Sterile consciousness is defined as being acutely aware of potential or actual contamination of the sterile field or object and taking steps to remedy the break.

You want surgeries to be as sterile as possible; as a patient, and as a surgical team member. There is a LOT of work done to keep it so.

A break in sterility happens when there is an inadvertant introduction of something non sterile into the sterile field. This can be a tear in the drapes, this can be a puncture from a blade being opened in the wrong area, this can be stray hair in the sterile instrument tray, or when people where their surgical cap in a messy manner with hair hanging out everywhere.

Many things can break the sterile field.

Today, I want to write about the sterile caskets. These are the hard metal containers that the instrument tray is sterilized and stored in. Some of these caskets have single-use filters that must be replaced in the bottom and the top. This is so steam can penetrate the instruments during the steam sterilization process.

You with me so far?

The filters themselves can be inserted incorrectly. There can be missing filters. There can be punctures in the filters from incorrect storage or from loose instruments in the casket. There can be folds in the filters. All of these instances render them unsterile.

If in doubt, sterility has been compromised and another tray must be opened. Hard and fast rule in any of the ORs I’ve worked in.

During the case opening process, the scrub tech does not continue set up and will stand there holding the instrument tray until the filters in the bottom of the casket can be checked for holes. Don’t wander off during this time, your scrub tech will not appreciate it as they are literally left holding the bag.

This next break in sterility has been reported to me. The scrub tech was holding the instrument tray, waiting impatiently for the circulator to reach into the casket, pull out and inspect the filters. Normal right? Yeah, the scrub tech placed the sterile instrument set BACK INTO THE NO LONGER STERILE CASKET and was picking instruments that they wanted out of the tray. No recognition that the entire instrument tray had been contaminated and must be taken away to be re-processed and protesting when the circulator told them it was now contaminated.

That is what I mean about breaks in sterile consciousness.

Don’t do this.

The OR is complicated.