SELF/Perioperative Nursing/Setting up the Sterile Field/Psychomotor Skills Practice Instructions
Setting Up the Sterile Field – Perioperative Nursing (ECSACONM)
[edit | edit source]Overview
[edit | edit source]This page provides a psychomotor skills practice guide for setting up 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 developer worksheet, outlining the sequential steps, associated learning objectives ("good skills"), common errors, and practical guidance for each stage of establishing and maintaining a sterile field.
To promote efficient use of resources, items such as sterile packs, drapes, gloves, and other consumables may be used in an unsterile state for practice purposes. During all skills practice activities, learners should handle and use these items as though they are sterile and intended for patient care, demonstrating correct aseptic technique and adherence to sterile principles throughout the procedure.
NB: The below skills should be practiced with an assistant.
Purpose
[edit | edit source]To guide nursing students and practitioners through a systematic, step-by-step process for establishing and maintaining a sterile field, ensuring patient safety, infection control, and correct aseptic technique.
Psychomotor Skills Practice Instructions
[edit | edit source]| Step | Instructions | Good Skills (Learning Objectives) | Common Errors | Guidance |
|---|---|---|---|---|
| 1 | Gather supplies | Articulates all supplies are gathered, ready, and pertinent to the procedure; sterility indicators and expiry dates confirmed | ||
| 2 | Perform surgical hand scrub | Articulates surgical hand scrub is completed | ||
| 3 | Don sterile gown and gloves (solo) | Articulates donning sterile gown and gloves | ||
| 4 | Open sterile table drape carefully | Place the drape pack on a clean dry surface at waist height. Open outer wrap away-from-you, then sides, then toward-you. Only touch the inside surfaces; present inner sterile drape for sterile handling.
Good skills: Opens sterile drape pack and removes from package with sterile gloves; places folded edge on table without touching table, allows to flop open and unfolds drape without touching hands to non-sterile surfaces; grasps corners and stretches out to drop over sides without touching, and covers back table fully |
Touches non-sterile table surface; allows drape to drop below sterile field; pulls the drape off the table while unfolding; uses a drape too small for the table | Narrate what is sterile and what is not. Open wrappers so the sterile inner drape is presented without you reaching over it. If an edge drops below table height, treat it as non-sterile and do not bring it back onto the field. |
| 5 | Confirm field surface is adequate and suitable | Check and articulate the following: all surfaces to be used are clean, dry, flat, and large enough for setup | ||
| 6 | Optional: Lay out drape on Mayo stand | If using Mayo: position and lock stand. Apply Mayo drape using pockets/handles; drop drape without touching the stand. Confirm full coverage and stable surface.
Good skills: Opens sterile drape pack and removes from package with sterile gloves; places folded edge on table without touching table; allows to flop open and unfolds drape without touching hands to non-sterile surfaces; grasps corners and stretches out to drop over sides without touching. Alternate: opens a specialized "sleeping bag" type drape for the Mayo stand and, with hands in the pockets to prevent contamination, slides it over the tray and pulls the drape down over the stand in a sterile manner |
Uses a drape too large for the Mayo stand | Use the drape's pockets/handles—don't grab the outside. Visualize the stand as contaminated until fully draped. If the drape shifts or exposes metal, re-drape rather than "tucking" with sterile gloves. |
| 7 | Correct opening of surgical instrument set | Ask the circulating nurse/non-sterile assistant to open the outer wrapper (away, sides, toward). Receive the sterile inner wrap onto the designated landing zone without reaching over the field and open inner wrap onto draped table, or place wrapped set onto draped surface then open.
Good skills: Identifies the correct instrument set; coordinates with the circulating nurse/non-sterile assistant to open the outer drape by first peeling back the flap furthest away, then sides and nearest; assistant drops the sterile content without contaminating edges/contents and never reaches across the sterile field; defines landing zone, keeps sterile contents within sterile boundary, receives items without being reached-over, immediately places on correct area; orients it to the correct position; opens the inner drape by handling edges only, unfolding flaps in correct sequence (away, then sides, and lastly toward the body); places the still-wrapped sterile set onto an instrument stand without touching the non-sterile surface |
The scrub nurse opens the outer drape; the circulating nurse/assistant touches the inner drape; assistant reaches over sterile contents; incorrect opening sequence; scrub nurse makes maximum amount of movements required to set up the sterile field | Closed-loop communication prevents contamination. The circulator opens the outer drape; the scrub nurse receives and opens the inner drape. If the inner wrap is touched by non-sterile hands or drops below the sterile level, replace it—don't salvage it. Make minimum movements to set up the sterile field to minimize the risk of breaking sterility. |
| 8 | Laying out of sterile surgical instruments | Transfer the contents of the instrument set onto the sterile field without crossing over or contaminating the field. Inspect for moisture/compromise and instrument completeness. Set aside contaminated/questionable items and request replacement immediately. Arrange instruments in a logical and accessible layout on the back table and Mayo stand by handling edges only and keeping minimal movements.
