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Principles of Asepsis

ST210ST210Concorde Career CollegeConcorde Career College

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Sterile Sterile

Because sterility cannot be Because sterility cannot be assured 100% of the time…assured 100% of the time…

**When in doubt, throw it out!**When in doubt, throw it out!

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practicing sterile techniquepracticing sterile technique

The goal is to The goal is to keep microbes to an keep microbes to an irreducible minimumirreducible minimum

Strict adherence is necessary for the Strict adherence is necessary for the protection of the patient that is undergoing protection of the patient that is undergoing evasive surgeryevasive surgery

Several concepts and applications are key to Several concepts and applications are key to the implementation of sterile techniquethe implementation of sterile technique

Use of common sense is a mustUse of common sense is a must Are there gray areas?Are there gray areas?

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practicing sterile techniquepracticing sterile technique There is no compromise in sterile techniqueThere is no compromise in sterile technique Sterility cannot be taken for granted; it must Sterility cannot be taken for granted; it must

constantly be checked and maintainedconstantly be checked and maintained Surgical team members constantly monitor their Surgical team members constantly monitor their

own technique, as well as that of the other team own technique, as well as that of the other team membersmembers

Breaks are identified and corrective actions are Breaks are identified and corrective actions are takentaken

Each team member must be expecting and be Each team member must be expecting and be able to accept critique from othersable to accept critique from others

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Keeping microbes Keeping microbes to an irreducible to an irreducible

minimumminimum

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Living tissue cannot be Living tissue cannot be sterilizedsterilized

The skin of the patient and surgical team The skin of the patient and surgical team members harbors microbes that cannot be members harbors microbes that cannot be removed via the skin prep, hand washing, or removed via the skin prep, hand washing, or surgical scrubsurgical scrub

Adequate prep of some surgical sites is Adequate prep of some surgical sites is impossible due to the presence of a large impossible due to the presence of a large number of microbesnumber of microbes

The wound may have already been exposed to The wound may have already been exposed to contaminants contaminants

Infection may already be presentInfection may already be present

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Environmental hazards are presentEnvironmental hazards are present

Environmental decontamination may be Environmental decontamination may be ineffectiveineffective

Airborne contaminants may come in Airborne contaminants may come in contact with the sterile fieldcontact with the sterile field

Destruction of microbial barriers results Destruction of microbial barriers results in contaminationin contamination

Movement in or around may cause Movement in or around may cause contaminationcontamination

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Sterility is not absolute and cannot Sterility is not absolute and cannot be effectively proven at all timesbe effectively proven at all times

Chemical indicators (external and internal) only Chemical indicators (external and internal) only verify exposure to the sterilization process. They verify exposure to the sterilization process. They are not proof of sterility.are not proof of sterility.

All types of packaging materials for sterilization All types of packaging materials for sterilization have disadvantageshave disadvantages

Human error can effect the outcome of the Human error can effect the outcome of the sterilization processsterilization process

Handling and storage conditions may compromise Handling and storage conditions may compromise sterilitysterility

Microbes that have not yet been identified may be Microbes that have not yet been identified may be a threata threat

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Surgical ConscienceSurgical Conscience THE HONESTY AND MORAL INTEGRITY THE HONESTY AND MORAL INTEGRITY

TO UPHOLD STRICT STERILE TO UPHOLD STRICT STERILE TECHNIQUETECHNIQUE

An STSR must be conscientious enough to An STSR must be conscientious enough to recognizerecognize andand correctcorrect breaks in technique breaks in technique

An individual who hesitates or refuses An individual who hesitates or refuses to admit a break in sterile technique to admit a break in sterile technique has no place in the operating roomhas no place in the operating room

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SURGICAL CONSCIENCE

THE SURGICAL TECHNOLOGIST MUST BE ABLE TO RECOGNIZE AND CORRECT BREAKS IN STERILE TECHNIQUE, WHETHER THEY ARE COMMITTED IN THE PRESENCE OF OTHERS OR ALONE.

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FUNDAMENTALS OF ASEPTIC TECHNIQUE

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““Considered Contaminated”Considered Contaminated”

A situation where one or more of the A situation where one or more of the principles of asepsis principles of asepsis may may have been have been violatedviolated

The term The term ““consideredconsidered”” means that the means that the situation has been thought about carefully situation has been thought about carefully and a decision has been made to and a decision has been made to “deem”“deem” or or “regard”“regard” the situation in the same the situation in the same manner as a manner as a “blatant”“blatant” or or “gross”“gross” contamination contamination

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PRINCIPLE # 1

A STERILE FIELD IS A STERILE FIELD IS CREATED FOR EACH CREATED FOR EACH SURGICAL SURGICAL PROCEDURE.PROCEDURE.

