Breaks in Aseptic Technique Require Review of OR Basics

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Do you know what’s happening in your facility’s operating rooms (ORs) related to infection prevention and control practices? To get an idea of how well recommended practices are being implemented in the surgical suites across the U.S., sister publication Infection Control Today magazine conducted an opinion poll of OR nurses in ambulatory care and acute care to gather their opinions on a number of issues related to infection prevention and control.

When asked what they believe are the most critical components of infection prevention and control in the OR, 76 percent of survey respondents cited maintaining the sterile field; 57 percent cited proper patient skin prep; 55 percent cited proper surgical scrub/hand antisepsis; and 43 percent cited proper barrier protection. Thirty-three respondents (28 percent) cited other main concerns that will be addressed in this article.

Skin Prep, Aseptic Technique and the Sterile Field

The best safeguard against surgical site infections (SSIs) and other infections acquired in the OR is maintaining aseptic technique — a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by infectious pathogens — at all times. Aseptic technique refers to the practices performed immediately before and during a clinical procedure to reduce post-operative infection; these include patient skin prep, handwashing, surgical scrub, using barrier protection for the patient (draping) and for the surgical team (surgical attire), maintaining the sterile field, using safe operative technique and maintaining a safe and sterile environment in the surgical arena.

The Centers for Disease Control and Prevention (CDC)’s Guideline for Prevention of Surgical Site Infections notes, “Rigorous adherence to the principles of asepsis by all scrubbed personnel is the foundation of surgical site infection prevention. Others who work in close proximity to the sterile surgical field, such as anesthesia personnel who are separated from the field only by a drape barrier, also must abide by these principles.” According to the AST, the three basic principles of asepsis, as stated in the Core Curriculum for Surgical Technology to be applied to all patients are: Principle I: A sterile field is created for each surgical procedure; Principle II: Sterile team members must be appropriately attired prior to entering the sterile field; Principle III: Movement in and around the sterile field must not compromise the field. These principles form the basis for the development of surgical conscience as applied to the surgical treatment of patients.

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