OR Sterility 101: What You Can and Can’t Touch in the Operating Room

The Operating Room (OR) is one of the most controlled environments in medicine, where precision, sterility, and teamwork are essential for patient safety. Unlike other areas of the hospital, the OR has strict protocols regarding what can and cannot be touched, as even the slightest contamination can lead to surgical site infections (SSIs), postoperative complications, and life-threatening sepsis.

For medical students, surgical residents, and even experienced healthcare professionals, mastering OR etiquette and sterility is critical to ensuring a safe and infection-free environment.

This guide will explore:
✔ The key principles of sterility in the OR ✔ What you can and cannot touch during surgery ✔ The consequences of breaking sterility and how to correct mistakes ✔ How to navigate the OR without contaminating the sterile field

By understanding and following these rules, you will gain the trust of your surgical team, avoid common mistakes, and most importantly, protect your patients.

1. The Golden Rule of OR Sterility: The Sterile Field is Sacred

The sterile field in the OR serves as an invisible barrier separating clean and contaminated areas. Anything designated as sterile must remain sterile, and anything non-sterile must never come into contact with sterile areas.

Rule #1: If you’re unsure whether something is sterile, assume it is not.

Breaking sterility, even unintentionally, means the contaminated area must be re-sterilized or replaced. This can delay the surgery, waste resources, and significantly increase infection risks.

Key areas of sterility in the OR include:
✔ Surgical instruments and drapes ✔ The surgical site on the patient ✔ The gloved hands and gown of the scrubbed surgical team ✔ The sterile table and Mayo stand (where instruments are placed)

Everything else in the OR is considered non-sterile and must not come into contact with sterile areas.

2. What You Can Touch in the OR: The Do’s of OR Etiquette

If you are a scrubbed-in member of the surgical team, you are permitted to touch only sterile objects within the sterile field.

A. What Scrubbed Personnel Can Touch
✔ Surgical instruments and trays (only within the sterile field) ✔ The patient’s sterile drapes and exposed surgical site ✔ The surgical table and Mayo stand (where instruments are arranged) ✔ Sterile surgical gloves and gowns worn by other scrubbed team members

Golden Rule: If you are scrubbed in, always keep your hands at chest level and in front of your body—never below the waist or above the shoulders.

B. What Non-Scrubbed Personnel Can Touch
If you are not scrubbed in (e.g., medical students observing, anesthesiologists, circulating nurses), you must stay away from the sterile field.

✔ Anesthesia equipment, monitors, and IV lines ✔ The patient’s non-sterile areas (head, feet, lower limbs) ✔ Computer screens, notes, and documentation ✔ OR doors, light handles, and supply cabinets

Tip: If you’re observing, keep your hands behind your back to avoid accidentally touching anything sterile.

3. What You CANNOT Touch in the OR: The Don'ts of OR Etiquette

Touching a sterile item when you are not scrubbed in or introducing a non-sterile object into the sterile field is a serious violation in the OR.

A. What Non-Sterile Personnel Cannot Touch
❌ Sterile surgical instruments or trays ❌ The surgeon or scrub nurse’s gloves and gown ❌ The surgical site or drapes covering the patient ❌ The Mayo stand or sterile table

Why it matters: If a non-scrubbed person touches a sterile item, it is immediately contaminated and must be replaced.

B. What Scrubbed Personnel Cannot Touch
Even if you are scrubbed in, there are things you must never touch, including:

❌ Non-sterile areas of your own body (face, mask, hair, arms below the gown) ❌ Equipment outside the sterile field (computer keyboards, doorknobs, phone) ❌ Anything below the sterile drapes—if an instrument falls off the Mayo stand, it is no longer sterile

What to do if you accidentally touch a non-sterile area? Immediately notify the team and re-scrub or replace the contaminated item.

4. The Sterile Zones: Knowing Where to Stand in the OR

Your position in the OR matters. If you’re not careful, you can accidentally contaminate sterile areas just by moving incorrectly.

A. The Sterile Zone (Scrubbed Team Only)
✔ The area immediately around the operating table ✔ Includes surgeons, scrub nurses, sterile instruments, and the draped patient ✔ Only scrubbed personnel can enter this zone

Rule: If you are scrubbed in, always face the sterile field—never turn your back on it.

B. The Non-Sterile Zone (For Observers, Anesthesiologists, and Circulating Staff)
✔ The area outside the sterile field, including anesthesia equipment, monitors, and supply cabinets ✔ Medical students and observers should stand near the OR walls, away from sterile zones

Tip: If you must move around the OR, always walk behind scrubbed personnel—never between them and the sterile field.

5. What Happens If Sterility is Broken? How to Fix Contamination

Mistakes happen—even experienced surgeons and scrub nurses occasionally break sterility. The key is to act immediately and correct the issue before it compromises patient safety.

A. If You Accidentally Touch a Sterile Object While Non-Sterile
✔ Immediately inform the scrub nurse or surgeon—don’t ignore it! ✔ The contaminated instrument must be removed and replaced with a sterile one.

B. If a Scrubbed Person Touches a Non-Sterile Surface
✔ If a glove becomes contaminated, it must be changed immediately. ✔ If the sterile gown is contaminated, a new gown and gloves must be worn.

C. If an Instrument or Item Falls Below the Sterile Field
✔ Any item that falls below waist level is no longer sterile and must be replaced. ✔ Never attempt to pick it up yourself—notify the scrub nurse instead.

6. Mastering OR Etiquette: Tips for Medical Students and Residents

✔ Always ask before touching anything – If unsure, check with the scrub nurse. ✔ Keep your hands where they belong – Non-scrubbed? Hands behind your back. Scrubbed? Hands at chest level. ✔ Don’t reach over the sterile field – Even if you’re scrubbed in, leaning over sterile areas is risky. ✔ Stay aware of your movements – Be mindful of where you walk and stand. ✔ When in doubt, ask! The OR team prefers questions over contamination mistakes.

Final Thoughts: Protecting Patients Starts With OR Sterility
The OR is a place where precision and sterility directly impact patient safety. Whether you’re a surgeon, scrub nurse, anesthesiologist, or medical student, knowing what you can and cannot touch is crucial.

✅ Respect the sterile field. ✅ Be mindful of your movements. ✅ If sterility is broken, correct it immediately.

Mastering OR etiquette not only earns you the trust of your surgical team but also ensures the best possible outcomes for your patients.