breaking sterility question

  1. Hi everyone!

    I have an interview for the OR this friday.. i'm very excited and nervous at the same time! One of the questions I am anticipating in the interview will be something along the lines of "if you witness a more senior nurse (or surgeon) breaking aseptic technique, how would you react?"

    I was wondering if anyone had any ideas how i could answer this question?

    Some ideas I had were:
    - approach the nurse discreetly and point out the event. The nurse might have made the mistake unintentionally and it's my job to advocate for the patient's safety.

    However.. if the nurse purposelly breaks sterility to cut corners and to avoid prolonging the case then I know this can be a serious problem. But.. how to address it? and how far do you go? It doesn't seem feasible re-set all the equiptment up.

    Please share any experiences you've had
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    About penny77

    Joined: Aug '08; Posts: 46; Likes: 11

    17 Comments

  3. by   frez
    Hi
    I am a fairly new nurse and a new OR Rn. The answer would be to inform them of the break, they might not have noticed that they broke the sterile field. Most won't be offended by informing them and even if they are, so what, its one of the jobs of circulater (and anyone in the room) to maintain the sterile field. It's all about the patient IMO they are the most important person in the room. You have a duty to inform people of breaks in sterility even if it means breaking everything down and resetting the room up. They shouldn't be cutting corners and contaminating the field with the patients outcome at stake.
    Just answer the question honestly.

    Frez
  4. by   fracturenurse
    I don't know, that seems kind of like a strange interview question. I worked in several OR's and never been asked that, I don't even think in my internship interview.

    Having said that, if you see a break in technique, you tell the person and they stop. I've never had a problem with someone disagreeing with me. Surgeons will stop, regown, change gloves, drop the contaminated needle, instrument, etc. I'm not sure why you want to confront the nurse/scrub "discreetly." If it's a break in technique or contamination, it must be addressed right there and then. If it's something before the case like we are doing a total joint and there's a hole in the back table cover, we stop, break it all down and the surgeon just waits for the instruments to be resterilized.

    Most nurses try to contain cost in the OR by not opening everything they find, not by breaking technique.

    Sterile technique shouldn't be an issue, period.

    Good luck.
    Last edit by fracturenurse on Apr 29, '09
  5. by   KayceeCA
    I totally agree with fracturenurse. I've pointed out breaks in sterile technique to others (surgeons, scrub techs, circulators) many times and the response has always been something like, "thanks for having my back." I've also had others point out my breaks in sterile technique, and I've always appreciated it. There's no ego involved when the patient's safety is involved. And while I try to watch out for costs because I know it impacts my job security, it's far from the top of my list of priorities. The first thing is patient safety. Everything else falls somewhere in line after that.
  6. by   ShariDCST
    Quote from penny77
    hi everyone!

    i have an interview for the or this friday.. i'm very excited and nervous at the same time! one of the questions i am anticipating in the interview will be something along the lines of "if you witness a more senior nurse (or surgeon) breaking aseptic technique, how would you react?"

    i was wondering if anyone had any ideas how i could answer this question?

    some ideas i had were:
    - approach the nurse discreetly and point out the event. the nurse might have made the mistake unintentionally and it's my job to advocate for the patient's safety.

    however.. if the nurse purposelly breaks sterility to cut corners and to avoid prolonging the case then i know this can be a serious problem. but.. how to address it? and how far do you go? it doesn't seem feasible re-set all the equiptment up.

    please share any experiences you've had
    cost containment is not on the top of my list of my worries whether i'm opening a case, or scrubbed in during one. now, i don't mean i don't pay attention to the obvious things, like not throwing out every single thing that gets pulled, especially if it's on the "hold" or "available only" list, or if it's #20 in a batch of 25 identical sutures that's been gathered up - i mean that's not my main #1 concern. of course i'm not going to go willy-nilly wasting money left and right. patient safety, effective patient treatment and best possible patient outcomes are way higher on my list of priorities.

    that being said - let's look at cost-containment from a "dollars-and-sense" standpoint. if a field, an item, or an instrument becomes contaminated, and someone takes offense to having it pointed out, that is their problem totally. the whole idea is efficient, effective care that does no harm. if contamination occurs, nobody calls them on it, and the surgical site becomes infected, what's going to happen? the patient has to be treated for the infection - more $$ spent. the patient has to spend more time in the hospital - more $$$ spent. the patient's insurance (especially medicare) does not pay for nosocomial infections - more $$$$$ spent and unreimbursed. the patient - and/or the patient's family - decides to sue, naming every person in the or, the hospital and so on as defendants - mega more $$$$$$$$ spent .........need i go on? so if it's cost-containment we're looking for, then contain those costs at all costs!

    now if it's personalities we're dealing with - that needs to be taken out of the or entirely, and dealt with off the premises of the or, let's say, in the or manager's office? pointing out breaks in sterility is not a personal attack, and it's not up for discussion or debate. if i happen to break sterile field please point it out!! there's not one person in the or who is immune to making mistakes - i don't care who they are or what they tell you. even if the person doing the pointing out is wrong - who cares? deal with it and move on. "when in doubt, throw it out."

    in all cases, however - aeger primo - the patient first..........


