Managing Infection Basic Draping Principles and Practices

November 2011

© 2012. All Rights Reserved.

Shawn Matalas, AAS, CVT

Objectives Identify and describe the clinical objectives of draping. Describe four aseptic practices for applying surgical drapes. Discuss the importance of barrier performance classification in drape selection and procedures for which each barrier level might be appropriate.

1. Draping is always done from an unsterile area toward sterile area by draping the furthest area away, first. A. True B. False 2. A sterile pack should be opened by a nonsterile person from the far side first and the near side last. A. True B. False 3. The sterile field consists of: A. An area that encompasses draped equipment, scrubbed personnel, and the draped patient. B. The draped patient and a 12 inch area around the incision site where direct contact with blood and body fluids is most likely to occur. 4. Exogenous flora is acquired from a contaminated source, such as hands or environmental surfaces, and includes any type of bacteria that can live on the skin, including bacteria that are pathogenic. Exogenous flora is also known as resident flora. A. True B. False

Test Questions

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Test Questions 5. Which statement regarding aseptic draping technique is False? A. Hold sterile drapes above waist level until properly placed on the patient or

object being draped. B. After a drape has been placed, it should not be moved unless it can be

repositioned onto a prepped area of skin. C. Protect the gown by distance and the gloved hands by cuffing drapes over them. D. Handle drapes carefully and as little as possible. 6. The Association for the Advancement of Medical Instrumentation (AAMI) Barrier Level 1–4 classification relates to the degree of barrier protection provided by the drape. Health care professionals should choose the highest level of protection required by a procedure. A. True B. False 7. Level 3 barrier protection is recommended for mastectomies. A. True B. False 8. All orthopedic procedures require level 4 barrier protection. A. True B. False 9. Risk of surgical site infection is reduced when the skin is sterilized during the surgical skin prepping process. A. True B. False 10. Prior to surgery, isolation drapes are used to wall-off dirty areas of the body from the operative site. A. True B. False

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The use of surgical drapes evolved as a standard of practice over a century ago. Their primary purpose was to protect the sterile surgical zones from microbial contamination. Selecting surgical drapes based on performance characteristics, barrier protection, and patient welfare initiatives, represents effective measures in infection prevention. Today’s operating room personnel face the challenge of changing trends in healthcare and industry standards, rapid technological advances, economic pressures and increasing demands for higher quality care in a competitive

environment. There is no denying the evolution of surgical drapes. As surgical science progressed, the performance requirements for surgical drapes advanced to address a constantly changing operating room environment. Surgical drapes are required to adapt in material, function, and specialty performance, as well as, ensure patient safety. A concept that has not changed is that surgical draping remains a foundation of surgical procedures and is an important aspect of aseptic practice.

Introduction

The Skin The skin harbors two types of microorganisms, transient and resident flora. Exogenous or transient flora is acquired from a contaminated source, such as hands or environmental surfaces, and includes any type of bacteria that can live on the skin, including bacteria that are pathogenic. Transient bacteria can be transferred to the wound through contact with instruments, gloves or sponges. Endogenous or resident flora is always

present on the skin but also resides in the deeper layers of the epidermis as well as hair follicles and sebaceous glands. While they cause no harm in healthy individuals, when there is a break in the skin’s integrity, these bacteria can cause infection.1 The patient’s endogenous flora is the leading cause of surgical site infection (see Figure 1).2

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To prevent bacteria on the skin from entering the surgical wound, the skin at and around the incision site must be cleaned and disinfected (see Figure 2).3 However, even the best antiseptic skin preparations, prior to surgery, will not eliminate all bacteria.4 Skin cannot be sterilized only disinfected. It is also important to remember that water-soluble skin preps are subject to removal throughout the surgical process by blood, body and irrigation fluids.

Bacterial regeneration occurs continuously on the skin, even after prepping. Risk of surgical site infection would be greatly diminished if the skin could be sterilized, and likewise, so would the demands of the material and performance of the surgical drape. Because this is not the case, we use surgical drapes to create a barrier to protect against bacterial migration and contamination of the surgical site.

The Skin (cont.)

