SUR 111 Lecture 5

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SUR 111 Lecture 5
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Todays Topics

• Supplies
• Sterile Packs
• Establishing the Sterile Field
• Opening the Sterile Field

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Supplies

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

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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

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Drape Materials

• Woven textile fabrics
• Non-woven textile fabrics
• Plastic Adhesive Drapes

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Drape Materials

• Woven textile fabrics
• Nondisposable
• Treated to prevent fluids from penetrating
• Must be laundered, inspected thoroughly, folded,
  and sterilized

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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

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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

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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

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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

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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

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Establishing the Sterile Field and Opening
Sterile Supplies
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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.

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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.

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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.

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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 onDuh!

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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.

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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.

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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)

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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.

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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 its 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.

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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!