Are You Making These 3 Critical Sterile Technique Mistakes?

3 Sterile Technique Mistakes and Fixes

Are you preparing the sterile field too early?

You may be inviting invisible contamination to your sterile field. Take a closer look at timing and other common sterile technique slip-ups and explore these new solutions that publish in April.

Following stringent sterile technique is absolutely critical to prevent surgical site infection. Unfortunately, sterile technique can be among the most challenging day-to-day practices in the OR.

Why? Contamination is usually invisible. Especially when airborne contaminants land on open surgical instruments, equipment, or the draped patient. And it happens more than you think. Every door opening or step a team member takes in the hustle of a case stirs contaminants. That’s according to Erin Kyle, DNP, RN, CNOR, NEA-BC. She's Editor in Chief of Guidelines for Perioperative Practice.

Next month AORN will release an updated Guideline for Sterile Technique. New tools and practices in the guideline based on the latest research will make it easier for teams to dial in sterile technique.

Three Sterile Technique Challenges and Solutions
Kyle explained the top three breaks in sterile technique in the OR. She also shared new evidence-based fixes coming in the forthcoming guideline update to reduce infection-causing contamination.

Problem #1: Poor Timing for Set-Up

Orchestrating the setup and preparation of the sterile field for procedures requires targeted preparation. “But you also don't want to set up too early. This is a tough balance,” Kyle acknowledged.

Solution: Look for updated guidance on timing sterile field set-up. For example, drape the patient, furniture, and equipment as close to the time of use as possible.  See recommendations 3.3, 5.1, 5.7, 7.4

You can also use the updated Isolation Technique Table. It has tips for using single- and dual-field approach. See recommendation 7

Problem #2: Ineffective Equipment Draping

Some equipment is large, awkwardly shaped, and just difficult to drape. “We found in the research that the C-arm is often contaminated, even after just draping it,” Kyle explained. Having it draped and ready for use is common while setting up for the procedure. However, movement around the C-arm can contaminate it before the procedure.

Solution: Teams should follow new guidance to drape the C-arm and other equipment as close to time of use as possible. See recommendations 4.2, 7.6

Problem #3: Contaminated Air

“Protecting the sterile field from airborne contaminants showed up in the literature in a big way. The air can never be sterile, and the air in the room touches everything,” Kyle reinforced.

Solution: Look for updated guidance that covers monitoring and improving the quality of air in the OR. Also, health care organizations should reduce the risk of airborne environmental contamination. This may include establishing an interdisciplinary air quality management program. A new Air Quality visual guidance can help this. See recommendation 9

Reduce sterile field contamination with new guidance on limiting movement and door openings and covering the sterile field. Also, look at contamination risks with open basins of solutions on the sterile field. See recommendation 6

Look for More Updates to Improve Your Sterile Technique

The guideline update is slated to publish online in April at aornguidelines.org. It will include a collection of guideline implementation tools. Start with Key Takeaways to easily identify what’s new and what needs to be reinforced. Don’t miss these other updates in the updated Guideline for Sterile Technique to discuss as a team:

• An updated Surgical Wound Classification Decision Tree. See figure 6
• New recommendations for PPE, including how to select surgical gowns and prevent sleeve contamination. See recommendations 1, 2