Is an unmonitored sterile field considered sterile?

MamaCheese · Jul 30, 2008

We do it by the book. If a sterile field cannot be monitered it must be broken down. We're lucky to have anough free staff on most days. There's always somebody kicking around that can sit in a room for a while.

shodobe · Jul 30, 2008

I really don't feel you need to keep your eye constantly on a sterile field. if we have a delay in starting we simply shut the door. I see nothing wrong with this practice. Sometimes people can be just a bit anal in their practice to a point and then it becomes ridiculous. This is only my opinion and everyone that I have come into contact with at different hospitals over 30 years has the same opinion. I do suggest you follow whatever department policy you have so you don't ruffle the feathers of the rule makers.

**canoehead, BSN, RN** · Jul 30, 2008

I'm not an OR nurse, but I have seen them seal a door with a piece of tape, and that signifies no one has been in or out of the room.

Scrubby · Jul 30, 2008

Lol I love this question, sort of reminds me of if a tree falls down in a forest and no one is there to hear it....:wink2:

I personally do consider the sterile field not sterile if it is not monitored. As a scrub nurse if I am not 100% satisfied that my field is kept sterile then I will refuse to use the equipment. It may be anal but I'm just advocating for my patient. What if theres a fly in the OR (yes it happens!) and it's landed on the field?

brewerpaul · Jul 30, 2008

We try hard to do it by the book, but once in a while, someone needs to leave an unattended setup for a SHORT period of time.

buck70 · Jul 31, 2008

Thanks for the responses. I appreciate the different opinions. It almost sounds like a "personal" choice; however, recommended practices are proposed for a reason. I guess we can, personally, do the best we can, and hope that we are a good influence to others.................:wink2:

KayceeCA · Jul 31, 2008

Our policy was always to have available staff monitor the setup or, if no staff was available, tape the door shut. I personally wouldn't be comfortable with an umonitored setup in a room that hadn't been sealed. The door may be closed, but who knows how many staff may have wandered in and out in search of one supply or another. Yeah, you can call me anal, but that's okay by me. :)

As far as a fly landing on the table...we once tore down an entire setup because we were fairly certain a fly had landed on it. It was a pretty substantial setup too...a decent-sized GYN case, if I recall correctly.

shodobe · Jul 31, 2008

Quicky question. So you start a case and it goes on for, let's say 7 hours! people come and go, come and go, come and go, etc.................... See where I am going with this. What makes this room any more sterile or your table which has 7 hours of dried blood anymore clean than leaving a room so-called unattended? you have to be able to trust the people who you work with to know when a room is set-up for the next case. if I go into the room to get something does this contaminate the room just because I walked by the table? I don't think so. There was a time so many years ago that we use to OPEN most of the cases for the day in a splash basin and cover with a sterile drape. We had a near perfect record of a NO INFECTION rate for many years until we had a bunch of so-called experts decide this wasn't appropriate and we stopped it. Unmonitored sterile fields need to be trust among workers that they know what to do when entering a room. I hate to tell you but we have a rule of thumb that we can leave a room set-up for 2 hours before we tear it down. It's been that way for 30 years and our rate of infection is nearly zero. Who knew!

Annony RN · Jul 31, 2008

Our policy was always to have available staff monitor the setup or, if no staff was available, tape the door shut. I personally wouldn't be comfortable with an umonitored setup in a room that hadn't been sealed. The door may be closed, but who knows how many staff may have wandered in and out in search of one supply or another. Yeah, you can call me anal, but that's okay by me. :)
As far as a fly landing on the table...we once tore down an entire setup because we were fairly certain a fly had landed on it. It was a pretty substantial setup too...a decent-sized GYN case, if I recall correctly.

Yup. And we've actually moved an intubated patient to a new room because it was easier than getting the fly out!

KayceeCA · Aug 1, 2008

What makes this room any more sterile or your table which has 7 hours of dried blood anymore clean than leaving a room so-called unattended? you have to be able to trust the people who you work with to know when a room is set-up for the next case. if I go into the room to get something does this contaminate the room just because I walked by the table?

The difference between a room that has been open for hours and attended versus a room that has been open and unattended is me - it's part of my job, as well as the rest of the team in that room, to monitor the field for sterility.

And no, I don't trust those who enter an unmonitored room to not contaminate it. Not intentionally of course. But I've seen plenty of people (me included) contaminate a sterile field without realizing it. If the room staff is there monitoring the field, and watching extra carefully when others are passing through, chances are someone will see any breaks in sterility and it can be remedied.

Do we catch everything when we're monitoring for breaks in sterility? Of course not. Do I believe you when you say you don't follow these procedures and yet your facility has near zero infection rates? Yes, I do. All I can say to that is that I do the best I can to follow the procedures I've been taught and protect my patient to the best of my ability. I haven't been an RN for all that long, so I don't have experiences from back when we used to do it a different way and it was still all good. I can just go by what I'm taught, and by experience as I gain it.

I respect your experience, and your confidence in what's acceptable and what's not. I hope that you respect my dedication to doing the best job I can as I gain more experience.

Christina1973 · Aug 8, 2008

I tend to view things by how I would want my loved ones cared for if they were the patient. I want that room/sterile field monitored. The high physical, emotional, and financial cost of a surgical site infection is not worth the risk. And now with the CMS rules about not paying for complications, the financial picture is even more grim. But $$ isn't what matters most - it's the patient.

I am very much against sacred cows, but have a definite reluctance to cut corners when it comes to sterility. Not gonna do it!

Criss