1. SUR 111 Lecture 5

2. Today’s Topics  Supplies  Sterile Packs  Establishing the Sterile Field  Opening the Sterile Field

3. Supplies  Any sterile or non-sterile items such as drapes, drains, dressings, casting materials, tape, etc.

4. Drapes  Used to isolate and protect operative site from contamination that could create an SSI  Barrier for preventing migration of microorganisms from non-sterile to sterile areas

5. Drape Materials  Woven textile fabrics  Non-woven textile fabrics  Plastic Adhesive Drapes

6. Drape Materials  Woven textile fabrics  Nondisposable  Treated to prevent fluids from penetrating  Must be laundered, inspected thoroughly, folded, and sterilized

7. Drape Materials  Nonwoven textile fabrics  Disposable  Made of cellulose bonded polyester or nylon  Aluminum coated preferred for laser cases as they are flame retardant  Light, disposable, come in a variety of styles

8. Drape Materials  Plastic Adhesive Drapes  Incise drapes  Thin, clear, adhesive back  May be impregnated with antimicrobial iodine agent (IOBAN)  Customary to towel out surgical site prior to applying  Skin should be dry prior to application  Aperture drapes  Small, clear, with an opening  Small and large styles  Small common with eye procedures  Large used with lower extremity fractures

9. Drape Types  Fenestrated  Have an opening to expose the surgical site  Non-fenestrated  No opening are flat or solid sheets  Various sizes: Minor, medium, large drape, three quarter reinforced  Also refers to custom made drapes, such as leggings made for lithotomy position  Stockinettes  Stretchable tubes with an opening for an extremity  Come impervious and non-impervious

10. Sterile Packs  Basic Packs  Drape  Gown/towel  Mayo stand cover  Suture bag  Four sticky towel drapes  Specialty or Custom Packs  Basic pack items plus specialty drapes for specific procedures  Also specialty supply items intended for specific procedures

11. Sterile Packs  Basin Packs  Minor basin pack  Kidney basin, medicine cups, bowls, needle board, raytex, cautery pencil, suction  Major basin pack  Same as minor basin with addition of nested large bowls x 2, larger bowl, cytal, laparotomy sponges  Basin packs may be seen wrapped in a large back table drape or individually wrapped for placement on a ring stand  These vary by manufacturer and can be built by institutions consulting with a specific manufacturer to create what they want

12. Establishing the Sterile Field and Opening Sterile Supplies

13. Daily Routines  Before the first case of the day the following must be performed:  Remove unwanted furniture.  Disinfect all horizontal surfaces. (Furniture and Equipment)  Mop floor with disinfectant solution.

14. Furniture Setup  Arrange for ease, use, and sterile technique.  Make sure all needed furniture is in the room.  Remove any unnecessary furniture.  Position all furniture furthest from the door.  Tables should be at least 18 inches from the wall and away from traffic patterns.  Position OR table under OR lights.  Anesthesia machine is placed at the head of the bed.  Position laundry hampers and trash receptacles at a safe distance from your working area.  Use a sterile drape or procedure pack to create a sterile field on your back table.  Basin sets should be place in a ring stand.

15. Furniture Setup Continued….  Wrapped or instrument containers should be placed on a clean, flat, and dry surface for opening.  Check preference card for any missing items. ( Basic and Emergent supplies)  All electrical equipment should be checked and placed in appropriate position.

16. Establishing the Sterile Field  Created after morning routine and Setup is complete.  Before the tech scrubs, open the necessary supplies.  Start with the back table first, then to the ring stand and then mayo stand if any items are placed on the mayo for opening (i.e. gown).  Check all indicators and packaging to ensure package integrity before opening.  Make sure you have your mask on…Duh!

17. Opening Sterile Supplies  Sterile supplies may be opened after the sterile field is created.  Check indicators and package integrity.  Never remove tape from wrappers, BREAK the seal of the tape to prevent tearing and exposure of items inside.

18. Opening a Back Table Pack  Remove dust cover.  Position pack in center of back table.  Locate seal that states front and orient accordingly.  Break seal and unwrap flaps towards end of tables touching outside of drape.( Light Blue portion)  Move to one end of back table and grasp outside folds on the end of drape. With both hands grasping drape, unfold to the right and left of the back table.  Be sure that you do not touch the inside with your hands or body.  Maintain 18 inch distance and move the other side and repeat.  Tuck the corners of the drape inside the legs of the table to prevent the excess drape from contaminating other fields.

19. Opening Peel Packs  Check the package for integrity. ( Single peel pack especially)  Check indicators.  Grasp edges at one end of the wrapper and peel back paper and clear plastic side at the top portion of wrapper.  At ½ to ¾ of the way down, toss the items onto the sterile field.  Make sure that you do not touch the inside of the wrappers with fingers or hands.  Be aware of how close you are to the sterile field when you “toss” the items onto the sterile field. (18 inches away for any sterile field)

20. Opening Envelope Style Packages  Check package integrity.  Check indicator for exposure.  Grasp bottom of package while breaking seal with other hand.  Step one: Pull the end of the wrapper that is facing you away from your body and over the back of your hand. Grasp the end of the wrapper in your ”holding hand”.  Step two: Move your hand under your “holding hand” And grasp the right side of the wrapper and pull it down to your “hold hand”. Grasp that end of the wrapper with your “holding Hand”.  Step three: Move your hand and grasp the left side and repeat second half of step two.  Step four: Grasp the last end of the wrapper and repeat as in step one.

21. Opening Envelope Style Wrapper  Do not touch the inside of the package once it is opened and take care while opening not to touch the inside wrapper and it’s contents.  Toss the opened item onto the sterile field maintaining an 18 inch distance.  Be careful not to toss and pierce the back table drape.  When passing a unwrapped item to a scrubbed person, stay as far away as possible from them and both should do an indicator check.  NEVER reach over a sterile field.  Never extend your arms over a sterile field if unscrubbed and sterile.

22. Instrument sets  Should be opened on clean, dry, flat surface.  Open in accordance to Envelope style wrapping using the holding technique or surface technique.  Containers:  Check integrity.  Check external chemical indicators.  Remove clips or break retaining clips/locks.  Lift clasp and remove lid.  Lift the lid up 12-16 inches and step away from the container.  Check internal chemical indicators.  BOOK!