Sterile Technique

Question 1

What should you perform Before opening the Sterile Field?

Answer 1

Perform hand hygiene

Question 2

When open sterile supplies are present, what should you wear?

Answer 2

Wear a clean surgical mask that covers the mouth and nose and is secured in a manner that prevents venting at the sides of the mask.

Question 3

When entering an OR or invasive procedure room for any reason (eg, stocking supplies, delivering equipment, transporting specimens what should you wear?

Answer 3

Wear clean surgical attire and a surgical head covering

Question 4

When should you implement practices to prevent contamination of the sterile field?

Answer 4

Before preparing a sterile field

Question 5

Select the surgical gown by task and anticipated degree of exposure to blood, body fluids, or other potentially infectious materials, as determined by the following factors:

Answer 5

team member’s role,

type of procedure (eg, minimally invasive versus open, superficial incision versus deep body cavity incision),

procedure duration,

anticipated blood loss,

anticipated volume of irrigation fluid,

possibility of handling hazardous medications,40 and

anticipated patient contact (eg, splash, soaking, leaning).

Question 6

Select the surgical gown needed for the procedure according to what?

Answer 6

the barrier performance class as stated on the product label

Question 7

Select and wear surgical gowns that wrap around the body and completely cover the wearer’s back. The gown sleeves should?

Answer 7

conform to the shape of the wearer’s arms

be of sufficient length to allow gloves to completely cover the cuffs

be of sufficient length to prevent the gown cuffs from being exposed when the wearer’s arms are extended.

Question 8

Perform surgical hand antisepsis before?

Answer 8

donning a sterile gown and gloves

Question 9

When donning the sterile gown without assistance, prevent contamination of the sterile field by?

Answer 9

following the manufacturer’s instructions for donning, if available;

opening and donning the sterile gown and gloves away from the sterile field

not opening sterile gloves directly on top of the open sterile gown

completely drying hands and arms prior to donning the gown;

only touching the inside of the sterile gown when picking it up for donning; and

not touching the sterile glove wrapper or gloves until the sterile gown has been donned

Question 10

What parts of the gown are sterile?

Answer 10

the front of a sterile gown from the chest to the level of the sterile field and

the gowns sleeves from the cuff to 2 inches above the elbow, circumferentially.

Question 11

What parts of the surgical gown are considered contaminated or unsterile?

Answer 11

the neckline, shoulders, and axillary regions

the gown back; and

the sleeve cuffs after the scrubbed team member’s hands pass through and beyond the cuff.

Question 12

When a gown sleeve is contaminated by an unsterile object, use clinical judgment to determine whether a sterile sleeve should be worn to cover the area of contamination or if the gown should be removed, surgical hand antisepsis performed, and a sterile gown and gloves donned. Base the decision on a risk assessment of the following variables:

Answer 12

the part of the gown that was contaminated;

the degree of contamination;

the risk of exposing the patient or other perioperative personnel to blood, body fluids, or other potentially infectious materials; and

the length of time remaining in the procedure.

Question 13

Perform gloving without assistance by doing what?

Answer 13

by touching only the inside of the glove

Question 14

Perform initial gowning and gloving with assistance in the following order:

Answer 14

The team member being gloved should don a surgical gown with the gown cuffs remaining at or beyond the finger tips.

A scrubbed team member should hold open the glove to be donned.

The person donning the glove should insert his or her hand into the glove with the gown cuff touching only the inside of the glove

Question 15

When the gown cuff is at the wrist level, perform gloving with assistance in the following order:

Answer 15

The team member being gloved should leave the gown cuff at wrist level, leaving the fingers and hand exposed.

A scrubbed team member should hold open the glove to be donned.

The person donning the glove should insert his or her hand into the glove with the gown cuff touching only the inside of the glove

Question 16

Scrubbed team members should wear two pairs of sterile surgical gloves (ie, double glove), and use a?

Answer 16

perforation indicator system.

Question 17

Completely cover the gown cuffs with?

Answer 17

gloves

Question 18

Change surgical gloves worn during invasive surgical procedures when?

Answer 18

after each patient procedure

every 90 to 150 minutes

when a visible defect or perforation is noted or when a suspected or actual perforation from a needle, suture, bone, or other object occurs

immediately after direct contact with methyl methacrylate

after touching optic eye pieces on the operative microscope

after touching a fluoroscopy machine

after touching a surgical helmet system hood or visor

when suspected or actual contamination occurs.

Question 19

When a perforation occurs in the outer pair of double gloves what should be done?

