# A circulating nurse observes events during sterile abdominal surgery. Which actions correctly identify or respond to contamination of the sterile field? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568913&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A circulating nurse observes events during sterile abdominal surgery. Which actions correctly identify or respond to contamination of the sterile field? Select all that apply.

1

Announce a recognized break promptly, remove or replace contaminated items, and document the event according to facility policy

2

Keep a sterile item in use after it briefly touches the back of the unsterile circulating nurse's gown because contact lasted less than 1 second

3

Treat a sterile drape that becomes wet by strike-through as contaminated and replace the wet drape or contaminated portion of the field

4

Treat a scrubbed team member's glove as contaminated if the hand drops below waist or sterile-field level, and replace the contaminated glove

5

Open the package flap away from the body first, then the side flaps, and the near flap last; keep the package's outer 1-inch border outside the sterile field

6

Continue using a sterile field that was left unattended because the sterility of its items does not change when no contact is observed

## Explanation

A recognized break requires immediate communication and removal or replacement of the contaminated item according to policy (Choice 1). Moisture can carry microorganisms through a drape by strike-through, so the wet area is contaminated and must be replaced rather than ignored (Choice 3). A scrubbed person's hands remain above waist and within the sterile field; a glove that drops below that level is contaminated (Choice 4). Opening the far flap first prevents reaching over the package, and the outer 1-inch border is kept outside the field (Choice 5). Contact with an unsterile gown contaminates an item regardless of how brief the contact was (Choice 2). An unattended sterile field cannot be continuously observed for contamination and is treated as contaminated (Choice 6).

## In-depth explanation

Sterile Field Principles
1. Sterility is binary: any contact with unsterile = contaminated, regardless of duration
2. Waist/table level rule: items below waist or below the table edge = contaminated
3. Never leave a sterile field unattended — unattended = contaminated
4. 1-inch edge rule: the outer 1 inch of any sterile drape/package edge is NOT sterile
5. Strikethrough: wet sterile drapes wick organisms from the unsterile surface beneath = contaminated; reinforce or replace
6. Hold gloved hands above waist, in front of body, never at sides or back
7. Sterile-to-sterile passes only; sterile-to-unsterile contact contaminates

Opening a Sterile Package
1. Place flat on a clean dry surface
2. Open flap AWAY from body first (so you do not reach across)
3. Open the sides next
4. Open the flap toward the body last
5. Drop sterile contents onto field within the inner sterile zone, not the 1-inch border

Common Breaks
- Hand drops below waist
- Reaching across the sterile field
- Wet drape (strikethrough)
- Field unattended
- Brief contact with unsterile (still contaminated)
- Talking, sneezing, coughing over the field without a mask

Response to a Break
1. Speak up immediately — culture of safety
2. Replace contaminated items
3. Re-glove/re-gown as needed
4. Document in operative record per policy
5. Postoperative SSI surveillance

Memory Tip
"Above the waist; In front; Never unattended; Wet = Out"

## Clinical scenario

Scenario
Circulating nurse in the OR during sterile abdominal surgery; multiple events to evaluate against AORN sterile-field principles.

Identification & Response Map
1. Hand below waist → contaminated, replace gloves
2. Wet drape (strikethrough) → reinforce or replace
3. Sterile package: flap away first → sides → flap toward last; 1-inch border NOT sterile
4. Speak up + replace + document at the moment of any break

Avoid
- Leaving sterile field unattended
- Treating brief contact as "not contamination"
- Continuing with a wet drape

## Key concepts

- **Surgical Sterile Field** — A defined area around the surgical site that is rendered free of microorganisms and maintained sterile throughout the procedure. Includes the sterile drapes, sterile instruments, gowned/gloved scrub team members, and the area immediately above the table within reach. Maintained by following AORN sterile-field principles: only sterile to sterile contact, items above the waist and on the sterile field, never leave unattended, the 1-inch border is not sterile, wet items are contaminated by strikethrough.
- **Common Breaks in Sterile Technique** — Frequent breaks: hand or instrument drops below waist or table level, reaching across the sterile field with an unsterile arm, contact between sterile and unsterile surfaces (regardless of duration), wet drapes (strikethrough), unmasked talking/sneezing/coughing over the field, leaving the sterile field unattended, contaminated package or expired sterilization date, item touching the 1-inch non-sterile border. Recognition requires constant vigilance by the entire team; immediate verbal acknowledgment and replacement of contaminated items is the standard.
- **Strikethrough Contamination** — Microbial passage through a wet sterile drape from the unsterile surface beneath. Saline, blood, irrigation fluid, or any liquid that soaks through a sterile drape transfers organisms from the unsterile side to the sterile side, contaminating the field. The wet area must be reinforced with a dry sterile drape or replaced; merely allowing it to dry does not restore sterility. Prevention: use moisture-resistant drapes, place absorbent pads at high-irrigation areas, change drapes that become saturated.

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