Good skills: Places instruments onto the back table first; groups instruments by type/use or procedural sequence; arranges instruments in a logical, systematic layout (according to order of use, starting with knives, pickups, scissors, and artery forceps in the proximal layer while tissue forceps/devices are laid in the distal layer of the instrument table); places frequently used instruments in accessible positions; places instruments methodically (heavy at edges, delicate centrally); positions sharps and heavy instruments in safe zones; transfers selected items to the Mayo table using sterile technique without dragging across edges; maintains a clear, uncluttered working area |
Dropping or dragging instruments across edges; disorganized layout; displaying faulty instruments; excessive movement | Treat moisture or a torn wrap as contamination. Pause and speak up early—replacement takes less time than managing an infection risk. Keep a clear "quarantine spot" for anything questionable. Set up for workflow, not aesthetics. Place first-use instruments where your hand naturally goes. Keep heavy items stable at the edges; keep sharps controlled and visible. Move less—every extra movement increases contamination risk. |
| 9 | Organize supplies on sterile field | Organize sterile supplies on the sterile field by arranging items using aseptic technique, handling only sterile edges, and positioning items in a logical, accessible layout.
Good skills: Receives supplies from circulating nurse/non-sterile personnel without crossing over sterile field; handles items using sterile technique (edges only if wrapped); opens sterile supplies using the correct sequence (far flap first, side flaps next, nearest flap last) if still wrapped; allows items to drop or slide onto sterile field without contact; places similar items together (e.g., dressings such as gauze and swabs in one area, sutures in another); positions frequently used items within immediate reach; places items in expected order of use during the procedure; keeps sharps and blades in a secure, designated area |
Reaches over sterile contents; contaminates edges or contents; dumps supplies carelessly; overcrowding of the sterile field; incorrect grouping of items | Think in zones and one-way traffic. Imagine the case progressing—your table should let you work "forward" without mixing used with unused. If you lose your organization, stop and reset before continuing. |
| 10 | Organize sharps for containment and counting | Create a dedicated sharps zone (magnetic pad/needle counter). Separate blades/needles from general instruments. Keep sharps visible and countable at all times.
Good skills: Places sharps in a designated, consistent area (e.g., sharps zone on back table or Mayo stand); places blades and needles in a stable position where they cannot roll or fall and pointed away from you; secures them in holders; places needles directly into a needle holder or safety tray; positions in the order they will be used; keeps them within easy reach but not in high-traffic zones; maintains sterile handling; sets up for counting out and counting back in |
Mixes sharps with general instruments; has no system for containment, management, or counting | Sharps safety is a counting and injury-prevention skill. Always know where blades/needles are. Use one dedicated spot and never bury sharps under gauze or instruments. |
| 11 | Prepare sterile solutions and medications | Confirm solution/med order with the team. The circulating nurse/assistant opens vials; pour without touching the basin rim. Label all cups/syringes immediately (name, strength, time).
Good skills: Has assistant open vials/ampoules and pour with vial at an angle without touching the basin; labels all medications immediately; places receiving container near the trolley edge or holds it while the circulating nurse pours solutions |
Assistant touches sterile basin with vial; scrub fails to label medications; leaves open containers | Labeling is patient safety. Say the medication name out loud as it's poured and label immediately—don't rely on memory. If unlabeled, discard and replace. |
| 12 | Prepare drapes, gowns, and gloves for surgeon and team | Prepare drapes/gowns/gloves for the surgeon/team in order of use. Present gown pack and gloves for sterile donning without contaminating. Keep extra sets accessible but protected.
Good skills: Opens and arranges additional sterile gowns and gloves for surgical team access |
Gowns fall off sterile field; gloves opened improperly; gloves placed on top of gowns; risk of contamination | Prepare in the order the team will gown and glove. Visualize a busy room: your setup should allow fast sterile donning without you turning away from the field or reaching over sterile items. |
| 13 | Final inspection of sterile field before team arrival | Do a final sterile-field sweep: edges covered, zones organized, sharps secured, counts started. Confirm critical items are ready (suction, cautery accessories, sutures). Stand ready to receive additional supplies safely.
Good skills: Reviews field for organization and contamination; confirms all supplies ready; stands ready to assist |
Field disorganized; missed contamination; not ready when team enters | Use this step like a pre-flight check. Confirm the layout supports the first 10 minutes of surgery. If you'll need something urgently (suction tubing, cautery tip, sutures), ensure it is ready and reachable. This is your last chance to catch small problems before they become delays or contamination. Do a deliberate sweep; confirm counts/labels/sharps; and stay still and ready until incision. |
References
[edit | edit source]
| Authors | Ian-laurel |
|---|---|
| License | CC-BY-SA-4.0 |
| Organizations | SELF, ECSACONM |
| Cite as | "SELF/Perioperative Nursing/Setting up the Sterile Field/Psychomotor Skills Practice Instructions". Appropedia. 2026. Retrieved July 14, 2026. |