Fundamentals - Practice & Skills, part 4: Sterile Field - Indications, Best Practices, and Preparation

July 22, 2021 Updated: December 29, 2021 8 min read

This article focuses on how to create and maintain a sterile field, including best practices, which are important to know both for your exams and for clinical practice.

The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

What is a sterile field?

A sterile field is a designated area which is free of microbes and other pathogens that can infect someone. The sterile field can include surfaces, instruments, and people. Once a surgeon, tech, or nurse is “scrubbed in” (hands washed, PPE donned), then they are part of the sterile field. Once you are scrubbed in and enter a sterile field, you should consider yourself part of the field; that means you must follow specific protocols so as not to contaminate it.

When is a sterile field used?

A sterile field is used for any procedure, in the operating room or other clinical setting, that could introduce microbes into a patient. Procedures that require a sterile field are usually invasive and include surgery, starting a central line or a PICC (peripherally inserted central catheter), inserting a urinary catheter (quick straight catheter or indwelling one), tracheostomy care (cleaning and caring for a hole that goes directly into the patient’s lungs), or inserting an arterial line or CVC (central venous catheter).

A sterile field is not required for administering medications or taking a patient’s vital signs. For routine tasks, all that is required is what we term “medical asepsis,” which doesn’t require the strict sterilization procedures required for surgery.

Medical asepsis vs. surgical asepsis

Medical asepsis simply means performing routine cleaning or washing in order to prevent pathogen transmission to reduce the number of organisms and prevent their spread. Washing hands, wearing clean gloves, or wearing a mask are examples of medical asepsis.

Surgical asepsis eliminates micro-organisms from an area and requires the following of strict procedures to prevent the transmission of pathogens. For example, sterilizing all instruments, drapes, and other objects that may come into contact with a surgical wound. Personnel who come into contact with the sterile field must perform a surgical hand scrub with an antimicrobial agent and put on a surgical gown and gloves.

Sterile field best practices

The following protocols must be followed to maintain a sterile field and keep it from being contaminated.

Never turn your back or leave the field unattended. If you turn your back, you are no longer looking at the sterile field, which means you don’t know if anything has touched it or fallen onto it.

Do not reach over a sterile field. Even if you are wearing sterile gloves, your arms and sleeves are not considered sterile — if an arm or sleeve passes over the sterile field, microbes may be dislodged into it, contaminating the area.

Do not talk, cough, or sneeze over the sterile field.

Always check the integrity of any packaged items for holes, damage, or moisture. Any of these is a sign that the package contents are no longer sterile.

What contaminates a sterile field?

When setting up a sterile field, you should imagine that there is a one-inch border surrounding it. This sterile border allows just enough room to work safely. Anything outside the border is considered to be non-sterile, so do not allow anything to touch beyond the border.

Objects held below the waist are considered non-sterile. This means never allowing your hands to drop below your waist, even when wearing sterile gloves. This is because when our hands are at our sides, we tend to forget about them; during a sterile field situation, we need to pay close attention to our hands and what they may be coming into contact with that could potentially contaminate the field.

If an object becomes wet, it is no longer sterile. For example, when pouring a sterile solution into a sterile container, if any splashes onto a sterile item, that item is no longer considered sterile. Bacteria can grow rapidly in areas that become wet.

How to prepare a sterile field

Sterile fields should always be established as close as possible to the time of a procedure and, once established, should not be left unattended. When opening sterile packages, follow this protocol:

  1. Position all packages so that the top flap will open away from your body.
  2. Open the top flap of the package first; open it away from you.
  3. Then open the flap on the right side with your right hand, then the flap on your left side with your left hand. This is to keep you from reaching over the sterile field.
  4. Open the last flap toward your body.
  5. To put an item into a package, open the package and drop the item from six inches above the field.

How to pour sterile solutions

As part of your sterile field setup, you may need to pour a sterile solution, such as an antiseptic solution when preparing for surgery. There are specific steps to follow when pouring sterile solutions to help maintain the integrity of the sterile field.

Remove the bottle cap and place it so that the inside of the cap is facing up on a non-sterile surface.

Hold the bottle so that the label is in the palm of your hand. This is to protect the label from being damaged due to a splash, which could make it difficult to read its contents.

When pouring, hold the bottle two inches above the receptacle. Pour slowly to avoid splashing, which would contaminate the sterile field.

Practice

It is important to practice these skills over and over again until they become muscle memory and you can do them by rote.

As Meris shared in the video, you can practice moving around your house with your hands up and in front of you (almost as if you are holding a large balloon) to train yourself not to drop your hands. The more you practice, the easier it will be to work in a sterile field without having to think about it!


