Performs All Procedures In Sterile Protective Clothing Using Sterile Technique

Mastering Sterile Technique: A Comprehensive Guide to Performing Procedures in Sterile Protective Clothing

The successful execution of any invasive medical procedure hinges on one non-negotiable principle: the absolute prevention of microbial contamination. This is achieved through the meticulous application of sterile technique, a standardized set of practices designed to create and maintain a sterile field and protect both the patient and the practitioner. Performing all procedures while attired in sterile protective clothing—including gowns, gloves, masks, and often caps—is the physical manifestation of this principle. It is not merely a ritual but a critical barrier system that interrupts the chain of infection transmission. This guide provides an in-depth, step-by-step exploration of the complete process, from initial preparation through the final moments of a procedure, ensuring you understand not only the "how" but the vital "why" behind every action.

The Foundational Pillar: Hand Hygiene and Surgical Attire

Before a single piece of sterile clothing is donned, the process begins with the most fundamental step in infection control: hand hygiene. This is the cornerstone upon which all subsequent sterile actions are built. Regardless of whether an alcohol-based hand rub (ABHR) or soap and water is used, the goal is to achieve a significant reduction in transient flora—the microorganisms picked up from the environment—on the hands and forearms. The technique must be thorough, covering all surfaces including fingertips, interdigital spaces, thumbs, and wrists, and must be performed for the recommended duration (at least 20-30 seconds for ABHR, longer for scrubbing). Hands must be dried completely with a sterile towel, as moisture can compromise the integrity of gloves.

Following hand hygiene, the practitioner dons the first layer of sterile protective clothing: the surgical cap or hood. Its purpose is to contain shed skin cells and hair, which are primary sources of microbial contamination. The cap should cover all hair completely. Next comes the surgical mask. It must be secured snugly over the nose and mouth, with the metal nose piece molded to the wearer’s face to prevent gaps. The mask is considered sterile on the front and ties or ear loops; it should not be touched or adjusted once positioned. If a face shield is part of the protocol, it is placed over the mask and cap.

The Gowning Process: Establishing a Sterile Barrier

Gowning is a precise, choreographed movement designed to prevent the outer, non-sterile surfaces of the gown from contacting the wearer’s skin or clothing, which are considered contaminated. The sterile gown is typically presented on a sterile wrapper. The practitioner, with hands still held above waist level and away from the body, picks up the gown by the inside of the neck and shoulder seams. They step back from the table, allowing the gown to unfold without touching any non-sterile surfaces. The gown is then lifted and allowed to fall forward. The practitioner inserts their arms into the sleeves one at a time, keeping hands within the cuff and elevated. A circulating nurse or assistant, using sterile gloves, will then tie the gown at the neck and waist from behind, ensuring a secure fit without creating tension that could tear the fabric. The gown’s sleeves must extend over the wrists, providing a seamless transition to the next critical step: gloving.

The Gloving Technique: The Final Sterile Barrier

Gloving is the final and most vulnerable point in the donning sequence, as the hands are the primary tools of the procedure. There are two primary techniques: open gloving and closed (or assisted) gloving. Closed gloving is the gold standard for maximal sterility in the operating room. After being gowned, the practitioner keeps their hands inside the gown cuffs, elevated and away from the body. The circulating nurse, wearing sterile gloves, opens the sterile glove package and picks up the first glove by the folded cuff, presenting it palm-up. The gowned practitioner slides their hand into the glove, using their gown-covered hand to carefully pull the glove over their fingers and hand without touching the outer surface. The nurse then picks up the second glove, and the practitioner repeats the process for the other hand. The gloves are then adjusted by touching only the sterile outer surface of the glove to the sterile surface of the gown cuff. In open gloving, performed when no assistant is available, the practitioner must touch only the inside of the gloves, a technique requiring significant practice to avoid contamination.

Executing the Procedure: Maintaining the Sterile Field

With full sterile protective clothing in place, the focus shifts to the procedure itself. The sterile field—comprising the draped patient, the sterile back table, and all instruments and supplies—must be vigilantly protected. Key principles include:

• Sterile Only Touches Sterile: The sterile gloves and gown may only come into contact with other sterile items. If a sterile glove touches a non-sterile surface (e.g., the practitioner’s face, a door handle, or their own skin), it is immediately contaminated and must be changed.
• The "Bloody Field" Rule: Once an instrument or sponge has entered the sterile surgical site (the "bloody field"), it is considered contaminated and cannot be returned to the sterile back table. A separate "dirty" area is established for such items.
• Passing Instruments: Instruments are passed from the scrub nurse/technician to the practitioner handle-first, with a brief, direct transfer. They are never tossed or handed across the sterile field in a way that could cause them to flip or be grabbed incorrectly.