Figure 1. Transient and Resident Flora

Transient Flora

Resident Flora

Stratum Corneum

Figure 2. Skin Antiseptic

Sterile Surface In addition to conventional drapes, sterile incise drapes, polymeric films coated with pressure sensitive adhesives, adhere securely to the skin, provide a sterile surface at the beginning of surgery and create a sterile barrier that immobilize bacteria beneath the drape.

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Incise drapes may be clear or an iodophor complex may be incorporated into the adhesive, providing antimicrobial properties. When an incise drape lifts at the wound edge, skin is exposed, allowing bacteria to be carried into the wound. One study showed a six-fold increase in the infection rate when there was incise drape lift.5

One thing to consider is that the prep used on the skin can significantly affect the adhesion of drapes, both fabric procedural sheets as well as incise drapes. Preps that contain a water-insoluble film will enhance drape adhesion while water-soluble preps, both povidone iodine and chlorhexidine based preps, will provide lower drape adhesion. .

Sterile Surface

Attributes of Surgical Drapes The main purpose of surgical drapes is to provide a safe, effective means of protecting the patient during surgical procedures. Patients are at a risk of contamination from both endogenous and exogenous microorganisms during surgery, and drapes must maintain an aseptic barrier throughout the procedure. Surgical drape properties, such as linting and barrier, have progressed greatly from the muslin drapes of a century ago. In fact, even the more modern version of reusable drapes, a polyester/cotton blend, has declined in use. 2 Current research strongly supports the use of nonwoven materials.2 Linen spreads lint which can act as a carrier for air-borne bacteria.

Studies indicate the use of reusable drapes may be a potential source of contamination, especially when wetted with blood or normal saline, and present a danger of strike-through contamination.6 To avoid fluid penetration some surgeons and nurses use multiple drape layers or incorporate additional plastic drapes to provide additional protection. For some health care facilities, the rising concern of wound contamination and surgical site infections has led to the preference of using nonwoven disposable drapes.

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Whether surgical draping is accomplished with reusable or single-use drapes, the Association of periOperative Registered Nurses (AORN), Perioperative Standards and Recommended Practices, suggest materials possess the following characteristics:7

Be abrasion resistant. The material surface should not abrade during normal use, under wet and dry conditions. Possess barrier properties. The material should resist the penetration of liquids, blood and body fluids, and/or microorganisms. Be biocompatible. A material free of toxic ingredients. Be drapeable. Surgical drapes should be of a material able to conform to the shape of the object over which it is placed. Electrostatic properties. The primary electrical safety consideration is the ability of the material to accept or dissipate an electrical charge. Be nonflammable. The material should not support open combustion. Be nonlinting. Materials should not contain, or generate free fiber particles

with normal use. Tensile strength. The material should be strong enough to withstand the stresses encountered during typical use when wet or dry. Be breathable. Capable of allowing gas and moisture vapor to pass through the material while maintaining a barrier to fluids and microorganisms. Be absorbent. Able to absorb and hold fluid while maintaining a barrier to penetration of fluid and microorganisms through the drape.

Material strength is an important factor in maintaining the integrity of the drape. A drape that tears easily compromises the sterile field and creates a pathway for bacteria from a non sterile surface (skin flora from a non prepped area) to migrate to the sterile surgical site. Another important component of effective draping is in the integrity of the adhesive interface.8 Because everything underneath a sterile surgical drape is a source of contamination, all drapes must adhere well to the skin surface. If a drape lifts or migrates, microorganisms can be introduced into the sterile field. .

Attributes of Surgical Drapes

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A certain amount of friction on the surface of a drape is unavoidable as tubes, cords, and heavy instruments used in retraction will be in contact with the drape. A drape material that abrades or frays easily releases fibers or lint that can lead to foreign body contamination or be a vehicle that carries bacteria into the surgical incision. The ability to control the direction of fluid run off from the surgical field is not a certainty. An absorbent material soaks up

fluids and reduces fluid run off. Minimizing the occurrence of run off reduces the potential for fluid to channel under the drape and carry bacteria into the surgical site. An absorbent fabric also decreases fluid pooling on the OR floor which can present a slip hazard for surgical staff as well as the potential exposure to bloodborne pathogens.

