Chapter 19: Sterile Technique

Question 1

Choose the INCORRECT statement. Proper sterile technique:
A. Eliminates all microorganisms in the OR
B. Is a key responsibility of perioperative personnel
C. Helps prevent health care-associated infections in patients and medical professionals
D. Includes wearing gowns, gloves, and surgical masks whose barrier performance is appropriate for the specific procedure being performed

Answer 1

A. Eliminates all microorganisms in the OR

Question 2

Complete the following statement: The bacterium \_\_\_\_\_\_\_\_\_\_, which colonizes the nose and throat of asymptomatic carriers, can cause surgical site infections (SSIs) as well as severe systemic infections including myocarditis, and pneumonia
A.  Pseudomonas aeruginosa
B.  Staphylococcus epidermidis
C.  Staphylococcus aureus
D.  Clostridium dificile

Answer 2

C. Staphylococcus aureus

Question 3

When entering the OR or procedure area, nonscrubbed members of the perioperative team should wear:
A. A head covering and clean, low-linting two-piece pantsuit, one-piece coverall, or scrub dress
B. A clean or single-use long-sleeved scrub jacket that is buttoned or snapped closed and fully covers the torso, arms and wrists
C. Shoe coverings, if spills or splashes are likely to occur
D. All of the above

Answer 3

D. All of the above

Question 4

Perioperative hand hygiene includes all of the following EXCEPT:
A. Removing bracelets and watches before washing hands or beginning a surgical hand scrub
B. Removing chipped nail polish before entering the perioperative area
C. Removing visible soil on the hands and arms with an alcohol-based antiseptic hand rub that meets US Food and Drug Administration standards for antimicrobial activity
D. Using a disposable nail cleaner to clean under the nails
E. Removing rings before entering the perioperative area

Answer 4

C. Removing visible soil on the hands and arms with an alcohol-based antiseptic hand rub that meets US Food and Drug Administration standards for antimicrobial activity

Question 5

The proper method of wearing a surgical mask is:
A. Tied closely to the face, to prevent venting of respiratory contaminants around the sides
B. Tied loosely around the face, to facilitate ease of breathing
C. With the ties crossed around the back of the head
D. None of the above

Answer 5

A. Tied closely to the face, to prevent venting of respiratory contaminants around the sides

Question 6

A surgical mask should be worn at all the following times EXCEPT:
A. During lumbar puncture
B. During insertion of a central venous catheter (CVC)
C. When placing a peripheral venous catheter
D. In the presence of opened packs of sterile supplies

Answer 6

C. When placing a peripheral venous catheter

Question 7

A surgical mask provides adequate protection when entering the room of a patient who requires airborne precautions.
A. True
B. False

Answer 7

B. False

Question 8

Sterile gowns and drapes are regulated as surgical devices. Federal law requires that I a gown or drape fails, the event must be reported to which US agency?
A. Centers for Disease Control and Prevention (CDC)
B. Agency for Health Care Research and quality (AHRq)
C. National Institutes of Health (NIH)
D. Food and Drug Administration (FDA)

Answer 8

D. Food and Drug Administration (FDA)

Question 9

When evaluating appropriate materials for gowns, gloves, and drapes, perioperative personnel should consider:
A. the length of the procedure and anticipated volumes of blood loss, fluid loss, and irrigation fluid used
B. the barrier performance of the products
C. whether electrosurgical cautery will be performed
D. A and B

Answer 9

D. A and B

Question 10

When performing a surgical hand scrub, it is acceptable to use an alcohol-based antiseptic solution if it exhibits persistent, cumulative antimicrobial activity that meets FDA standards
A. True
B. False

Answer 10

A. True

Question 11

A surgical hand scrub should be performed:
A. Before donning sterile gowns and gloves for surgical and other invasive procedures
B. Whenever you need to enter the OR
C. In the OR or invasive procedure area
D. Before opening a sterile instrument pack

Answer 11

A. Before donning sterile gowns and gloves for surgical and other invasive procedures

Question 12

Which areas of a surgical gown are considered sterile?
A. the front, from the chest to six inches below the surgical field
B. The front, from the chest to the level of the surgical field
C. The neck and shoulders
D. The axillary area

