Surgical field: asepsis and preparation

Authors: Oladzko A.A., Budritskiy A.A., Rednenko V.V., Rednenko L.I.

Editor: Rednenko V.V.

Equipment for the practical skill:

• instrument table (sterile)
  • surgical clamp - 2 pcs.
  • clamps for drape (linen holder) - 4 pcs.
  • sterile gauze pads - 5 pcs.
• instrument table (sterile)
  • sterilization box with 4 sterile cloth drapes
  • antiseptic for processing the operating field (1% solution of iodopyrone, 1% solution of iodonate, etc.) in a glass
• manipulation table (non-sterile)
  • tray for collecting used instruments
• basin for collecting used dressings (on the floor or on a stand)

Clinical situation:

• Treat the surgical field before abdominal surgery. The proposed surgical approach is the upper midline gastrointestinal tract. The patient is in a state of anesthesia. You are wearing sterile clothing and gloves.

Order of the skill performance:

Preparatory stage:

• check the medical equipment required to treat the surgical field. If necessary, ask the nurse (teacher) to complete the table.

Main stage:

! do not turn your back to the patient during all the time!

! don't keep your hands below the level of your abdomen during all the time!

• Treat the surgical field for the first time.
  • Stage 1
    • Take a gauze pad with a surgical clamp, moisten it with an antiseptic solution by dipping into a glass
    • Treat the operating field "wide" from the center to the periphery for at least 30 seconds (processing time is determined by the instructions for use of the antiseptic) ! Say "30 seconds" out loud!
    • Drop the used gauze pad into the basin ( don't keep your hands below the level of your abdomen)
  • Stage 2
    • Take a gauze pad with a surgical clamp, moisten it with an antiseptic solution by dipping into a glass
    • Treat the operating field "narrowly" from the center to the periphery for at least 30 seconds (the exact time is determined by the recommendations for the use of the applied antiseptic) ! Say "30 seconds" out loud!
    • Drop the used gauze pad  into the basin ( don't keep your hands below the level of your abdomen)
    • Give the used clamp to the nurse without touching the nurse's hand (if practicing without an assistant, place the clamp in the tray without touching the tray).
• Isolate (drape) the surgical field with sterile cloth drapes ( don't keep your hands below the level of your abdomen)
  • Take first sterile cloth drape is folded in half and limit the lower border of the operating field with it.
  • Take second sterile cloth drape is folded in half and limit the upper border of the operating field with it.
  • Take third sterile cloth drape is folded lengthwise and limit border of the operating field  closest from the surgeon.
  • Take fourth sterile cloth drape is folded lengthwise and limit border of the operating field farthest from the surgeon.
  • Fix the drapes together with drape clamps (towel clips).
  • Place the drape clamps under drapes.
• Treat the surgical field a second time.
  • Take a gauze pad with the second clamp, moisten it with an antiseptic solution by dipping into a glass
  • Treat the operating field from the center to the periphery for at least 30 seconds (the exact time is determined by the recommendations for the use of the applied antiseptic).
  • Drop the used gauze pad  into a basin ( don't keep your hands below the level of your abdomen)
  • Give the used clamp to the nurse without touching the nurse's hand (if practicing without an assistant, place the clamp in the tray without touching the tray).

Final stage:

• Check the preparation of the surgical site