sterile fields in operating room

[pcoburn]

If a case is postponed, how long can you keep the sterile field intact before it is considered contaminated? Plese give references of information

[passionate]

I have never opened a room in the presence of a patient unless it was an emergency and I was scrambling to get my set up going. I don't understand opening with a patient in the room. As a circulator I have a patient to focus on directly. I too was taught to keep the noise level down, especially during induction and reverse of general anesthesia. If a pt. is under a ketamine anes. then noise is a real concern.

[bifurcated]

Are we amazing creatures or what? In AORN standards of practice you have your answer to so many questions. Yes, 2 hours is what I have been use to in facilities that I work. Human beings tend to "over think" some things.That is why we practice with standards of care. I just have to say that you need to go with your gut on some things. Sterile is Sterile........ if in doubt you throw it out! If there is ever a question then do not use it. I do not know that sealing a room helps..... probably makes you feel better knowing a lot of people didn't walk through the room but if you strictly go by standards....... no one watched the field.. did it have a fly in it before you sealed it? No one knows....... common sense is the best when questioning yourself. NEVER EVER COVER YOUR TABLE WITH ANYTHING!! That is an ancient concept that just does not make any sense at all. Opening when your patient is in the room is not great either in my opinion. Put your self in that person's place and how would you feel if there was all that activity happening and no one was paying attention to you as your trying to go off to sleep? Patients still have to go through the levels of anesthesia...... just because we usually do not notice the excitement phase in an adult doesn't meant it isn't there. Our anesthesiologist's would have cows if we did this.Not only that, but it must take "extra time" that your patients must be paying for under anesthesia while you get everything ready.Sorry, I do not like that idea. Now while I spouted AORN and standards of practice earlier, you also deal in a "real world" where things do NOT go by the book. We had a heart patient on the table once, asleep, prep started when our heart surgeon ( only one open heart guy on staff at the time) was paged stat to the ICU. Our last patient was bleeding in the unit. We had to wake up patient #2 and rush patient #1 back to the OR. Did we break everything down because it was "patient contaminated?" Heck NO...... the patient would have died if we would have done that. All of the nurses in the OR quickly talked it through and that was our decision...... all of us have tons of experience so we "thought it through" and that is what we did. You need to be able to look at yourself in the mirror and say did I do the right thing? I think we did. I think that is what a good surgical conscience is about.

[DTCC]

According to Surgical Technology Principles & Practice, page 144 (Fuller, Joanna Kotcher) "The sterile field is created as close as possible to the time of surgery and is monitored throughout the procedure... The longer a sterile setup remains exposed, the greater the risk for contamination. It is not recommended that supplies be left open before a case for more than 2 hours; after 2 hours the items should be considered contaminated, and the room should be broken down. After a room is opened, it must be constantly monitored to prevent accidental contamination. "

And according to Berry & Kohn's Operating Room Technique, "the sterile field is created as close as possibel to the time of use. The degree of contamination is proportionate tot he length of time that sterile items are exposed to the environment....It is virtually impossible to uncover a table of sterile contents without a potential for contamination. Covering sterile tables for later use is not recommended. The sterile field is not in direct wision and is not considered sterile. A covered table is not under observation at all times." By that token, taping & locking room doors is also unacceptable, "sterile areas are continuously kept in view, to ensure this, the following steps must be taken: someone must remain in the room to maintatin vigilance when sterile packs are opened in a room or a sterile field is set up. Sterility cannot be ensured without direct observation. An unguarded sterile field should be considered contaminated."

[Scrubby]

We do not set up (open) until the pt is in the room. Once pt is in the room, everything is open and set up. If after that, the case is cancelled, everything is thrown away.

This is how we do it as well. I don't really like it though because the patient hears everything being opened and people counting. The problem is we have no where else to set up our fields except in the OR. Our 'anaesthetic rooms' are an absolute joke, they are just rooms that are full of anaesthetic supplies and our trolley set ups for the next case. There is no room to intubate a patient in there. The surgeons want to start as soon as the patient is asleep and so we really have no choice but to set up the way we do.

[Geani]

We do not set up (open) until the pt is in the room. Once pt is in the room, everything is open and set up. If after that, the case is cancelled, everything is thrown away.

We do the same in Cyprus. I think this is the best practice.

Thank you:yeah:

[jdg0719]

We put tape on across the doors on ours with a sign that states: DO NOT ENTER. We never open unless the patient is in the holding area. AST and AORN highly discourge from covering up a sterile feild with a drape, 3/4 sheet, etc. For some reason, if the case gets CXd, then we have to tear everything down after 1 hour.

[RockRN]

according to aorn (recommended practices, 2010), there is no specific amount of time that a sterile field is considered usable after set up; it is event related. however, an open sterile field should be continually monitored by authorized or personnel to ensure that the set up is not contaminated. obviously, a case should not be set up until it is absolutely necessary. common sense should be used. however, if there is a delay of 2, 4, 6 hours, etc., just monitor the set up, limit traffic in/out of the room, monitor environmental controls, etc. finally, remember that your vigilance and practice of surgical conscience is for the good of the patient.

[RockRN]

A sterile set up should NEVER be covered, as stipulated by AORN (Recommended Practices, 2010).