AORN Guideline in Focus: Sterile Technique in the OR

Sterile technique is a foundation of perioperative practice to safeguard patients against surgical site infections. AORN’s Guideline for Sterile Technique provides evidence-based recommendations for maintaining asepsis throughout every phase of a procedure—before, during, and after the sterile field is established. Breaks in sterility can introduce harmful microorganisms, increasing the risk of infection and complications for surgical patients.

From how and when to prepare a sterile field to minimizing contamination risks, the guideline covers key areas that support best practices in the operating room, including:

• Proper gowning and gloving to maintain barrier protection
• Best practices for opening and handling sterile supplies
• Strategies for maintaining the integrity of the sterile field
• Controlling OR movement and air quality to reduce contamination risks

Here’s a closer look at some of the critical elements of sterile technique:

When Should You Prepare the Sterile Field?

The sterile field should be set up as close as possible to the time of use to minimize contamination risks (3.3).

Only one sterile field should be open per patient (3.4), and all sterile supplies should be handled by a scrubbed team member using aseptic technique.

How Should You Handle Gowns and Gloves?

Before donning a surgical gown and gloves, always perform surgical hand antisepsis (2.2).

Gloves should be inspected for integrity immediately after donning and throughout use (2.5). And if contamination occurs, they must be changed using sterile technique (2.4).

What Are the Best Practices for Introducing Items to the Sterile Field?

• Introduce sterile items as close as possible to the time of use (5.1)
• Inspect sterile packaging for integrity before opening (5.2)

How Can OR Movement Impact the Sterile Field?

Limiting movement and keeping doors closed reduces airborne contamination that could compromise sterility. To protect the sterile field:

• Keep the number of people in the room to a minimum (6.1)
• Reduce nonessential movement around the field (6.3)

What If a Break in Sterile Technique Occurs?

If contamination is suspected, corrective action must be taken immediately. For major breaks in sterile technique, the surgical team should evaluate whether a change in surgical wound classification is necessary (8.2).

Maintaining High Standards for Sterility

To support safe surgery, perioperative teams should participate in ongoing education and quality improvement initiatives that reinforce best practices for sterile technique (9.1).

Learn more about these and other evidence-based recommendations, including more about air quality and standards for sterility, in the 2025 Guidelines for Perioperative Practice.

Sterile Technique Guideline References

• Guideline for team communication. In: Guidelines for Perioperative Practice. Denver, CO: AORN Inc, 2024:1085–1120. [IVA]
• Guideline for transmission-based precautions. In: Guidelines for Perioperative Practice. Denver, CO: AORN Inc, 2024:1121–1148. [IVA]
• Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN Inc, 2024:1025–1040. [IVA]
• Guideline for hand hygiene. In: Guidelines for Perioperative Practice. Denver, CO: AORN Inc, 2024:277–314. [IVA]
• Guideline for design and maintenance of the surgical suite. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2024:79–142. [IVA]
• Guideline for prevention of unplanned patient hypothermia. In: Guidelines for Perioperative Practice. Denver, CO: AORN Inc, 2024:339–364. [IVA]
• Guideline for environmental cleaning. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2024:197–226. [IVA]
• Guideline for medical device and product evaluation. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2024:755–764. [IVA]