Must be appropriately Must be appropriately attired prior to entering attired prior to entering the sterile fieldthe sterile field

Movement in and Movement in and around the sterile field around the sterile field must not compromise must not compromise the sterility of the fieldthe sterility of the field

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PRINCIPLE # 1 cont.

THE STERILE FIELD CONSISTS OF a THE STERILE FIELD CONSISTS OF a separate, sterile area that in a larger sense separate, sterile area that in a larger sense consists of the consists of the surgical sitesurgical site itself, the itself, the draped draped portions of the patientportions of the patient and OR tableand OR table, the , the sterile portions of the gownssterile portions of the gowns and and glovesgloves and the and the drapeddraped ring standsring stands, , Mayo standMayo stand, and , and back tableback table..

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PRINCIPLE # 1 cont.

AS TIME PASSESAS TIME PASSES there is a likelihood that there is a likelihood that a sterile field has become contaminated by a sterile field has become contaminated by error or by airborne contaminants. error or by airborne contaminants. Therefore, it should be created as close to Therefore, it should be created as close to the time of use as possible. After the sterile the time of use as possible. After the sterile supplies have been opened, the room supplies have been opened, the room must be monitored.must be monitored.

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PRINCIPLE # 1 cont.

If a case is switched to another OR, and the sterile supplies and instruments have already been opened, the back table should NEVER be covered with a sterile drape to be moved to another room.

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PRINCIPLE # 1 cont.

CHEMICAL INDICATORS- Internal or external monitors change color when exposed to the sterilization process. If the indicator did not change to the appropriate color, the items should be considered unsterile.

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PRINCIPLE # 1 cont.

Instruments, such as knife blades, that Instruments, such as knife blades, that come in contact with the come in contact with the skinskin should not should not be reused. The instrument should be set be reused. The instrument should be set in a designated area to prevent further in a designated area to prevent further use on deeper tissue. use on deeper tissue.

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PRINCIPLE # 1 cont.

Personnel should not reuse instruments Personnel should not reuse instruments used during used during open bowel open bowel or dirty portions or dirty portions of the procedure and scrubbed team of the procedure and scrubbed team members should regown and reglove members should regown and reglove before returning to use sterile before returning to use sterile instruments from the clean setupinstruments from the clean setup. (IF 2 SEPARTE SET UPS ARE USED)

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PRINCIPLE # 1 cont.

When removing instruments from the When removing instruments from the autoclave, the sterile team member must autoclave, the sterile team member must not touch the not touch the edge edge of the sterilizer with of the sterilizer with the instrument, tray, gown, or gloves.the instrument, tray, gown, or gloves.

The inside of wrappers containing sterile The inside of wrappers containing sterile items is considered sterile except for a items is considered sterile except for a 1-21-2”” perimeter perimeter around the outside edge around the outside edge of the wrapper.of the wrapper.

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PRINCIPLE # 1 cont.

The The inner edgeinner edge of a heat sealed peel of a heat sealed peel pack is considered the line between pack is considered the line between sterile and nonsterile.sterile and nonsterile.

The flaps should be pulled back The flaps should be pulled back without without tearstears in the peel pack itself. in the peel pack itself.

The contents must never be allowed to The contents must never be allowed to slide over the edgeslide over the edge of the peel pack. of the peel pack.

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PRINCIPLE # 1 cont.

When opening a sterile wrapped item, the When opening a sterile wrapped item, the team member opens the (team member opens the (11STST) flap ) flap awayaway from from the body. The side flaps are opened and the body. The side flaps are opened and secured in order one at a time. The secured in order one at a time. The lastlast flap is flap is pulled pulled toward toward the body. The item is then the body. The item is then transferred onto the sterile field or is taken transferred onto the sterile field or is taken from the package by a sterile team member.from the package by a sterile team member.

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PRINCIPLE # 1 cont.

The The toptop of a sterile table is the only part of a sterile table is the only part considered sterile. considered sterile.

Any part of the Any part of the drapedrape extending below extending below the topthe top of the sterile table is considered of the sterile table is considered nonsterilenonsterile..

Any item extending beyond or falling Any item extending beyond or falling over the top of the sterile table edge is over the top of the sterile table edge is considered considered contaminatedcontaminated..