Attributes of Surgical Drapes

Professional organizations, such as AORN, the Association for the Advancement of Medical Instrumentation (AAMI), and the Centers for Disease Control and Prevention (CDC), use evidence based data and theoretical rationale to develop standards and recommended practices intended to assist health care personnel in clinical decisions. The industry standards developed by these organizations represent what is considered to be the best practice and provide key considerations in selecting and using surgical drapes.

Industry Standards

AORN AORN promotes standards of perioperative nursing practice, and advances patient safety in the perioperative setting. AORN includes recommended practices for selection and use of surgical gowns and drapes as well as practices for aseptically applying the drapes and maintaining the sterile field.

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AAMI AAMI protective barriers committee has established a system of classification for protective apparel and drapes used in health care facilities based on their liquid barrier performance (AAMI TIR: 2005 PB70). In October 2004 this standard of protective barriers was recognized by the FDA as a consensus standard for use in premarket reviews.9 CDC The CDC 1999 Guideline for Prevention of Surgical Site Infection addresses surgical drapes and attire, asepsis and surgical technique. Recommendations for the prevention of surgical site infections are categorized as I and II.2 Category I recommendations include IA and IB and are viewed as effective by HICPAC Healthcare Infection Control Practices Advisory Committee, experts in the fields of surgery, infectious diseases and infection control, for the reduction of surgical site infections.2 The recommendation “Use surgical gowns and drapes that are effective barriers when wet” is classified as IB and is strongly recommended for implementation in the prevention of surgical site infections. Both category IA and IB recommendations should be adopted by all healthcare facilities, they differ only in the strength of the supporting scientific evidence.

ASTM The American Society for Testing and Materials (ASTM) has developed standards and methods for testing the flammability of textile fabrics including surgical gowns and drapes. The standard also explains three classes of flammability.10 The Consumer Products Safety Commission Standard CFR 1610 for Flammability of Clothing Textiles, is the current industry standard used to differentiate materials having normal flammability, from those materials which exhibit rapid and intense burning. Surgical Drapes rated as having normal flammability, are classified as Class 1 per the Consumer Products Safety Commission Standard.11 ECRI The Emergency Care Research Institute (ECRI), initiated clinical practice recommendations to reduce the risk of operating room fires in oxygen-rich environments. The key change in recommendation is that with certain limited exceptions, the traditional practice of open delivery of 100% oxygen should be discontinued. These new recommendations represent significant changes and advanced safety measures in clinical practice for anesthesia and operating room professionals.12

Industry Standards (cont.)

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The drape in Figure 3 shows the fenestration in white, area A represents the critical zone, and area B encompasses the rest of the drape. The critical zone has been defined as the area of the drape where direct contact with blood and body fluids is most likely to occur and, consequently, where the highest level of barrier protection is required. Traditionally, the critical zone was considered to be approximately a 12 inch area around the incision site. The overall level of drape barrier protection is dictated by the level of the critical zone.7 Today, the area considered the critical zone has been redefined as it is often determined by the parameters of the surgical procedure and the level of barrier protection required. Surgeries of longer duration, those that involve implants, and use large volumes of irrigation fluid, require higher levels of barrier protection throughout the entire drape. The risk of infection increases when strike-through occurs anywhere within the sterile field. More invasive surgeries, such as cardiovascular and orthopedic procedures, are at a greater risk of surgical site infection and require drapes that provide high levels of barrier protection. Therefore the entire drape may be considered the critical zone. In 1999, AAMI established a Protective Barriers Committee to develop a standard for the barrier performance of surgical gowns,

surgical drapes and drape accessories. This standard, ANSI/AAMI PB70, established the classification system for barrier performance along with associated labeling requirements. Barrier performance test methods designed to assess strike-through, include tests developed by the American Association of Textile Chemists and Colorists (AATCC 42 and 127), and the American Society for Testing and Materials (ASTM F 1670).13

The classification system of levels of barrier performance for surgical drapes and drape accessories is based on a standardized test and it is intended to assist users in selecting the appropriate level of protection for a given clinical use. The Level 1-4 classification relates to the degree of barrier protection provided by the drape.

Surgical Drape Areas

Figure 3. Surgical Drape Areas

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Table 1 below illustrates the requirements of 4.2.3.2 ANSI/AAMI PB70:2003 and shows how the barrier performance classification of the drape would be determined.

