Surgical Support and Asepsis: sterile technique, sterilization, and counts
Surgical Support and Asepsis
This domain tests operating-room preparation, sterile technique, instrument processing, patient skin prep, and the documentation that prevents retained foreign bodies.
Core rules and concepts
- Sterile field: only sterile items touch the field; gowned staff are sterile from chest to waist and from gloves to shoulders. Non-sterile personnel never reach over the field.
- Hand scrub: first scrub 3–5 minutes with chlorhexidine or povidone-iodine, cleaning nails first, then hands and forearms; subsequent scrubs shorter.
- Patient prep: clip widely, then alternate scrub and rinse with chlorhexidine solution and 70% isopropyl alcohol for 3–5 minutes, moving from the incision outward. Never clip after prepping, and never return to a contaminated area.
- Sterilization: steam autoclave at 121 °C/15 psi for 15–20 min or 132 °C/27 psi for ~4 min. Chemical indicators show exposure only; biologic indicators (Geobacillus stearothermophilus spores) verify lethality.
- Counts: instruments and sponges counted before and at closure. A missing sponge means intraoperative radiograph before the patient leaves.
- Halsted principles: asepsis, hemostasis, gentle handling, accurate apposition, tension-free closure.
Worked example
A pack's autoclave tape has changed color but the pouch is wet and the external indicator is intact. Tape color alone does not prove sterility: moisture in the pack wicks contaminants. Reject the pack, check the cycle log, and confirm with the weekly biologic indicator rather than releasing it to surgery.
Traps
Believing indicator tape equals sterility. Using alcohol as a final "sterilant" on instruments. Prepping with chlorhexidine near eyes or ear canals without protection. Skipping the sponge count because the surgery was "minor."