Principles of Aseptic Technique

The nature of the procedures performed at our organization precludes the use of sterile technique. Sterile draping, gloving and technique is not used during endoscopic procedures and endoscopic instrument reprocessing. High level disinfection is used for endoscopic instrument reprocessing. Staff using sterile gowns for endoscopic reprocessing are trained to use it for high level disinfection and to guard against chemical exposure to their persons. 


The boundaries between sterile and unsterile are often not 
clearly delineated.  For purposes of performing procedures 
requiring a sterile field, the following procedures apply:
When opening large items, such as a linen pack, the item 
should be placed on a flat surface with the end flaps 
extended.  The outer wrapper is then cuffed so the staff 
member avoids contact with the sterile contents by keeping 
all fingers under the cuff.  To open the opposite side of the 
pack, the staff member must move to the other side of the 
table.  If the wrapper is used to drape the table, the margin 
begins at the table edge.  The edges of sterile containers 
are not considered sterile once the package is opened.
When opening smaller items the ends of the flaps are secured 
in the hand so they do not flip back and contaminate the 
contents or the sterile individual.  A 1-inch safety margin 
is considered standard on package wrappers.
On peel-back packages the inner edge of the heat seal is the 
sterile boundary.  The surgical team member removes items 
from these packages by lifting them straight up and not 
allowing the contents to slide over the edge.  Sterile items 
must not be 'flipped' onto the sterile field from peel-back 
packages as sterility cannot be guaranteed.
To receive solutions: the surgical team member moves the 
container to the table's edge or holds the receptacle so the 
circulator does not reach over the sterile field.  When 
dispensing liquids to the sterile field:
1.  The entire contents of the bottle should be poured or the 
    remainder discarded.
2.  Solutions are poured to avoid splashing of fluids onto 
    sterile field. Care is consistently exercised to prevent 
    the solution from running over the unsterile part of the 
    bottle and then dripping onto the sterile field, thereby 
    contaminating it.
Gowns are considered sterile in front from shoulder to table 
level. The sleeves are sterile to 2 inches above the elbow.  
Wrap around gowns which cover the back may be sterile when 
they are first put on.   Since the back of the gown cannot be 
continuously observed, sterility cannot be assured and the 
back is not considered to be sterile.
Gloved hands should be kept in sight, at or above the waist 
level.  The arms should not be folded with the hands tucked 
in the axillary region as they may become contaminated with 
Draped tables are sterile only at table level.
The sterile field on the back table, or a 'prep' table,  is 
limited to the top of the table.  Any item falling over the 
edge is considered contaminated and cannot be brought back 
into the sterile field.
All staff involved in the procedure must exercise astute 
observation and professional judgement when interpreting 
sterile versus unsterile areas on the draped patient:
The sterile dressing is applied to the operative site before 
the drapes are removed to avoid contamination.
Sterile persons and items may contact only sterile areas: 
unsterile persons and items contact only unsterile areas:  
The sterile members of the team contact only sterile areas 
and sterile items.  The unsterile members should not touch 
the sterile field, reach over it, or permit unsterile items 
to come in contact with it. 

When opening a sterile item, all clinical staff should 
position hands so as to avoid accidental contact with the 
other staff or the sterile field.  This safety margin can be 
created by using the cuff created by the sterile wrapper as 
an extension of the hand.  A sterile instrument may be used 
for one transfer and then is considered contaminated.
When opening a sterile package, the surgical team member 
opens the near side first (so the gown is protected) and the 
far side last; whereas the circulator opens the far side 
first and the near side last to prevent reaching over a 
sterile field.
Movement within or around a sterile field must not cause 
contamination of the STERILE FIELD.  Sterile team members 
stay close to the sterile field, not wandering about the room 
or leaving the room while in sterile attire.  When sterile 
persons change positions, they move back to back or face to 
face, maintaining a safe distance from each other and the 
sterile field.
Unsterile team members circulate around the sterile area but 
do not come in direct contact with it.  When passing a 
sterile field, unsterile persons should maintain at least 1 
foot of distance, always facing the sterile field and never 
walking between two sterile fields.
A sterile barrier that has been permeated must be considered 
The integrity of drapes and gowns must be visually inspected 
before use and continuously during intervention.  When a 
sterile item that is pervious becomes damp or wet, it is 

considered contaminated.  When a sharp instrument, such as a 
towel clip, perforates the sterile surface of the barrier, 
the points of the towel clips are contaminated and the towel 
clip may not be relocated.
Non-sterile equipment brought into and/or over the sterile 
field will be draped with a sterile material or covering.
When a sterile item wrapped in a pervious wrapper--such as 
muslin--is dropped on the floor, contaminated air may enter 
the package from the force of the fall.  These items should 
be considered unsterile.  For this reason, items packaged in 
impervious wrappers, then dropped, are less likely to become 
contaminated.  If the integrity of the package is maintained, 
the item can be considered sterile and safe for immediate use.
Sterile fields are set up no longer than 30-45 minutes prior 
to the procedure and must never be left unguarded.  They 
should not be set up and then covered for later use as it is 
impossible to remove the cover sheet without contaminating 
the field.  If a case is canceled or delayed once the patient 
is in the operating room, the field is considered to be 
contaminated and a new setup is prepared.  An unguarded 
sterile field must be considered as contaminated.
All members of the treatment team are responsible to point 
out known or suspected violations of sterile technique and 
initiate corrective action.
Approved By Governing Board    
Control #108.0