Asepsis, Sterilization, and Infection Prevention
Asepsis, sterilization, and infection prevention tests the chain that keeps instruments and the surgical field sterile, plus the bundle that prevents surgical site infection. The RNFA is expected to recognize breaks in technique and correct them immediately.
Core rules and concepts
- Sterile field: only sterile items above table level; gowns are sterile in front from chest to waist and on sleeves; gloves are sterile; never turn your back to the field or reach over an open sterile area.
- Spaulding classification: critical items enter sterile tissue or vasculature and require sterilization; semicritical items contact mucous membrane and need high-level disinfection; noncritical items contact intact skin and need low-level disinfection.
- Sterilization monitoring: use mechanical, chemical, and biological indicators; a failed biological indicator quarantines the load. Packaging must be dry and intact.
- SSI bundle: timely weight-based antibiotics, skin antisepsis with alcohol-chlorhexidine unless contraindicated, normothermia, glucose control, minimal traffic, supplemental oxygen when indicated, and hair removal with clippers.
- Hand hygiene and attire: scrub according to policy, keep nails short, avoid artificial nails, and cover hair and jewelry.
Worked example
A sterile instrument touches the unsterile drape edge. Wiping it with alcohol is not acceptable because the item is contaminated. The RNFA removes it, replaces it from a sterile package, and if the field is compromised, re-drapes. The break is documented per policy and the team reviews the cause.
Traps
Treating clean as sterile; touching the gown below waist or above chest; pouring solution across the field; using a biological indicator before it is read; and shaving with a razor the night before surgery.