Answer 12

B. The front, from the chest to the level of the surgical field

Question 13

When donning a surgical gown, it is permissible to:
A. Stand next to the instrument table
B. Grasp the outside back of the gown with your scrubbed hands
C. Accept help from an unscrubbed perioperative team member, so long as the helper touches only the inside of the gown
D. Don the surgical gloves first, and then the gown

Answer 13

C. Accept help from an unscrubbed perioperative team member, so long as the helper touches only the inside of the gown

Question 14

When performing closed assisted gloving, you whould pull the gown cuffs up over your wrists toward your elbows and then don the gloves
A. True
B. False

Answer 14

B. False

Question 15

Randomized studies show that _______ gloving is associated with increased microbial contamination of glove cuffs. For this reason, ________ gloving should be performed whenever possible when donning the initial pair of gloves.
A. Open assisted, closed assisted
B. Closed assisted, open assisted

Answer 15

A. Open assisted, closed assisted

Question 16

Even small perforations in surgical gloves increase risk of exposure to bloodborne pathogens and potentially infectious materials. When wearing surgical gloves, it is appropriate to do all of the following EXCEPT:
A. Double glove during surgical and other invasive procedures
B. Change gloves when contamination or perforation is suspected, even if you are not sure it happened
C. Change gloves every 45 minutes during surgical and other invasive procedures
D. Use a performance indicator system in which the inner pair of gloves is colored to make perforations easier to see

Answer 16

C. Change gloves every 45 minutes during surgical and other invasive procedures

Question 17

Surgical gloves should be changed:
A. Immediately after your gloves come in contact with methyl methacrylate, because it can rapidly break down latex
B. Between patients, but only if the patient is suspected to have an infection or if the gloves are visibly contaminated
C. If they become loose on the hands from exposure to fluids or fat
D. A and C

Answer 17

D. A and C

Question 18

A sterile field includes which of the following?
A. The site surrounding an incision or tissue perforation
B. The site where an instrument has been introduced into a body orifice that has been prepared for a surgical or other invasive procedure
C. Working areas, furniture, and equipment covered with sterile drapes and drape accessories
D. Personnel in sterile attire
E. All of the above

Answer 18

E. All of the above

Question 19

When preparing a sterile field, the first thing that team members should do is:
A.  Perform a surgical hand scrub
B.  Don sterile gloves
C.  Don a sterile gown
D.  Don clean (nonsterile) gloves

Answer 19

A. Perform a surgical hand scrub

Question 20

To decrease risk of contamination, AORN recommends that a sterile field be:
A. Prepared in the room adjacent to where it will be used
B. Prepared as close as possible to the start time of the procedure
C. Prepared no more than 60 minutes before the start time of the procedure
D. Covered and left for up to two hours if a procedure is unexpectedly delayed

Answer 20

B. Prepared as close as possible to the start time of the procedure

Question 21

While assisting during a surgery, a team member observes that an instrument in a set is clamped shut. The rest of the instruments in the set are unclamped, as expected. The chemical sterilization indicators have changed, as expected. The team member has already passed other instruments in the pack to the surgeon. To take corrective action, the team member should:
A. Unclamp the instrument
B. Use a sterile sponge or towel to pick up the clamped instrument and set it aside, then continue using the rest of the pack
C. Set the instrument and the rest of the pack aside, and discuss the event with the team when the procedure is over
D. Remove the entire set and any other instruments the set may have come in contact with; change gloves; and notify the team right away, so that additional corrective steps can be taken, if needed

Answer 21

D. Remove the entire set and any other instruments the set may have come in contact with; change gloves; and notify the team right away, so that additional corrective steps can be taken, if needed

Question 22

Which of the following procedures for isolation technique, also known as bowel technique or contamination technique, is NOT recommended?
A. When practicing single setup, segregate all instruments, towels, and other items (e.g. Mayo stand, basin) that have contacted the bowel lumen to a designated area
B. Begin isolation technique when the gastrointestinal tract is transected, and end it when the anastomosis is complete
C. After announcing the change to clean closure, ensure that the entire scrubbed team leaves the sterile field and changes into sterile gown and gloves at the same time
D. A health care facility should develop and follow standardized procedures for bowel isolation technique to reduce errors and improve efficiency among perioperative team members

