At the commencement of surgery, all surgical instruments and materials have been sterilized and disinfected, surgical staff have completed their hand and arm antisepsis, donned sterile surgical gowns and gloves, and the patient’s surgical area has been disinfected and covered with sterile drapes. These steps establish a sterile environment for the procedure. However, during the course of surgery, without adherence to established protocols for maintaining asepsis, sterile items or the surgical field may become contaminated, potentially leading to wound or deeper infections. All participants in the surgical process are expected to diligently follow the aseptic principles outlined below:
After donning sterile gowns and gloves, the sterile area for surgical personnel is defined as the front of the body between the shoulders and waist (up to the midaxillary line) and both arms. The covered surface of the operating table and instrument trolley also constitutes a sterile field once draped with sterile covers. Hands must not touch the back, areas below the waist, or areas above the shoulders as these are considered non-sterile zones, nor should the undersides of surgical drapes be contacted. In the event of unexpected contamination, immediate replacement or re-disinfection is required.
Surgical instruments or materials should not be passed behind a member of the surgical team. Items that fall outside of the sterile drape or surgical table area are treated as contaminated.
If a glove becomes torn during surgery or comes into contact with a non-sterile area, it must be replaced with a sterile glove. If the forearm or elbow contacts a non-sterile surface, the sterile gown should be replaced or a sterile sleeve applied. If sterile drapes or materials become soaked, their barrier integrity is compromised, and they should be covered with a dry, sterile drape.
A preoperative count of instruments and dressings should be conducted. At the end of the surgery, the thoracic, abdominal, or other body cavities must be inspected, ensuring the instrument and dressing count is accurate before closing the incision. This step is critical to prevent leaving foreign objects inside the body, which could produce serious consequences.
Before making a skin incision or suturing the skin, the area should be disinfected again with 70% alcohol.
Sterile gauze pads should be used to cover the edges of the incision. For example, during abdominal surgery, sterile drapes are often sutured to the peritoneum to protect the abdominal wall incision. Additionally, pre-manufactured incision protection devices are now commercially available. These devices are inserted into the abdominal cavity after the initial incision, and the sterile membrane is folded outward to cover the entire incision, providing excellent protection.
Before opening a hollow organ, gauze pads should be used to shield surrounding tissues to prevent or minimize contamination.
Surgical staff on the same side of the operating table who need to exchange positions should step back first and rotate back-to-back to avoid contacting each other’s non-sterile back areas.
The number of observers present in the operating room should be limited, and they should maintain a distance of at least 30 cm from surgical staff and sterile instrument tables. Movement within the operating room should be minimized as much as possible.
Windows should remain closed during the surgery, and fans should not be used. Air from the air conditioning system should not be directed toward the operating table.
All personnel involved in the surgery must strictly adhere to aseptic protocols and exhibit a strong sense of responsibility toward maintaining aseptic principles. Any items suspected of being contaminated must always be treated as contaminated.