The act of opening a sterile package without introducing contamination is a fundamental practice in preventing healthcare-associated infections. Sterile packaging is designed to maintain the absence of all microorganisms (sterility) for medical supplies and instruments until they are needed. This process is a component of aseptic technique, which maintains a microbially free environment during invasive procedures. A breach in packaging integrity can compromise the contents and introduce pathogens, leading to serious complications like surgical site infections.
Pre-Procedure Preparation and Package Inspection
Before any sterile package is handled, preparation must minimize the risk of contamination from the handler or the environment. The process begins with rigorous hand hygiene, involving either a thorough hand wash or the use of an alcohol-based hand rub. Hands must be completely dry, as moisture allows microorganisms to multiply and compromises the barrier integrity. The work surface where the package will be opened must also be clean and dry, and disinfected if necessary, then allowed to air dry completely.
Checking the package integrity determines if the contents are still considered sterile. The outer packaging must be inspected for any signs of compromise, such as tears, punctures, or moisture. Moisture is concerning because it can allow microorganisms to “wick” from a non-sterile surface into the package, contaminating the contents. The expiration or sterilization date must also be confirmed as valid; if any damage or expired dating is found, the package must be considered non-sterile and discarded.
Technique for Opening Sterile Peel Packs
Peel packs are common single-use packages, often made of paper and plastic film, designed for small items like gauze, gloves, or simple instruments. To open a peel pack aseptically, hold the package with one hand on each side of the sealed edges. The goal is to peel the two layers apart slowly and evenly, starting from the unsealed edges. Peeling too quickly or tearing the packaging can cause fibers or particulates to fall onto the sterile item, contaminating it.
The plastic side should face the sterile field, and the item should be pulled apart toward the person opening the package. As the package is peeled open, the exposed interior surfaces are considered sterile, while the outer surfaces and edges remain non-sterile. The contents must be gently dropped onto the sterile field from a height that prevents the package edges from touching the sterile area, typically about six inches above the field. Ensure the sterile item is delivered straight down and does not touch the non-sterile inside edges of the open package during transfer.
Technique for Opening Wrapped Trays
Opening a large, double-wrapped tray or kit requires a precise technique to transform the wrapper into a sterile field, often using a four-corner unwrapping method. Position the tray on a flat surface so the first flap to be opened is oriented away from the person. The person opening the tray must only touch the outer edge of the wrapper, typically a one-inch border, which is considered non-sterile.
The first flap is unfolded by pulling it away from the body, securing the corner to prevent it from flipping back over the sterile contents. Next, the side flaps are opened one at a time (left then right) by securing the corner and pulling the flap out and away from the center. Avoid reaching over the exposed sterile contents at any point, as this risks contaminating the field with non-sterile clothing or skin particles. Finally, the last flap, which is closest to the body, is unfolded by pulling it straight down toward the person.
Rules for Maintaining the Sterile Field
Once a sterile field has been established, protocols must be followed to maintain its integrity until the procedure is complete. The outer one-inch perimeter of the sterile wrapper is considered non-sterile, and any item placed onto this border is immediately contaminated. Sterile fields must remain within the direct line of sight; turning one’s back or leaving it unattended means its sterility can no longer be guaranteed, requiring replacement.
Any object held below waist level or above shoulder level is considered non-sterile, and sterile gloves and equipment must be kept within the safe operating zone. When adding supplies, non-sterile personnel must never reach over the sterile area. Solutions should be poured into receptacles from approximately six inches, avoiding splashes that could cause wicking of contaminants and ensuring the non-sterile bottle lip does not touch the sterile container. If the sterile field becomes wet, or if a non-sterile item touches the field, the entire setup is considered contaminated and must be re-established.