Disposable Drapes Research Articles

Perioperative Skin Preparation and Draping in Modern Total Joint Arthroplasty: Current Evidence.

Besides the vast success and reliability of lower extremity joint replacement, deep and periprosthetic infection remains a serious complication of such operations. Many publications addressing periprosthetic infection have remarked about this "devastating" complication, with a risk around 1% after total hip arthroplasty and between 1% and 2% after total knee arthroplasty. The purpose of this study is to assess current trends in prevention of contamination with improved up-to-date pre-operative skin preparation methods and intra-operative draping. A literature review was conducted in MEDLINE, Web of Science, and the Cochrane database, looking for high-quality papers summarizing the most widely held and up-to-date concepts of perioperative measures for reducing infection, focusing on the best available evidence concerning skin preparation for joint arthroplasty (THR and THR) and surgical draping. Current evidence suggests the use of alcohol solutions for pre-operative painting with emphasis on the use of chlorhexidine gluconate solutions beginning the night before surgery. Hair removal should be performed in the operating room with electric clippers, not razor blades. In order to enhance drape adhesion to the skin, the use of iodophor-in-alcohol solutions is recommended over the traditional scrub-and-paint technique. Disposable non-woven drapes are superior to reusable woven cotton/linen drapes in resisting bacterial penetration. Finally, the use of adherent plastic adhesive incision drapes for the prophylaxis of post-operative surgical site infections is considered not necessary in orthopedic surgery. The importance of skin preparation and adequate and reliable draping cannot be overemphasized for infection prevention, especially in clean operations such as THR and TKR. Thorough and strict protocols are mandatory for every department, as well as education curricula for operating room personnel. Further randomized studies are mandatory to specify the effect of the above measures, their pitfalls, and their improvement, along with further crucial details such as cost-benefit analysis of different pre-operative preparations in preventing infections.

Use of plastic adhesive drapes during surgery for preventing surgical site infection.

Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach. A systematic review was required to guide clinical practice. To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity. For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 4th March 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid MEDLINE (2012 to 3rd March 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 2012 to 3rd March 2015); Ovid EMBASE (2012 to 3rd March 2015); and EBSCO CINAHL (2012 to 4th March 2015). Randomised controlled trials comparing any plastic adhesive drape with no plastic adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes, in patients undergoing any type of surgery. Ring drapes were excluded. Two review authors independently selected and assessed studies for trial quality and both independently extracted data. We contacted study authors for additional information. We identified no new studies for this fourth update. The review includes five studies involving 3082 participants comparing plastic adhesive drapes with no drapes and two studies involving 1113 participants comparing iodine-impregnated adhesive drapes with no drapes. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drapes (risk ratio (RR) 1.23, 95% confidence interval (CI) 1.02 to 1.48, P = 0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.06 to 1.66, P = 0.89). Length of hospital stay was similar in the adhesive drape and non-adhesive drape groups. There was no evidence from the seven trials that plastic adhesive drapes reduce surgical site infection rates, and some evidence that they increase infection rates. Further trials may be justified, using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection, based on different wound classifications.

Rola jednorazowych obłożeń pola operacyjnego w profilaktyce zakażeń miejsca operowanego

Rola jednorazowych obłożeń pola operacyjnego w profilaktyce zakażeń miejsca operowanego

Novel Lead-Free Drape Applied to the X-Ray Detector Protects against Scatter Radiation in the Angiography Suite

PurposeTo evaluate a sterile, disposable lead-free drape for reducing scatter radiation exposure during fluoroscopy-guided procedures. Materials and MethodsComputer-aided design software was used to model a procedure room with a thoracic anthropomorphic phantom on the angiography table. Using this model, measurements of scatter radiation were made from the phantom before and after the application of the drape using a collimated and full field of view in low-output conditions (70 kVp, 48 mA) and high-output conditions (125 kVp, 156 mA). Transmission of x-rays through the drape and entrance exposure rates were also measured. Statistical significance was measured using a Student t test. ResultsScatter radiation was attenuated throughout the procedure room when the drape was applied. The highest level of scatter radiation was detected in the expected position of the operator, adjacent to the phantom. Radioprotection by the drape was the greatest in this position: 71.5% attenuation at waist level and 89% at neck level (P < .0001). The use of the drape did not result in an increase of backscatter radiation to the phantom. ConclusionsThe use of this drape significantly reduces scatter radiation in the procedure room; this effect is maximal in close proximity to the phantom.

