Cleaning, disinfection and sterilization.

Reusable instruments should be processed according to local policy, along with theatre drapes and reusable scrub gowns. Decontamination is defined as ‘the combination of processes including cleaning, disinfection and sterilisation, used to make a reusable device safe for further use on patients and handling by staff.

Sterile field

This consists of the instrument trolleys, the scrub team and the draped patient. There must be a wide margin of safety marked by an invisible wall at the trolley edges, which marks the barrier over which non-sterile items should not cross. An aseptic technique is essential and sterile items must be received from the circulating person in a manner that does not contaminate the field. Any breaks in sterility or the sterile field should be reported immediately to the scrub person so that the contaminated item can be isolated and removed if possible. Instruments should be inspected by the scrub nurse and rejected if any visible sign of contamination remains after the sterilisation process. The spread of resistant bacteria such as methiciilin-resistant Staphylococcus aureus (MRSA) and conditions such as variant Creutzfeldt-Jakob disease (CJD) are well publicised by the media and are of particular concern. Patients who pose a high risk of infection should be left until the end of the case list and universal precautions strictly observed.

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