A scrubbed surgical technologist notices a small hole in the fingertip of their right glove during a procedure. What is the correct action?

Inform the team and immediately change the contaminated glove. A break in sterile technique must be remedied IMMEDIATELY. A hole in the glove compromises the sterile barrier, exposing the patient to potential contamination from the technologist's skin flora. The contaminated glove must be changed right away — delaying puts the patient at risk for surgical site infection.

Which area of the sterile gown is considered sterile?

The front from chest to waist and sleeves from hands to 2 inches above the elbows. The sterile zone of the gown includes the front from chest to waist level and the sleeves from the hands to 2 inches above the elbows. The back of the gown, below the waist, neckline, and axillary areas are NOT considered sterile regardless of how they were donned.

Two scrubbed surgical technologists need to pass each other in the OR. How should they move?

They should pass face-to-face or back-to-back. Two scrubbed (sterile) persons should pass either face-to-face or back-to-back. This ensures that their sterile fronts either face each other (maintaining awareness) or their non-sterile backs face each other. Turning one's sterile front toward a non-sterile surface risks contamination.

A sterile instrument slides off the Mayo stand and falls below table level. What should be done?

Consider it contaminated and remove it from the sterile field. Tables are sterile only at table level. Any item that falls below the edge of the sterile table is considered contaminated, even if it does not touch the floor. The item must be removed from the sterile field and replaced with a new sterile instrument.

The circulating nurse needs to pour sterile saline into a basin on the sterile field. What is the correct technique?

Pour from a height of 6-8 inches without touching the basin, pouring steadily. The circulating nurse pours sterile solutions from a distance (approximately 6-8 inches) to avoid contaminating the sterile basin rim. The bottle lip must NOT touch the basin or sterile field. The solution should be poured steadily to minimize splashing. The cap should be removed and held with the inside facing down to prevent contamination.

Key Takeaways

Sterile technique (aseptic technique) prevents the introduction of microorganisms into the surgical wound
A sterile field is created using sterile drapes, gowns, gloves, and instrument covers
Only sterile items may be placed on the sterile field — if in doubt, consider it contaminated
Sterile persons contact only sterile areas; unsterile persons contact only unsterile areas
The edges of any sterile wrapper or container are considered unsterile (1-inch border rule)
The front of the sterile gown from chest to waist and from the hands to 2 inches above the elbows is considered sterile
Tables are sterile only at table level — anything that falls below the table edge is contaminated
Movement around the sterile field should be face-to-face or back-to-back, never turning your back to the field

Principles of Sterile Technique

Maintaining sterile technique (also called aseptic technique) is the single most important responsibility of the surgical technologist. Every action in the operating room revolves around preventing contamination of the surgical wound.

The Cardinal Rules of Sterile Technique

Rule 1: Only sterile items are placed on the sterile field

Every item introduced to the sterile field must be verified as sterile
Check package integrity (no tears, holes, moisture), sterilization indicators, and expiration dates
If in doubt, throw it out — when sterility is uncertain, consider the item contaminated

Rule 2: Sterile persons handle only sterile items; unsterile persons handle only unsterile items

Scrubbed team members (surgeon, surgical technologist, first assist): wear sterile gowns and gloves, handle sterile instruments
Unscrubbed team members (circulating nurse, anesthesiologist): do NOT touch anything sterile
The circulating nurse opens sterile items and flips them onto the sterile field without touching the sterile area

Rule 3: The sterile field is created as close to the time of use as possible

Do not set up the sterile field hours before the case
Cover the field if there is a delay, and ensure continuous monitoring
An unmonitored sterile field is considered contaminated

Rule 4: Sterile gowns are considered sterile only in specific areas

Sterile zone of the gown: Front from chest to waist level, and sleeves from hands to 2 inches above the elbows
Non-sterile areas: Back of the gown, below the waist, neckline, axillary region, and sleeve cuffs (under the glove cuff)

Rule 5: Tables are sterile only at table level

Anything that falls below the edge of the table is contaminated and cannot be brought back
Items hanging over the table edge are considered unsterile

Rule 6: The edges of sterile containers and wrappers are unsterile

The 1-inch perimeter of any opened wrapper is considered contaminated
When opening peel packs, the inner contents are sterile but the edges of the peel-back are not
Pour solutions without splashing — hold the bottle at a distance that avoids contact with the sterile basin edge

Rule 7: Sterile fields are maintained by keeping sterile areas in view

Do not turn your back on the sterile field
Scrubbed team members face the field at all times
Movement around the sterile field: face-to-face (two scrubbed persons) or back-to-back (two scrubbed persons passing)
An unscrubbed person passes a scrubbed person by facing the sterile field and passing with their back to unsterile areas

Rule 8: Contamination must be remedied immediately

If a break in sterile technique is identified, it must be corrected immediately
Change contaminated gloves or gowns right away
Remove contaminated items from the field
Report any break in technique — it is everyone's responsibility

CST Certified Surgical Technologist Exam

1Introduction: CST Exam Overview

2Chapter 1: Perioperative Care — Preoperative Preparation

3Chapter 2: Perioperative Care — Intraoperative Procedures

4Chapter 3: Postoperative Procedures & Ancillary Duties

5Chapter 4: Basic Science

6Chapter 5: Exam Strategy & Practice