Defibrillators

Defibrillators

Stapled double head and neck drape for otological procedures

During otologic surgical procedures, there is often a dilemma when ensuring that hair is kept out of the surgical field. For a surgeon, the simplest and commonest technique is to liberally shave the head, but this can cause aesthetic concerns for the patient. Failure to keep the area hair-free can lead to a range of adverse surgical outcomes including wound infection and poor scar cosmesis. We describe a technique used in our department to effectively control hair during otologic surgical procedures, with no post-operative aesthetic concerns. The use of re-usable or disposable surgical drapes with disposable skin staples can effectively exclude hair from the operative field throughout the procedure, without fear of the drapes slipping or losing adhesiveness. The authors have obtained good results both during and after surgery, using this quick and easily learnt method, with no cases of long-term skin damage or scarring. We find this to be an effective method of hair and skin preparation for otologic surgical procedures, and suggest it to fellow otorhinolaryngologists as a helpful alternative technique.

Abstract No. 271 - Creating a standardized method of evaluating supplemental radiation protection products and its use in evaluating disposable radiation-reduction drapes

Purpose Interventional radiology (IR) procedures expose the performing physician and staff to potentially high radiation exposures, among the highest of all radiation workers. As a result, medical equipment vendors are continually introducing new radiation protection products such as the sterile, disposable radiation-reduction patient drape. Manufacturers of these drapes claim their ability to reduce up to 95% of scattered radiation. However, these claims are often not corroborated in clinical practice due to technique and operator-related factors. We have developed a method for evaluating radiation-reduction in order to delineate their true efficacy and cost effectiveness. This technique requires no special equipment and can be easily managed and organized by a technologist. Materials and Methods Two IR physicians were issued a set of radiation monitors in order to evaluate the AngioSystems SorbX lead-free, disposable scatter-reduction drape. Each monitor set included a ring monitor, collar badge, and a badge worn under the apron at the xiphoid level. Monitoring was performed in 90 day alternating increments with and without the use of drapes to establish a control and experimental dataset for each physician. Badge doses for each monitoring period were normalized by total dose-area-product (DAP). Results Monitoring was achieved in a total of 73 procedures with fluoroscopy time greater than 8 minutes. Physician 1 experienced a 40% reduction in dose and physician 2 experienced a 55% reduction in dose for femoral entry. Neither physician experienced a quantifiable dose reduction for jugular entry procedures. Data analysis suggests that physician 2 had better results due to rigorous use of the hanging leaded-glass shield. Conclusion The efficacy of supplemental radiation protection devices depends on many factors such as technique, procedure type, and concomitant use of other radiation protection devices. Thus, it may not be cost effective to use devices such as radiation-reduction drapes for all procedures, all patients, or for all physicians. In our case, this study has resulted in limiting use of the drapes to lengthy femoral-entry studies where their use is likely to provide the most dose savings.

PIH8 Comparative Pharmacoeconomic Study of Disposable and Reusable Gowns and Drapes

PIH8 Comparative Pharmacoeconomic Study of Disposable and Reusable Gowns and Drapes

A survey of surgical draping practices in small‐animal practice in the UK

Veterinary practices in the United Kingdom were surveyed to compare their surgical draping practices with Royal College of Veterinary Surgeons (RCVS) accreditation tier and other surgery-related factors. Using descriptive statistics and logistic or ordinal regression analysis (where appropriate), the relationships between draping material and accreditation tier and other surgery-related factors were assessed. Procedures were categorised as short or long. Two hundred and sixty-nine surveys were completed. Reusable drapes were used in 66 per cent of practices. Antibiotics were administered routinely in 38 per cent of short and 93 per cent of long procedures. Practices accredited as a Veterinary Hospital (VH) were 6.3-7.2 (short and long surgeries, respectively) times more likely to use disposable drapes, when compared with non-accredited practices. Use of dedicated surgical attire, draping the whole animal/table, and routine antibiotic usage were also positively correlated with disposable drape usage. Fifty-one per cent of practices rated infection rate as most important when choosing drape material. 'Best practice' techniques are associated with lower importance given to infection rate, and higher importance given to financial cost, when choosing drape material. Disposable drape use correlates with RCVS accreditation and with other aspects of surgical technique. Importance ratings awarded correlate with best practice procedures. Clinical relevance 'Best practice' draping procedures, that are not governed by RCVS accreditation scheme, are also more frequently performed in accredited VHs.

