During the operation, the surgeon, surgeon’s assistants, and the scrub corpsman must wear sterile gowns and gloves and must not touch anything that is not sterile. Maintaining sterile technique is a cooperative responsibility of the entire surgical team. Each member must develop a surgical conscience, a willingness to supervise and be supervised by others regarding the adherence to standards. Without this cooperative and vigilant effort, a break in sterile technique may go unnoticed or not be corrected, and an otherwise successful surgical procedure may result in complete failure. Basic Guidelines To assist in maintaining the aseptic technique, all members of the surgical team must adhere to the following principles:  All personnel assigned to the operating room must practice good personal hygiene. This includes daily bathing and clothing change.  Those personnel having colds, sore throats, open sores, and/or other infections should not be permitted in the operating room.  Operating room attire (which includes scrub suits, gowns, head coverings, and face masks) should not be worn outside the operating room suite. If such occurs, change all attire before re-entering the clean area. (The operating room and adjacent supporting areas are classified as “clean areas.”)  All members of the surgical team having direct contact with the surgical site must perform the surgical hand scrub before the operation.  All materials and instruments used in contact with the site must be sterile.  The gowns worn by surgeons and scrub corpsmen are considered sterile from shoulder to waist (in the front only), including the gown sleeves.  If sterile surgical gloves are torn, punctured, or have touched an unsterile surface or item, they are considered contaminated.  The safest, most practical method of sterilization for most articles is steam under pressure.  Label all prepared, packaged, and sterilized items with an expiration date.  Use articles packaged and sterilized in cotton muslin wrappers within 28 calendar days.  Use articles sterilized in cotton muslin wrappers and sealed in plastic within 180 calendar days.  Unsterile articles must not come in contact with sterile articles.  Make sure the patient’s skin is as clean as possible before a surgical procedure.  Take every precaution to prevent contamination of sterile areas or supplies by airborne organisms. Methods of Sterilization Sterilization refers to the complete destruction of all living organisms, including bacterial spores and viruses. The word “sterile” means free from or the absence of all living organisms. Any item to be sterilized must be thoroughly cleaned mechanically or by hand, using soap or detergent and water. When cleaning by hand, apply friction to the item using a brush. After cleaning, thoroughly rinse the item with clean, running water before sterilization. The appropriate sterilization method is determined according to how the item will be used, the material from which the item is made, and the sterilization methods available. The physical methods of sterilization are moist heat and dry heat. Chemical methods include gas and liquid solutions. P H Y S I C A L M E T H O D S . — St e a m u n d e r pressure (autoclave) is the most dependable and economical method of sterilization. It is the method of choice for metalware, glassware, most rubber goods, and dry goods. All articles must be correctly wrapped or packaged so that the steam will come in contact with all surfaces of the article. Similar items should be sterilized together, especially those requiring the same time and temperature exposure. Articles that will collect water must be placed so that the water will drain out of the article during the sterilization cycle. A sterilizer should be loaded in a manner that will allow the free flow of steam in and around all articles. Each item sterilized must be dated with the expiration of sterility. Sterilization indicators must be used in each load that is put through the sterilization process. This verifies proper steam and temperature penetration. The operating procedures for a steam sterilizer will vary according to the type and manufacturer. There are a number of manufacturers, but there are only two types of steam-under-pressure sterilizers. They are the 2-31