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PRINCIPLE # 1 cont.

Any portion of a Any portion of a hose or cordhose or cord that is hanging that is hanging off of a sterile field is considered off of a sterile field is considered contaminatedcontaminated and and cannotcannot be pulled back up be pulled back up onto the sterile field. Two examples are the onto the sterile field. Two examples are the BovieBovie cord and cord and suction tubingsuction tubing..

Once sterile Once sterile drapes or towelsdrapes or towels have been have been placed, they placed, they cannotcannot be repositioned. be repositioned.

The portion of the drape that is below the The portion of the drape that is below the table table levellevel is considered is considered contaminatedcontaminated..

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QUESTIONABLE STERILITY

WHEN IN WHEN IN DOUBT , THROW DOUBT , THROW IT OUT.IT OUT.

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INTEGRITY-INTEGRITY- COMPLETE, NO COMPLETE, NO BREAKS OR TEARSBREAKS OR TEARS

There must be no evidence of strike-There must be no evidence of strike-through, tears, or punctures; all seals through, tears, or punctures; all seals must be intact; chemical indicators must must be intact; chemical indicators must have turned color to indicate exposure to have turned color to indicate exposure to sterilization conditions.sterilization conditions.

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PRINCIPLE # 1 cont.

STERILESTERILE ITEMS MUST ITEMS MUST NOTNOT BE STORED BE STORED

WITH WITH UNSTERILEUNSTERILE ITEMS. ITEMS.

STERILE ITEMS FOUND IN UNSTERILE STERILE ITEMS FOUND IN UNSTERILE STORAGE AREAS SHOULD BE STORAGE AREAS SHOULD BE CONSIDERED CONSIDERED UNSTERILEUNSTERILE AND SHOULD AND SHOULD NOT BE USEDNOT BE USED

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PRINCIPLE # 1 cont.

IMPERVIOUSIMPERVIOUS- Not allowing moisture to - Not allowing moisture to penetrate (i.e., plastic drape). penetrate (i.e., plastic drape).

PERMEABLEPERMEABLE- capable of allowing the - capable of allowing the passage of fluids or substances. passage of fluids or substances.

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PRINCIPLE # 1 cont.

If a package that is wrapped in a pervious woven material drops to the floor, the package is considered contaminated.

If the package is impervious and the floor is dry, the item can be transferred to the back table but should not be placed back in sterile storage.

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PRINCIPLE # 1 cont.

CUASES OF CONTAMINATIONCUASES OF CONTAMINATION Punctures, tears, or strike-through Punctures, tears, or strike-through

compromise the sterility of packages or compromise the sterility of packages or drapes and is considereddrapes and is considered contaminated contaminated..

If a permeable drape covers a sterile If a permeable drape covers a sterile table or field and any liquid penetrates the table or field and any liquid penetrates the drape, the drape must be considered drape, the drape must be considered contaminatedcontaminated..

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PRINCIPLE # 1 cont.

Sterile packages should be stored on smooth, clean, dry surfaces to prevent damage of packaging materials.

Sterile packages should be stored in a designated sterile supply storage area.

Sterile packages should be handled with clean, dry hands.

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PRINCIPLE # 1 cont.

Unnecessary pressure should not be placed on sterile packs to prevent forcing air outward and allowing air to be pulled inward.

Peel packs should be stored on their sides to prevent pressure that can rupture the package.

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PRINCIPLE # 1 cont. Use non-penetrating instruments to hold Use non-penetrating instruments to hold

drapes and cords in place.drapes and cords in place. If towel clips used on the field puncture any If towel clips used on the field puncture any

draping material, the tips of the instrument draping material, the tips of the instrument must be considered contaminated and should must be considered contaminated and should be left in place until the end of the procedure.be left in place until the end of the procedure.

If a penetrating towel clip is used and is If a penetrating towel clip is used and is removed for any reason, the STSR should removed for any reason, the STSR should pass the instrument off without touching the pass the instrument off without touching the contaminated tips and a drape should be used contaminated tips and a drape should be used to cover the area from which it was removed. to cover the area from which it was removed.

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PRINCIPLE # 2

STERILE TEAM MEMBERS MUST BE STERILE TEAM MEMBERS MUST BE APPROPRIATELY ATTIRED PRIOR TO APPROPRIATELY ATTIRED PRIOR TO ENTERING THE STERILE FIELDENTERING THE STERILE FIELD

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PRINCIPLE # 2 cont.

