Surgical Education Learners Forum/Perioperative Nursing/Instrument Handling and Maintaining Sterile Field/Psychomotor Skills Practice Instructions

Instrument Handling and Maintaining Sterile Field – Perioperative Nursing (ECSACONM)

Overview

This page provides a psychomotor skills practice guide for instrument handling and maintaining the sterile field, developed for perioperative nursing training under ECSACONM (East, Central and Southern Africa College of Nursing). It is intended as a self-directed practice sheet, outlining the sequential steps, associated learning objectives ("good skills"), common errors, and practical guidance for safe instrument handling during surgery.

Details of setup can be found here

Purpose

To guide nursing students and practitioners through a systematic, step-by-step process for handling surgical instruments and maintaining the sterile field, ensuring patient safety, safe instrument and sharps handling, effective anticipation and communication, and continuous awareness of sterile boundaries throughout the procedure.

Psychomotor Skills Practice Instructions

#	Step	Instructions	Good Skills (Learning Objectives)	Common Errors	Guidance
1	Set up OR Back Table	Set up the back table, Mayo stand, and operative field as described in the practice setup. Gather the general laparotomy set and required additional supplies. Establish designated locations for sharps, cleaning instruments, and contaminated instruments.	All required instruments and supplies are present and the "sterile field" is established.	Missing equipment; no designated location for sharps or contaminated instruments.	Practice setting up the same arrangement each time. Before starting, mentally identify where clean instruments, sharps, returned instruments, and contaminated instruments will go.
2	Organize Instrument Tables and Instruments for Safe Handling and Workflow	Arrange instruments logically by function and anticipated use. Place frequently used instruments on the Mayo stand. Keep sharps, heavy instruments, delicate instruments, and other instrument groups appropriately separated.	Instruments are grouped logically and can be reached without searching. The learner can explain how the layout supports safe and efficient workflow.	Random instrument placement; sharps mixed with other instruments; frequently used instruments difficult to reach; instruments piled on one another.	Practice finding each instrument without searching. Ask yourself whether another scrub nurse could understand your organization immediately.
3	Pass and Receive Back the Scalpel	Pick up the scalpel by the handle. Orient the blade away from both people's hands and toward the operative field. Present the handle securely to the surgeon. On return, maintain control of the sharp and place it in the designated sharps area.	Scalpel reaches the surgeon in a usable grip orientation with the blade toward the field. Transfer and return are controlled and hands remain clear of the blade.	Blade toward a hand; fingers near the blade; unsafe hand-to-hand movement; releasing before the surgeon has control; leaving the returned scalpel unsecured.	Practice slowly at first, concentrating on where the blade is throughout the entire transfer. Increase speed only after safe orientation becomes automatic.
4	Perform Alternate Pass of Scalpel in Kidney Dish	Place the scalpel securely in the kidney dish with the handle toward the surgeon and blade away from hands. Present the dish within easy reach and keep it stable while the surgeon removes the scalpel.	Dish remains stable and controlled; blade is visible and safely oriented; surgeon can grasp the handle immediately without touching or repositioning the blade.	Scalpel passed hand-to-hand; blade toward surgeon's hand; handle facing away from surgeon; unstable or poorly positioned dish.	Practice positioning the dish so the surgeon can safely remove the scalpel while continuing to look at the operative field.
5	Pass and Receive Back a Ring-Handled Clamp	Hold the clamp so the rings are presented toward the surgeon and the jaws toward the operative field. Place the rings into the surgeon's fingers with the ends of the clamp pointing in the same direction as their thumb. Receive the instrument securely, wipe/clean it as if soiled, and return it to its appropriate location.	Rings enter the surgeon's fingers in a usable position; jaws are pointing in the same direction as the thumb; release occurs only after the surgeon has control.	Passing by the jaws; rings inaccessible; clamp backwards; releasing too early; contamination during passage; returning a soiled instrument without cleaning it.	Practice with several different ring-handled clamps. Aim for the same hand position and transfer technique regardless of clamp size.
6	Pass and Receive Back Tissue/Thumb Forceps	Hold the forceps away from the working tips. Present the proximal end toward the surgeon with the tips directed away from the thumb. Receive securely, wipe/clean as if soiled, and return to the appropriate location.	Forceps arrive directly into the surgeon's thumb-finger grip with the tips ready for use.	Passing by the tips; tips toward the surgeon's palm; instrument upside down with tips towards the thumb; contamination during passage; returning it soiled.	Practice placing the forceps directly into a waiting thumb and fingers rather than simply offering the instrument for the surgeon to take.
7	Pass and Receive Back Scissors	Ensure the scissors are closed. Present the rings to the surgeon's hand with the tips directed toward the thumb, and the curvature towards the operative field. Receive securely, wipe/clean as if soiled, and return to the appropriate location.	Rings enter the surgeon's fingers with the closed blades already oriented toward the field.	Scissors open during transfer; tips toward a hand; instrument backwards; contamination during passage; returning scissors without cleaning when needed.	Practice with both curved and uncurved scissors so the passing technique becomes independent of the particular scissors used.
