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The Critical Cover-Up

Tue, 03/20/2007 - 12:35pm
OrthoMax Orthopedic Drapes from Medline Industries are made with DuPont™ Suprel™ medical fabric to withstand rigorous orthopedic surgical procedures.
Draping a patient prior to surgery can be as critical a safety step as prepping the surgical site itself. And, like surgical procedures themselves, no two draping strategies are going to be exactly the same. Each procedure and each patient can present its own unique challenges in finding the optimal draping solutions to protect against surgical site infection and exposure to fluid and other contaminants.

Surgeons and OR staff are fortunate in one respect, though; there are a multitude of different surgical drapes on the market to choose from. With the variety of sizes, configurations and safety features being provided by a vast number of surgical drape manufacturers and marketers, the options are there to find a safe and effective draping strategy for every patient and procedure.

3M Health Care (St. Paul, MN) has called on its expertise in adhesives, coatings, film and non-woven technologies to engineer and offer a comprehensive drape line that include fabric, clear and antimicrobial incise drapes, as well as clear plastic drapes. The company provides a wide range of drape components specific to certain procedures including Orthopedic, Cardiovascular/Cardiac Catheterization, Obstetrics and Gynecology, EENT, Urology, Neurology and General Surgery. They also offer one piece procedural sheets, equipment drapes, fluid collection pouches and drape/sheeting accessories to complement any and all draping needs. All 3M drapes meet and exceed industry guidelines and standards.

While a majority of Cardinal Health’s surgical drapes are designed for specific surgeries, many offer the flexibility to be used in multiple procedures.
3M effectively pioneered the concept of incise and antimicrobial incise drapes over twenty-five years ago and has been building on that technology ever since. 3M incise drapes adhere to the skin to create a sterile operative surface, act as a barrier to block skin flora from migrating to the incision and help reduce the risk of wound contamination.

For additional safety, many 3M drapes are treated with the 3M™ Ioban™ 2 Antimicrobial Incise Film, which provides continuous, broad-spectrum, antimicrobial activity that is impregnated in the drape adhesive where it can’t be washed away. The active ingredient in Ioban 2 film is molecular iodine (I2), which is commonly used as an antiseptic and is well-established as an effective broad-spectrum, persistent antimicrobial agent. The I2 is formulated into the Ioban 2 film adhesive, which is in direct contact with the patient’s skin, at a concentration of two percent. In addition to providing continuous antimicrobial activity, the superior adhesive technology of the film allows the drape to adhere better to the skin than other incise drapes.

Recognizing that the risk of infection increases when strike-through occurs anywhere within the sterile field and not just in the traditional critical zone, 3M also offers their Absorbent Prevention Fabric drapes constructed of an absorbent fabric that is resistant to strike-through throughout the drape. This unique property qualifies the entire 3M drape as level 4 barrier performance throughout the fabric. As a result, use Absorbent Prevention Fabric drapes eliminates the need to layer additional fabric drapes. These drapes provide an effective barrier against transmission of microorganisms to help protect the patient from post-operative wound infections while helping to absorb irrigation and body fluids, minimizing spills and splatters onto the OR floor to reduce the risk of slipping and increase staff safety. 3M fluid control and collection pouches provide additional patient and staff protection by channeling and collecting body and irrigation fluids.

The X-Drape® from AADCO Medical is a disposable product that provides protection from scattered radiation associated with X-ray Fluoroscopy.
To help customers ensure they are meeting all of their safety needs, 3M offers many different sources of drape education including drape in-services, written literature, step-by-step application photos and drape application DVDs. The company also makes available their Sales Representatives Asepsis/Infection Prevention Specialists, and OR experienced Technical Service personnel for on-site personnel training.

Microtek Medical, Inc. (Columbus, MS) offers draping products for practically any procedure performed in every clinical environment across the spectrum of health care and has developed a number of innovative specialty products to address the needs of specific procedures and safety concerns. Whether for Interventional Radiology or Cardiology, Urology, Obstetrics-Gynecology, Orthopedic, Neurosurgery, Ophthalmic, ENT, CVOR or General Purpose Surgery, Microtek offers a wide variety of drapes that are both procedure specific and designed exclusively with the intent of reducing risk both for patient and medical professionals.

The Microtek range of specialty draping products includes such innovations as PerfectPouch, which features a unique pouch with an inflated rim to more efficiently collect fluids, minimizing the spread of infectious fluids and cross-contamination for patients and professionals. Another beneficial safety feature is the RADBarrier, which reduces scatter radiation to protect not only the patients but also to reduce exposure for surgeons and staff during fluoroscopically-guided procedures. These features and others allow Microtek’s specialty drapes to assist in protecting the entire clinical environment, including valuable equipment which can ultimately be yet another source of contamination.

Precept Medical Products offers a wide variety of standard surgical drapes and drapes for specific procedures.
Another innovative Microtek draping product is the Drape’N Dress feature, which delivers a procedure specific sterile wound dressing on the surface of the surgical patient drape near the procedure site. This allows for instant access to just the right wound dressing for immediate sterile application when a procedure is completed. Since the dressing can be applied before removing the procedure drape, risk of exposure to infection is reduced while speed and efficiency are increased.

Microtek also offers assistance to hospitals with regards to the proper and safe use of draping products. Based on the understanding that no surgical drape is effective unless used properly, the company offers comprehensive customer support and a highly trained staff to help ensure proper use of every draping solution.

Precept Medical Products, Inc. (Arden, NC) offers a wide array of surgical drapes, from standard drape sheets (such as a small fenestrated drape sheet or a three quarter drape sheet) that can be used in a number of different procedures, to drapes for specific procedures such as laparotomies and Caesarean sections. Their main categories of drapes include General Surgery, Cystoscopy, Peri/GYN, Obstetrics, Orthopedics, EENT, Cardiovascular and Angiography. The drapes can be ordered separately or as part of a prepared procedure pack.