Full Transcript

Hi, I'm Meris. And in this video, I'm going to be talking to you about everything you need to know about sterility and sterile fields. And we'll be following along with our Fundamentals of Nursing flashcards. These are available on our website, levelupRN.com, but if you already have a set and you want to follow along with me, I am starting on card number 53. So let's get started.

Okay. So first and foremost, what are the indications for sterile field? Do we do it with every patient? Absolutely not.

So we need to do a sterile field when we're doing a sterile procedure. These are going to be really invasive things. So, for instance, if the provider is starting a central line or a PICC line, when we are inserting a urinary catheter, be that a quick straight catheter or an indwelling one.

Any time we do tracheostomy care, we're actually providing care into a hole that goes directly into my patient's lungs, I need to provide really good sterile care there, and any kind of surgical procedure as well. So that's when we're going to use sterile field.

We're not going to do it for things like just passing medications or getting vital signs, though. That's going to be routine with clean gloves.

So you'll hear that called medical asepsis. Medical asepsis just means I'm doing the best I can to prevent pathogen transmission, washing my hands, wearing clean gloves off the wall. That's medical asepsis.

But surgical asepsis means that I am following strict sterile procedure to prevent transmitting pathogens.

So best practices, these are things that you've got to know for your exams and for clinical practice.

One of the things is we don't ever turn our back on a sterile field. If I turn my back, I'm not looking at it anymore, so I can't guarantee that nothing has touched it or fallen onto it or anything like that.

Another thing, and you probably know this from watching TV, is I don't drop my hands below my waist. Anything below the waist is considered to be non-sterile. Even if I'm wearing sterile gloves, they have to stay up here. So I can provide patient care all here, but the second I drop my hands, they are not sterile anymore.

I'm also not going to reach over my sterile field with anything that is not sterile. So if I take my hand and reach over my sterile field, and I have a sterile glove on, awesome, we're doing great. But as soon as my dirty sleeve or arm passes over the sterile field, it is no longer sterile.

I should not be talking or coughing or sneezing over the field. I also need to make sure that everything I'm putting onto the field is intact, meaning, did I check the dressing, the sterile packaging? Is that all intact? There were no holes or anything? That's very important.

Then remember, when you do set up a sterile field, there is an imaginary one-inch border that we consider to be non-sterile sterile. So that just gives us room to work, but that one inch, no more, no less, is going to be considered non-sterile of my sterile field.

And then also remember that if an object becomes wet, let's say I'm putting sterile solution into a sterile container but I accidentally splash some onto the drape, it's not sterile anymore. So any moisture on the field means that my field is no longer sterile. It has been contaminated.

Okay. So now, let's move on to card 54, where we talk about how to actually prepare a sterile field. You'll notice these are numbered bullets, meaning that we have put them in order for you.

So one of the things that I want to point out, I'm not going to go through each step, but the package should be positioned so that the topmost flap will open away from my body. When I open a sterile package, the first flap must open away from me. So I want that flap to point towards my body.

Then I will do one side and then the other before opening the one closest to me last.

When I pour sterile solutions, remember a few things here.

First is, I want to open the bottle and place the cap so that the inside is facing up on a nonsterile surface. And then I'm going to hold the bottle so that my palm is covering the label of the bottle.

Why does this matter? If anything were to splash, I don't want to get that on the label of the bottle because then I might not be able to read what it says anymore. Very important that I know what is in that container.

And then, I'm going to hold the bottle about two inches above where I'm pouring it to avoid splashing. And I should also pour that solution slowly.

I'm not just going to be dumping it in because that would encourage splashing.

So that's everything you need to know about best practices and indications and how to set up a sterile field.

I would definitely encourage you to practice these skills over and over again because it is just rote memory, muscle memory. I don't drop my hands.

When I was in skills, I literally sat around the house like this, trying to train myself not to drop my hands. So whatever it takes.

I hope this review was helpful. If you did find it helpful, please go ahead and like this video. It means the world to us. And if you have anything to add or a funny way to remember things, please drop me a comment. I would love to read that and see what you have to say.

I do want to let you know that the next video is going to be a really big one. We're going to be talking about bed baths, bed making, oral care, denture care, and seizure precautions which are very important to know.

So be sure that you subscribe to the channel so that you are the first to know when it posts. Take care and happy studying.

I invite you to subscribe to our channel and share a link with your classmates and friends in nursing school. If you found value in this video, be sure to hit the like button and leave us a comment. And let us know what you found particularly helpful.


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