4 Sterile Technique Questions Answered

Sterile technique is part of everyday perioperative practice, and it often prompts practical, case-based questions from OR teams looking to confirm the safest next step.

AORN Sr Perioperative Practice Specialist, Julie Cahn, DNP, RN, ACNS-BC, CNS-CP, NPD-BC, CNOR, FAORN, regularly fields sterile technique questions through the AORN Nurse Consult Line. Here, she answers four recent sterile technique questions nurses ask AORN, offering evidence-based guidance aligned with the AORN Guidelines for Perioperative Practice.

Is there a recommendation that implants be verified by the RN and surgical tech before opening to the field?

Before introducing any item to the sterile field, perioperative personnel should verify package and product integrity, sterility—including chemical indicator results—and expiration dates when applicable. Implants often require additional inspection or verification, such as confirming size and other device-specific characteristics (GL for ST 5.5).

Implants containing or impregnated with medications—such as medication pumps, antibiotic cement, or shunts—must also meet medication safety requirements, including allergy verification and adherence to the five rights of medication administration (GL for Med Safety 7.3 & 8.5). When an implant includes a medication component, documenting that medication in the patient's medication administration record is recommended (GL for Med Safety 8.5.1).

Tissue-based implants and transplantable organs may require further verification, such as ABO blood type confirmation, review of pathology or infectious disease screening results, or assessment for alpha‑gal syndrome. Organizations that store and replant autologous tissue may have additional verification steps, such as confirming patient identity and integrity of a cranial bone flap packaging when it is retrieved from freezer storage.

Consistent adherence to organizational policies, procedures, and manufacturer instructions for use is essential to ensure safe management and handling of all implants.

What to do when a contaminated tray discovered during surgery?

If any instrument in a set is found to be improperly disassembled or contaminated with debris, the sterility of the entire set is compromised and the whole set must be considered contaminated. When contamination occurs, the team should remove the affected item(s) and any items that contacted them, have all personnel who handled the contaminated item(s) change gloves, apply isolation technique as appropriate, and take any additional corrective actions based on the specific situation. Prompt response to breaks in sterile technique helps limit further contamination. (GL for ST 7.8.3 & 7.8.4)

Also see the July 2025 AORN Journal Clinical Issues column question (3^rd down) on "Black flecks found inside instrument sets after sterilization"

Who is responsible for determining wound classification? Where can I find this in the guidelines?

The Guideline for Sterile Technique, Section 8 outlines AORN's recommendations for Surgical Wound Classification and includes the AORN Surgical Wound Classification Decision Tree. Organizations may further define wound classification processes in their policies and procedures. AORN recommends that the surgical team—including the surgeon, RN circulator, and other involved clinicians—determine the wound classification during the postprocedural debriefing and before documentation. Verifying the classification with all team members supports discussion when differences arise and helps ensure that the documented classification reflects the team's shared clinical judgment.

Should a scrub nurse reach over the sterile field to grab an item from circulator?

AORN provides guidance on how unscrubbed personnel should interact with the sterile field (GL for ST 5.3). When an unscrubbed team member presents a sterile item, it should be handed directly to a scrubbed team member or placed securely onto the sterile field. To reduce contamination risk, AORN recommends minimizing unnecessary movement in and around the sterile field and having scrubbed personnel in close proximity to it.

Scrubbed team members may reach over the sterile field; however, if their positioning forces an unscrubbed individual to enter the vertical unidirectional airflow curtain or move too close to the sterile field (GL for ST 6.5), the scrubbed team member should adjust their position to reduce the potential for contamination.