(8) During surgery, if a solution soaks through a sterile area from an
unsterile one--or through an unsterile area from a sterile one, the wet area should be
covered with another sterile drape.
l. Whenever microorganisms cannot be eliminated from a field, they should be
kept to an irreducible minimum. Although absolute asepsis in an operative field cannot
be reached, every effort is made to control sources of possible contamination (refer to
(1) Skin. Skin cannot be sterilized. Skin normally harbors staphylococcus
and other organisms; however, any agent capable of sterilizing skin will also destroy the
skin. The skin of the patient as well as that of members of the "sterile" team is therefore
a potential source of contamination in every operation. However, this does not remove
the need for strict aseptic technique. Defenses within the patient's body will usually
overcome the relatively few organisms left on the skin when the following protective
measures are carried out:
(a) The patient's skin is given a shave and scrub before surgery, and is
again thoroughly cleansed in the OR just prior to the incision.
(b) The skin of OR personnel is another source of contamination.
They follow rigid steps in scrubbing their hands and arms, using brushes and
detergents and adhering to strict technique. This is done to remove the maximum
number of organisms. When drying their hands, hand towels should not touch
their scrub clothes.
(c) "Sterile" team members gown and glove without touching the
outside of gowns or gloves with their bare hands.
(d) All of the patient's skin area except the site of incision is covered
with sterile drapes.
(e) When no longer needed, the knife used for the skin incision is
placed in a basin and kept within the sterile area by the scrub.
(f) Sterile towels/materials may be used to cover the skin after the
incision is made. The reason for this additional precaution is to protect the surgical
wound from the waste products continually excreted by the skin, because this waste
contains microorganisms. In addition, airborne organisms continuously pose a threat of
contaminating the incision.
(g) If a "sterile" team member's glove is punctured during an operation,
the glove is to be changed at once. If the glove is pricked by a needle or an instrument,
the glove is to be changed immediately and the needle or instrument is discarded from
the sterile field. Notify the circulator of the needle's whereabouts.