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Table overhang; hypothermia; separating sponges, skin lacerations when scrubbing; wound classification; forced air warming - Clinical Issues

AORN Journal, July, 2003 by Carol Peterson

Question: We have a special custom cover designed to fit our crescent-shaped cardiovascular back table. The table cover has an extension that is designed to extend to the patient bed under the patient's legs. This extension remains folded on top of the back tab[e until the patient is draped. Our concern is the overhang at the back of the table cover. The back side of the table cover extends approximately 12 inches to 14 inches. Some believe this is too short and may be an infection control problem. What is the recommended length for material that hangs below the top of the back table?

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Answer: AORN makes no official recommendation regarding the length of the drape that extends over the edge of the sterile back table. The draped table is sterile only at the top surface, according to established and recognized principles of aseptic practice. Drapes extending below the table level are considered unsterile. (1) How far the drape extends over the edge of a draped surface becomes irrelevant in terms of sterility because any portion of the drape beyond the flat surface is contaminated. This same principle applies to the surgical field and any other draped item on the surgical field; only the top surface can be considered sterile. After a drape is placed, it should not be shifted or moved so that part of the drape that was below the table level is not moved inadvertently to the top, which would compromise the sterile field. (2) It is not how far the drape falls over the side of the table that is of concern but rather that it does not shift during preparation for the procedure or during the procedure. If the drape does shift, corrective measures should be taken.

Using this aseptic principle, when a sterile item is placed on the back table, any portion of that item extending below the sterile boundary of the table top is contaminated regardless of how far over the edge of the table the drape extends. The extended portion of the item cannot be brought back to the sterile area. For example, when sterile suction tubing is dispensed on the back table, if one end falls below the table level, that end must not be brought back to the sterile field. The contaminated suction tubing should be lifted clear of the surgical field without contacting the sterile surface and dropped to an unsterile team member or surface.

Occasionally, after sterile drapes have been applied to a patient, it may become necessary to raise or lower the surgical bed to accommodate the surgeon's height. Later, it may be necessary to adjust the height of the surgical bed again to accommodate an assistant surgeon who will perform a portion of the procedure. Changing heights presents an aseptic challenge because gowns only are considered sterile in front from the shoulder to the level of the sterile field, and only the top of the surgical field is sterile. To avoid moving the sterile field into unsterile areas of the gown or contaminating the sterile area with the unsterile areas of the drape, individuals should

* avoid leaning against the side of the sterile field at all times,

* step away from the bed whenever it is raised or lowered to prevent the side of the drapes from contacting any portion of the gown front, and

* use one or more foot stools to maintain the level of the sterile field at or near the gown waist at all times. (3) Protecting patients and reducing risks associated with infections is a primary responsibility of perioperative nurses. Observing sterile boundaries and strictly adhering to sound principles of aseptic technique are key in preventing postoperative surgical site infections.

Question: A surgeon at our facility gets very hot during surgical procedures and requests that the room temperature be set extremely low, around 65[degrees]F (18.5[degrees]C). (4) We have trouble keeping patients warm and are concerned that the very cold temperature is putting patients at risk for complications. In addition to the risk to patients, the remaining surgical team members are freezing. We are having trouble convincing this surgeon that the room is too cold. What does AORN recommend for the temperature of the room? Is there any evidence that hypothermia poses a risk to patients and can cause surgical complications?

Answer: AORN and the Centers for Disease Control and Prevention (CDC) support the American Institute of Architects' Academy of Architecture's recommendation that OR temperature be maintained between 68[degrees]F and 73[degrees]F (20[degrees]C to 23[degrees]C). (4) Negative consequences for patients who experience hypothermia during a surgical procedure may include adverse myocardial events, impaired platelet functions and coagulopathy, reduced medication metabolism, shivering, discomfort, impaired wound healing, and increased risk of surgical site infection. (5-7) All patients undergoing a surgical procedure, no matter how minor, are at risk, to varying degrees, of developing hypothermia. Low ambient room temperature is among the many contributing factors. Other risk factors for hypothermia include

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Table overhang; hypothermia; separating sponges, skin lacerations when scrubbing; wound classification; forced air warming - Clinical Issues

AORN Journal, July, 2003 by Carol Peterson

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