SUR 111 Lecture 5SUR 111 Lecture 5

Today’s TopicsToday’s Topics

SuppliesSupplies Sterile PacksSterile Packs Establishing the Sterile FieldEstablishing the Sterile Field Opening the Sterile FieldOpening the Sterile Field

SuppliesSupplies

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

DrapesDrapes

Used to isolate and protect operative site Used to isolate and protect operative site from contamination that could create an from contamination that could create an SSISSI

Barrier for preventing migration of Barrier for preventing migration of microorganisms from non-sterile to sterile microorganisms from non-sterile to sterile areasareas

Drape MaterialsDrape Materials

Woven textile fabricsWoven textile fabrics Non-woven textile fabricsNon-woven textile fabrics Plastic Adhesive DrapesPlastic Adhesive Drapes

Drape MaterialsDrape Materials

Woven textile fabricsWoven textile fabricsNondisposable Nondisposable Treated to prevent fluids from penetratingTreated to prevent fluids from penetratingMust be laundered, inspected thoroughly, Must be laundered, inspected thoroughly,

folded, and sterilizedfolded, and sterilized

Drape MaterialsDrape Materials

Nonwoven textile fabricsNonwoven textile fabricsDisposableDisposableMade of cellulose bonded polyester or nylonMade of cellulose bonded polyester or nylonAluminum coated preferred for laser cases as Aluminum coated preferred for laser cases as

they are flame retardant they are flame retardant Light, disposable, come in a variety of stylesLight, disposable, come in a variety of styles

Drape MaterialsDrape Materials

Plastic Adhesive DrapesPlastic Adhesive Drapes Incise drapesIncise drapes

Thin, clear, adhesive backThin, clear, adhesive backMay be impregnated with antimicrobial iodine agent (IOBAN)May be impregnated with antimicrobial iodine agent (IOBAN)Customary to towel out surgical site prior to applyingCustomary to towel out surgical site prior to applyingSkin should be dry prior to applicationSkin should be dry prior to application

Aperture drapesAperture drapesSmall, clear, with an openingSmall, clear, with an openingSmall and large stylesSmall and large stylesSmall common with eye proceduresSmall common with eye proceduresLarge used with lower extremity fracturesLarge used with lower extremity fractures

Drape TypesDrape Types

FenestratedFenestrated Have an opening to expose the surgical siteHave an opening to expose the surgical site

Non-fenestratedNon-fenestrated No opening are flat or solid sheetsNo opening are flat or solid sheets Various sizes: Minor, medium, large drape, three Various sizes: Minor, medium, large drape, three

quarter reinforcedquarter reinforced Also refers to custom made drapes, such as leggings Also refers to custom made drapes, such as leggings

made for lithotomy positionmade for lithotomy position StockinettesStockinettes

Stretchable tubes with an opening for an extremityStretchable tubes with an opening for an extremity Come impervious and non-imperviousCome impervious and non-impervious

Sterile PacksSterile Packs

Basic PacksBasic Packs DrapeDrape Gown/towelGown/towel Mayo stand coverMayo stand cover Suture bagSuture bag Four sticky towel Four sticky towel

drapesdrapes

Specialty or Custom Specialty or Custom PacksPacks Basic pack items plus Basic pack items plus

specialty drapes for specialty drapes for specific proceduresspecific procedures

Also specialty supply Also specialty supply items intended for items intended for specific proceduresspecific procedures

Sterile PacksSterile Packs

Basin Packs Basin Packs Minor basin packMinor basin pack

Kidney basin, medicine cups, bowls, needle board, raytex, Kidney basin, medicine cups, bowls, needle board, raytex, cautery pencil, suctioncautery pencil, suction

Major basin packMajor basin pack Same as minor basin with addition of nested large bowls x 2, Same as minor basin with addition of nested large bowls x 2,

larger bowl, cytal, laparotomy spongeslarger bowl, cytal, laparotomy sponges

Basin packs may be seen wrapped in a large Basin packs may be seen wrapped in a large back table drape or individually wrapped for back table drape or individually wrapped for placement on a ring standplacement on a ring stand

These vary by manufacturer and can be built by These vary by manufacturer and can be built by institutions consulting with a specific institutions consulting with a specific manufacturer to create what they wantmanufacturer to create what they want

Establishing the Sterile Field and Establishing the Sterile Field and Opening Sterile SuppliesOpening Sterile Supplies

Daily RoutinesDaily Routines

Before the first case of the day the Before the first case of the day the following must be performed:following must be performed:

Remove unwanted furniture.Remove unwanted furniture. Disinfect all horizontal surfaces. (Furniture Disinfect all horizontal surfaces. (Furniture

and Equipment)and Equipment) Mop floor with disinfectant solution.Mop floor with disinfectant solution.

Furniture SetupFurniture Setup

Arrange for ease, use, and sterile technique.Arrange for ease, use, and sterile technique. Make sure all needed furniture is in the room.Make sure all needed furniture is in the room. Remove any unnecessary furniture.Remove any unnecessary furniture. Position all furniture furthest from the door.Position all furniture furthest from the door. Tables should be at least 18 inches from the wall and away Tables should be at least 18 inches from the wall and away

from traffic patterns.from traffic patterns. Position OR table under OR lights.Position OR table under OR lights. Anesthesia machine is placed at the head of the bed.Anesthesia machine is placed at the head of the bed. Position laundry hampers and trash receptacles at a safe Position laundry hampers and trash receptacles at a safe

distance from your working area.distance from your working area. Use a sterile drape or procedure pack to create a sterile field Use a sterile drape or procedure pack to create a sterile field

on your back table.on your back table. Basin sets should be place in a ring stand.Basin sets should be place in a ring stand.