Answer 22

C. After announcing the change to clean closure, ensure that the entire scrubbed team leaves the sterile field and changes into sterile gown and gloves at the same time

Question 23

When opening a sterile package, the LAST flap to be opened should be:
A.  The flap to your left
B.  The flap closest to you
C.  The flap to your right
D.  The flap farthest from you

Answer 23

B. The flap closest to you

Question 24

Which of the following activities is NOT correct when inspecting a rigid sterilization container?
A. Check external locks, latch filters, temperevident devices, and valves to ensure that the seal is intact
B. Place the container on the sterile field and lift the lid up and away from you
C. Inspect the lid’s filter to be sure it is not moist, broken, ripped, or torn
D. After a scrubbed team member has lifted the inner basket out of the rigid container, check the inside surface of the container for signs of damage, contamination or debris

Answer 24

B. Place the container on the sterile field and lift the lid up and away from you

Question 25

When two scrubbed team members need to change position during an operative or other invasive procedure, they should do so by passing each other:
A.  Back to back
B.  Front to front
C.  Back to front
D.  A or B

Answer 25

D. A or B

Question 26

Which is NOT a recommended practice for maintaining a sterile field?
A. When scrubbed, keep hands and arms above waist level and away from the axillary region at all times
B. When near the sterile field, speak only when necessary
C. If the surgery or procedure is delayed, tape the door to the procedure room closed to prevent contamination from air currents
D. Minimize movements when near the sterile field, and do not move in between two sterile fields

Answer 26

C. If the surgery or procedure is delayed, tape the door to the procedure room closed to prevent contamination from air currents

Question 27

When is it acceptable for a scrubbed team member to move away from a sterile field?
A. To retrieve items from a sterilizer
B. When radiographs (xrays) are being taken
C. when changing into sterile gown and gloves after announcing the change to clean closure
D. All of the above

Answer 27

C. when changing into sterile gown and gloves after announcing the change to clean closure

Question 28

Scrubbed team members should sit during an operative or other invasive procedure only if the entire procedure will be performed at that level
A. True
B. False

Answer 28

A. True

Question 29

To prevent contamination of the sterile field, unscrubbed team members should face the field when approaching it, should not walk between two sterile fields or scrubbed persons, and should stay at least \_\_\_\_\_\_ away from a sterile field and from scrubbed persons at all times
A. 6 inches
B.  12 inches
C.  18 inches
D.  24 inches

Answer 29

B. 12 inches

Question 30

To promote facility wide best practice in sterile technique, AORN recommends that registered nurses
A. Practice collaboration, leadership, and teamwork in the perioperative environment
B. Take part in ongoing quality assurance, monitoring, and performance activities designed to improve the performance of sterile technique
C. Help establish a culture in which concerns about breaches in sterile technique are communicated immediately and appropriately
D. all of the above

Answer 30

D. all of the above

Question 31

List the areas of the sterile gown that are considered sterile:

Answer 31

The front from the chest to the sterile field level and at the sleeves from two inches above the elbow to the cuff

Question 32

The barrier performance class of surgical gowns, gloves and drape products refers to:

Answer 32

The designation can be seen on the label of the product. Barrier that is resistant to tears, punctures and abrasions. They are non abrasive, non toxic and lint free, functioning and flexible.

Question 33

Explain the reasons for double-gloving and how a perioperative nurse would know his/her glove was perforated:

Answer 33

It prevents transmission of infection, sharps injury and maintains sterility. Wearing a colored surgical glove beneath a standard pair of surgical gloves can be seen more easily if there is a perforation.

Question 34

Why is there a recommendation to change surgical gloves after a maximum time of 150 minutes?

Answer 34

Perforation rates have been shown to increase significantly after 150 minutes

Question 35

Describe the process of applying sterile drapes to cover the back table

Answer 35

Hold in a controlled manner, cuff the draped material over gloved hands, place in a way that does not require scrubbed team members to lean over unsterile areas, place sequentially from surgical site to peripheral area

Question 36

Plastic adhesive incise drapes should NOT be used for prevention of surgical site infection - why?

Answer 36

Attempting to isolate the skin from the surgical wound is of no benefit and may create increased moisture and bacterial growth under adhesive drapes