THE ATTIRE WORN BY THE ATTIRE WORN BY STERILESTERILE TEAM MEMBERS INCLUDEs A TEAM MEMBERS INCLUDEs A STERILESTERILE GOWN, GOWN, STERILESTERILE GLOVES, GLOVES, MASK, and HAIR COVERMASK, and HAIR COVER

Team members must don sterile gown Team members must don sterile gown and gloves themselves using aseptic and gloves themselves using aseptic technique, or be gowned and gloved by technique, or be gowned and gloved by another sterile team memberanother sterile team member

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PRINCIPLE # 2 cont.

The surgical gown is considered sterile from The surgical gown is considered sterile from the the waist waist to the to the mid-chest linemid-chest line in in frontfront and and 2 inches 2 inches PROXIMALPROXIMAL to the to the elbows elbows on the on the sleeves.sleeves.

The The upper chest areaupper chest area of the gown is of the gown is considered considered contaminatedcontaminated because it cannot because it cannot be viewed directly by the wearer and be viewed directly by the wearer and because of the possibility of the chin coming because of the possibility of the chin coming into contact with this part of the gowninto contact with this part of the gown.

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PRINCIPLE # 2 cont.

When standing at a table, the gown should be When standing at a table, the gown should be considered sterile to the considered sterile to the top of the operating top of the operating tabletable oror the top of the back tablethe top of the back table

The arms should The arms should notnot be folded with the hands in be folded with the hands in the axillary region. This region is considered the axillary region. This region is considered contaminated because it cannot be viewed by the contaminated because it cannot be viewed by the wearer and because of strike-through wearer and because of strike-through contamination.contamination.

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PRINCIPLE # 2 cont.

Hands should never be allowed to fall Hands should never be allowed to fall below waist or table level.below waist or table level.

The team member should The team member should avoid raising the avoid raising the hands above the mid-chest line or over the hands above the mid-chest line or over the head.head.

The back of the gown is consideredThe back of the gown is considered contaminatedcontaminated because it cannot be viewed by because it cannot be viewed by the wearer.the wearer.

When wearing a sterile gown, the When wearing a sterile gown, the back should back should never be turned toward a sterile fieldnever be turned toward a sterile field..

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PRINCIPLE # 2 cont.

The stockinette cuffs of the surgical gown are The stockinette cuffs of the surgical gown are consideredconsidered nonsterile nonsterile and should be covered and should be covered by the cuff of the glove.by the cuff of the glove.

A sterile person should sit only when the entire A sterile person should sit only when the entire procedure will be performed sitting downprocedure will be performed sitting down

and the hands and the hands must notmust not fall into the lap. fall into the lap.

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PRINCIPLE # 2 cont.

A separate sterile surface should be used for A separate sterile surface should be used for gowning and gloving to avoid contamination of gowning and gloving to avoid contamination of the back table.the back table.

The gown and gloves may be opened on a The gown and gloves may be opened on a mayo stand or small table priormayo stand or small table priorto the surgical scrub.to the surgical scrub.

When using a platform, moving from a lower When using a platform, moving from a lower position to a higher position should be avoided position to a higher position should be avoided as much as possible.as much as possible.

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PRINCIPLE # 3

MOVEMENT IN AND AROUND THE MOVEMENT IN AND AROUND THE STERILE FIELD MUST NOT STERILE FIELD MUST NOT COMPROMISE THE STERILE FIELDCOMPROMISE THE STERILE FIELD

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PRINCIPLE # 3 cont.

STERILE TOSTERILE TO STERILESTERILE Only sterile members may touch Only sterile members may touch

sterile surfaces and items.sterile surfaces and items. Nonsterile personnel must not touch Nonsterile personnel must not touch

sterile surfaces and items.sterile surfaces and items. Walking between two sterile areasWalking between two sterile areas

should be should be avoidedavoided..

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PRINCIPLE # 3 cont.

STERILE INDIVIDUALS KEEP WITHIN THE STERILE INDIVIDUALS KEEP WITHIN THE STERILE FIELDSTERILE FIELD

Scrubbed personnel should stay close to the Scrubbed personnel should stay close to the sterile field throughout the procedure.sterile field throughout the procedure.

Movement within the sterile field should be Movement within the sterile field should be

kept to a minimum to avoid airborne kept to a minimum to avoid airborne contamination.contamination.

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PRINCIPLE # 3 cont.

Sterile team members should pass each Sterile team members should pass each other other face to faceface to face or or back to back.back to back.

A sterile person should A sterile person should always facealways face the sterile the sterile field to avoid contamination.field to avoid contamination.

