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Fundamentals
문제

A nurse is preparing to change a sterile dressing on a patient's surgical wound in a pediatric unit. During the procedure, the nurse accidentally touches the outer wrapper of a sterile gauze package with contaminated gloves. What is the most appropriate action for the nurse to take?

해설
When contaminated gloves touch sterile supplies, the sterile field is compromised. The nurse must remove gloves, perform hand hygiene, and don new sterile gloves to maintain asepsis and prevent infection.
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심화 해설


Understanding the Principle of Surgical Asepsis

The core of this scenario rests on the principle of surgical asepsis (sterile technique), which aims to eliminate all microorganisms, including spores, from an area. This is distinct from medical asepsis (clean technique). In the context of a sterile dressing change, any object that is not sterile is considered contaminated. When your sterile glove touches a non-sterile surface—in this case, the outer wrapper of a gauze package—the glove is instantly contaminated. The outer wrapper of a sterile package is not sterile; only the inner contents are. Therefore, continuing the procedure with that glove would introduce microorganisms directly to the surgical wound, violating the sterile field and significantly increasing the risk of a surgical site infection (SSI) [1].



Analyzing the Inappropriate Options


  • Option 1 (Continue the procedure): This is incorrect and dangerous. The contamination event, however minor it seems, has broken the sterile barrier. The literature emphasizes that even seemingly small sterile breaches, such as a defective wrapper or contact with a non-sterile item, require immediate corrective action to protect the patient from infection risk [1]. Ignoring it directly exposes the patient's open wound to pathogens.

  • Option 3 (Use alcohol-based hand sanitizer on the gloves): This is a critical error. Sterile gloves are a single-use item designed to be an impermeable microbial barrier. They cannot be effectively decontaminated with a hand sanitizer. This action would not restore sterility and could also compromise glove integrity, creating a false sense of security while still posing an infection risk.

  • Option 4 (Complete the dressing change and document): This action prioritizes documentation over patient safety. The immediate priority is to stop the procedure and prevent a potential SSI. The surgical team's primary responsibility during a sterile breach is to make a rapid decision that minimizes the patient's infection risk, which means stopping the contaminated step immediately [1]. Documentation occurs after the corrective action is taken and patient safety is secured.





Rationale for the Correct Action (Option 2)

The most appropriate action is to remove the contaminated gloves, perform hand hygiene, and don new sterile gloves. This sequence directly addresses the breach in sterile technique by removing the source of contamination and re-establishing a sterile barrier. The process involves:

  1. Recognizing the Breach: Acknowledging that the glove is no longer sterile after touching the outer wrapper [1].

  2. Removing the Contaminated Item: The contaminated gloves are carefully removed to prevent further spread of microorganisms.

  3. Performing Hand Hygiene: Washing hands is essential because gloves can have microscopic defects, and hands may have become contaminated during glove removal. This step reduces the microbial load on the skin before a new sterile barrier is applied.

  4. Donning New Sterile Gloves: This restores the sterile field, allowing the procedure to continue safely with a new, sterile gauze package. This systematic approach directly mitigates the risk of introducing pathogens into the surgical wound, which is the ultimate goal of sterile technique [1].


References (research sources)
  • [1]
    How to Manage Intraoperative Contamination.Research articleLawing C, Hedrick L, Startzman A. (2026) · DOI: 10.1016/j.jposna.2025.100298

임상 시나리오

Clinical Practice Guide: Managing a Sterile Field Contamination

The most critical principle in surgical asepsis is that any break in sterility requires immediate correction. When a sterile glove touches a non-sterile surface, such as the outer wrapper of a package, the glove is contaminated. The outer wrapper is not part of the sterile field; only the inner contents are sterile. Continuing the procedure with a contaminated glove introduces microorganisms directly into the surgical wound, significantly increasing the risk of a surgical site infection (SSI).

The correct sequence of actions is: Stop the procedure immediately. Remove the contaminated gloves. Perform thorough hand hygiene. Don a new pair of sterile gloves. Only then should you continue the dressing change. This process ensures the sterile field is re-established before any further contact with the wound or sterile supplies.

Common errors to avoid include attempting to disinfect gloves with alcohol-based solutions, which is ineffective and not an evidence-based practice, or completing the task and documenting the breach later, which prioritizes documentation over patient safety. In the event of any sterile technique violation, the nurse's primary responsibility is to protect the patient from infection by restoring a sterile environment immediately.

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