  7. by   penny77
    Thanks to those who answered me!

    I see that it's really a no-nonsense rule. I have heard a of couple stories involving surgeons who continued with a case with contaminated instruments. I was advised that the interview would include questions that will evaluate how i would deal with conflict in the OR. I think the question in my OP is to see if as a new OR nurse, would I feel confident to stand up in a situation where senior nurses are breaking rules/cutting corners. I am imagining the worse case scenario where i notice a break in sterility but the other nurse doesn't think it happened, and the surgeon is pressing for time. But.. I will have to trust in what I saw.. better be safe than sued??

    If anyone has any other questions that can relate to "conflict in the OR" i would be grateful to hear them! i want to be prepared for this interview (and for the job if i get it )
  8. by   penny77
    Quote from fracturenurse
    I don't know, that seems kind of like a strange interview question. I worked in several OR's and never been asked that, I don't even think in my internship interview.

    Having said that, if you see a break in technique, you tell the person and they stop. I've never had a problem with someone disagreeing with me. Surgeons will stop, regown, change gloves, drop the contaminated needle, instrument, etc. I'm not sure why you want to confront the nurse/scrub "discreetly." If it's a break in technique or contamination, it must be addressed right there and then. If it's something before the case like we are doing a total joint and there's a hole in the back table cover, we stop, break it all down and the surgeon just waits for the instruments to be resterilized.

    Most nurses try to contain cost in the OR by not opening everything they find, not by breaking technique.

    Sterile technique shouldn't be an issue, period.

    Good luck.
    that makes perfect sense.. especially "Most nurses try to contain cost in the OR by not opening everything they find, not by breaking technique."
  9. by   shodobe
    After 31 years if someone told me I screwed up then I would expect to be told about it. There will be those who will be offended but you have to go home with a clear conscious. Tell them no matter what.
  10. by   Scrubby
    Quote from penny77
    Hi everyone!

    I have an interview for the OR this friday.. i'm very excited and nervous at the same time! One of the questions I am anticipating in the interview will be something along the lines of "if you witness a more senior nurse (or surgeon) breaking aseptic technique, how would you react?"

    I was wondering if anyone had any ideas how i could answer this question?

    Some ideas I had were:
    - approach the nurse discreetly and point out the event. The nurse might have made the mistake unintentionally and it's my job to advocate for the patient's safety.

    However.. if the nurse purposelly breaks sterility to cut corners and to avoid prolonging the case then I know this can be a serious problem. But.. how to address it? and how far do you go? It doesn't seem feasible re-set all the equiptment up.

    Please share any experiences you've had
    I would point out any breach in sterility straight away. I'd be respectful and not go around announcing 'hey everyone nurse so and so has just broken the sterile field!. If someone got offended and upset about it then that's THEIR problem. Quite frankly they shouldn't be in the OR if their ego can't handle someone telling them they breached asepsis.

    I've come across surgeons who will still insist on using an instrument despite it not being sterile. Last week as the scout nurse I had to 'accidentally' drop an instrument on the floor so it couldn't be used because I knew the instrument nurse was the type to cave in.

    Of course if an emergency such as ruptured AAA sort of thing comes through the door then you would be more concerned about clamping off the aorta than breaking sterility.
  11. by   penny77
    I had my interview and this questions was asked. Thanks to all of you, I had a well thought-out, confident answer.. and i got the job! thanks again for everyone's advice!
  12. by   Scrubby
    Congrats! Good luck to you and well done for being prepared in advance for the interview!
  13. by   penny77
    Quote from Scrubby
    I've come across surgeons who will still insist on using an instrument despite it not being sterile. Last week as the scout nurse I had to 'accidentally' drop an instrument on the floor so it couldn't be used because I knew the instrument nurse was the type to cave in.
    Thank you, Scrubby! Yes, this is exactly the type of situation I was concerned about, when the surgeon insists on using the instruments despite contamination. What did you do in that situation? Was the surgeon persuaded to stop?
  14. by   Scrubby
    Quote from penny77
    Thank you, Scrubby! Yes, this is exactly the type of situation I was concerned about, when the surgeon insists on using the instruments despite contamination. What did you do in that situation? Was the surgeon persuaded to stop?
    I've found that some surgeons just don't care about things like holes in sterile wrapping etc. The reason I dropped the instrument on the floor like I did is because I knew it was the only thing I could do to stop the instrument being used. By dropping it on the floor it is such an obvious breach of sterility (more than holes in the wrapping) and even the surgeon isn't stupid enough to use an instrument that has been on the floor.

    I didn't really hide the fact I did it deliberately either. I sort of said "oh....what a shame, I'll have to go get another STERILE instrument now'.Maybe this isn't the most professional way to advocate for my patient but it saved a lot of time instead of arguing with the surgeons and having to explain the basics of asepsis.

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