Dr.

Ravi Arjunan

The procedure of covering a patient and surrounding areas with a sterile barrier to create and maintain a sterile field during a surgical procedure is called draping. The purpose of draping is to eliminate the passage of microorganisms between nonsterile and sterile areas. Draping materials may be disposable or nondisposable. Disposable drapes are generally paper or plastic or a combination and may or may not be absorbent. Nondisposable drapes are usually doublethickness muslin. Drapes, of course, must be sterile.

Draping procedures create an area of a sepsis called a sterile field Created by placement of sterile sheets and towels in a specific position to maintain the sterility of surfaces on which sterile instruments and gloved hands may be placed The patient and operating room bed are covered with sterile drapes in a manner that exposes the prepared site of incision and isolates the area of the surgical wound Objects draped include instrument tables, basin and Mayo stand, trays and some surgical equipment

Are selected to create and maintain an effective barrier that minimizes the passage of microorganisms between nonsterile and sterile areas To be effective, a barrier material is resistant to blood, aqueous fluid and abrasion as lint free as possible Maintain isothermic environment that is appropriate to body temperature Meet the requirements of the current National Fire Protection Association Standards so that no risk from a static charge exists Fabric draping materials must be penetrable by steam under pressure or by gas to acheive sterilization within hospital facilities

The performance characteristic of primary concern for drapes (or gowns) to be used repeatedly is fluid impermeability under the conditions of use The process of steam sterilizing and laundering swells the fabric whereas drying and ironing shrinks the fibers This cycle increases the propensity for loosened fibers that alter the fabric structure Most manufactures report a loss of barrier quality after 75 laundryand/or sterilization cycles A system to monitor the number of times an item has been laundered is essential for barrier quality control

Prevent bacterial penetration and fluid breakthrough Successfull drapes are soft, lint, free, lightweight, compact moisture resistant, nonirritating, and static free Lightness and compactness of synthetic drapes prevent heat retention by patients, contribute to ease inhandling and storage and conserve storage space and personnels time Disposable drapes reduce the hazards of contamination in the presence of known infectious microorganisms in body fluids and excretions and in situations in which laundering of grossly contaminated textiles is a problem

Collection, transportation and storage of waste materials can be a problem Incineration (burning) is a method for destroying waste disposables- but must properly managedto prevent environmental contamination

Impermeable polyvinyl sheeting are available in the form of sterile, prepacked surgical drapes The incision is made directly through the adherent plastic drape Facilitates draping of irregular body surfaces as neck and ear regions, extrimities and joints

A whole , or plain sheet is used to cover instrument tables, operating tables, and body regions The sheet should be large enough to provide an adequate margin of safety between the surrounding pgysical environment end the prepared operative field Surgical towels in one or two sizes should be available to drape the operative site. Four surgical towels are sufficient Fenestrated or slit sheets are used for draping patients. They leave the operative site exposed,use for (laparatomy draping)abdomen, chest, flank, back, other size for limb, head and neck

For operations on the perineum and genitalia with the patient in lithotomy position A lithotomy drape consists of a fenestrated sheet and two triangular leggings A commercial disposable lithotomy drape back, is suitable for delivery, cystoscopy, hemorrhoidectomy and vaginal procedures

Drapes should be folded so that the gowned and gloved members of the team can handle them with ease and safety The larger, regular sheet is usually fanfolded from bottom to top The bottom folds may be 4 inches wider than the upper ones The small sheet is folded in half and then quartered

Carry the folded drape to the operative site, where the drape is carefully unfolded and placed in proper position after a drape has been placed, it should not be moved Hold sterile drapes above waist level until properly placed on the patient or object being draped. If the end of a drape falls bellow waist level, it should not be retrieved because the area bellow the waist is considered unsterile Protect the gown by distance and the gloved hands by cuffing drapes over them The scrub nurse should have all parts of the drape under positive control at all times during placement and should use precise and direct motion

Drapping is always done from sterile area to an unsterile areaand by drapping nearest first The scub nurse should never reach across an unsterile area to drape When the opposite side of the operating room bed must be draped , the scrub nurse must go around the bed to drape Do not flip, fan or shake drapes. Rapid movement of drapes creates air currents on which dust, lint and droplet nuclei may migrate Shaking a drape causes uncontrolled motion of the drape which may cause it to come in contactwith an unsterile surface or object

A drape should be carefully unfolded and allowed to fall gently into position by gravity The low portion of a sheet that falls bellow the safe working level should never be raised or lifted back onto the sterile area Drape the incisional area first and then the periphery Use nonperforating towel clamps or devices to secure tubing and other items on a sterile field When sterility of a drape is questionable, consider it contaminated

Factors to be considered include the surgeons method of working, ease in handling, preparing, transporting items and reduction in human energey

Effective sanitation techniques should be established to control and reduce the possibility of cross infection of patients in OR Blood and tissue fluids from any patient may contain microorganisms that are pathogenic to other persons Operating room practices should be developed to provide complete isolation for each patient This isolation is accomplished by considering every surgical wound to be potentially contaminated

This principle recommends that personnel restrict all patient microorganisms to an area of 3 feet around the patient To implement this principles prevents the transfer of microorganisms an=and protects patients and personnel Adherence to this principle eliminates the costly practice of special decontamination procedures for dirty cases

1) Handle the drapes as little as possible. (2) Never reach across the operating table to drape the opposite side; go around the table. (3) Hold the drapes high enough to avoid touching nonsterile area but avoid touching the overhead light. (4) Hold the drape high until it is directly over the proper area, then drop (open fingers and release sheet) it down where it is to remain. NEVER ADJUST ANY DRAPE. If the drape is incorrectly placed, leave it in place and place another drape over it. (5) Protect the gloved hands by cuffing the end of the sheet over them. Do not let the gloved hand touch the skin of the patient

6) In unfolding a sheet from the operative site toward the foot or head of the table, protect the gloved hand by enclosing it in the turned back cuff of the sheet. (7) If a drape becomes contaminated, discard it immediately. (8) If the end of a drape falls below waist level, do not handle it further. Drop it and use another drape. (9) If in doubt about sterility, discard the drape. (10) If a hole is found in a drape after it is laid down, cover the hole with another drape or discard the entire drape.