What Happens to a Sterile Setup During a Procedural Delay in the OR?
By: AORN Staff
Published: 6/5/2025
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Picture this scene in the OR: sterile supplies are open. The room is prepped. The procedure is about to begin—or already has. And then, there’s a delay.
So, how long can the room setup remain sterile?
While facility policy is the deciding factor, the AORN Guideline for Sterile Technique offers evidence-based recommendations to help perioperative teams manage delays safely.
One key recommendation from the Guideline: prepare the sterile field as close to the time of use as possible.
“Preparing a sterile field as close as possible to the time of use remains the primary strategy for minimizing the risk of sterile field contamination before a surgical procedure,” says former AORN Senior Perioperative Practice Specialist and author of the Sterile Technique Guideline, Julie Cahn.
“Another important strategy is preparing instrument tables away from areas of movement.”
How to Protect a Sterile Field When the Procedure Is Delayed
There isn’t enough high-quality research, and there are too many facility-specific and procedure-specific factors to make a universal recommendation on the length of time a covered instrument table remains sterile, Dr. Cahn, DNP, RN, ACNS-BC, CNS-CP, NPD-BC, CNOR, FAORN, said.
However, when a delay occurs before the patient enters the OR, AORN recommends the following actions for what should be done to prevent contamination of a sterile field after it is set up:
- Leave the table in the OR where it will be used. Don’t move it out of the room.
- Cover the table using one of two methods:
The two “cuffed” drape method
A drape made for table covering - Note the time the table was set up and covered.
- Limit traffic, post a sign communicating the presence of a covered sterile table, or use direct observation if organizational policy requires it.
- Communicate the delay to the patient’s family per organizational policy.
Dr. Cahn added that contamination of a covered sterile field can occur between 1 hour and 3 days, with an average time of 13.76 hours.
Key Factors That Influence Sterile Field Safety
1. What Type of Surgical Procedure Is Scheduled?
Organizations specializing in orthopedics, neurosurgery, cardiovascular surgery, or transplant procedures may opt for shorter time limits for covered sterile tables than those focused on gastrointestinal procedures.
2. What If the Delay Happens After the Patient Enters the OR?
Delays may occur even after the patient has entered the room, but before the procedure begins. In these situations, many of the same strategies apply, though signage may not be necessary due to active staff presence.
Facilities often monitor these delays via:
- Electronic health record (EHR) timestamps
- Direct communication with the surgical team
3. Procedural Delays That Influence Sterile Field Setup Timing
Any procedure that depends on the completion or timely progress of another case—or the availability of a specific team member—can impact when the next room is set up.
A common example is when one surgeon is working between two rooms. If there’s a delay in one, the team may choose not to open the second room until the delay is resolved, depending on the nature of the delay and the assistants available that day.
Another scenario involves surgeons or interventionalists scheduling procedures in two departments on the same day, which is especially common in specialties like obstetrics and gynecology or gastroenterology.
Delays can also occur during living donor transplant procedures. If a delay happens before the organ is removed, the team may wait to open the second room for the transplant recipient until the first procedure progresses.
How Do Unidirectional Air Delivery Systems Affect OR Airflow and Airborne Contaminants?
There are reduced airborne contaminants within the system's airflow curtain. This helps keep the cleanest air over the area where the patient is located. The air is more contaminated in the room periphery, where the OR doors are located and where personnel walk around the room, causing contaminants on the floor to be added to the air currents when disturbed. Instrument tables are typically set up in the OR periphery.
“This is one of the reasons why covering the table when there is an unanticipated delay is so important,” Dr. Cahn says.
While it may seem logical to move the covered table into the air curtain, it is unclear whether the movement will expose it to additional contaminants compared to leaving it covered in the periphery.
When No Policy Exists, Create One
If there is no policy to guide practice, she suggests setting up an interdisciplinary team to develop one. Ultimately, she says decisions regarding the duration a sterile field can remain covered and still be considered sterile should account for the potential impact on surgical site infection risk.
“When the sterility of a covered field is in question, establishing a new sterile field is always the safest course of action.”
Train on Sterile Technique Best Practices
- Rooted in AORN Guidelines for Perioperative Practice, Periop 101: A Core CurriculumTM onboards novice nurses on evidence-based sterile technique best practices to prepare them for the operating room. Additionally, the Periop 101 program package includes extended AORN memberships for learners and program administrators, which opens access to Guideline Essentials. For more experienced nurses on your team, the program package also includes additional continuing education (Periop Mastery 2.0 & Knowledge Assessment) that include sterile technique topics.
- Both new and experienced nurses can benefit from the comprehensive video-based courses on Sterile Technique and Draping, Hand Hygiene Sterile Guidelines and Technique, and Patient Skin Antisepsis — three of more than 40 courses in the AORN CineMed Video Library, focused on patient and staff safety.
Put the Sterile Technique Guideline into Practice
- From table setup to managing contamination risks, sterile technique is critical to safe surgery. AORN’s Guideline for Sterile Technique offers evidence-based best practices on topics such as preparing the sterile field, covering instrument tables, managing delays, and maintaining asepsis throughout the procedure. Download a back-to-basics sterile technique checklist and explore quick guides to best practices on room setup for 18 different types of surgical procedures in eGuidelines+. Sign up for a free facility trial of eGuidelines+ today.
- AORN’s Guideline Essentials help perioperative teams apply the Sterile Technique Guideline with tools like a customizable competency verification template, an implementation road map, and a policy and procedure template you can adapt to your facility. These resources are available exclusively to AORN members. Log in to access the Sterile Technique Guideline Essentials today.
