Proper Draping for Abdominal Surgery

Good surgery draping is one of the keys to reducing surgical site infections, one of the most common — and most dangerous — complications of surgery. Proper draping for abdominal surgery is important because the abdomen is a site where avoiding infection is of particular concern.

The Importance of Draping for Abdominal Surgery: Sterile Technique

The purpose of surgery drapes is to create a sterile field for the abdominal surgery. Maintaining a sterile field is a key part of so-called sterile technique — methods used to keep microbes to a minimum. By necessity, much of the operating room is unsterile, such as the anesthesiologist/anesthetist’s work area. Draping for abdominal surgery physically separates the surgical site from the nonsterile areas of the operating room.

Before Draping for Abdominal Surgery

The surgical site must be prepared and sterilized before sterile surgery drapes can be put into place. The microorganisms that cause surgical site infections are generally bacteria that occur naturally on the patient’s skin. Hair should be clipped (not shaved) immediately prior to surgery if it will interfere with the surgical site. Once the patient has been anesthetized and positioned, a topical antiseptic such as Betadine should be applied to a large area surrounding the incision site.

Incise Surgery Drapes

For some procedures, surgery draping includes covering the skin all the way to the incision site. Called incise drapes, these are sterile adhesive-backed surgery drapes. So-called “drape lift,” in which the edge of the incise drape lifts away from the skin at the edge of the incision during surgery, is associated with a six-fold increase in the risk of surgical site infection.

Principles of Draping for Abdominal Surgery

Surgery draping follows several basic principles. The first principle is to isolate the surgical area using impervious drapes. The impervious drape has a plastic layer to provide a barrier to fluids, the second principle of surgery draping. The third principle is the creation of a sterile field by applying sterile drapes using aseptic technique. The fourth principle is to create a sterile surface using an incise drape, since skin cannot be completely sterilized. The fifth surgery draping principle is to cover equipment that is not sterile.

Surgery Drape Material Characteristics

The material used for surgery drapes will vary depending on the application, but all materials should have certain characteristics. The drape material should be resistant to abrasion under both wet and dry conditions, able to act as a barrier (resistance to liquid and/or microbe penetration), non-toxic, drapeable (able to conform its shape to the object underneath it), able to dissipate static charges, nonflammable, nonlinting, and strong enough not to tear during the procedure. Surgery drapes may be reusable or single-use, depending partly on application.

Preventing Drape Failure

Draping for abdominal surgery may fail by allowing contamination of the surgical site in several ways. The most significant is called “strike through,” in which fluid passes all the way through a drape, giving microbes a route in. Multiple layers of drapes can prevent strike through. Another cause of surgery drape failure is failure of drape adhesion — in other words, the drape coming loose. A gape, opening, or movement of the drape can allow contamination to enter the wound. Drapes themselves can be a vector of infection if they give off lint that clings to surfaces or travels through the air.

Reference

Ellen Anderson Manz, RN, BSN; Debbie Gardner, LPN, OPAC; and Maret Millard, NREMT-B. “Clipping, Prepping and Draping for Surgical Procedures (PDF).” August 2006, Managing Infection Control Magazine.