Procedural Observations

1. Skin Antisepsis (Preoperative bathing)

CHG shower or bath three days before surgery.

Chlorhexidine Gluconate (CHG) soap shower or bath the night before surgery.

CHG soap shower or bath the day of surgery.

If patient did not bathe with CHG before surgery, the skin is washed at the surgical site before performing pre-op skin antisepsis.

Comments:

2. Skin Antisepsis (Intraoperative skin preparation).

If hair removal necessary, hair is removed in the pre-op area.

If additional hair removal necessary, hair is removed with a clipper.

Skin at incision site is free of soil, debris, and emollients.

Alcohol-containing antiseptic agent is used.

Non-scrubbed team member applying skin antiseptic performs hand hygiene before applying the skin antiseptic.

Sterile gloves are worn when applying the skin antiseptic.

Surgical attire that covers the team member's arms are worn when applying the skin antiseptic.

Sterile supplies are used to apply the skin antiseptic.

Skin antiseptic was applied using aseptic technique and following manufacturer's instructions for use.

If incision site is generally clean, skin antiseptic applied at the incision site and moves toward the periphery.

If incision site is more highly contaminated than the surrounding skin (e.g., open wound), area with a lower bacterial count is prepped first.

Applicator is discarded after contact with the periphery and another sterile applicator used for additional applications.

When performing pre-op skin antisepsis of the hand/foot, antiseptic is applied to all surfaces b/w fingers/toes and does not drip clean to dirty.

The skin antiseptic is removed from the patient's skin at the end of the surgical procedure.

Comments:

3. Surgical Attire

Peri-op personnel entering operating room are wearing clean scrub attire including freshly laundered or single-use long-sleeved jacket snapped closed with cuffs down to the wrists.

Top of scrub suit is secured at the waist or tucked into pants.

All personal clothing is contained within scrub attire.

Personnel are wearing disposable surgical head cover or hoods that cover all hair and scalp skin, including facial hair and sideburns.

Shoe covers are worn in instances when gross contamination can reasonably be anticipated (e.g. orthopedic procedures).

Surgical mask covers the mouth and nose, and all straps are tied and secured in a manner to prevent venting.

Masks are not allowed to hang around the neck.

Masks are removed by handling only the mask ties.

Eye protection is worn.

Jewelry (e.g. earrings, necklaces, bracelets, watches, rings) are contained within the scrub attire.

Briefcases, backpacks, cell phones, pagers, and other personal items are cleaned with a low-level disinfectant and not placed on the floor.

Comments:

4. Opening/Introduction of Sterile Supplies onto the Sterile Field

Sterile field is prepared as close as possible to the time of use.

Personnel perform surgical hand scrub and don sterile gown and gloves before setting up sterile supplies.

Only sterile items come in contact with the sterile field.

Separate setups are used for procedures that involve both abdominal and perineal areas.

Sterile items are inspected for proper processing, packaging, andpackage integrity immediately before presenting to the sterile field.

Chemical indicator is inspected for color change.

Heavy or sharp items are presented directly to the scrubbed team member or opened on a separate clean, dry surface.

When opening items in peel pouches, the contents are not allowed to slide over the unsterile edges of the package.

Rigid sterilization containers are inspected (e.g. external locks, latch filters, valves, tamper-evident devices, and external chemical indicators) and opened on a clean, flat, and dry surface.

Rigid sterilization container lid is lifted up and toward the person opening the container and away from the container.

Rigid sterilization container lid is inspected for integrity of the filter/valve/gasket.

If organic material or other debris is found on an instrument or item in a sterile set, the entire set is considered contaminated and corrective actions are immediately taken.

Sterile transfer devices (e.g. sterile vial spike, filter straw, plastic catheter) are used when transferring medications/solutions to sterile field.

Stoppers are not removed from vials for the purpose of pouring medications (unless specifically designed for removal and pouring by the manufacturer).

Sterile field is constantly monitored and not left unattended.

Breaks in technique are immediately recognized and corrected.

Comments:

5. Donning/Wearing Sterile Gowns & Gloves

Hand hygiene is performed before entering the OR where sterile supplies are open.

Sterile technique is used when donning/wearing sterile gown & gloves.

Surgical hand scrub is performed before donning sterile attire.

Sterile gown & gloves are donned in a sterile area away from main instrument table.

Sterile gown is considered sterile only from chest to level of the sterile field and from 2 inches above elbow to the cuff (all other areas are considered unsterile including the cuff once the team members' hands pass through and beyond the cuff).

Two pairs of surgical gloves are worn (preferred).

Gloves are changed at appropriate times/intervals (e.g. suspected contamination, after direct contact with methylmethacrylate, visible defect, every 90-150 minutes).

Comments:

6. Draping

Sterile equipment is covered on the top, bottom, and sides with sterile barrier materials before being introduced to or brought over a sterile field.

Gloved hands are shielded during draping.

Drapes are placed in a manner that does not require scrubbed team members to lean across an unsterile area and prevents the front of the surgical gown from contacting an unsterile surface.

Drapes are placed from the surgical site to the peripheral areas.

Drapes are not moved after being placed.

Only the top surface of a sterile, draped area is considered sterile (items that fall below the sterile area are considered contaminated).

Only iodophor-impregnated plastic adhesive incise drapes are used (for prevention of SSI).

Comments:

7.Traffic Control/Moving within the Sterile Environment

Scrubbed members remain close to the sterile field and touch only sterile areas or items.

Scrubbed members do not leave the sterile field to retrieve items from the sterilizer.

Scrubbed members keep their hands and arms above the waist level at all times.

Scrubbed members do not fold their arms/place hands in axillary area.

Scrubbed members avoid changing levels and are seated only when the entire procedure is performed at that level.

Scrubbed members pass "back-to-back" or "face-to-face".

Unsterile personnel face the sterile field on approach, do not walk between the sterile fields or persons, and maintain a 12 inch distance from the sterile field and scrubbed persons at all times.

Conversations in the presence of a sterile field are kept at a minimum.

Number and movement of individuals involved in the procedure is kept at a minimum.

Comments:

8. Major OR/Procedure Room Findings

There were no other major findings in the OR/Procedure room.

What were the additional findngs:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.