Surgical Drape Areas (cont.)

Factors such as the amount of liquid, pressure applied to the drape, variations in surgical technique and the duration of the procedure should be considered when choosing the appropriate level of barrier performance in a drape. Health care professionals should choose the highest level of protection required by a procedure. For example, a Level 1 or Level 2 drape provides less barrier protection against fluid strike-through and would be appropriate for surgical procedures where minimal or low levels of blood and body fluids are anticipated, such as simple biopsies or ophthalmic procedures. The effectiveness of the barrier in maintaining the sterile field is determined by the ability to prevent strike-through.

A drape with Level 4 barrier protection is recommended for procedures with high levels of fluid. Cardiovascular surgeries are invasive procedures where the surgeon’s hands enter the body cavity, pressure and friction from heavy retraction and manipulation occurs. This increases the possibility of strike-through and more barrier protection is required. Table 2 provides examples of expected use conditions and health care applications for which each level of barrier performance might be appropriate.

Table 1. Barrier Performance Classification of Surgical Drapes9

Area A (Critical Zone)

Area B Final Barrier Performance

Classification

Level 1 Level 1,2,3, or 4 Level 1

Level 2 Level 1,2,3, or 4 Level 2

Level 3 Level 1,2,3, or 4 Level 3

Level 4 Level 1,2,3, or 4 Level 4

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Surgical Drape Areas (cont.)

Clinical objectives of draping4

Wherever surgery is performed, in an OR, surgical center or physician’s office, one or more surgical drapes will be used. The drapes used during a procedure will address one or more of these clinical objectives.

Isolation: Separating or blocking a contaminated area from clean Sterile Field: Creating a sterile operative environment Barrier: Preventing fluid penetration Sterile Surface: Creating a sterile surface on the skin – a barrier to prevent skin flora migration

Fluid Control Channeling: Collecting blood, body and irrigation fluids Equipment Draping: Allowing non-sterile equipment into the sterile field

It is important to create and maintain a sterile field for all surgical patients, in order to reduce the risk of surgical site infection. The sterile field is the area that encompasses draped equipment, scrubbed personnel, and the draped patient (see Figure 4).

Table 2. General Relationships between Barrier Performance and Anticipated Exposure Risks 14

ANSI/AAMI

PB70 barrier per- formance

Fluid Amount

Fluid spray or splash

Pressure on gown or drape

Examples of procedures with

anticipated exposure risks

Level 1

Minimal

Minimal

Minimal

Simple excisional biopsies

Excision- “lumps and bumps”

Ophthalmic procedures

Simple eye, nose and throat (ENT) procedures

Level 2

Low

Low

Low

Tonsillectomies/adenoidectomies

Endoscopic gastrointestinal procedures

Simple Orthopedic procedures with tourniquets

Open hernia repair

Minimally invasive surgery

Interventional radiology./catheter lab procedures

Level 3

Moderate

Moderate

Moderate

Mastectomies

Arthroscopic orthopedic procedures

Endoscopic urological procedures TUR

Open gastrointestinal and genitourinary procedures

Level 4

High

High

High

Any procedure in which the surgeon’s hands are in a body cavity

Orthopedic procedures without a tourniquet

Open cardiovascular/thoracic procedures

Trauma procedures

Caesarean sections

Anticipated Risk of Exposure

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Figure 4. The Sterile Field Surgical drape selection should be based on anticipated use, the performance attributes required of the drape to facilitate the surgical procedure and most importantly, appropriate barrier protection. Economic factors are often a consideration in drape selection. However, cost should not take precedence over performance, patient protection or surgical outcome (see Table 3).

Table 3. Principles of Draping – Functions and Features

Objective Drape Purpose Clinical Use Drape Selection Important Attributes

Isolation

Isolate dirty areas from clean Non-sterile equipment from operative site

Isolate groin from hip operative site Non-sterile equipment, (tourniquet) from area to be prepped

Isolation accomplished using impervious drape – Often fabricated from plastic material

Effective adhesive to secure drape and maintain isolation

Barrier

Sterile drapes used during the draping process to create a barrier from blood and body fluids and reduce the risk of strike-through

Creates a sterile barrier to help minimize or eliminate the passage of microorganisms from non-sterile to sterile areas.

