Sterile Field: A Challenge for CTE Students
An area where, year after year, I see students have the greatest challenges is in creating and maintaining a sterile field. This is understandable because this is not a straightforward procedure where the student follows the steps, but it is more of a concept that requires vigilance throughout the procedure. As it pertains to CTE students, the most common errors I see are:
students do not establish a sterile area,
students contaminate their sterile gloves and then contaminate the sterile field
students place non-sterile items onto the sterile field.
Without a true understanding of the risk and the process of creating and maintaining a sterile field, a student is bound to violate the field and place the patient at risk of infection.
A sterile field is an area free from pathogens or other microbes that can infect someone. It is required for procedures that are at high risk for infection. A sterile field is created by establishing an area where only sterile procedural equipment and supplies will be allowed. This area of sterility is then maintained by only permitting sterile items to enter this area. If a non–sterile item enters this area, the sterile field has been broken, and the procedure must be stopped and the sterile field created again.
Where is such a field required? Surgery is an obvious example, and anyone participating in the surgery must maintain sterility at all times. However, this also pertains to smaller procedures such as suturing, urinary catheter placement, large IV placement, and some office-based procedures. A surgical scrub is an expert in creating a sterile environment and maintaining sterility because this is a primary component of their job. With that being said, most healthcare professionals, from medical assistants to ER doctors, need to understand how to create and maintain a sterile field.
So, how can students learn to create and maintain a sterile field? As with any skill, it requires understanding and practice. There are many quality resources available online with a simple search. Here are a couple of short videos I have created for SimRated students:
Sterile Glove https://youtu.be/BRTQHKI1BGc
Creating a sterile field https://youtu.be/XarURAqkUHU
SimRated courses that involve this concept are “Creating a Sterile Field” and “Suture.” It is everyone's responsibility to maintain a sterile field, as the patient’s health depends on it. In a clinical setting, it is not uncommon to have one healthcare professional call out another who has broken sterility, even if it was unknowingly or inadvertently done. The practitioner who broke sterility will then step out of the sterile field and re-establish sterility before returning. It may be a good practice to empower all students who witness a break in sterility to identify it and require the violator to step out and re-establish sterility before continuing.
Creating and maintaining a sterile field is a valuable skill that can be mastered by any student, is a required skill for most healthcare professionals and improves patient safety.