A sterile person should A sterile person should turn their backturn their back to a to a nonsterile person or area when walking past.nonsterile person or area when walking past.

Talking should be kept to a minimum to Talking should be kept to a minimum to prevent contamination from airborne prevent contamination from airborne moisture droplets.moisture droplets.

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PRINCIPLE # 3 cont. A nonsterile person should keep at least A nonsterile person should keep at least 12-18 12-18

inchesinches from from ANYANY sterile item, area, or sterile sterile item, area, or sterile fieldfield. .

Additionally, equipment and furniture that is not Additionally, equipment and furniture that is not covered by sterile drapes must not be included covered by sterile drapes must not be included in the sterile field and must be kept a minimum in the sterile field and must be kept a minimum of 12-18 inches away from a sterile surface or of 12-18 inches away from a sterile surface or item.item.

The STSR must be conscious of these The STSR must be conscious of these nonsterile items and personnel and maintain nonsterile items and personnel and maintain the 12-18 inch distance the 12-18 inch distance

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PRINCIPLE # 3 cont.

NONSTERILE TO NONSTERILE Nonsterile persons should Nonsterile persons should never reach over a never reach over a

sterilesterile field because of field because of contamination from contamination from skin falloutskin fallout..

While pouring solutions While pouring solutions only the lip of the only the lip of the bottlebottle should be over the sterile basin while should be over the sterile basin while maintaining maintaining 12-18 inches12-18 inches above the basin. To above the basin. To accommodate this,accommodate this, a scrub could move a scrub could move containers to be filled close to the edge.containers to be filled close to the edge.

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PRINCIPLE # 3 cont.

Solutions must Solutions must never be recappednever be recapped or reused or reused because recapping contaminates the solution because recapping contaminates the solution within the bottle. within the bottle.

When draping, a sterile person should When draping, a sterile person should cuff cuff their hands in the foldstheir hands in the folds of the drapes. of the drapes.

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PRINCIPLE # 3 cont.

When draping a nonsterile surface to When draping a nonsterile surface to create a sterile field, the nonsterile create a sterile field, the nonsterile person should cuff the hands within the person should cuff the hands within the underside folds of the drape or table underside folds of the drape or table cover; the drape should be opened away cover; the drape should be opened away from the body toward the far side of the from the body toward the far side of the table first, then toward them last table first, then toward them last

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CREATING THE STERILE FIELD

The The mask must be applied priormask must be applied prior to to creation of the sterile field and is worn by creation of the sterile field and is worn by all individuals in the presenceall individuals in the presence of the of the sterile field.sterile field.

The OR doors The OR doors should be closedshould be closed prior to prior to creation of the sterile field.creation of the sterile field.

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CREATING THE STERILE FIELD

A NUMBER OF TASKS MUST BE PERFORMED QUICKLY AND EFFICIENTLY PRIOR TO INITIATION OF THE SURGICAL PRODCEDURE

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CREATING THE STERILE FIELD cont.

FURNITIRE NEEDED TO FURNITIRE NEEDED TO CREATE A STERILE FIELDCREATE A STERILE FIELD

BACK TABLE- Back table packBACK TABLE- Back table pack RING STAND- Basin setRING STAND- Basin set MAYO STAND- Gown and glovesMAYO STAND- Gown and gloves ADDITIONAL STAND TO OPEN ADDITIONAL STAND TO OPEN

INSTRUMENTSINSTRUMENTS PREP STANDPREP STAND

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CREATING THE STERILE FIELD cont.

Check datesCheck dates on packages before opening. on packages before opening. If and item is double wrapped it will be necessary If and item is double wrapped it will be necessary

to to open both wrappersopen both wrappers at that time. at that time. If an item is only wrapped one time or wrapped If an item is only wrapped one time or wrapped

more than twice, it must be considered more than twice, it must be considered contaminated.contaminated.

When adding items to the sterile field, be careful When adding items to the sterile field, be careful not to drop heavy items on the sterile field since not to drop heavy items on the sterile field since they could puncture the barrier covering the they could puncture the barrier covering the unsterile surface.unsterile surface.

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CREATING THE STERILE FIELD cont.

