Sterile field monitored constantly? Define please

  1. Does anyone have a policy that defines who to monitor constantly a sterile field when a case is delayed? With staffing being so tight how can you balance using staff to monitor a room with the need for them to help in some other duty? Is securing a room with tape an appropriate and acceptable technique that qualifies as monitoring constantly? What are you doing to follow this practice guideline.
    Hannah Rose
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    About Hannah Rose

    Joined: Feb '02; Posts: 8


  3. by   inches
    cover the trolley with pieces of sterile towel and
    if u have the authority to seal the doors, it is a good idea.
  4. by   Marijke
    Sealing the door with a piece of tape is very common practice, I don't know however how it would stand up in court.
    What I do know is, that covering a trolley, set up or whatever you call it in your hospital, is not recommended practice. Research is showing that it is almost impossible to remove the drapes used, without contaminating your sterile field.

  5. by   ORJUNKIE
    AORN standards are the recognized authority for periop nursing. They prescribe that someone must be in any room that has been opened for a procedure to ensure that no contamination has occurred. This can be someone who remains sterile or not. Use this standard as a reason to support your request for more help! You will be held liable if an infection occurs and it is proven that you covered a table and/or left a room unsupervised.
  6. by   canoehead
    Jeepers, you mean that AORN does not trust it's member to see a room is set up and have the sense not to disturb it? It's not like they have members of the public walking around the OR suite who wouldn't know better.

    If they are concerned about monitering a table before the procedure it stands to reason in my mind that they should have someone watching the table during the procedure as the same people have a greater risk of inadvertently touching a sterile table with nonsterile items when they are working in the room.

    The number of moniters could get ridiculous. Sometimes the patients benefit from putting that $ to better use elsewhere.
  7. by   mud
    Never cover a sterile set-up!!! It is near impossible, as already mentioned, to remove a drape without contaminating it.
  8. by   nrw350
    How can a non-sterile person monitor a sterile room without containmenating it? In my opinion, that person would have to "scrub-in" (I think that is the right word) and be wearing gloves, mask, and the whole works in order to keep the room sterile.

  9. by   meandragonbrett
    They aren't talking about keeping the room sterile. The entire room isn't sterile. They are talking about the instruments and things of that nature that are sterile. Not everybody in the OR Scrubs-in. Only the person scrubbing for the case, the first assistant if there is one, and the MD. Anesthesia doesn't scrub, and the circulator doesn't scrub.

  10. by   nrw350
    hmm, why dont they scrub in too? I mean they are working in the OR with patient too. I know they at least have to wash their hands and all. Also, what exactly is involved in "scrubbing-in"?


  11. by   CarolineRn
    nick, as brett explained, the whole room is not sterile. There is a sterile "field" that must be maintained, and cannot be touched by the circulator, anesthesia, or any other person not scrubbed in. Part of the circulator's job is to take care of the needs of their scrub. (sterile person who is asisting the doctor) This includes going into the core (room which contains all the sterile instruments) and retrieving them as needed, and opening them up to the sterile field. The circ only touches the outside of the container, and if she inadvertantly touches anything inside, the item is contaminated.

    Scrubbing in is only done by the persons who will be in physical contact with the open part of the patient. The area around the incision is draped off (with sterile drapes). All non-scrubbed in personel are very careful not to contaminate these areas. The tables with the instuments and supplies that are opened and set up are also sterile, and cannot be touched by anyone who hasn't scubbed in.

    So as you see, there are only certain areas around a patient and the equiptment that are considered sterile. There is no way ( to my knowlege) to completely sterilize an entire room. If there was, it would be unnessecary, as well as unpractical.
  12. by   nrw350
    WOW!! This is really complicated and and amazing. I definitely do not think that I have what it takes to work in an OR. That is not even taking into account my weak stomach. I hope my questions have not offended or annoyed anyone in this board. I really appreciate everyone's time and patience in explaining things to me. I am really glad that I joined this board, because I have learned so much more than I have in a long time.

    What is it like to be in OR for a surgery? I mean what are the feelings you get from being htere?

  13. by   CarolineRn
    WOW!! This is really complicated and and amazing. I definitely do not think that I have what it takes to work in an OR. That is not even taking into account my weak stomach.
    Don't sell yourself short. Even the most seasoned OR nurses I've had the pleasure to work with are ALWAYS watching and maintaining that sterile field, and I got some great advice as a newbie from one of them. She said her secret is to visualize everyone and everything in the sterile field as having an "aura" (or force field, whichever works fo you) around them, and that you cannot cross into that aura. Maintain a safe distance, and genrally follow procedures. Manipulating around this environment soon becomes one of the easier parts of the job, because you become so aware of it. The complicated stuff comes later.

    I say this from the prospective of a student nurse who has the fortunate opportunity to work as a nurse tech in an OR. I've only been working here for about six months, and there is so much to learn! I've got the sterile field part down, can follow a case from start to finish, from pre-op report to post-op. Help in setup, do many of the "go-fer" duties when something is needed by the team, (flipping supplies or passing them onto the field.) I can set up the bovie and suction, am becoming very aware of the many types of tables and positioning standards, follow the patient into recovery and listen to report.

    Those things are exhausting enough, but then the truly challenging part comes in. Knowing which instruments will be needed by which surgeon for which case. Sure, we have "cards" that are printed out that have surgeon prefernences, but many of these cards are out of date. Why? Well, it *is* the RN's job to add in any changes. Most of these RN's have been working at this job for so long, "they don't need no stinkin' cards!":chuckle

    Is it a wonder with RN's having to know every aspect and anticipate each step of so many surgeries, done by so many different surgeons that "cards" don't always get filled in? When one circ is answering calls for doctors, taking care of the scrub, the surgeon, and the anisthesiologist, as well as being constantly aware of the patient and be ready to act in a split second, not to mention the neccessary paperwork for the patient, I somehow can forgive these hard working people for allowing the "cards" to be a low priority.

    Whew! OR nurses really are great. Can't wait to beome one officially!

    What is it like to be in OR for a surgery? I mean what are the feelings you get from being htere?
    For me, I'm still in awe. And I have gotten to second scrub on a few cases. Whenever I get the chance to, I second scrub. The human body is amazing, and actually being able to visualize everything helps immensely, indeed it's vital to an OR nurse.

    As for if you could stomach it, well, many can't. Some get over it, others don't. Though I was too in awe when I was first allowed to watch a surgery from the anesthesiologist's spot above the patient's head, with the firm admonition "don't move, and if you get sick, take a step back and sit down on the ground." I never had a problem with nausea.

    Your questions are welcome, and no matter what you go on to do, never loose that curiosity or be afraid to ask.
    Last edit by CarolineRn on May 31, '02
  14. by   nrw350
    Thanks alot. This is what makes me really enjoy chatting with medical people. That is many of them are more than willing to share their exerpeices and explain htings. This is truly amazing to me. I can not describe how much I appreciate all of you.