Sterile Field Skill 23-3
DELEGATION CONSIDERATIONS
Procedures requiring the use of a sterile field and other sterile items are not
delegated to nursing assistive personnel (NAP) or unlicensed assistive personnel
(UAP). Depending on the state’s nurse practice act and the organization’s policies
and procedures, these procedures may be delegated to licensed practical/vocational
nurses (LPN/LVN). The decision to delegate must be based on careful analysis of the
patient’s needs and circumstances, as well as the qualifications of the person to
whom the task is being delegated.
EQUIPMENT
Sterile wrapped drape or commercially prepared sterile package
Additional sterile supplies, such as dressings, containers, or solution, as
needed
PPE, as indicated
Preparing a Sterile Field
3. Check that packaged sterile drape is dry and unopened. Also, note expiration date,
making sure that the date is still valid.
Moisture contaminates a sterile package. Expiration date indicates period that
package remains sterile.
4. Select a work area that is waist level or higher.
Work area is within sight. Bacteria tend to settle, so there is less contamination above
the waist.
5. Open sterile wrapped drape or commercially prepared kit following the directions
below.
For a Prepackaged Sterile Drape
a. Open the outer covering of the drape. Remove sterile drape, lifting it carefully by
its corners. Hold away from body and above the waist and work surface.
Outer 1 inch (2.5 cm) of drape is considered contaminated. Any item touching this
area is also considered contaminated.
b. Continue to hold only by the corners. Allow the drape to unfold, away from your
body and any other surface (Figure 1).
Touching outer side of wrapper maintains the sterile field. Contact with any surface
would contaminate the field.
c. Position the drape on the work surface with the moisture-proof side down (Figure
2). This would be the shiny or blue side. Avoid touching any other surface or
object with the drape. If any portion of the drape hangs off the work surface,
, that part of the drape is considered contaminated. Do not touch or reach over
the sterile field.
Moisture-proof side prevents contamination of the field if it becomes wet. The
moisture penetrates the sterile cloth or paper and carries organisms by capillary
action to contaminate the field. A wet field is considered contaminated if the
surface immediately below it is not sterile.
For a Commercially Prepared Kit or Tray
a. Open the outside cover of the package and remove the kit or tray (Figure 3).
Place in the center of the work surface, with the topmost flap positioned on the
far side of the package. Discard outside cover.
This allows sufficient room for sterile field.
b. Reach around the package and grasp the outer surface of the end of the
topmost flap, holding no more than 1 inch from the border of the flap. Pull open
away from the body, keeping the arm outstretched and away from the inside of
the wrapper (Figure 4). Allow the wrapper to lie flat on the work surface.
This maintains sterility of inside of wrapper, which is to become the sterile field.
Outer surface of the wrapper is considered unsterile. Outer 1-inch border of the
wrapper is considered contaminated.
For b c e
c. Reach around the package and grasp the outer surface of the first side flap,
holding no more than 1 inch from the border of the flap. Pull open to the side of
the package, keeping the arm outstretched and away from the inside of the
wrapper (Figure 5). Allow the wrapper to lie flat on the work surface.
e. Stand away from the package and work surface. Grasp the outer surface of the
remaining flap closest to the body, holding not more than 1 inch from the border of
the flap. Pull the flap back toward the body, keeping arm outstretched and away from
the inside of the wrapper. Keep this hand in place. Use other hand to grasp the
wrapper on the underside (the side that is down to the work surface). Position the
wrapper so that when flat, edges are on the work surface, and do not hang down over
sides of work surface. Allow the wrapper to lie flat on the work surface.
,f. The outer wrapper of the package has become a sterile field with the packaged
supplies in the center Do not touch or reach over the sterile field.
Sterility of the field and contents are maintained.
Adding Items to a Sterile Field
6. Place additional sterile items on field as needed.
Sterility of the field is maintained.
To Add an Agency-Wrapped and Sterilized Item
a. Hold agency-wrapped item in the dominant hand, with top flap opening away from
the body. With other hand, reach around the package and unfold top flap and both
sides.
Only sterile surface and item are exposed before dropping onto sterile field.
b. Keep a secure hold on item through the wrapper with the dominant hand. Grasp
the remaining flap of the wrapper closest to the body, taking care not to touch the
inner surface of the wrapper or the item. Pull the flap back toward the wrist, so the
wrapper covers the hand and wrist.
Only sterile surface and item are exposed before dropping onto sterile field.
, c. Grasp all the corners of the wrapper together with the nondominant hand and pull
back toward wrist, covering hand and wrist. Hold in place.
Only sterile surface and item are exposed before dropping onto sterile field.
d. Hold the item 6 inches above the surface of the sterile field and drop onto the field.
Be careful to avoid touching the surface or other items or dropping onto the 1-inch
border.
This prevents contamination of the field and inadvertent dropping of the sterile item
too close to the edge or off the field. Any items landing on the 1-inch border are
considered contaminated.
To Add a Commercially Wrapped and Sterilized Item
a. Hold package in one hand. Pull back top cover with other hand. Alternately,
carefully peel the edges apart using both hands (Figure 10).
Contents remain uncontaminated by hands.
b. After top cover or edges are partially separated, hold the item 6 inches above
the surface of the sterile field. Continue opening the package and drop the item
onto the field (Figure 11). Be careful to avoid touching the surface or other items
or dropping onto the 1-inch border.
This prevents contamination of the field and inadvertent dropping of the sterile item
too close to the edge or off the field. Any items landing on 1-inch border are
considered contaminated.
c. Discard wrapper.
