Any non-sterile piece of equipment that will be brought into the sterile field must be draped in order to isolate it from the patient and the surgical site. This includes the C-arm, surgical microscope, ultrasound equipment, the handles that control the lights and any other equipment that hasn't been sterilized. Here are 6 ways to handle this job more efficiently and economically.

1 Read before you drape. Just as there are specialized drapes for dozens of different procedures, there are drapes specially designed for the equipment that will be inside the sterile field. Make sure that whoever is charged with draping the equipment is familiar with the different types of specialized drapes, knows where they're stored and has read the manufacturer's instructions. Before opening a pack of sterile drapes, check to see that each pack is well-sealed and without any perforations or tears, make sure that the expiration date hasn't passed and make sure that you maintain sterility by keeping the sterile drape from touching the non-sterile packaging.

2 Drape the C-arm as needed. Just as sterile packages should be opened as close as possible to the time they will be used, the C-arm should be draped and brought into the sterile field only at the moment it's needed. If it will be used at the beginning of the procedure, drape it before the procedure starts. Otherwise, wait to bring it into the room until just before it's needed and then drape the C-arm.

Specialty drapes for C-arms, usually clear, impervious material, cover only the top portion of the C that hangs over the patient. Start at the top of the C and pull the drape over the arm. The lower portion, which is beneath the patient, is not always draped, especially for large C-arms, since the lower part of the C is usually beneath the drape on the OR table. However, when the C-arm is set to capture images in the lateral position, the lower portion of the C can stick out of the OR table drape. Then you have a non-sterile item in the sterile field. To avoid this, you can add a large drape to the side of the OR table to isolate the non-sterile part of the C-arm from the patient, or purchase a specialized drape designed for this purpose that attaches to the OR table drape. Drapes for mini C-arms are available in versions that cover the entire C so you can avoid this problem.

3 Know what's sterile and what's not. Since equipment drapes are sterile, make sure that the person opening the drapes is wearing sterile gloves. When you open the drape's peel pack, look for the cuff on each drape that will help you guide the drape as you pull it over the C-arm or microscope. The cuff will also cover your hands and help you maintain the sterility of your gloves during draping. Remember, C-arms and microscopes aren't sterile. If your glove touches the piece of equipment, you lose your sterility and have to change gloves. The same goes for the sterile side of the drape. Don't let the drape unfold too much because the sterile outside of the drape shouldn't touch the unsterile surface of the equipment. If it does, you have to start over, which costs time and money since you'll have to open a new drape pack. Make sure that the drape stays within the sterile field.

4 Draping microscopes is a 2-person job. Since surgical microscopes are large and usually remain in the same place during the procedure, they should be draped before the patient arrives in the operating room. The circulator can help the tech or team member in charge of draping the microscope. Some surgeons like to do this, since the configuration of the microscope is surgeon-specific. After opening the drape pack, look for the cuffs and pull the drape over the head of the microscope and then work your way over the arm and body. Most microscope drapes come with sterile straps that you can use to gather the excess material to keep it out of the way. When you bunch up the excess, make sure that the drape is tight at the control buttons and knobs so that the surgeon can easily locate and activate them. The drape should also allow for easy articulation at the joints of the microscope.

Once the drape covers the entire microscope, attach the sterile eyepieces on the head, making sure that the hole in the drape is lined up with the end of the ocular tube where the eyepiece attaches. Here, the drape should fit tightly. Some microscope drapes have sterile straps that can be brought tight over the ocular tube. When you're attaching the eyepiece, make sure that your gloves don't touch the surface of the microscope, which is not sterile. Otherwise, you'll have to change your gloves.

Some minor procedures don't require the microscope to be completely draped. Instead, sterile covers only need to be attached to the focusing knobs.

Protect equipment with drapes. In cases that generate a lot of fluid, you can drape your endoscopic cameras and keep them from getting wet. Using drapes also eliminates the need to sterilize the camera between cases, which can improve efficiency and reduce your equipment costs. Power cords that cannot be sterilized should be draped with specialized tube-like drapes. These cords can also help reduce OR clutter because the cords can be bunched together in the drape.