Asepsis in Action
During setup, a sterile tray is opened and left unattended for 15 minutes before use.
What is the most appropriate action?
Answer: Consider the field contaminated and re-establish sterility.
A patient in lithotomy position develops foot drop post-op.
What is the likely cause?
Answer: Common peroneal nerve injury.
A scalpel is passed hand-to-hand during a fast-paced procedure.
What safer alternative should be used?
Answer: Neutral zone (hands-free technique).
A staff member leaves theatre wearing scrubs and returns without changing. What is the concern?
Answer: Environmental contamination introduced into sterile area.
The team skips the “time-out” due to being behind schedule.
What is the risk?
Answer: Wrong patient, site, or procedure error.
You notice moisture on a sterile drape after prepping.
What risk does this pose?
Answer: Strike-through contamination.
A patient is in steep Trendelenburg for 4 hours.
What is the highest physiological concern?
Answer: Respiratory compromise (reduced lung expansion).
A nurse sustains a needlestick injury but delays reporting.
What is the key risk?
.
Answer: Delayed prophylaxis and increased infection risk
A mask is worn under the nose during a sterile procedure.
What is the risk?
Answer: Droplet contamination of the sterile field.
A junior nurse notices a discrepancy but feels unable to speak up.
What safety issue does this represent?
Answer: Poor safety culture / lack of psychological safety.
A scrub nurse reaches across a non-sterile area to grab an instrument without noticing.
What is the priority response?
Stop, declare contamination, and replace affected items.
You notice the patient’s arm is abducted beyond 90 degrees on the arm board. What is your immediate action?
Answer: Reposition to ≤90° to prevent brachial plexus injury.
A junior staff member recaps a needle after use.
What should you do?
Answer: Immediately stop practice and educate—recapping is unsafe.
A gown becomes visibly wet during surgery.
What is the correct response?
Answer: Change gown due to strike-through risk.
During handover, critical patient information is omitted. What type of error is this?
Answer: Communication failure.
The circulating nurse questions whether a break in sterility occurred but is unsure. What should happen next?
Answer: Treat as contaminated and escalate/replace—when in doubt, it’s contaminated.
A high-BMI patient is positioned without additional pressure-relieving devices.
What complication is most likely?
Answer: Pressure injury due to increased tissue load.
A sharps container is overfilled but still in use. What is the risk?
Answer: Increased likelihood of sharps injury.
A staff member wears jewellery under gloves. What is the issue?
Answer: Increased microbial load and glove integrity risk.
The team assumes counts are correct without verification. What potential outcome could occur?
Answer: Retained surgical item.
During a long case, staff begin relaxing sterile technique due to fatigue. What safety principle is being compromised?
Answer: Maintenance of aseptic discipline and vigilance.
During a prolonged procedure, the limb appears tense and swollen. What emergency complication should you suspect?
Answer: Compartment syndrome.
During surgery, multiple sharps are in use with poor communication.
What human factor risk is present?
Answer: Loss of situational awareness leading to injury
Different PPE levels are used inconsistently during the same procedure.
What principle is being breached?
Answer: Standardised infection prevention practices.
Multiple small deviations from protocol occur but no one intervenes.
What human factor concept explains this?
Answer: Normalisation of deviance.