Whether you're draping for long, high-fluid procedures or for shorter, cleaner cases, the goal of draping is the same: to establish a sterile field around the surgical site. We went searching for ways to help you improve the way you go about creating a sterile barrier with an eye on saving time and money, but without jeopardizing safety.

1 Think infection prevention.
According to AORN's 2003 Standards, Recommended Practices, and Guidelines, surgical drapes "should be as lint-free as possible. Lint particles are disseminated into the environment where bacteria attach to them. This bacteria-carrying lint may settle in surgical sites and wounds with the resultant increase in post-operative patient complications." The CDC says that 2.6 percent of all surgical procedures result in a surgical site infection, increasing the patient's hospital stay by seven days to 10 days at an estimated cost of $3,000 per incident.

Post-operatively, make sure that the patient has a dressing on before you remove his drapes. Otherwise, you increase the risk of exposing the patient to contaminated areas, says Mike Burnette, CST, the surgical director of the Clarke Orthopedic Clinic in Springfield, Mo. "Migration of bacteria on skin is a major way for infection to enter the wound," he says.

2 Compare and save.
Leslie R. Jebson, MHA, CHE, the associate director of the University of Florida Orthopaedics & Sports Medicine Institute in Gainesville, Fla., figured he could save if he switched the drapes his center uses for the 200 laparoscopic cholecystectomies it performs each year. He was spending $5,696 per year ($28.48 per procedure: $11.26 for a basic pack and $17.22 for a lap chole sheet with instrument pad) on Manufacturer A's drapes. Manufacturer B's drapes would cost him $4,920 per year ($24.60 per procedure: $10.24 for a basic pack and $14.36 for a general endoscopy sheet), a savings of 13.62 percent and $776.

3 Prune your procedure packs.
Revisit your packs once a year to ensure that you're using what's in the pack, says Linda MacGaffin RN, BSN, CNOR, the materials manager at the Glasgow Medical Center in Newark, Del. "I was told once that the rule of thumb was that you had to use 80 percent of your supplies in the pack. I don't believe that's true today. We can't afford a 20 percent waste in a surgery center," she says.

Consultant Ann Geier, RN, MS, CNOR, CASC, takes it further: If you don't use an item in a procedure pack 100 percent of the time for 100 percent of your docs, take the item out of the pack.

Let the type of procedure and instruments used to complete a case dictate the gauge drape necessary to maintain your sterile field, says Lori Robertson, RN, BBA, CNOR, the assistant director for perioperative services at Rockingham Memorial Hospital in Harrisonburg, Va. "A tonsillectomy requires a thinner or lower-gauge drape than a total joint procedure," she says.

4 Eliminate wasted towels on a back table.
If you've ever used cloth drapes, you know that it was common to add layers of drapes and an additional layer of sterile towels on the back table before placing the instrumentation on the table, says Ms. Robertson. "With today's impervious back table covers, this practice is no longer necessary," she says. Her advice: Choose the correct gauge drapes to maintain the sterile field with one layer. Use one back table cover and don't add sterile towels to the back table, a practice that's not only wasteful but one that can create hidden spaces where small instruments or needles may be lost.

5 Don't overdrape.
"If you're removing a mole, you won't use the same drape as you would if you were repairing a hernia," says Ms. MacGaffin. "I'm exaggerating, but look closely at the cases you're doing." In ophthalmology, for example, all you need is a plastic Steri-Drape, says Ms. Geier. "If you eliminate the towels that you put around a patient's head, you can save a lot of money. Cataract patients are already wearing street clothes. There's no reason to put sheets all the way down to their feet."

To save set-up time and expenses associated with additional draping, use a fully impervious drape, suggest several administrators we consulted. This practice eliminates the need to use multiple drapes for fluid absorption. Keep in mind, they say, that not all surgical drapes are fully impervious to blood and viral penetration. Until recently, surgical drapes were treated to be repellent because they weren't impervious. To enhance barriers, manufacturers thickened drape materials and clinicians added layers by using multiple drapes (for example, drape sheets). But adding thickness or layers still didn't yield a fully impervious barrier.

6 Staple the drape to the skin.
Orthopedic surgeon Michael Clarke, MD, the founder and owner of the Clarke Orthopedic Clinic in Springfield, Mo., says this creates a good barrier and eliminates clamps getting in the way of performing the case. For elbow and knee cases, he'll use only one or two staples to join two regular half-sheet extremity drapes at the site.

7 Use a drape that is absorbent for enhanced fluid control.
Drapes typically feature an absorbent impervious reinforcement around the fenestration. Some drapes extend that level of protection and fluid control throughout the entire drape. This helps control fluids that typically roll off repellent drapes and onto the floor.

8 Consult the AAMI standards for liquid barrier classification.
This classification system sets a common foundation for the levels of barrier protection available and makes it easier to determine which of four drape levels to use. A drape classified as level 4 provides the highest level of protection available. Visit writeOutLink("www.aami.org",1) for more information.