Sustainable Anesthesia

Sustainable Anesthesia

A Comparison of Reusable and Disposable Perioperative Textiles

Contemporary comparisons of reusable and single-use perioperative textiles (surgical gowns and drapes) reflect major changes in the technologies to produce and reuse these products. Reusable and disposable gowns and drapes meet new standards for medical workers and patient protection, use synthetic lightweight fabrics, and are competitively priced. In multiple science-based life cycle environmental studies, reusable surgical gowns and drapes demonstrate substantial sustainability benefits over the same disposable product in natural resource energy (200%-300%), water (250%-330%), carbon footprint (200%-300%), volatile organics, solid wastes (750%), and instrument recovery. Because all other factors (cost, protection, and comfort) are reasonably similar, the environmental benefits of reusable surgical gowns and drapes to health care sustainability programs are important for this industry. Thus, it is no longer valid to indicate that reusables are better in some environmental impacts and disposables are better in other environmental impacts. It is also important to recognize that large-scale studies of comfort, protection, or economics have not been actively pursued in the last 5 to 10 years, and thus the factors to improve both reusables and disposable systems are difficult to assess. In addition, the comparison related to jobs is not well studied, but may further support reusables. In summary, currently available perioperative textiles are similar in comfort, safety, and cost, but reusable textiles offer substantial opportunities for nurses, physicians, and hospitals to reduce environmental footprints when selected over disposable alternatives. Evidenced-based comparison of environmental factors supports the conclusion that reusable gowns and drapes offer important sustainability improvements. The benefit of reusable systems may be similar for other reusables in anesthesia, such as laryngeal mask airways or suction canisters, but life cycle studies are needed to substantiate these benefits.

Burn Center Management of Operating Room Fire Injuries

Approximately 100 operating room (OR) fires occur per year in the United States, with 15% resulting in serious injuries. Intraoperative cautery was frequently associated with OR fires before 1994; however, use of supplemental oxygen (O(2)), ethanol-based products, and disposable drapes have been more frequently associated with OR fires. Fires resulting from cosmetic and other small procedures involving use of nasal canula O(2) and electrocautery have been described in six published reports. We report five thermal injury cases admitted to our burn treatment center because of fires during surgical procedures over a 5-year period. Two patients undergoing supraorbital excision experienced 2.5 and 3% TBSA involvement burns; in a third patient surgical excision of a nasal polyp resulted in a 1% TBSA burn; in a fourth patient an excisional biopsy of a lymph node resulted in a 2.75% TBSA burn; and the last patient was burned during placement of a pacemaker, with resulting TBSA of 10.5%. Two of the five patients required intubation for inhalational injury. Two patients required tangential excision and grafting of their thermal injuries. All patients had received local or parenteral anesthesia with supplemental O(2)/nitrous oxide (N(2)O) for surgical procedure. There are a number of ignition sources in the OR, including electrocautery, lasers, and faulty OR equipment. The risk of OR fires increases with surgical procedures involving the face and neck, including tracheostomy and tracheobronchial surgery. The common use of O(2)/N(2)O mixtures or enriched O(2) for minimally complex surgical procedures and disposable drapes adds to the risk of an OR fire: the O(2)/N(2)O provides a fuel source, and the disposable drapes trap thedelivered gas. Electrocautery near an O(2)/N(2)O source resulted in the five thermal injuries and warrants careful reconsideration of technique for surgical procedures.