Furniture Setup Continued….Furniture Setup Continued….

Wrapped or instrument containers should Wrapped or instrument containers should be placed on a clean, flat, and dry surface be placed on a clean, flat, and dry surface for opening.for opening.

Check preference card for any missing Check preference card for any missing items. ( Basic and Emergent supplies)items. ( Basic and Emergent supplies)

All electrical equipment should be All electrical equipment should be checked and placed in appropriate checked and placed in appropriate position.position.

Establishing the Sterile FieldEstablishing the Sterile Field

Created after morning routine and Setup is Created after morning routine and Setup is complete.complete.

Before the tech scrubs, open the necessary Before the tech scrubs, open the necessary supplies.supplies.

Start with the back table first, then to the ring Start with the back table first, then to the ring stand and then mayo stand if any items are stand and then mayo stand if any items are placed on the mayo for opening (i.e. gown).placed on the mayo for opening (i.e. gown).

Check all indicators and packaging to ensure Check all indicators and packaging to ensure package integrity before opening.package integrity before opening.

Make sure you have your mask on…Duh!Make sure you have your mask on…Duh!

Opening Sterile SuppliesOpening Sterile Supplies

Sterile supplies may be opened after the Sterile supplies may be opened after the sterile field is created.sterile field is created.

Check indicators and package integrity.Check indicators and package integrity. Never remove tape from wrappers, Never remove tape from wrappers,

BREAK the seal of the tape to prevent BREAK the seal of the tape to prevent tearing and exposure of items inside.tearing and exposure of items inside.

Opening a Back Table PackOpening a Back Table Pack Remove dust cover.Remove dust cover. Position pack in center of back table.Position pack in center of back table. Locate seal that states front and orient accordingly.Locate seal that states front and orient accordingly. Break seal and unwrap flaps towards end of tables touching outside Break seal and unwrap flaps towards end of tables touching outside

of drape.( Light Blue portion)of drape.( Light Blue portion) Move to one end of back table and grasp outside folds on the end of 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 drape. With both hands grasping drape, unfold to the right and left of the back table.the back table.

Be sure that you do not touch the inside with your hands or body.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.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 Tuck the corners of the drape inside the legs of the table to prevent

the excess drape from contaminating other fields.the excess drape from contaminating other fields.

Opening Peel PacksOpening Peel Packs

Check the package for integrity. ( Single peel pack Check the package for integrity. ( Single peel pack especially)especially)

Check indicators.Check indicators. Grasp edges at one end of the wrapper and peel back Grasp edges at one end of the wrapper and peel back

paper and clear plastic side at the top portion of wrapper.paper and clear plastic side at the top portion of wrapper. At ½ to ¾ of the way down, toss the items onto the At ½ to ¾ of the way down, toss the items onto the

sterile field.sterile field. Make sure that you do not touch the inside of the Make sure that you do not touch the inside of the

wrappers with fingers or hands.wrappers with fingers or hands. Be aware of how close you are to the sterile field when Be aware of how close you are to the sterile field when

you “toss” the items onto the sterile field. (18 inches you “toss” the items onto the sterile field. (18 inches away for any sterile field)away for any sterile field)

Opening Envelope Style Opening Envelope Style PackagesPackages

Check package integrity.Check package integrity. Check indicator for exposure.Check indicator for exposure. Grasp bottom of package while breaking seal with other hand.Grasp bottom of package while breaking seal with other hand. Step one: Pull the end of the wrapper that is facing you away from 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 your body and over the back of your hand. Grasp the end of the wrapper in your ”holding hand”.wrapper in your ”holding hand”.

Step two: Move your hand under your “holding hand” And grasp the 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 right side of the wrapper and pull it down to your “hold hand”. Grasp that end of the wrapper with your “holding Hand”.that end of the wrapper with your “holding Hand”.

Step three: Move your hand and grasp the left side and repeat Step three: Move your hand and grasp the left side and repeat second half of step two.second half of step two.

Step four: Grasp the last end of the wrapper and repeat as in step Step four: Grasp the last end of the wrapper and repeat as in step one.one.

Opening Envelope Style Opening Envelope Style WrapperWrapper

Do not touch the inside of the package once it is opened Do not touch the inside of the package once it is opened and take care while opening not to touch the inside and take care while opening not to touch the inside wrapper and it’s contents.wrapper and it’s contents.

Toss the opened item onto the sterile field maintaining Toss the opened item onto the sterile field maintaining an 18 inch distance.an 18 inch distance.

Be careful not to toss and pierce the back table drape.Be careful not to toss and pierce the back table drape. When passing a unwrapped item to a scrubbed person, When passing a unwrapped item to a scrubbed person,

stay as far away as possible from them and both should stay as far away as possible from them and both should do an indicator check.do an indicator check.

NEVER reach over a sterile field.NEVER reach over a sterile field. Never extend your arms over a sterile field if unscrubbed Never extend your arms over a sterile field if unscrubbed

and sterile.and sterile.

Instrument setsInstrument sets

Should be opened on clean, dry, flat surface.Should be opened on clean, dry, flat surface. Open in accordance to Envelope style wrapping using the Open in accordance to Envelope style wrapping using the

holding technique or surface technique.holding technique or surface technique. Containers:Containers: Check integrity.Check integrity. Check external chemical indicators.Check external chemical indicators. Remove clips or break retaining clips/locks.Remove clips or break retaining clips/locks. Lift clasp and remove lid.Lift clasp and remove lid. Lift the lid up 12-16 inches and step away from the container.Lift the lid up 12-16 inches and step away from the container. Check internal chemical indicators. Check internal chemical indicators. BOOK!BOOK!