accomplish into the sterile field with the elbow raised, using simply the tips of the fingers before extracting. Pay shut attention to where your body and clothing are in relationship to the sterile field to avoid inadvertent contamination.

When dispensing sterile supplies onto a sterile field:
- Earlier dispensing sterile supplies to a sterile field, do not permit sterile items to touch whatsoever role of the outer packaging one time it is opened, including the onetime packet seal.
- Heavy or irregular items should be opened and held, allowing a second person with sterile gloves to transfer them to the sterile field.
- Wrapped sterile items should be opened similarly to a sterile kit. Tuck each flap securely inside your palm, and and so open the flap abroad from your body first. Then open each side flap; secure the flap in the palm one at a time and open up. Finally, open the flap (closest to you) toward you, while too protecting the other opened flaps from springing back onto the wrapped detail.
- Peel pouches (i.due east., gloves, gauze, syringes, etc.) can exist opened by firmly grasping each side of the sealed edge with the thumb side of each hand parallel to the seal and pulling carefully autonomously.
- Drop items from 6 inches away from the sterile field.
- Sterile solutions should be poured into a sterile bowl or tray from the side of the sterile field and not directly over it. Use merely sealed, sterile, unexpired solutions when pouring onto a sterile field. Solution should be held six inches away from the field as it is being poured. Avert splashing solutions considering this allows wicking and transfer of microbes. After pouring of solution stops, it should non exist restarted because the edge is considered contaminated. Come across Figure four.18^{^[iii]} of an image of a nurse pouring sterile solution into a receptacle in a sterile field before the process begins.
- Don sterile gloves away from the sterile field to avoid contaminating the sterile field.