Comparing Strategies for Operator Eye Protection in the Interventional Radiology Suite

To evaluate the impact of common radiation-shielding strategies, used alone and in combination, on scattered dose to the fluoroscopy operator's eye. With an operator phantom positioned at the groin, upper abdomen, and neck, posteroanterior low-dose fluoroscopy was performed at the phantom patient's upper abdomen. Operator lens radiation dose rate was recorded with a solid-state dosimeter with and without a leaded table skirt, nonleaded and leaded (0.75 mm lead equivalent) eyeglasses, disposable tungsten-antimony drapes (0.25 mm lead equivalent), and suspended and rolling (0.5 mm lead equivalent) transparent leaded shields. Lens dose measurements were also obtained in right and left 15° anterior obliquities with the operator at the upper abdomen and during digital subtraction angiography (two images per second) with the operator at the patient's groin. Each strategy's shielding efficacy was expressed as a reduction factor of the lens dose rate compared with the unshielded condition. Use of leaded glasses alone reduced the lens dose rate by a factor of five to 10; scatter-shielding drapes alone reduced the dose rate by a factor of five to 25. Use of both implements together was always more protective than either used alone, reducing dose rate by a factor of 25 or more. Lens dose was routinely undetectable when a suspended shield was the only barrier during low-dose fluoroscopy. Use of scatter-shielding drapes or leaded glasses decreases operator lens dose by a factor of five to 25, but the use of both barriers together (or use of leaded shields) provides maximal protection to the interventional radiologist's eye.

Prophylactic use of antibiotic-loaded bone cement in primary total knee arthroplasty: Justified or not?

Background:The routine use of antibiotic-loaded bone cement (ABLC) during primary or uninfected revision arthroplasty remains controversial. Many studies quote the total joint arthroplasty (TJA) infection rate to be less than 1%. Total knee arthroplasty (TKA) has a higher infection rate than total hip arthroplasty (THA). Based on both animal and human studies in the past, ABLC has been found effective in reducing the risk of infection in primary TJA. We are presenting retrospective analysis of results in terms of infection rate in 659 TKA performed by a single surgeon under similar conditions during 2004–2007 using CMW1 (Depuy, Leeds, UK) with premixed 1 g of gentamicin.Patients and Methods:We did primary TKA in 659 knees of 379 patients during 2004–2007 using CMW1 (Depuy, Leeds, UK) cement containing 1 g of gentamicin in 40 g of cement in a premixed form. Standard OT conditions were maintained using laminar air flow, isolation suits for the operating team, pulse lavage and disposable drapes in each patients. Midvastus approach was used in all the patients to expose the knee joint. A systemic antibiotic (third-generation cephalosporin and aminoglycoside) was used preoperatively and 48 h postoperatively. We observed the patients in terms of infection in the high-risk and low-risk group till the recent follow-up with a mean of 20.6 months (9–38 months).Results:We had deep infection in six knees in six patients and all of them required two-stage revision surgery later in the high-risk group. Infection occurred at a mean of 20.5 months after surgery earliest at 9 months and latest at 36 months after surgery. The infection rate in our study was 0.91% which is comparatively less than the reported incidence of 1–2% in reported studies.Conclusion:We conclude that the use of antibiotic loaded bone cement is one of the effective means in preventing infection in primary TJA.

Cost Effectiveness of Reusable Surgical Drapes versus Disposable Non-woven Drapes in a Latin American Hospital

Cost Effectiveness of Reusable Surgical Drapes versus Disposable Non-woven Drapes in a Latin American Hospital

Evaluation of Wraps Covering the Distal Aspect of Pelvic Limbs for Prevention of Bacterial Strike‐Through in an Ex Vivo Canine Model

To determine differences in bacterial strike-through for materials commonly used to cover the distal aspect of the pelvic limb during operative site preparation. Randomized block design; ex vivo model. Canine cadaveric pelvic limbs (n=40). Pelvic limbs (n=40) were randomly assigned to 4 treatment groups: Group 1=Vetrap+sterile Coban; Group 2=latex glove+Vetrap+sterile Coban; Group 3=latex glove+Vetrap+sterile Coban+sterile latex glove+sterile Coban; and Group 4=latex glove+Vetrap+sterile disposable drape+sterile Coban. Limbs were contaminated with a standardized bacterial solution and routinely prepared using the assigned distal leg wrap. Bandages were fluid challenged with a saline (0.9% NaCl) solution-soaked laparotomy sponge for 30 seconds. The wrap surface was sampled for microbial culture before surgical preparation, immediately after, and 60 minutes after applying a sterile leg wrap. Bacterial growth occurred in all Group 1 cultures, 90% of Group 2 cultures, and none of the Group 3 and 4 cultures, 60 minutes after applying the sterile wrap. A distal leg wrap of Vetrap+sterile Coban is not effective in preventing bacterial strike-through. If similar results occur in the live animal, then a sterile impermeable barrier must be incorporated into the distal leg wrap to prevent bacterial strike-through.

