Sterilization Practices

I also would like to say that egg crate padding still is very much in use at our facility, although I do thank you for the comment. I hope, however, that the gist of the article, which was the necessity of continuously circulating during a procedure to prevent or minimize potential hazards the patient may incur during a surgical procedure, was not lost. Regardless of how wellequipped an institution is, proper equipment does not necessarily prevent potential danger to a patient if the circulating nurse is not constantly monitoring him or her.

mental controls similar to those found in the OR. Access is through the OR only and is limited to people in appropriate surgical attire. When a scrubbed person enters the substerile area, he or she touches nothing except the item(s) to be removed from the sterilizer. No people from adjoining rooms are to be in the substerile area at that time. Of course, if a contaminating event occurs at any time, regardless of where the scrubbed person or other members of the sterile team are, the break in technique must be corrected before the surgical procedure continues. Even though it is possible LISA MACAPAGAL to place more than one tray in RN, C N O R the sterilizer for a single sterilSTERILIZATION PRACTICES ization cycle, the sterilizer should be used for instruam writing about the BRENDA WHITWORTH ments for only one room at a answer to a question in the RN, C N O R time. The sterilizer must be EDUCATION/COMPUANCE COORDINATOR run again if items from an "Clinical Issues" column in TOPS SURGICALSPECIALTY HOSPITAL adjoining room are included the AORN Iouml (~0180,July HOUSTON in the load. Whenever anyone 2004). As a member of AORN (eg, scrub person or circulatfor more than 25 years, I am Author's response. Acing nurse) reaches into the one of your strongest advosterilizer, items in the sterilizcates. I am very proud of our cording to AORN's "Recomer are considered dedicated to professional organization and mended practices for mainthat room or patient, and any have always considered AORN taining a sterile field,"' items belonging to an adjoinas the "gatekeeper" of recom- scrubbed persons should not ing room will require resterilmended practices and stan- leave the immediate area of ization before use. dards. This is the first time I the sterile field. AORN conhave interpreted one of siders the substerile area to be DOROTHY FOGG AORN's recommendations for within the immediate area of RN, MA perioperative practice as a the sterile field. AORN does PERIOPERATIVE NURSING SPECIALIST not consider movement from compromise to patient safety. AORN CENTER FOR NURSING PRACTICE The answer to the steriliza- the sterile field to the substerile area and back to the sterile tion question, in my opinion, NOTE field to be a breach of techdoes not represent the stan1. "Recommended practices for nique or a compromise of dard of practice that the maintaining a sterile field," in AORN standards recommend practice and patient safety. Standards, Recommended Practices, The substerile area is a and support. It was recomand Guidelines (Denver:AORN, I ~ c2004) , 367-371. mended in the article that the restricted area with environ-

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scrub person in the OR leave the sterile field and retrieve flash sterilized instruments directly from the sterilizer in a substerile room. It is not accepted practice to leave the sterile field at any time, and I believe that going from a sterile field to a substerile field and then back to the sterile field is a compromise of practice and patient safety. A scrub person would contaminate the substerile room when he or she retrieved the instruments, compromising the environment and staff member safety. The practice outlined in the article is a compromise, in my opinion, of the basic standards of perioperative practice and a contradiction of AORN's standard of practice.