Sterile draping involves placing sterile sheets around a patient to isolate the surgical area. This process creates an aseptic barrier between non-sterile surfaces, such as the patient’s skin and the operating table, and the surgical site itself. The fundamental purpose of this technique is to prevent microorganisms from migrating into the surgical wound, thereby reducing the risk of surgical site infections (SSIs). The application of sterile drapes is a precise procedure performed by trained professionals to ensure the integrity of the sterile field. The meticulous order and technique of draping directly influence patient safety and surgical outcomes.
Establishing the Sterile Field
The process of sterile draping is preceded by preparatory steps designed to minimize the microbial load in the surgical environment. Before any sterile supplies are opened, the surgical team must perform rigorous hand hygiene, such as a surgical scrub or an approved antiseptic hand rub. This step significantly reduces the transient and resident flora on the hands and forearms of personnel handling the sterile equipment.
Next, the patient’s intended operative site undergoes thorough preparation with an antiseptic solution, such as chlorhexidine or povidone-iodine. This skin prep is applied to the incision area and surrounding tissue, then allowed to air dry completely to maximize its antimicrobial effect. The person responsible for draping must then be correctly attired in a sterile gown and gloves. Finally, the sterile drape package is opened onto a clean, dry surface, ensuring the contents are presented without contamination and are ready for application.
The Standard Sequence for Applying Drapes
The sequence for applying drapes is designed to progressively cover non-sterile areas, moving from the smallest, most controlled area outward to the largest field. The first materials applied are typically four sterile towels used to “square off” the perimeter of the incision site. These towels are placed immediately adjacent to the prepared skin, establishing the precise boundaries of the sterile surgical field.
The first towel is usually placed on the side closest to the person performing the draping, with the folded edge toward the incision line. Subsequent towels follow, placed on the opposite side, then the foot and head ends of the incision, often secured with towel clips or adhesive strips. Following the towels, a sterile under or bottom sheet is placed to cover the area toward the patient’s feet, extending the sterile field below the operative site.
A sterile top or outer sheet is then placed toward the patient’s head, covering the anesthesia screen and the upper part of the patient’s body. The final drape applied is the fenestrated drape, which is a large sheet featuring a pre-cut opening designed to fit precisely over the squared-off incision site. This aperture isolates the operative area while covering the remaining expanse of the patient. This final layer often includes fluid collection pouches to help manage surgical irrigation and blood loss.
Essential Rules for Maintaining Aseptic Technique
Maintaining an aseptic technique during the application of drapes is just as important as the order of placement itself. The person applying the drapes must protect their sterile gloves by using the “cuffing” principle. This involves folding the edges of the drape over the hands as they are placed, preventing the gloved hand from touching the patient’s non-sterile skin or the operating table as the drape is unfurled.
Drapes must be handled gently, without shaking or flapping, because rapid movement can create air currents that carry airborne contaminants onto the sterile field. Once a drape has been placed on the patient, it can never be repositioned toward the incision site, even if incorrectly placed, as the underside is immediately considered non-sterile upon contact with the skin. If a drape needs adjustment, it can only be moved away from the incision, and a contaminated drape must be covered with a fresh, sterile one. All sterile items, including the drapes, must be kept above waist level, as anything below that level is considered non-sterile.
Safe Handling and Disposal Post-Procedure
Once the surgical procedure is complete, the removal and disposal of the drapes must be managed carefully to contain biohazardous materials and prevent contamination. Before the drapes are removed, the surgical wound is typically dressed with a sterile covering. This protects the incision from any contaminants that might be released during the removal process.
The drapes must be removed by rolling them inward, away from the patient, to contain all soiled surfaces and fluid contamination within the bundle. This technique ensures that the contaminated exterior does not contact other surfaces or personnel. All sharps, such as towel clips and instruments, must be accounted for and removed from the drapes before disposal to prevent needlestick injuries. The contaminated drapes are then placed into designated biohazard receptacles, following specific facility protocols for infectious waste.