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Sterile Technique


Why should health care practitioners double-glove during invasive procedures?

Answer:

Health care practitioners should double glove (wear two pairs of gloves, one over the other) during invasive procedures to:

  • reduce the risk of glove perforation,
  • reduce the risk of surgical site infection for the patient,
  • protect the wearer from exposure to bloodborne pathogens, and
  • minimize the amount of blood exposure during needlestick injuries.

In addition, using perforation indicator systems as part of double gloving can assist the wearer to identify glove failure.

Resources

  • Recommended practices for prevention of transmissible infections in the perioperative practice setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:331-364.
  • Recommended practices for sterile technique. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:91-120.

Updated January 28, 2013 

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Why does a sterile field opened prior to a procedure need to be monitored continuously?

Answer:

A sterile field established in advance of a procedure should be monitored continuously because sterility is event-related. The purpose of monitoring the sterile field is to observe for, or prevent, an event leading to contamination of the sterile field. These events may be caused by personnel, falling objects, or other means such as insects. Taping the door shut is not acceptable because it does not prevent all events from occurring or provide a means to observe the occurrence.

Resource

  • Recommended practices for sterile technique. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:91-120.

Updated January 28, 2013 

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Are there specific recommendations for gowning and gloving for clean-contaminated procedures (i.e. tonsillectomy, cystoscopy)?

Answer:

There is no distinction between procedure types in the practice of gowning and gloving. The purpose of gowning and gloving, as well as wearing other appropriate surgical attire such as caps, masks, and eye protection is to prevent microbial transference to the sterile field, surgical site, and patient during the surgical procedure. As part of Standard Precautions, this practice also reduces the risk of occupational exposure to bloodborne pathogens and other potentially infectious materials.

Resources

  • Recommended practices for sterile technique. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:91-120.
  • Recommended practices for prevention of transmissible infections in the perioperative practice setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:331-364.

Updated January 28, 2013 

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Can the same sterile field setup be used for two different areas on the same patient if both are classified as clean procedures (eg, anterior and posterior spine)?

Answer:

Yes, from a sterile technique standpoint, the same sterile supplies and instrumentation can be used when moving from one sterile area to another sterile area if the move is from a clean area to another clean, clean-contaminated, contaminated, or dirty area on the same patient. The same sterile supplies and instrumentation should not be used when moving from a clean-contaminated, contaminated, or dirty area to a clean area on the same patient. For example, it would be acceptable to move from a clean anterior neck to a clean posterior neck, but not from the perineum to a clean anterior neck.

However, there may be times when even though acceptable within the rules of sterile technique, perioperative personnel should consider using two setups in order to avoid the potential risk of contamination. For example, although a breast biopsy would be considered a clean case, separate setups should be used if doing biopsies on both the both breasts on the same patient in order to avoid the potential seeding of cancer cells. Another example might be when performing a clean-contaminated cholecystectomy, and a rectocele repair on the same patient. Although acceptable if no bile spillage occurred, it might be aesthetically unpleasant to use the same set up for both procedures.

Resource

  • Recommended practices for sterile technique. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:91-120

Updated July 18, 2013 

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What should a scrubbed team member do if they sneeze?

Answer:

The scrubbed team member should distance themselves from the sterile field before sneezing, if possible. Following the sneeze, the person should discard the sterile gown and gloves and leave the room to remove and discard the mask. At this time, the team member may don a clean surgical mask, perform a surgical hand scrub, and return to the OR to don a sterile gown and gloves.

Resource

  • Van Wicklin S. Scrubbed personnel who are sneezing. [Clinical Issues]. AORN J. 2013;97(5):592-593.

Updated August 7, 2013 

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How often should a surgical mask be changed?

Answer:

According to the AORN Recommended Practices for Surgical Attire, the surgical mask should be changed when it becomes wet or soiled. Researchers Barbosa and Graziano found that surgical masks may need to be changed when worn continuously for more than four hours.

Resources

  • Van Wicklin S. Length of time after which a surgical mask should be changed. [Clinical Issues]. AORN J. 2013;97(5):593-594.
  • Recommended practices for surgical attire. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:51-62.
  • Barbosa MH, Garziano KU. Influence of wearing time on efficacy of disposable surgical masks as microbial barrier. Braz J Microbiol. 2006;37(3):216-217.

Updated August 7, 2013 

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