A nurse is preparing to change a sterile dressing on a postoperative chest wound. Which action demonstrates proper sterile technique during the dressing change procedure?

Maintaining forceps tips below hand level prevents contamination by gravity, demonstrating proper sterile technique. Other actions breach sterility by contaminating the field or supplies.

Understanding the Rationale: Maintaining Sterile Technique

When changing a sterile dressing on a postoperative chest wound, the primary goal is to prevent the introduction of microorganisms that could cause a surgical site infection (SSI). SSIs are a significant healthcare-associated infection linked to prolonged hospitalization, readmission, and increased costs, making meticulous aseptic technique a critical nursing responsibility across the perioperative continuum ^[1]. The correct action, using sterile forceps to handle gauze while keeping the tips below the hands, is a foundational principle of surgical asepsis.

Why Option 2 is Correct

The principle demonstrated in this option is that a sterile object remains sterile only when touched by another sterile object. Using sterile forceps creates a barrier between the nurse's contaminated hands and the sterile gauze that will contact the wound. The specific instruction to keep the forceps tips below the level of the hands is based on gravity. Any potential contaminants from the non-sterile hands or forearms will fall downward, away from the sterile tips. If the tips were raised above the hands, contaminants could fall onto the sterile portion of the instrument, breaking the sterile field. This practice is a core component of the nursing assessment and surveillance required to prevent SSIs during postoperative wound care .

Why the Other Options are Incorrect

- Option 1: Opening sterile packages by tearing corners and allowing contents to fall onto the field is incorrect. The proper method is to peel the wrapper away, creating a sterile inner surface, and then carefully drop the item onto the field without the wrapper’s outer, non-sterile surface crossing over the sterile field. Allowing items to tumble out risks the item touching the non-sterile package edges, which would contaminate it. This violates the principle that the edges of a sterile package are considered contaminated once opened .

- Option 3: Reaching across the sterile field is a direct violation of sterile technique. The area above a sterile field is considered part of that field. Reaching over it with a non-sterile arm or clothing introduces a direct pathway for microorganisms to shed from the nurse’s body onto the sterile items. This action would immediately contaminate the field and all supplies on it, posing a direct risk for introducing pathogens into the chest wound ^[1].

- Option 4: Touching the outer 2-inch border of the sterile drape is incorrect because the outer 1-inch margin of a sterile drape is considered non-sterile. Any contact with this border, even to reposition it, contaminates the nurse's gloves. If the nurse then handles sterile supplies, the contamination is transferred, breaking the aseptic technique. A drape should only be handled by its sterile inner surface, and if it becomes misplaced, the entire field is considered compromised .