3.

SKIN PREPARATION AND DRAPING ON SURGICAL SITE Skin Preparation Goal: Decrease the number of microorganisms at the operative site. Dirt and skin oils are removed with scrubbing action and antimicrobial agents are used to reduce the number of bacteria present on the skin and prevent further microbial growth. Cleansing and antisepsis of the skin are accomplished by the circulating nurse who wears sterile gloves and mask and uses a sterile for the solution and supplies.

Principles 1. Maintain the dignity and privacy by exposing only the necessary areas of the body. 2. Assess skin prior to beginning the preparation. Breaks in the skin or symptoms of infection may preclude the surgery. 3. Check patient allergies prior to using any solution. 4. Use warm solution and keep patient well-covered for comfort and to reduce the risk of hypothermia. 5. Scrub in a circular motion from the incisional site outward in an expanding circle. Discard each sponge when the periphery has been reached and start again in the center of the circle with anew sponge. 6. Never reapply a sponge to an area that has been cleansed because bacteria form adjacent skin can be introduced on the prepped area. 7. Do not allow prep solutions to pool under the patients or under tourniquets, grounding pads, or electrodes because skin irritation and chemical burns may occur. This is particularly true for the patients with fair or sensitive skin and for those who are placed on warming blankets during the procedure. 8. Always move form cleanest to the dirtiest. For instance, the vagina and rectum are cleansed after the surrounding skin for a perineal preparation. The axilla is prepared last during a shoulder preparation. 9. Limb preparation requires the limb to be held up by another person or device to allow the entire circumference to be prepared. 10. Cleansing is done gently when a superficial malignancy is suspected so as not to spread potentially cancerous cells. 11. Flammable liquids like acetone and alcohol are not recommended because remaining liquids or lingering fumes can create a spark when used in conjunction with electrocautery or lasers. If they are used drapes should not be applied. 12. Allow antiseptic paints to dry prior to applying drapes.

 Draping on Surgical Site Purpose: To provide a sterile operative field by placing drapes over the patient, leaving only a minimum area of skin exposed around the site of the incision. Principles of Draping 1. Isolate Dirty from clean (e.g., groin, colostomy and equipment from the area to be prepped). Isolation is accomplished by using an impervious drape, usually fabricated from a plastic material. Any impervious material can be used. 2. Barrier Provides an impervious layer; must have a plastic film to prevent strike-through. 3. Sterile Field Creation of a sterile field is through sterile presentation of the drape and aseptic application technique. If the drape used is not impervious, an additional impervious layer needs to be added. 4. Sterile Surface Because skin cannot be sterilized, it is necessary to apply an incise drape to create a sterile surface. Only an incise drape can create a sterile surface. 5. Equipment Cover Sterile drapes cover nonsterile equipment or organize equipment used on the sterile field. This helps to protect the patient from the equipment as well as to protect and prolong the life of the equipment. 6. Fluid Control Collection of fluid keeps the patient dry, decreases healthcare worker exposure and decreases clean up. A fluid control system should be used any time the procedure is known to include large amounts of body fluids or irrigating solution. Surgical Drape Characteristics Regardless of which materials are used, all surgical drape materials should possess the following traits: a. Abrasion resistanceThe material surface should not abrade during normal use, under wet and dry conditions. b. Barrier propertiesThe ability of a material to resist the penetration of liquids and/or microorganisms. c. BiocompatibilityA material free of toxic ingredients. d. DrapeabilityThe ability of a material to conform to the shape of the object over which it is placed. e. Electrostatic propertiesIn the context of a surgical drape, the ability of the material to accept or dissipate an electrical charge is desirable. f. NonflammabilityThe materials should not support open combustion.

g. NonlintingDrape materials should not contain, or generate with normal use, free fiber particles. h. Tensile strengthDrape materials should be strong enough to withstand the stresses encountered during typical use when wet or dry. In addition to the required traits referenced above, some applications call for the drape materials to be: i. j. BreathableCapable of allowing gas and moisture vapor to pass through the material while maintaining a barrier to fluids and microorganisms. AbsorbentThe ability to absorb and hold fluid while maintaining a barrier to penetration of fluid and microorganism through the drape.

Surgical Draping Draping procedures create an area of a sepsis called a sterile fiel. 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 Draping Materials 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 achieve sterilization within hospital facilities. 1. Reusable Drapes 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 laundry and/or sterilization cycles.

 A system to monitor the number of times an item has been laundered is essential for barrier quality control. 2. Disposable Drapes Prevent bacterial penetration and fluid breakthrough. Successful drapes are soft, lint, free, lightweight, compact moisture resistant, non-irritating, and static free. Lightness and compactness of synthetic drapes prevent heat retention by patients, contribute to ease in handling 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 managed to prevent environmental contamination. 3. Plastic Incisional Drapes 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, extremities and joints. 4. Standard drapes 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 physical 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. 5. Aperineal drape 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. Folding drapes for use 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 fan folded 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

Draping Procedure 1. 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. 2. Hold sterile drapes above waist level until properly placed on the patient or object being draped. 3. If the end of a drape falls below waist level, it should not be retrieved because the area below the waist is considered unsterile. 4. Protect the gown by distance and the gloved hands by cuffing drapes over them. 5. 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. 6. Draping is always done from sterile area to an unsterile area and by draping nearest first The scrub nurse should never reach across an unsterile area to drape. 7. When the opposite side of the operating room bed must be draped , the scrub nurse must go around the bed to drape. 8. Do not flip, fan or shake drapes. 9. Rapid movement of drapes creates air currents on which dust, lint and droplet nuclei may migrate. 10. Shaking a drape causes uncontrolled motion of the drape which may cause it to come in contact with an unsterile surface or object. 11. A drape should be carefully unfolded and allowed to fall gently into position by gravity. 12. The low portion of a sheet that falls below the safe working level should never be raised or lifted back onto the sterilearea. 13. Drape the incisional area first and then the periphery. 14. Use non-perforating towel clamps or devices to secure tubing and other items on a sterile field. 15. When sterility of a drape is questionable, consider it contaminated. Sources: http://www.scribd.com/doc/49440555/Surgical-Draping http://www.csao.net/files/pdfs/70-2009-7475-9-Clip,Prep,Drape806.pdf