# Preparing an Aseptic Field

## Overview

Infection Prevention and Control (IPC) during procedures includes the safe management of ‘sharps’, encompasses high-level measures such as health facility design and management, protocol-based measures such as adherence to national and facility level guidelines, and individual actions by each health care provider and ancillary staff member. The health care provider is encouraged to familiarise themselves with their facility’s specific IPC protocols and reporting systems, which is outside the scope of this module.

All clinical procedures pursue the IPC goal of asepsis. The traditional hierarchy of sterile, aseptic, and clean is outdated, poorly-defined and misleading, and is no longer recommended. While this procedure is commonly referred to as preparing a 'sterile' trolley, achieving 'sterility' is technically impossible.

Guiding principles

1. All objects placed on an aseptic field must originate from sterile, non-expired packaging.

2. A newly-opened sterile object that touches a non-aseptic object/field is considered contaminated. To prevent contamination, always keep your hands above your waistline and keep the aseptic field in your line of sight. If you are unsure about an object’s status, consider it non-aseptic.

3. Moisture, tears or punctures that penetrate an aseptic barrier render it non-aseptic.

4. The outer 2 cm of an aseptic field is prone to contamination.

5. Coughing and reaching over an aseptic field may compromise it.

## Preparing a critical aseptic field

The aseptically-prepared work area including 'sterile' surfaces of equipment and consumables are treated as non-touch

key-parts

key-parts

critical components of the equipment that are sterile when unopened and when contaminated are most likely to introduce infection, such as catheter tips and dressing packs

. After hand hygiene, a sheet from a sterile pack is draped over a prepared general aseptic tray and sterile-packaged equipment is opened without touching any part of the aseptic field. The patient is draped to expose only the aseptic

key-site

key-site

insertion sites or open wounds/broken skin

. Sterile gloves are donned for the procedure and an assistant must handle non-sterile items such as medication vials.

1. Perform hand hygiene.

2. Collect and inspect your supplies and equipment, including sterile gloves. Items should be dry, sealed, and not expired.

3. Clean a trolley with an alcohol based solution and let dry. The surface should be at waist level or higher.

4. Explain to your patient not to touch or reach over your sterile field.

5. Perform hand hygiene again.

6. Place your sterile pack on the clean surface.

7. If using a disposable pack,

   pull off the paper top
   pull off the paper top

   and dispose of it in the waste bag. If using a cloth or paper pack, break the tape seal and unfold the outer and inner layers, touching only the very edges of the inner layer.

8. Pinch up the

   red waste bag
   red waste bag

   , lift it out and place the bag opened beside (not on) your sterile field.

9. If using a disposable pack: touching only the corners, lift the

   blue sterile field
   blue sterile field

   from the pack and pull to unfold it. Take care not to let it touch other surfaces. Lay it on the clean surface with the blue side up. If using a cloth or paper pack: the surface covered by cloth is the aseptic field.

10. Open each sterile packet and drop the items onto the aseptic field. Don't allow the packaging to touch the field. Pour disinfectant into the well or bowls. Place non-sterile items NEXT TO the aseptic field.

11. Don sterile gloves.

12. Taking care NOT to touch the skin with your gloved fingers, clean the procedure/insertion site with a soaked cotton wool, starting in the centre and working outwards, and drape the area if drapes are supplied. You may touch the outer surface of the drapes and the cleaned skin, if necessary.

13. Perform the procedure, keeping key-parts such as sterile catheter tips sheathed until needed and avoid touching it with your hands.

## References

1. Doyle GR & McCutcheon JA. Clinical Procedures for Safer Patient Care. BCcampus: 2015.

2. Rebeiro G, Jack L, Scully N, Wilson D. Fundamentals Of Nursing. London: Elsevier Health Sciences APAC; 2014.