6 Updates on Sterile Technique to Share

Sterile technique practices typically don’t change drastically over time. However, AORN’s updated Guideline for Sterile Technique, slated for e-release this fall, does have several significant changes.

“New evidence has generated interesting and exciting changes since this guideline was last updated in 2012,” says Julie Cahn, DNP, RN, CNOR, RN-BC, ACNS-BC, CNS-CP, lead author and AORN perioperative practice specialist.

She says these changes, some of which may not be obvious without a thorough read of the updated guideline, could significantly change longstanding sterile technique practices.

Here are the top six updates that could impact your practices in the OR:

1. “Continually maintain” the sterile field (in Recommendation VI) — Previously, it was recommended that the sterile field be “constantly monitored.” However, this recommendation has changed because there is no evidence to suggest that a person physically monitoring a covered sterile field during a procedural delay would detect or prevent contamination. A list of potential interventions has been included for facilities to determine how to assure the covered sterile field remains sterile during delays.

   No matter if the sterile field is in use or not, one of the best ways to reduce the risk of airborne contamination is to cover it.



2. Cover the back table (in Recommendation VI)—Based on more than 20 references investigating airborne contamination rates and table covering, AORN now recommends not only covering the sterile field during delays but also covering portions of the sterile field that are not in immediate use.

   “Many studies support the recommendation to cover all or portions of the back table when not in use. Several studies found instrument and implant trays were becoming increasingly contaminated over time,” Cahn shares.



3. Limit door opening (in Recommendation VII)—Based on a handful of studies, it was previously recommended in the Guideline for a Safe Environment of Care, Part 2 that the OR door be kept closed. However, a significant number of new studies have identified how door openings can correlate to increased levels of bacteria and particulates. Therefore, the new sterile technique guidance includes fourteen evidenced-based interventions to decrease door opening rates.

   “Nurses can play a critical role in preventing traffic during a procedure,” Cahn acknowledges. Some interventions include: preplanning, consolidations of supply and equipment retrieval, keeping surgeon preference cards current, and posting a sign on the door to restrict traffic.



4. Positioning the OR table within the unidirectional ultraclean air delivery system (eg,  laminar air flow) (in Recommendation VI)—New language in the guideline now emphasizes the importance of positioning the OR table directly within the air flow curtain. Unidirectional vertical air flow from the ceiling down provides a steady stream of HEPA-filtered air to theoretically sweep away particles and bacteria from the surgical site or the instrument table.

   One study describes how the investigators marked the OR floor to indicate the boundaries of the laminar air flow. Cahn says this study formed the basis for the new recommendation that the impact area of the air delivery system may be visually identified on the floor so the surgical site and sterile tables can be positioned accordingly.



5. Wearing a surgical helmet system (SHS) when splatter is anticipated (in Recommendation II)—The SHS is typically worn during orthopedic surgeries to contain bacterial shedding of the user. However, Cahn says new evidence shows that wearing a SHS reduces the risk of exposure from splatter. “We want perioperative professionals to be aware that these systems can be protective for personnel, as well.”


6. Use of iodophor-impregnated adhesive incise drapes (in Recommendation IV)—The guideline update now recommends against the use of adhesive incise drapes without antimicrobial properties but does state that iodophor-impregnated adhesive incise drapes may be used in accordance with the manufacturer instructions for use.

Cahn points out that “a few studies indicate that the adhesiveness of the drape to the skin may improve the effectiveness of the product making it crucial that perioperative personnel apply the drape in accordance with the manufacturer’s instructions for use.”