Drapes that provide impervious properties Incorporates plastic film to prevent strike- through Barrier performance appropriate for procedural use

Secure Adhesion to skin/drapes. Tear resistant Fluid Resistant Appropriate Barrier level for invasive and high fluid volume procedures

Sterile Field

Any sterile drape applied to a surface in a sterile manner and used to create and maintain a sterile field.

Creates a sterile barrier to help minimize or eliminate the passage of microorganisms from non-sterile to sterile areas. Used to create the sterile field encompassing patient, equipment and personnel.

Absorbent Fabric drapes to control fluid and provide barrier protection Sterile plastic equipment drapes that allow nonsterile items into the sterile field. Incise drapes for sterile surface

Barrier level Tear/puncture resistant. Low linting. Absorbent. Effective Adhesion to skin

Sterile Surface Incise drapes provide a sterile surface up to the wound edge.

Microbial barrier film that adheres to skin and wound edge helps reduce risk of wound contamination and bacterial migration

Incise drape to provide sterile surface

Adhesion to skin. Antimicrobial activity. Moisture vapor transmission rate.

Fluid Control

Collection and control of blood, body and irrigation fluids Control fluid strike-through by absorbing

Pouches collect fluids prevent run off and migration under drape reducing risk of wound contamination An absorbent drape with barrier performance greatly reduces risk of fluid strike-through

Pouches and absorbent fabric drapes collect and control fluids-helping to reduce OR personnel’s potential exposure to blood and body fluids.

Adhesion to skin/drapes Ability to collect fluids and maintain secure drape placement Ability to absorb fluid Provide high level barrier protection Prevent strike-through.

Equipment Draping

Sterile drape that allows non-sterile equipment into the sterile field and protects expensive equipment

Covers equipment that cannot be sterilized and is needed in the sterile field. Decreases potential of exposure between patients.

Usually a clear plastic drape to cover a variety of OR equipment and instrumentation Protect equipment

Tear resistant, conformable plastic Fits a variety of like equipment. Clear visual and operational access

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As discussed, drapes create an area of asepsis called the sterile field. The sterile field is created by placing sterile drapes in a specific manner and position, to maintain sterility. The basic principles of draping involve understanding and implementing aseptic practices. The following practices should be implemented when applying sterile drapes.3

Allow sufficient time and space so that drapes can be placed carefully, using proper aseptic technique. Handle drapes carefully and as little as possible. Rapid movement of draping materials creates air currents on which dust, lint and other particles can migrate. Carry the folded drape to the operative site. Then, carefully unfold the drape and place it in proper position. After a drape has been placed, it should not be moved. Shifting or moving a sterile drape may transfer bacteria from an unprepped area of the patient’s skin into the sterile surgical field. Hold sterile drapes above waist level until properly placed on the patient or object being draped. If the end of a drape falls below waist level, it should not be retrieved because the area below the waist is considered unsterile. Immediately discard any drape that becomes contaminated during draping without contaminating the gloves or other sterile items.

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 control at all times during placement and should use precise and direct motions. Draping is always done from a sterile area to an unsterile area by draping nearest first. The scrub nurse should never reach across an unsterile area to drape. When draping the opposite side of the OR bed, go around the bed to place the drape. Drape the incisional area first then the periphery to avoid contamination of the surgical site. Do not flip, fan or shake drapes. Shaking can cause uncontrolled motion of the drape which may cause it to come in contact with an unsterile surface or object. Use nonperforating towel clamps or devices to secure tubing and other items on the sterile field. When sterility of a drape is in question, consider it contaminated.3

Aseptic practice for draping

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Prior to opening, a sterile pack should be examined for shelf life, indicating a time interval for safe use. If the pack is torn or punctured, it should be discarded and replaced with an undamaged pack. If an unopened pack is accidently dropped and comes in contact with the floor, it too should be discarded. Sterile items are packaged so they can be delivered aseptically. Each package must be opened under strict aseptic technique, guaranteeing the sterility of the sterile field.15

The manner in which sterile drape packs are opened and delivered depends on the size of the pack and the type of packaging.