Resistance of Disposable Drapes to Bacterial Penetration

To test the bacterial penetrability of disposable non-woven drapes used specifically for total hip arthroplasty. 12 round agar plates were inoculated with 107 colony-forming units/ml of coagulase-negative staphylococci (CNS) and incubated in air at 37 degrees Celsius for 18 hours to obtain a semi-confluent growth of organisms. Six brands of disposable drapes were tested; each was assigned to 2 plates. Each disposable drape was placed between a round agar plate and an inverted square agar plate filled with blood agar. After 30 and 90 minutes, the square agar plates were removed and incubated for 48 hours and inspected for growth of CNS. Bacterial penetration was time dependant. Certain brands of drapes were more impenetrable than others; none was impenetrable at all time points, but most remained so or allowed passage of fewer than 100 colony-forming units at 90 minutes. It is recommended that drapes be rigorously tested with regard to their resistance to bacterial penetration.

Stopping Surgical Drapes from Slipping During Pinnaplasty Using Steri-Strips

Every surgeon over time develops a preferred method of surgical draping when operating on the head and neck region. Securing the head towel with a towel clip or adhesive tape, for example, is important because slippage of these drapes creates an unsterile operating field [4]. Unfortunately, this seems to occur often during pinnaplasty despite the various observed techniques of draping. Draping of the head is made slightly more awkward if single-use synthetic disposable drapes are applied, which seem firmer than traditional linen and thus more difficult to fold easily around the head. Use of adhesive strips to secure the head drape is not without its risks including allergic reactions, loss of skin or hair at removal of the drape, venous obstruction, tension pneumothorax, and premature inadvertent extubation of a patient [1–3] Other reasons why the head towel may slip during pinnaplasty include the shape of the patients’ skull, less circumference of the skull covered by the drapes because of ears left exposed, rotational movement of the head within the drapes as the head is turned from side to side during the procedure, inability to apply sufficient tension for the drapes of patients whose procedure is performed while they are under local anesthesia. A solution to this problem of slipping head towels is to use three strategically placed 1⁄2-in. Steri-strips (3M Healthcare, Neuss, Germany) once the patient has been draped in the standard manner: one over the central forehead and one above each eyebrow (Fig. 1). I have that found this simple technique helps to create a cheap and effective additional

Feasibility and safety of a simplified draping method for pacing procedures

Traditional draping for pacing procedures is time-consuming. We evaluated prospectively the safety of a simplified method using a single adhesive drape intended for use in cardiac catheterization. A single disposable adhesive drape was used in each of 250 consecutive pacing procedures by the same operator including 200 device implants and 50 revision procedures. We compared the results with those of 114 procedures performed in the same cardiac catheterization laboratory by three other operators using traditional draping methods for most cases. In the study group, no wound or pacemaker pocket infection, device erosion, or endocarditis was observed within the first 6 months after the procedure (0%, 95% CI 0-1.2%). One suspected infection occurred at 10 months (0.4%, 95% CI 0.1-2.2%). In the control group, there were two cases of early infection or suspected infection (2 of 114 procedures, 1.8%, 95% CI 0.27-6.1%), four cases of confirmed or suspected infection more than 6 months after the procedure giving an overall infection rate (6 of 114, 5.3%, 95% CI 2.1-11.0%) significantly higher than in the study group (P = 0.014, Fisher's exact test). A simplified draping method involving a single adhesive fenestrated drape can be used for pacemaker or ICD implantation or revision procedures without an excessively elevated risk of infective complications.

Designing surgical clothing and drapes according to the new technical standards

Hospitals will continue to be the largest consumers of disposables, because of the diverse range of procedures they provide. Favourable growth is forecast for non‐wovens. Increasing concern over contamination and nosocomial infections will boost the demand for consumable and disposable surgical gowns and drapes. But, until now neither the manufacturers nor the end users of surgical gowns and drapes could agree on standards. So, a mandatory European standard is being developed to establish basic requirements and test methods for disposable and reusable materials used for surgical gowns and drapes. Once this standard has been adopted, the continued use of cotton textiles and conventional cotton‐polyester mixed textiles will become questionable.