Draping, Gowning & Gloving APN Fung Man Yi OT,PMH

Objectives To understand the importance of draping, gowning and gloving in maintaining a sterile field.

Purpose To provide a barrier that prevents transfer of microorganisms to the surgical site. To protect the operator from exposure to patient’s blood and exudates during the procedure.

What’s draping? Draping is the procedure of covering the patient and surrounding areas with a sterile barrier to create and maintain an adequate sterile field.

How contamination occurs ? Microorganisms can be transferred through barrier materials by wicking of fluids (capillary action) strike-through mechanical actions such as pressure can result in both liquid and dry penetration of microbes if the pressure exceeds the max. level of resistance

Criteria for effective drape: Blood and fluid resistant to keep drapes dry and prevent migration of microorganism. Material should be impermeable to moist. Resistant to tear, puncture, or abrasion that cause fiber breakdown.

Criteria for effective drape: Line free to reduce airborne contaminants and shedding into the surgical site. Antistatic to eliminate risk of a spark from static electricity. (National Fire Protection Association)

Criteria to establish an effective barrier are: Sufficiently porous to eliminate heat buildup so as to maintain an iso-thermic environment for patient. Drapable to fit around contours of patient, furniture and equipment.

Dull to minimize colour distortion from reflected light. Free from toxic ingredients Flame-resistant to self-extinguish rapidly on removal of an ignition source.

Recommended Practices for selection and use of surgical gowns & drapes Surgical gowns and drapes should be evaluated a/c to the AORN recommended practices for product selection in perioperative settings Safe construction & meet identified needs and promote patient safety Reinforcement consists of additional layers of the same material or layers of different materials

Recommended Practices for selection and use of surgical gowns & drapes Material used for surgical gowns and drapes should be resistant to penetration by blood and other body fluids as necessitated by their intended use. - Manufacturers data verifying on materials used are protective barriers against the transfer of microorganism.

Recommended Practices for selection and use of surgical gowns & drapes Surgical gowns and drapes should maintain their integrity and be durable.( resistant to tears, punctures, and abrasion) Reusable materials should be inspected visually, small damage (hole) can be patched with heat-sealed patches of the same quality

Recommended Practices for selection and use of surgical gowns & drapes Materials used for surgical gowns and drapes should be appropriate to the method(s) of sterilization Steam/ EO/ Radiation Reusable materials lose their protective barrier quality after repeated processing  manufacturer’s instructions for handling and suggested no. of processing  tracking system.

Recommended Practices for selection and use of surgical gowns & drapes Surgical gowns and drapes should resist combustion With accepted flammability standards Care when exposed to light/heat source, electrosurgical devices, lasers and other power equipment

Recommended Practices for selection and use of surgical gowns & drapes Surgical gowns and drapes should be comfortable and contribute to maintaining the wearer’s desired body temperature Flexible to patient/worker’s contour Isothermic environment

Recommended Practices for selection and use of surgical gowns & drapes Surgical gowns and drapes selected for use should have a favorable cost-benefit ratio Policies and procedures for selecting and using surgical gowns and drapes should be developed

Drapes Material Category Material Reusable woven fabric Muslin Blended sheeting T280 barrier Polyester sheeting Disposable single-use non-woven fabric Non-woven material

Muslin 100% cotton Knitted Thread count per inch2 :140 Soft but extremely porous Permeable to fluid and bacteria when wet, abrade easily

Blended sheeting Polyester and cotton blended sheeting Knitted Thread count per inch2 :180 Similar to muslin but less pores Permeable to fluids

T280 barrier Tightly woven cotton polyester Fabric is treated with a water repellent chemical finish Thread count per inch2 :175-280 Improve liquid resistant and durability Light weight Resistant to liquid penetration diminishes with repeated wash cycle and sterilization process

Polyester sheeting Tightly woven fabric is made of continuous filament synthetic yarn Laminated, coats with various films or chemically finished Thread count per inch2 :280 or above Extends durability through multiple uses and increases protection against strike-through of liquid and micro-organisms. Least drape weight, antistatic and resistant to tears, allow vapor permeation Lose their barrier qualities after laundering and sterilizing 75 times

Disposable non-woven material Natural: wood, cotton Synthetic fibers: polyester, polyolefin, polypropylene, Bonds together chemically/mechanically Light weight, soft, drapable fits around contours of patient by adhesive tapes Less shedding lint, blood and fluid resistant or repellent, resistant to tears, punctures and abrasion, antistatic, flame retardant and maintain an isothermic envt.