Large drape pack: A large drape pack may contain numerous draping components. The pack may be wrapped “envelope style” with disposable wrap material or in a peel-back package. Small drape pack: A small drape pack, wrapped “envelope style” can be held in one hand and the wrapper removed with the other hand. It can also be placed on a flat surface and opened there. Drapes contained in a peel-package: Grasp the two sides of the wrapper and peel back to expose the item.1

When opening a large sterile peel-back drape pack, the pack is placed in the center of the back table and the peel pack is opened by non-sterile personnel (circulator). The contents are contained in an inner wrap which serves as the back table cover (see Figure 5).16

When an “envelope style” wrap is opened by nonsterile personnel, the first fold of the wrap is opened away from the circulator, each side fold is opened and the last fold is opened toward the circulator.15 This technique allows the pack to be opened in a manner in which the hand and arm of do not extend over the sterile contents of the pack (see Figure 6).

Opening and delivering sterile drapes

Figure 5. Orthopedic Pack

Figure 6. Gown Pack Opened on Mayo Stand

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Prior to surgery, isolation drapes are used to isolate dirty areas of the body from the operative site. The groin and auxiliary region are examples of dirty or contaminated sites. Non sterile plastic drapes can be used for this purpose. Squaring off or modular draping has been a basic draping technique for many years. This technique incorporates the use of individual drapes to create the sterile field. Typically, modular draping of the patient begins with four smaller drapes, commonly called towel or utility drapes, which are used to square off the incision. When reusable drapes are used in procedures that require a high level of barrier protection, plastic draping materials should be incorporated to prevent strike-through. After squaring off, larger fabric drapes are used to complete the draping procedure. Two half sheets can be used; one drape covers the lower portion of the patient and another drapes the upper portion. A full sheet is unfolded to cover the patient. The edge of the full sheet is handed off to the circulating nurse and is anchored to IV poles, creating the anesthesia screen. Other draping components are often added to isolate, collect fluids, secure instruments or create a sterile surface.

The use of procedure or specialty sheets in patient draping is becoming more popular. An advantage of procedure sheet draping is providing coverage with a single drape sheet. Procedure sheets often address a specific procedure and accommodate a particular surgical position. They eliminate the need for multiple drapes, often incorporate pouches for fluid collection and disbursement, and may ultimately offer cost benefits (see Figure 7). Specialty sheets standardize the draping procedure; saving time during application and post operative clean up. Inventory may be reduced, as multiple drapes of varying size are needed in modular draping procedures. In most instances, the size and technique required to aseptically apply a procedure sheet requires two sterile staff members.

Basic procedures for patient draping

Figure 7. Knee Arthroscopy Procedure Sheet with Fluid Collection Pouch

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Aseptic Technique Methods and practices in surgery that prevent contamination with microorganisms.

Barrier Material

Material that minimizes or retards the penetration of microorganisms, particulates and fluids.

Exogenous Flora Flora acquired from a contaminated source, such as hands or environmental surfaces, and includes any type of bacteria that can live on the skin, including bacteria that are pathogenic. (Also known as transient flora).

Endogenous Flora Flora that resides on the patient’s own skin, is always present, can not be entirely removed from the surface of the skin and is the leading cause of surgical site infection. (Also known as resident flora).

Pathogen

A microorganism that causes disease.

Contaminated Refers to any surface, living or nonliving, which is known to harbor organisms.

Shelf Life The length of time a wrapped sterile package remains sterile while in storage.

Sterile Completely free of all living microorganisms, including spores.

Sterile Field An area that encompasses draped equipment, scrubbed personnel, and the draped patient.

Squaring Off Four towel drapes or utility drapes placed around the immediate surgical site.

Strike-through Penetration of microorganisms, particulates or fluids through a barrier material.

Critical Zone Area of a surgical drape where direct contact with blood or body fluids and other potentially infectious material (OPIM) is most likely to occur.

