“Whatever you do, don’t touch that wall behind you,” my attending physician warned as I donned a sterile gown for my first central line placement in the cardiothoracic intensive care unit (CTICU). Our patient was a lung transplant recipient, acutely vulnerable to infections due to their immunosuppressive medications. As such, maintaining a sterile field was crucial to protect their health. With my elbows at my side, I awkwardly maneuvered my right arm through the sleeve of the gown, followed by my left. “Well, you already messed that up!” he sternly admonished as my fear was realized: I had brushed up against the wall with my left hand.

In the ICU, every detail matters. I was acutely aware of the patient’s vital signs—blood pressure, oxygen levels, and ventilation—as well as the precise anatomy relevant to the procedure. Each step of the technical process, from properly donning my sterile attire to successfully introducing and securing the central line, demanded my complete attention. What I was not aware of is the attention to detail that occurred before these devices even ended up in my hands. In the hospital setting we take notably high measures to ensure sterility and safety for our patients – but what measures are taken on the devices themselves before they even arrive in the ICU?