Answer 19

change the outer gloves and inspect the inner gloves.

Question 20

When a glove change is indicated, use clinical judgment to determine whether the individual glove should be changed or if the gown and gloves should be removed, surgical hand antisepsis performed, and a sterile gown and gloves donned. Base the decision on a risk assessment of the following variables:

Answer 20

The part of the glove that was contaminated;

the degree of contamination;

the risk of exposing the patient or other perioperative personnel to blood, body fluids, or other potentially infectious materials; and

the length of time remaining in the procedure.

Question 21

Where should gloves be changed?

Answer 21

in a location away from the sterile field.

Question 22

To change a sterile glove during a procedure, perform gloving with assistance in the following order

Answer 22

An unscrubbed team member should remove the glove to be changed without altering the position of the gown cuff (ie, not pulling the cuff down over the scrubbed team member’s hand).

A scrubbed team member should hold open the glove to be donned.

The person donning the glove should insert his or her hand into the glove with the gown cuff touching only the inside of the glove.

Question 23

Don the unsterile helmet and a surgical mask before ?

Answer 23

performing surgical hand antisepsis.

Question 24

Don the sterile visor hood or toga that covers the unsterile helmet before ?

Answer 24

donning the sterile gown and gloves.

Question 25

Turn the fan in the unsterile helmet on after?

Answer 25

gowning is completed.

Question 26

What should be done before preparing or using a sterile field?

Answer 26

Perform surgical hand antisepsis and don a sterile gown and gloves

Question 27

When should the sterile field be Prepare ?

Answer 27

as close as possible to the time of use

Question 28

Open the sterile field for only one patient at a time.

Answer 28

One patient at a time should occupy the OR or procedure room

Question 29

Prepare the sterile field in the OR or procedure room

Answer 29

where it will be used and do not move to another room

Question 30

Only sterile items should come into contact with ?

Answer 30

the sterile field

Question 31

For procedures that involve different wound classifications (ie, clean, clean-contaminated, contaminated, dirty),what should be done with instruments?

Answer 31

keep sterile fields and instrumentation separate and do not use them interchangeably on the cleaner wound.

Question 32

Use isolation technique during?

Answer 32

1. bowel surgery and

2. procedures involving resection of metastatic tumors.

Question 33

Use what according to the manufacturer’s IFU for procedures that enter the gastrointestinal or biliary tract?

Answer 33

a wound protector

Question 34

Where should sterile drapes be placed?

Answer 34

1. patient,
2. furniture
3. equipment in the sterile field in a manner that prevents contamination of the sterile field

Question 35

Handle sterile drapes as little as possible and in a controlled manner that prevents contamination.

Answer 35

Rapid movement of draping materials creates air currents that can cause dust, lint, and other particles to migrate

Question 36

How should sterile drapes be placed?

Answer 36

Place sterile drapes in a manner that does not require the scrubbed team members to lean across an unsterile area and that prevents the sterile gowns from contacting an unsterile surface.

Question 37

During draping, shield gloved hands by ?

Answer 37

cuffing the interior portion of the drape material over the sterile gloves.

Question 38

Place sterile drapes first ?

Answer 38

at the surgical site then outward toward the peripheral areas

Question 39

Secure surgical equipment (eg, tubing, cables) on the sterile field to the sterile field with what type of device?

Answer 39

nonperforating devices.

Question 40

Consider only what part of the sterile drape to be sterile?

Answer 40

top surface of the sterile drape

Consider items that fall below the level of the sterile field to be contaminated.

Question 41

When a C-arm is moved into lateral position what should be considered?

Answer 41

consider the upper portion of a C-arm drape to be contaminated and

do not bring the sterile drape that is below the level of the OR bed up into the sterile field

Question 42

When should you Introduce sterile items to the sterile field?

Answer 42

as close as possible to the time of use.

Question 43

Present sterile items directly to the scrubbed team member or placed securely on the sterile field.

Answer 43

Present heavy or sharp items directly to a scrubbed team member or opened them on a separate clean, dry surface

Question 44

Open items packaged in sterile barrier systems according to?

Answer 44

the manufacturers’ IFU, if available

Question 45

Inspect rigid sterilization containers for intact external locks, secured latch filters, valves, and tamper-evident devices, and for the correct color change to external chemical indicators before they are opened onto a clean, flat, and dry surface. Open the rigid sterilization container in the following order:

Answer 45

An unscrubbed person should lift the lid up and toward himself or herself while moving the lid away from the container.

