4 Common Sterile Technique Questions Answered

Sterile technique is foundational to perioperative nursing practice because it protects the patient from infection via surgical items, the sterile field, and the surrounding OR environment. Yet sterile technique is complex and highly situational. It takes nuanced decision-making and requires collaborative risk-based decisions when the unexpected happens.

For these reasons, it’s not uncommon for members to consult AORN with questions on sterile technique, says Erin Kyle, DNP, RN, CNOR, NEA-BC, EBP-C, editor-in-chief of AORN’s Guidelines for Perioperative Practice. 

She welcomes these questions because sterile technique is about more than simply following rules. “Prioritizing sterile technique and speaking up when something seems unsafe is the essence of surgical conscience and a culture of safety,” she said.

Your Top Sterile Technique Questions Answered

Here, Dr. Kyle answers some frequently asked sterile technique questions that come to AORN’s Clinical Consult line. Read more on the evidence behind each answer in the Guideline for Sterile Technique.

1. What actions should be taken when expired suture is opened on the back table?

Expired suture opened on the sterile field should be considered contaminated and removed immediately. Any other items that came into contact with the expired suture should also be removed. Team members who handled the expired item should change their gloves.

The incident should be reported per facility policy, and the surgical wound classification may need to be reassessed through a team discussion—especially if the expired item was used or introduced into the wound.

2. What is the latest evidence on wound classification that nurses can share with their team?

The key to wound classification is remembering its purpose—to reduce SSI risk. It needs to be a team effort to tackle these essential tasks:

• Assess contamination risk
• Standardize documentation
• Guide infection prevention strategies
• Support surveillance and quality improvement

Wound classification should be determined collaboratively during the postprocedural debrief and documented by someone involved in the procedure—either the surgeon or the circulating RN. Using the AORN Surgical Wound Classification Decision Tree (found in the Guideline for Sterile Technique) can help this process.

Three important reminders for correct wound classification:

• Certain procedures cannot be classified as Class I, Clean, including appendectomy, cholecystectomy, and colon surgery.
• Major breaks in surgical or sterile technique can require wound reclassification.
• Misclassification is common, especially if the EHR pre-populates a wound class based only on the scheduled procedure. The team must account for factors specific to the patient and the actual procedure to correctly classify a wound.

3. How should instruments be soaked for point-of-use handling during a procedure? What type of water should be used? Can instruments be soaked in a basin?

For instruments that will be needed later in the procedure, point-of-use handling should not be done by soaking. Instead, wipe instrument surfaces and flush lumens with sterile water.

Instruments that are not needed again during the procedure may be soaked in open basins of sterile water. But note these important caveats:

• The basin should be separated from other items on the sterile field (e.g., placed in a ring stand or on a separate table).
• The water should never be used for patient irrigation.
• Instruments placed in the basin should not be returned to the sterile field.
• The water should not be reused for moistening sponges or flushing lumens.

4. What should the team do as soon as a break in sterile technique is identified?

Immediate action is essential. Steps include:

• Remove the contaminated item(s).
• Remove any other items that contacted the contaminated item(s).
• Change gloves for any team member who touched the contaminated item(s).
• Implement isolation technique, if appropriate.
• Assess whether the surgical wound classification needs to be updated.
• Collaboratively determine the indicated interventions that can reduce SSI risk to the patient.

Make sure to report the incident per your facility policy.

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AI is now part of AORN’s electronic access to every AORN Guideline, including Sterile Technique. This new AI tool offers more targeted access to the evidence that can help teams make the right decision when seconds count.

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