In addition to the broad selection of drape configurations, Precept offers drapes made from its UltraGard™ SMS material, which is a multi-layer material that incorporates a spunbond outer layer with inner layers of meltblown fibers. The outer layers provide strength and durability while the inner layers enhance barrier properties and breathability. The fabric is also treated to help prevent the transmission of fluids and microorganisms. The UltraGard SMS drape fabric also exhibits high tensile strength and tear resistant properties to help prevent the fabric from ripping and tearing during a procedure and exposing the patient to contaminants.

In addition to providing individual drapes and drape accessories, Precept also provides packs that include the drapes, accessories and surgical gowns necessary to complete a procedure. The company also works with custom procedure tray companies to help hospitals and surgery centers streamline packs to fit their specific procedures.

AADCO Medical, Inc. (Randolph, VT) specializes in drapes that incorporate X-ray shielding into their design to protect the physician, staff and operators from radiation when surgical procedures require the use of X-ray Fluoroscopy.

The 3M™ Ioban™ 2 Antimicrobial Incise Drape provides continuous, broad-spectrum antimicrobial activity.
The X-Drape®, which is provided sterilized and ready to use, is a disposable product that provides protection from scattered radiation associated with X-ray Fluoroscopy. To achieve this, the drape is constructed with AADCO’s proprietary composite radiation absorbing material, X-Ban®. The outer medical fabric material covering is a DuPont Advanced Composite Technology (ACT) product. The drapes can be used for a broad range of procedures involving fluoroscopy and is specifically designed to be positioned on the patient to minimize scatter radiation throughout the operative field.

The lead-free X-Drape is manufactured in special designs to fit any application. Measuring 12 inches by 17 inches it is intended to be positioned on the patient over the preferred draping material normally used to protect the patient and staff from bacteria and infections. Once the primary drapes are in position, the X-Drape is placed over the drapes and safeguards the staff from radiation through attenuation, or its ability to absorb the scatter radiation emanating from the patient.

While the X-Drape itself is an important safety innovations, there are techniques that can be used by physicians to adjust where they position the X-Drape, the Image Intensifier and themselves to reduce radiation exposure. A dosimeter that checks the radiation can be used during a procedure to immediately give feedback in order to make safe adjustments.

Cardinal Health (Dublin, OH) offers an impressive surgical drape portfolio that extends across all surgical specialties, including a specialized line of premium orthopedic drapes with enhanced strength properties. The drapes are available with a variety of innovative features including cord control features, fluid control pouches, instrument pouches and reinforcements specific to the key clinical requirements for associated surgical procedures. Each surgical drape is clearly marked with directions on how to orient the drapes and unfold them when they are placed on the patient to ensure proper coverage and maximum safety. All of the drapes are disposable and designed for single-use only.

While a majority of Cardinal’s drapes are designed to meet the clinical needs and requirements for specific procedures, many drapes also offer the flexibility to be used in multiple procedures. Their standard spine drape, for instance, is often used for lap/chole procedures when clinicians are looking for a slightly larger fenestration. The bariatric drape can also be used for lap/chole or endoscopy procedures for facilities that are looking to rationalize SKUs.

According to the CDC’s 1999 Guidelines for the Prevention of Surgical Site Infection, surgical drapes should be impervious to both blood and viral penetration. As a result, most standard surgical drapes feature an impervious reinforcement immediately surrounding the incision site. Cardinal’s Tiburon® Surgical Drapes go a step farther. They are made with a composite material that extends that same level of impervious protection throughout the entire drape. While most surgical drapes meet AAMI Level 4 requirements because they are impervious within the critical zone, being fully impervious, Tiburon meets AAMI Level 4 requirements throughout the entire drape, not just within the critical zone. The benefit of a fully impervious drape fabric is the elimination of the risk for strikethrough to occur.

The Tiburon drape is also absorbent for enhanced fluid control. This added absorbency improves control and containment of fluids that would typically either pool on the drape or run off onto the floor. In addition, Tiburon is made of synthetic materials that are very low-linting as well as flame-resistant and will melt away versus ignite when in contact with a heat source.

Medline Industries, Inc. (Mundelein, IL) markets the broad range of Proxima brand surgical drapes and supports several fabric technologies, allowing customers a wide variety of choices when it comes to draping their individual surgical cases. While offering some general purpose drapes, a majority of the drapes in the Proxima family are designed for a specific surgical specialty. This allows for better functionality for the cases and a better overall sterile field.

Medline’s drapes provide several features designed to make the drapes more functional. The overall drape sizing is larger to create a better field, and they utilize optimally large absorbent pads that exceed the AAMI Level 4 requirements. The drapes are also equipped with high quality surgical tapes and incise films and have Velcro-style lineholders on all of the Proxima key sheets to better placate lines and tubing.

In addition, Medline offers large impervious “soakers” to maintain fluids and thereby reduce the risk of cross-contamination. The company also use one to two inches of surgical tape on all of their draping products to create superior adhesion, which keeps the surgical field isolated from the unprepped part of the patient. The tape is positioned flush to the fenestrated site to eliminate pooling of blood and body fluids which can potentially delaminate those tapes and increase the risk of infection.

Surgical drapes play an important role in the infection prevention process to reduce the risk of surgical site infections in the OR. As a result, it is important to consider the unique needs of each surgical case in order to determine the best drapes and to utilize. Choosing appropriate products made of the appropriate materials can help to provide optimum patient protection, streamline procedures and reduce cost. Not all drapes are created equal, but fortunately there is a vast pool of possibilities to draw from.
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