Draping technique Sterile drape should be placed on the patient, the furniture, and equipment to be included in the sterile field. Sterile drapes should be handled as little as possible because the rapid movement creates air currents on dust, lint and droplet.

Draping technique Never reach across the operating table to drape the opposite side Carry folded drapes to the operating table. Watch the front of the sterile gown, it may bulge and touch the non-sterile items. Stand well back.

Draping technique Draping material should be compact, higher than the OR bed, and draped from the operative site to the periphery. During draping, sterile gloves should be protected by cuffing the draping material over the hands.

Draping technique Once the sterile drape is positioned, it should not be removed because shifting the drape can compromise the sterility of the field. If the drape contaminated, discard.

Draping technique If in doubt to sterility, consider it becomes contaminated. If unwanted substance present on the drape, remove it and cover the area with a new drape.

AORN Recommended Practice Gowning & Gloving Sterile gowns and gloves should be used within the sterile field. Materials for gowns should be selected. Surgical hand antisepsis/hand scrubs before donning sterile gown and gloves. The scrubbed persons should don a sterile gown and sterile gloves from a sterile field other than the main instrument table

AORN Recommended Practice Gowning & Gloving Scrubbed personnel should inspect gloves for integrity after donning Ensure donning of gown and gloves are completed before entering the sterile field Sterile gowns should be considered sterile in front from the chest to the level of the sterile field, and the sleeves should be considered sterile from two inches above the elbow to the cuff.

The area of sterility in the front of the gown extends to the level of the sterile field because most scrubbed personnel work adjacent to a sterile table. As the arms of a scrubbed person must move across the sterile field, gown sleeves up to two inches above the elbow must remain sterile. The neckline, shoulders, under the arms, the cuffed portion of the sleeves, and the back are areas of friction. Thus, they are not considered effective microbial barriers. For the areas that cannot be constant observation, are considered contaminated.

Once the original gloves are donned, the gown cuff should be considered contaminated. Change into a new set of gloves and/or gown when contamination or breaks in integrity of the gown and gloves occurs.

Option to put on the sterile exam. gloves

Grasp gown at the neckline, unfold, slip hands into open armholes

Hands not extended from the sleeves

Hand advanced only to the edge of the cuff

Put the glove in place and then pull the sleeve to protrude hands out of cuff

Inspect after gloving

Open method of gloving Potential for aseptic breaks Difficult not to touch any part of the skin to the sterile glove exterior Use for many minor procedures in emergency department Use for change of new gloves during operation

Assisted method To glove the surgeon by scrub person to spread the glove apart widely and circumferentially, the surgeon slip his hand into the inside of the glove.

Various types of sterile gloves With powder and Latex Latex free Powder free

Discussion 1. Benefits of double gloving

Discussion 2. Disposable Vs reusable drape & gown

Disposable Vs reusable Pros of Disposable: Consistent quality (bursting and tensile strength) Fluid repellent Resistance to wet and dry microbial penetration Cons of Disposable: Lack of comfort Waste, irrespective of the disposal method, has the potential to pollute land, air and water ?$$

Disposable Vs reusable Pros of Reusable: More comfortable More adaptable Less harm to environment Cons of Reusable: Lack of consistent quality Not always fluid repellent (cloth & linen material have a shelf life, e.g. 50uses) ?$$

Consideration of using disposable/reusable Best practice & standard requirement Total cost of purchase includes transport, storage, waste disposal, decontamination processes and replacement Environmental costs

References Hopper W R., Moss R. Common Breaks in Sterile technique: Clinical Perspectives and Perioperative Implications. AORN. 2010; 91(3): 356-363. Diane G. Considerations for Gown and Drape Selection in the United Kingdom. AORN. 2010;92(4): 461-465. Mcdougall C. Maintaining Asepsis: Preventing Infection of the Surgical Site. Minor Surgical Procedure for Nurses and Allied Healthcare Professionals. 2007;113-129. Recommended Practices for Selection and use of surgical gowns and drapes. Perioperative standards and Recommended Practice. Denver, CO: AORN, Inc; 2010:127-131. Recommended Practices for Maintaining a Sterile Field. AORN Recommended practice Committee. 2006; 83(2): 402-416.

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