8	Pass and Receive Back a Loaded Needle Holder	Secure the needle correctly in the needle holder before passing. Keep the needle visible and directed away from both people's hands. Present the handle toward the surgeon. On return, maintain visual control of the needle, safely remove it, and place the needle and needle holder in their appropriate locations.	Needle is secure and correctly positioned in the jaws. Handle is placed into the surgeon's operating grip while both people's hands remain behind and clear of the needle.	Loose or poorly mounted needle; needle toward the surgeon's hand; fingers crossing the needle; losing sight of the needle; contamination during passage.	Practice loading, passing, receiving, and unloading as one continuous sequence. Develop the habit of visually locating the needle before moving your receiving hand.
9	Pass and Receive Back a Sponge Stick	Secure the sponge in the sponge-holding forceps. Present the rings toward the surgeon and the sponge/working end toward the operative field. Receive the sponge stick securely and return it to the designated basin.	Rings enter the surgeon's fingers with the sponge secure and the shaft already oriented for use.	Loose sponge; working end toward the surgeon's hand; poor control during transfer; contamination during passage; returning the used sponge stick to the wrong area.	Before every pass, check that the sponge is firmly held. Practice returning the sponge stick directly to its designated location rather than laying it among clean instruments.
10	Pass and Receive Back a Hand-Held Retractor	Hold and orient the retractor so the handle is toward the surgeon and the blade is toward the operative field with its edge away from the surgeon's hand. Support the instrument until the surgeon has control. On return, take positive control, check and clean the working end as if soiled, and return it to its designated location.	Handle is placed firmly into the surgeon's palm with the blade correctly oriented for immediate use. Control is maintained throughout the exchange.	Blade toward the surgeon's hand; retractor backwards; releasing before the surgeon controls it; contamination during passage; returning a soiled retractor to the clean instrument area.	Practice with retractors of different sizes and shapes. Before passing, identify the handle, working blade, and direction in which the blade will enter the operative field.
11	Pass and Receive Back Suction	Present the suction handle toward the surgeon with the tip toward the operative field. Manage the tubing so it remains controlled, has adequate slack, and does not pull across the field. On return, secure the suction and manage/stow the tubing.	Suction is placed into the surgeon's operating grip with the tip ready for use and the tubing slack, controlled, and clear.	Suction passed backwards; tubing tangled or pulling; tubing crossing other instruments; tubing unsecured after return; contamination during passage.	Practice the tubing management at the same time as the handoff. The surgeon should be able to move the suction without immediately encountering tension from the tubing.
12	Pass and Receive Back the ESU Pencil / Cabled Instrument	Present the ESU pencil handle toward the surgeon with the active tip away from hands. Orient the controls for easy access and manage the cable so it remains controlled and has adequate slack. Receive and return the pencil to a safe location, demonstrating scraping the tip as if coated with char.	Pencil enters the surgeon's operating grip with controls accessible, active tip safely directed, and cable slack and clear. Pencil tip cleaned without dislodging the tip.	Active tip toward a hand; tangled or pulling cable; covering the controls; unsafe placement after return; contamination during passage.	Practice managing the pencil and cable as one task. Develop a consistent safe location for the ESU pencil whenever it is returned.
13	Manage Contaminated Instruments Separately	When an instrument is identified as contaminated, recognize that it must not return to the sterile field. Handle it by an uncontaminated portion when possible and move it directly to the designated contaminated-instrument basin or area.	Contamination is recognized immediately and the instrument is isolated without contaminating the learner's hands, sterile field, or other instruments.	Returning the contaminated instrument to the sterile field; allowing it to contact sterile instruments; contaminating gloves or the field while moving it; placing it somewhere that could allow accidental reuse.	During practice, have the surgeon or instructor unexpectedly declare different instruments to contaminated. Practice identifying a safe path from the surgeon to the contaminated-instrument area without crossing the sterile field.
14	Post-Procedure Instrument Handling and Field Breakdown	After being informed that the final count is complete and correct, secure sharps first. Separate instruments, sharps, waste, and other materials according to their required disposition. Consolidate instruments and systematically break down the sterile field.	Learner verbally confirms that counting is complete before beginning breakdown, secures sharps first, and then clears and organizes the field systematically while maintaining appropriate separation of materials.	Beginning breakdown before the final count is confirmed; unsecured sharps; discarding items before reconciliation; mixing instruments with waste; losing control of instruments during breakdown.	Practice using the same sequence every time: count confirmed → sharps secured → instruments consolidated → waste separated → field broken down. Avoid rushing simply because the simulated procedure has ended.

References

Page data
Keywords	surgery, health
SDG	SDG03 Good health and well-being
Authors	Ian-laurel
License	CC-BY-SA-4.0
Organizations	SELF, ECSACONM
Language	English (en)
Related	0 subpages, 0 pages link here
Views	24 page views (analytics)
Created	July 16, 2026 by 24.137.217.194
Last edit	September 27, 2026 by StandardWikitext bot
Cite as	Ian-laurel-1 (2026). "SELF/Perioperative Nursing/Instrument Handling and Maintaining Sterile Field/Psychomotor Skills Practice Instructions". Appropedia. Retrieved October 3, 2026.
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