Surgical Site Infection

An infection that develops within 30 days of an operation or within one year if an implant was placed and the infection appears to be related to the surgery. (SSI)

Preventing infection is one of the health care professional’s primary goals for all surgical patients. Whether your healthcare facility uses reusable or single-use drapes, procedure sheets or separates, surgical drapes create and maintain the sterile field and serve as microbial barriers. Effective selection and use of surgical drapes is important in preventing disease transmission. Adhering to aseptic practices is fundamental in attaining optimum patient safety and welfare. Industry standards and recommendations have been developed to assist health care personnel in clinical decisions and provide key considerations in selecting and using surgical drapes. Surgical procedures require drape components that address specific needs. Knowing the basic principles of draping, understanding the attributes of draping materials and selecting drapes that provide the appropriate level of barrier protection contribute to positive surgical outcomes. Through this knowledge surgical team members can use surgical drapes more effectively, provide optimum quality care and reduce the risk of surgical site infections.

Conclusion

Glossary

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1. Fuller JR. Surgical Technology Principles and Practice,

3rd ed.; Philadelphia, PA: W.B Saunders; 1994: 53, 66-89,100-104, 671.

2. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis

WR. Guideline for prevention of surgical site infection, 1999. Infection Control and Hospital Epidemiology. 1999; 20(4): 247-250, 262, 266, 268.

3. Nicolette LH. Infection prevention and control in the

perioperative setting. Alexander’s Care of the Patient in Surgery, 10th ed.; JC Rothrock, Ed. St , MO: Mosby; 1995: 49-52, 87-93.

4. Anderson-Manz E., Laboe Edgar B. Examining

draping practices for cost-effectiveness. Surgical Services Management. 1998;4(8): 41-47.

5. Alexander, J.W., Aerni, S., and Plettner, J.P.

Development of Safe and Effective On-Minute Preoperative Skin Preparation. Arch Surg. 1985;120: 1357-1361.

6. Blom A.W., Gozzard C., Heal J., Bowker K., Estela C.M.

Bacterial strike-through of re-usable surgical drapes: the effect of different wetting agents. Journal of Hospital Infection. 2002;52(1): 52-55.

7. Association of periOperative Registered Nurses.

Recommended practices for selection and use of surgical gowns and drapes. Perioperative Standards and Recommended Practices. Denver, CO; AORN, Inc.; 2010: 119-123, 127-131.

8. Gardner D. Safekeeping. The role of drapes in infection

prevention. Managing Infection Control. November, 2004: 72-77.

9. Association for the Advancement of Medical 9. Instrumentation. Liquid Barrier Performance and

Classification of Protective Apparel and Drapes Intended for use in Health Care Facilities; ANCI/AAMI PB70. Arlington, VA: AAMI; 2003: 2-5.

10. American Society for Testing and Materials. ASTM D

1230 -94. Standard Test Method for Flammability of Apparel Textiles. West Conshohocken, PA; ASTM (reapproved 2001): 1-7.

11. Federal Register: 16 C.F.R. PART 1610 – Standard for

the Flammability of Clothing Textiles. 12. Emergency Care Research Institute. ECRI. New

clinical guide to surgical fire prevention [guidance article]. Health Devices 2009; October 38(10): 314-332.

13. American Association of Textile Chemists and

Colorists. Water Resistance: Impact Penetration Test. AATCC Test Method 42-2000. Research Triangle Park, NC: AATCC; 2000.

14. Association for the Advancement of Medical

Instrumentation. TIR11:2005: Selection and use of protective apparel and surgical drapes in health care facilities. Arlington, VA: AAMI: 2005: 19-22.

15. Fairchild SS. Perioperative Nursing Principles and

Practices, 2nd ed.; Miami Shores, FL: Little, Brown and Co.;1996: 153-159, 242.

16. Atkinson LJ., Kohn ML. Berry and Kohn’s Introduction

to Operating Room Technique, 6th ed.; New York, NY: McGraw Hill; 1986: 115-118,145-181.

References

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ANSWERS

1. B 2. A 3. A 4. B 5. B 6. A 7. A 8. B 9. B 10. A

Shawn Matalas, AAS, CVT is a Technical Service Representative with 3M Health Care’s Infection Prevention Division group. She is routinely involved in troubleshooting and addressing surgical draping questions. Shawn’s role at 3M includes providing education for customers and sales personnel and improving the performance and design of surgical drapes and implementing best practices.

Shawn Matalas, AAS, CVT

Infection Prevention Division 3M Health Care 3M Center, Building 275-4W-02 St. Paul, MN 55144-1000 1-800-228-3957 3M.com/InfectionPrevention