DELEGATION CONSIDERATIONS
Procedures requiring the use of a sterile field and other sterile items are not
delegated to nursing assistive personnel (NAP) or unlicensed assistive personnel
(UAP). Depending on the state’s nurse practice act and the organization’s policies
and procedures, these procedures may be delegated to licensed practical/vocational
nurses (LPN/LVN). The decision to delegate must be based on careful analysis of the
patient’s needs and circumstances, as well as the qualifications of the person to
whom the task is being delegated.
EQUIPMENT
Sterile wrapped drape or commercially prepared sterile package
Additional sterile supplies, such as dressings, containers, or solution, as
needed
PPE, as indicated
Preparing a Sterile Field
3. Check that packaged sterile drape is dry and unopened. Also, note expiration date,
making sure that the date is still valid.
Moisture contaminates a sterile package. Expiration date indicates period that
package remains sterile.
4. Select a work area that is waist level or higher.
Work area is within sight. Bacteria tend to settle, so there is less contamination above
the waist.
5. Open sterile wrapped drape or commercially prepared kit following the directions
below.
For a Prepackaged Sterile Drape
a. Open the outer covering of the drape. Remove sterile drape, lifting it carefully by
its corners. Hold away from body and above the waist and work surface.
Outer 1 inch (2.5 cm) of drape is considered contaminated. Any item touching this
area is also considered contaminated.
b. Continue to hold only by the corners. Allow the drape to unfold, away from your
body and any other surface (Figure 1).
Touching outer side of wrapper maintains the sterile field. Contact with any surface
would contaminate the field.
c. Position the drape on the work surface with the moisture-proof side down (Figure
2). This would be the shiny or blue side. Avoid touching any other surface or
object with the drape. If any portion of the drape hangs off the work surface,
, that part of the drape is considered contaminated. Do not touch or reach over
the sterile field.
Moisture-proof side prevents contamination of the field if it becomes wet. The
moisture penetrates the sterile cloth or paper and carries organisms by capillary
action to contaminate the field. A wet field is considered contaminated if the
surface immediately below it is not sterile.
For a Commercially Prepared Kit or Tray
a. Open the outside cover of the package and remove the kit or tray (Figure 3).
Place in the center of the work surface, with the topmost flap positioned on the
far side of the package. Discard outside cover.
This allows sufficient room for sterile field.
b. Reach around the package and grasp the outer surface of the end of the
topmost flap, holding no more than 1 inch from the border of the flap. Pull open
away from the body, keeping the arm outstretched and away from the inside of
the wrapper (Figure 4). Allow the wrapper to lie flat on the work surface.
This maintains sterility of inside of wrapper, which is to become the sterile field.
Outer surface of the wrapper is considered unsterile. Outer 1-inch border of the
wrapper is considered contaminated.
For b c e
c. Reach around the package and grasp the outer surface of the first side flap,
holding no more than 1 inch from the border of the flap. Pull open to the side of
the package, keeping the arm outstretched and away from the inside of the
wrapper (Figure 5). Allow the wrapper to lie flat on the work surface.
e. Stand away from the package and work surface. Grasp the outer surface of the
remaining flap closest to the body, holding not more than 1 inch from the border of
the flap. Pull the flap back toward the body, keeping arm outstretched and away from
the inside of the wrapper. Keep this hand in place. Use other hand to grasp the
wrapper on the underside (the side that is down to the work surface). Position the
wrapper so that when flat, edges are on the work surface, and do not hang down over
sides of work surface. Allow the wrapper to lie flat on the work surface.
,f. The outer wrapper of the package has become a sterile field with the packaged
supplies in the center Do not touch or reach over the sterile field.
Sterility of the field and contents are maintained.
Adding Items to a Sterile Field
6. Place additional sterile items on field as needed.
Sterility of the field is maintained.
To Add an Agency-Wrapped and Sterilized Item
a. Hold agency-wrapped item in the dominant hand, with top flap opening away from
the body. With other hand, reach around the package and unfold top flap and both
sides.
Only sterile surface and item are exposed before dropping onto sterile field.
b. Keep a secure hold on item through the wrapper with the dominant hand. Grasp
the remaining flap of the wrapper closest to the body, taking care not to touch the
inner surface of the wrapper or the item. Pull the flap back toward the wrist, so the
wrapper covers the hand and wrist.
Only sterile surface and item are exposed before dropping onto sterile field.
, c. Grasp all the corners of the wrapper together with the nondominant hand and pull
back toward wrist, covering hand and wrist. Hold in place.
Only sterile surface and item are exposed before dropping onto sterile field.
d. Hold the item 6 inches above the surface of the sterile field and drop onto the field.
Be careful to avoid touching the surface or other items or dropping onto the 1-inch
border.
This prevents contamination of the field and inadvertent dropping of the sterile item
too close to the edge or off the field. Any items landing on the 1-inch border are
considered contaminated.
To Add a Commercially Wrapped and Sterilized Item
a. Hold package in one hand. Pull back top cover with other hand. Alternately,
carefully peel the edges apart using both hands (Figure 10).
Contents remain uncontaminated by hands.
b. After top cover or edges are partially separated, hold the item 6 inches above
the surface of the sterile field. Continue opening the package and drop the item
onto the field (Figure 11). Be careful to avoid touching the surface or other items
or dropping onto the 1-inch border.
This prevents contamination of the field and inadvertent dropping of the sterile item
too close to the edge or off the field. Any items landing on 1-inch border are
considered contaminated.
c. Discard wrapper.
