Chapter 2
Sterile Technique
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hospital Acquired Infections (HAI)
• Also known as nosocomial infections
• Acquired by patients whose natural defenses against
infection are often missing or overridden in the health
care setting
• HAIs are very expensive in terms of money and human
life
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hospital Acquired Infections (HAI)
(cont.)
• The CDC estimates that 250,000 patients a year get an
HAI just from urinary catheters alone
• Patients with an HAI need additional treatment and
longer hospital stays, and incur higher health care costs
• The CDC also reports that between 10% and 25% of
patients who acquire an HAI die
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterile Technique
• Involves:
– Creating a sterile field (a microbe-free area to work
in)
– Using equipment and supplies that have been made
sterile (completely free of microbes) to minimize the
risk of infection
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Levels of Sterilization for Equipment and
Supplies
Category I: Critical—for items that carry a very high risk because
they penetrate the skin or are placed in body cavities that are
normally free of microbes
Category II: Semi-critical—for items that come into contact with
mucous membranes and carry a moderate risk for causing
infection
Category III: Non-critical—for items that come into contact with
intact skin and carry a lower risk for causing infection
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
High-level Disinfection
• Involves using a very strong chemical to kill microbes on
items that will come in contact with a person’s skin or
mucous membranes
• Kills almost all microbes except for some bacterial
endospores
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterilization
• The most complete method of killing all microbes
• Kills microbes as well as endospores
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
What is the most complete method of killing all microbes
as well as endospores?
A. High-level disinfection
B. Sanitation
C. Sterilization
D. Disinfection
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
C. Sterilization
Sterilization is the most complete method of killing all
microbes; it kills microbes as well as endospores.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterile Packages
• Fabric-wrapped: items inside are sterilized onsite
• Envelope-wrapped package: one corner is opened at a
time to create a sterile field; may be made of fabric or
paper
• Peel/sterilization pouches: small sterile items
wrapped in a combination of paper and plastic. Both
sides are peeled at the same time, enabling the user to
carefully drop the item onto the sterile field
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Indications That an Item Is Sterile
• Commercially prepared items have writing on the outside
of the packaging
• Items that are sterilized onsite will have two chemical
indicator strips
– Outside strip changes color after being processed
– Indicator strip inside the package will also change
color to show the sterilizing agent penetrated the
packaging
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Indications That an Item Is Sterile (cont.)
• The sterility of items is maintained as long as a sterile
package is stored properly and the packaging material is
not damaged or placed on a wet surface
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
Sterilized items usually reach expiration in about one (1)
year
A. True
B. False
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B. False
Sterilized items have no expiration date.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
When Creating a Sterile Field, You Need:
• A sterile area where other sterile supplies can be opened,
arranged, and moved around
• A place where sterile supplies can be opened in a manner
that does not contaminate them or the sterile field
• Sterile gloves to arrange and use sterile supplies within
the sterile field, and, if you wish, sterile transfer forceps
to move items around within the sterile field.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Procedures That Require a Sterile Field
 Inserting urinary catheters
 Giving injections
 Starting intravenous (IV) lines
 Changing sterile dressings
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
All instruments, supplies, and gloved hands remain sterile
so that _______ are not introduced into the body
A. Asepsis
B. Calories
C. Microbes
D. Disinfection
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
C. Microbes
Sterilization prevents endospores and microbes from
entering the body.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Guidelines for sterile items
• a sterile object may not touch a nonsterile object
• sterile objects must not be wet. Moisture draws
microorganisms into the sterile object
• a one in border is between an sterile area and a nonsterile area
(place sterile items in the center of the sterile field away from
the edges)
• do not turn your back on a sterile field ( you can’t see the field
and don’t know what touched it)
• Anything below the waist is considered out of the sterile range
(all surgery trays should be positioned above the waist, hold all
above waist)
• All sterile objects must be held in front and away from the
body
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Guidelines for sterile item
Do not cough, sneeze, or talk over a sterile field
Do not reach over the sterile area
Do not pass contaminated dressings or instruments
over the sterile field.
Contaminated instruments should be placed in a
separate container or area
Be aware of actions in order to determine if the
sterile field has been compromised
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Guidelines for sterile items
Outer wrapper of sterile packages are contaminated
and should be opened without touching the inner
contents
Sterile solutions in bottles should be poured into
sterile basins or sups on the sterile field without
touching the rim of the bottle and without splashing
solution onto the sterile
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Using an Envelope-Wrapped Package
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Using a Sterile Drape
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pouring Liquid Into a Sterile Container
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transfer Forceps
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterile Gloves
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
THINK ABOUT IT
• You are working at the bedside of Mrs. Thomas,
preparing to assist the nurse with a sterile dressing
change. You have created a sterile field on the over-bed
table and you are arranging the supplies for the nurse to
use. Mrs. Thomas is occasionally a bit disoriented as the
result of her pain medication. Suddenly, she reaches up
to the field and removes a stack of gauze sponges you
have just arranged. What should you do? What steps
could you take to prevent this from happening in the
future?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• You must discard the sterile field and set up a new one.
Explaining to Mrs. Thomas that sterile technique is being
used to lower her risk of infection and helping her to
understand how sterility is maintained may help to
prevent this from happening in the future.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
THINK ABOUT IT
• You are preparing to set up a sterile field and open sterile
supplies for a procedure in a patient’s room. You plan to
arrange your sterile field on the over-bed table. What
must you do to prepare this area before setting up the
sterile field?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• The over-bed table must be cleaned with a disinfectant,
and dried thoroughly.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
THINK ABOUT IT
• It is time for the sutures to be removed from Mr. Wilson’s
wound. Kari, the nurse you are working with, is preparing
to carry out this procedure using sterile technique. You
have assisted her by setting up the sterile field and
opening the sterile supplies. You are now wearing sterile
gloves and have everything neatly arranged for the
procedure. Right before Kari starts to clean Mr. Wilson’s
wound, you notice a hole in one of your gloves, and you
are not sure how it got there. What should you do?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• First, you must alert Kari that the sterile field may have
become contaminated, so that she can stop the
procedure. Then you must discard the sterile field and
set up a new one.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins