SUR 111 Lecture 5
Today’s Topics
 Supplies
 Sterile Packs
 Establishing the Sterile Field
 Opening the Sterile Field
Supplies
 Any sterile or non-sterile items such as
drapes, drains, dressings, casting
materials, tape, etc.
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
Drape Materials
 Woven textile fabrics
 Non-woven textile fabrics
 Plastic Adhesive Drapes
Drape Materials
 Woven textile fabrics
Nondisposable
Treated to prevent fluids from penetrating
Must be laundered, inspected thoroughly,
folded, and sterilized
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
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
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
Sterile Packs
 Basic Packs
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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
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
Establishing the Sterile Field and
Opening Sterile Supplies
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.
Furniture Setup
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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.
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.
Establishing the Sterile Field
 Created after morning routine and Setup is
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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!
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.
Opening a Back Table Pack
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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.
Opening Peel Packs
 Check the package for integrity. ( Single peel pack
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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)
Opening Envelope Style
Packages
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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.
Opening Envelope Style
Wrapper
 Do not touch the inside of the package once it is opened
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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.
Instrument sets
 Should be opened on clean, dry, flat surface.
 Open in accordance to Envelope style wrapping using
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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!