Disposables and sacred cows

AORN Journal,  Feb, 2005  by Nathan L. Belkin

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In his survey on sacred cows ("Sacred cows revisited, vol 80, December 2004) author Michael P. Ryon, RN, MSN, asked 50 hospitals if they were using cloth or disposable drapes. Not surprisingly, 84% of the hospitals indicated they were using disposable drapes.

When disposables first became available, most hospitals continued to use products made of traditional cloth. They simply could not buy into the alleged benefits of using something once and then throwing it away. On the other hand, some hospitals incorporated the use of disposables into their gown and drape system with the thought that these items would perhaps protect patients from another possible portal of entry for exogenous contamination. Incidentally, the effectiveness of disposable drapes in that regard has yet to be conclusively demonstrated. (1)

The popularity of single-use products, however, mushroomed dramatically when their use was skewed by a reimbursement system that permitted all single-use items to be charged to the patient on a cost-plus basis. When disposables came to be viewed as revenue generators, whatever clinical benefit could be derived from their use was obscured by the financial gain they could provide.

Today, what is perhaps a sacred cow about surgical drapes is not the quality of the material from which they are made but rather whether their design and performance capability is commensurate with the procedure being performed. For example, in some health care facilities, rather than whole body drapes being used to isolate the surgical field for certain narrowly focused surgical procedures (eg, eye; ear, nose, and throat; most types of skin surgery) patients are being draped with half-body sheets. (2)

Not to be overlooked is the data released by the American Hospital Association in 2003, which indicates that 16.6 million (61%) of the 27.2 million surgical procedures performed in hospitals in 2001 were performed on an outpatient basis. (3) How essential are full body drapes for those procedures? This says nothing about the corresponding increase in the number of procedures performed at freestanding ambulatory surgery centers.

It was once said that draping is an ingrained practice that is hard to change. (4) From what we have seen here, it appears that rather than the material of which drapes are made, it is the draping practices in the hospitals surveyed by Ryon that warrant being classified as sacred cows.

NATHAN L. BELKIN

PHD

CLEARWATER, FLA

NOTES

(1.) A J Mangram et al, "Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee," Infection Control and Hospital Epidemiology 20 (April 1999) 262.

(2.) N L Belkin, F T Koch, "OR barrier materials--Necessity or extravagance?" AORN Journal 67 (February 1998) 443-445.

(3.) Hospital statistics (Chicago Health Forum, LLC, 2003).

(4.) J M Mathias, ed, "Draping: An ingrained practice that is hard to change," in Sacred Cows in the OR Revisited (Boulder, Colo: OR Manager, Inc, 1996) 41-45.

COPYRIGHT 2005 Association of Operating Room Nurses, Inc.
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