The unscrubbed person should inspect the integrity of the lid filter or valve and consider the contents to be contaminated if the filter is dislodged, damp, or not intact (eg, holes, tears, punctures).

A scrubbed team member should lift the inner basket(s) out of and above the container without contacting the unsterile surfaces of the table or container.

Before the instruments are placed on the sterile field, the scrub person should examine the internal chemical indicator for the correct color change and inspect the inside surface of the container for debris, moisture, contamination, or damage.137

If there are any filters in the bottom of the container, an unscrubbed person should inspect the integrity of the filters.

Question 46

Inspect wrapped sterile packages for intact tape and the correct color change for external chemical indicators before they are opened. An unscrubbed person should open the wrapped sterile package by

Answer 46

opening the farthest wrapper flap and securing the flap in the hand that is holding the item;

opening each of the side flaps, one at a time, and securing the flaps in the hand that is holding the item;

opening the nearest wrapper flap and presenting the item to the scrubbed team member; and

visually inspecting the entire wrapper for integrity (eg, no holes, tears, punctures) and presence of moisture before the sterile item is placed onto the sterile field.

Question 47

inspect paper-plastic pouches (ie, peel pouches) for ?

Answer 47

intact seals and for the correct color change of external chemical indicators. Present the pouch to the scrubbed team member or opened onto the sterile field by pulling back the flaps without touching the inside of the package, allowing the contents to slide over the unsterile edges of the package, or tearing the package.

Question 48

When transferring medications and sterile solutions (eg, normal saline) to the sterile field?

Answer 48

transfer as close to the time of use as possible;

transfer in a slow, controlled manner using a sterile transfer device (eg, sterile vial spike, filter straw, plastic catheter) unless the item is packaged for sterile delivery to the sterile field;

transfer into a receptacle that is placed near the sterile table’s edge or is held by a scrubbed team member; and

verify and label the medication or solution immediately after transfer.

Do not remove medication vial stoppers from vials for the purpose of pouring medications unless they are specifically designed for removal and pouring by the manufacturer.

Pour medications or sterile solutions from the container only once, and do not replace the cap. Discard any remaining fluids in the opened container at the end of the procedure

Question 49

Continually maintain the sterile field

Answer 49

The sterile field is subject to contamination by personnel, breaks in sterile technique, vectors (eg, insects), and exposure to air.

Question 50

When this is in use, position the surgical site and instrument tables within the air curtain of the system, if possible.

Answer 50

unidirectional ultraclean air delivery system (eg, laminar airflow)

Question 51

When using intraoperative debridement devices with irrigation (ie, hydrosurgery, pulse lavage, low-frequency ultrasonic debridement) on open, infected wounds, implement interventions to minimize personnel exposure to potentially infectious materials and reduce contamination of the sterile field. Interventions may include

Answer 51

wearing PPE

wearing a surgical helmet system47-49;

training personnel on correct use of the device49,192,196;

using manufacturer’s recommendations for power, irrigation, and suction settings that limit mist, splatter, or spray, if patient care allows193,194,196,198; and

covering the active hand piece with a clear sterile drape

Question 52

Scrubbed team members should

Answer 52

remain close to the sterile field and touch only sterile areas or items;

keep their hands and arms above waist level at all times

not fold their arms with their hands positioned in the axillary area

avoid changing levels, and be seated only when the entire procedure will be performed at that level

not turn their backs on the sterile field

turn back to back or face to face while maintaining distance from each other, the sterile field, and unsterile areas during position changes;

not be positioned between the horizontal unidirectional ultraclean air delivery system air curtain and the surgical site

not leave the sterile field to retrieve items from the sterilizer; and

use shielding devices (eg, lead aprons, mobile shields) that reduce radiological exposure in order to stay near the sterile field when radiology equipment is used

Question 53

Unscrubbed team members should

Answer 53

face the sterile field on approach,

not walk between sterile fields or scrubbed persons,

not reach over an uncovered sterile field,

stay as far back from the sterile field143,144 and scrubbed persons as possible,

remain outside of a vertical unidirectional ultraclean air delivery system air curtain,144 and

not walk between the horizontal unidirectional ultraclean air delivery system air curtain and the sterile field.171

Question 54

Unscrubbed team members should

Answer 54

face the sterile field on approach,

not walk between sterile fields or scrubbed persons,

not reach over an uncovered sterile field,

stay as far back from the sterile field143,144 and scrubbed persons as possible,

remain outside of a vertical unidirectional ultraclean air delivery system air curtain

not walk between the horizontal unidirectional ultraclean air delivery system air curtain and the sterile field.171