Surgical Asepsis and the Sterile Field on the NCLEX
Sterile field rules, what breaks the field, and the gowning and gloving order.
One principle decides every sterile technique question: when in doubt, it is contaminated.
The field rules
The outer 1-inch border of a sterile field is not sterile. Below the waist or table level is not sterile. Sterile-gloved hands stay above the waist and in sight. Out of sight is out of sterility: never turn your back on a sterile field, and never leave it unattended. Only sterile touches sterile. Reaching across the field with an unsterile arm, coughing over it, or letting hair or a dangling ID badge cross it contaminates it. Open wrapped packages first flap away from you, sides next, last flap toward you, so you never reach over exposed contents.
What breaks the field
Moisture strike-through: liquid soaking through a sterile drape wicks organisms up from the unsterile surface beneath. A wet field on a non-waterproof surface is contaminated. Pouring: remove the cap without touching the rim, hold the bottle with the label against your palm (drips cannot ruin the label), and pour from a few inches without touching the container to sterile items. An opened bottle is used per policy, not saved indefinitely. A torn wrapper, a wet package, or an expired date means the contents are not sterile. Turning away, dropping hands below the waist, a glove brushing a bed rail: contaminated. Say so, replace it, and no one competent will fault you. The exam answer is always to re-establish sterility, never to proceed and hope.
Gowning and gloving order
Surgical scrub first, hands held above the elbows to dry. Gown before gloves. Touch only the inside of the gown; a scrubbed person's gown is sterile in front from chest to table level and on the sleeves to the cuff. The back is never sterile. Closed gloving: hands stay inside the gown cuffs while the gloves are pulled on, so bare skin never touches the glove exterior. Open gloving for bedside sterile procedures: first glove touched only by its folded inner cuff; second glove picked up by sliding gloved fingers under its outer cuff. Skin touches only inside surfaces; glove exterior touches only sterile surfaces.
Frequently asked
Sterile solution splashed on the cloth drape?
Strike-through. The wet area, and on a permeable drape the field, is contaminated. Replace it.
Which part of a sterile gown stays sterile?
Front from chest to table level and the sleeves to the cuffs. Back, neckline, axillae, and anything below the table are not.
You think your glove grazed the bed rail but are not sure?
Treat it as contaminated. Change gloves. Doubt equals contamination.
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