Nonsterile surfaces that will have sterile drapes applied are draped first toward the sterile person to prevent contamination of the gown and to avoid reaching over the nonsterile surface

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Breach of the Sterile FieldBreach of the Sterile Field

What occurs when one of the principles of asepsis are violated

and the goal of keeping the microbial count within the

sterile field to an irreducible minimum is not met

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Breach of the Sterile Field #1Breach of the Sterile Field #1

Disregard the contaminationDisregard the contamination

• Only one application and is temporary - Only one application and is temporary - the patient’s life is at immediate riskthe patient’s life is at immediate risk

• Once the patient is stabilized, the Once the patient is stabilized, the contamination must be reported and contamination must be reported and appropriate corrective measures takenappropriate corrective measures taken

• The surgeon may want to give systemic The surgeon may want to give systemic prophylactic antibiotics to the patientprophylactic antibiotics to the patient

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Breach of the Sterile Field #2Breach of the Sterile Field #2

Remove the sterile item from the Remove the sterile item from the sterile fieldsterile field• The most common action chosenThe most common action chosen

• Appropriate for most situationsAppropriate for most situations

• The contaminated item is removed and The contaminated item is removed and replacedreplaced

• Any items subsequently contaminated must Any items subsequently contaminated must also be removedalso be removed

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Breach of the Sterile Field #3Breach of the Sterile Field #3

Cover the contaminated item or areaCover the contaminated item or area

•Due to timing or other Due to timing or other circumstances, the contaminated circumstances, the contaminated item cannot be removeditem cannot be removed

•An impervious drape should be An impervious drape should be used to cover the item or area to used to cover the item or area to reestablish the sterile fieldreestablish the sterile field

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OPENING THE BACK TABLE PACK

Check integrityCheck integrity Remove outer wrapperRemove outer wrapper Check inner packageCheck inner package Orient on back tableOrient on back table Break the sealBreak the seal Unfold accordingly Unfold accordingly WITHOUT PULLING FLAPS WITHOUT PULLING FLAPS

BACK ON TABLE TOP AND TOUCHING BACK ON TABLE TOP AND TOUCHING ONLY EDGES OF BACK TABLE DRAPEONLY EDGES OF BACK TABLE DRAPE

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OPENING BASIN SET

Check integrity Orient basin set Break the seal Unfold the first flap away from you Unfold each side flap with respective

hands Pull flaps down instead of out to avoid

hitting sterile back table

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OPENING SMALL WRAPPED PACKAGE (such as initial gown on mayo) ONTO A CLEAN SURFACE

Check integrity Orient packageOrient package Break sealBreak seal Open first flap away from youOpen first flap away from you Unfold each side flap with respective Unfold each side flap with respective

handshands Pull the last flap toward youPull the last flap toward you

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OPENING A PEEL PACK Check integrityCheck integrity Orient package by grasping one edge of the Orient package by grasping one edge of the

peel pack in each handpeel pack in each hand Slowly separate the sides of the peel pack Slowly separate the sides of the peel pack (do (do

not change hands halfway through opening)not change hands halfway through opening) Balance the item to keep it between the edges Balance the item to keep it between the edges

of the glueof the glue Maintain a safe distanceMaintain a safe distance Transfer the item by projecting it onto the sterile Transfer the item by projecting it onto the sterile

field without dropping it below waist level or field without dropping it below waist level or breaking the plane of the sterile fieldbreaking the plane of the sterile field

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OPENING THE INSTRUMENT SET(Rigid Container System)

Set on suitable surfaceSet on suitable surface Verify external indicators Verify external indicators Break the seals and release the lidBreak the seals and release the lid Lift the lid Lift the lid straight up straight up 12-18 inches then 12-18 inches then

step back step back 12-18 inches from the tray12-18 inches from the tray Invert the lid and inspect the insideInvert the lid and inspect the inside Remove the retainer and check the filterRemove the retainer and check the filter

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OPENING THE INSTRUMENT SET(Wrapped)

Set on suitable surfaceSet on suitable surface Verify external indicatorsVerify external indicators Orient set where the first flap opens away from youOrient set where the first flap opens away from you Break the sealBreak the seal Open the first flap away from you by reaching around the Open the first flap away from you by reaching around the

side – opposite side form sterile fieldside – opposite side form sterile field Unfold each side flap with respective hands (Unfold each side flap with respective hands (Pull flaps

down instead of out) Pull last flap toward yourselfPull last flap toward yourself

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SCRUBBING, GOWNING, AND GLOVING

Once the initial sterile filed has been established, the STSR:• All personal needs are attended to, PPE is donned

(eyewear, lead aprons, etc.)

• perform scrub, dry, gown, and then glove• Set up case

• Perform the initial count

• Drape the prepped area

• Create sterile field

• TIME OUT!

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