General patient coverage

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

Prepared by 

To create a barrier against bacterial invasion of the wound.

Required Supplies:

• Required surgical drapes
• Additional drapes
• Towel clamp from the instrument tray
• Sterile wound cover, if needed

Procedure Steps:

1. Verify the surgical schedule to select the correct sterile drapes for the procedure.

2. Circulating nurse opens the drape pack, while the scrub nurse removes the required items following sterile technique.

3. Arrange the sterile drapes from the pack in the correct order of use.

4. The scrub nurse and the surgeon (or assistant) should drape the patient after skin preparation.

o   Ideally, two sterile persons should perform the draping.

5. The scrub nurse hands the drape to the surgeon, ensuring proper coverage while avoiding leaning over the patient.

6. When unfolding the drapes, stand back from the operating table and spread the drape over a wide area.

7. Hold the drape at arm’s length and at a reasonable height to avoid contamination but not too high to touch the surgical light.

8. Do not shake the drape to unfold it.

9. Small drapes should be held at the corners for controlled opening.

10. Medium and large drapes or those for abdominal procedures should be unfolded as follows:

o   Surgeon holds one end.

o   Both surgeon and scrub nurse unfold and place it fully over the patient.

o   Ensure it does not touch any unsterile surface before full placement.

11. Create a fold at the edge of the drape or wrap it around a gloved hand for controlled placement.

12. Perineal drapes should be placed using sterile forceps.

13. Before using a drape, check for moisture, tears, or damage:

o   Discard if wet or torn.

o   If already placed on the patient, cover with another sterile drape.

14. Drapes should remain dry throughout the procedure.

o   If a drape becomes wet, cover it with a dry one.

15. Cover the operating table with two drape layers, including:

o   Additional pieces

o   Anesthesia armrests

o   Anesthesia screen

16. Once placed, drapes should not be repositioned.

o   If coverage is inadequate, add extra drapes.

17. If sterility is in doubt, replace or cover the drape immediately.

18. If using a split drape, it can be applied before or after general draping.

19. Use towel clamps to secure drapes at the incision site:

o   If a split drape is used over cloth drapes, clamps may not be necessary.

o   Ensure that only the drape fabric is clamped, not the patient’s skin.

o   Avoid moving towel clamps after placement.

20. Drapes should extend at least 20 cm from the operating table sides.

o   Ensure that the table legs, armrests, and anesthesia screen are fully covered.

21. If no anesthesia screen is available, use IV pole stands to hold the drape in place.

o   Secure the barrier using towel clamps.

22. The instrument cleaning trolley should be removed from the OR, with staff wiping the wheels with disinfectant-soaked drapes before taking it to the dirty instrument storage area.

o   The used drapes should also be taken to the dirty instrument storage area.

23. The operating room is ready for reuse once the floor is dry.

24. If no circulating nurse is available, the scrub nurse inside the OR should:

o   Remove the mask and apron after cleaning.

o   Change gloves before handling suction bottles and specimens outside the OR.

25. Once the scrub nurse exits the OR, they must not re-enter.

26. If the surgical field is contaminated, notify the head nurse, who will arrange for additional sterile equipment and disinfectants.

• 1 Medium Sterile Head Drape
• 2 Towels
• 3 Towels
• 1 Open Laparotomy Drape
• 2 Folded Towels (for padding)
• 1 Large Drape

Steps:

1. Once the anesthesiologist secures the patient, a non-sterile assistant lifts the patient’s head from the operating table.

2. Place a medium drape and two towels under the patient's head and shoulders.

3. Fold the front edge of the towels around the face and forehead, covering the hair and as much skin as possible.

4. Secure the towels using towel clamps.

5. Position two rolled towels on either side of the neck, filling the gap between the neck and shoulders to absorb fluids and prevent bacterial contamination.

6. Arrange three towels around the surgical site, forming a triangular opening with adequate but minimal exposure.

7. Secure the towels with clamps.

8. Unfold the large drape, placing it below the surgical site, and tuck the medium drape under the head.

• 2 Towels
• 3 Medium Drapes
• 1 Additional Medium Drape
• 1 Large Drape
• 1 Laparotomy Drape
• Sterile Bandage

Steps:

1. The circulating nurse lifts the affected arm.

2. Place a medium drape beneath the arm, extending under the shoulder and chest.

3. Extend a towel, allowing the assistant to position the arm without touching the sterile drape. Wrap the arm and secure it with a sterile bandage.

4. A sterile assistant may help secure the bandage.

5. Spread a medium drape over the chest and anesthesia screen, covering the surgical area.

6. Drape a large sheet over the abdomen and legs, covering the lower body.

7. Place a towel on the chest, forming a square around the surgical site, leaving sufficient space for the procedure.

8. Secure the drapes with clamps at each corner.

9. Open the laparotomy drape and extend it, ensuring the arm is positioned through the pre-cut opening.

10. Use additional towels to cover any exposed areas.

• 3 Towels
• 3 Medium Drapes
• 1 Large Drape
• 1 Laparotomy Drape
• 1 Folded Towel (for padding)
• Sterile Bandage

Steps:

1. The circulating nurse lifts the affected leg.

2. Place two medium drapes on the operating table, covering both the injured and uninjured leg.

3. Extend a medium drape, allowing the assistant to place the leg without touching the sterile drape.

4. The scrub nurse lifts the leg, allowing a towel to be wrapped around the thigh.

5. Secure the towel with clamps.

6. Drape the large sheet over the patient, covering the surgical area.

7. Place a towel under and another over the thigh, forming a square around the surgical site.

8. Secure the towels with clamps.

9. Unfold the laparotomy drape, threading the leg through the pre-cut opening.

10. Use towels to cover any exposed areas.

11. If the leg is not amputated, the draping method follows standard laparotomy procedures.

• 2 Towels
• 2 Medium Drapes
• 1 Large Drape
• 1 Laparotomy Drape
• Sterile Stockings or Bandages

Steps:

1. The circulating nurse lifts the affected leg.

2. Place two medium drapes—one under each leg.

3. Wrap the leg in a towel and secure it with a sterile bandage or stocking.

4. Hold the towel firmly, allowing the assistant to position the foot on it without touching the sterile area.

5. Wrap the leg with a towel, covering the surgical site.

6. Secure the towel with clamps.

7. Unfold a medium drape and place it over the leg.

8. Secure the drape with clamps.

9. Unfold the laparotomy drape, extending it from the table head and threading the leg through the opening.

10. Cover any exposed areas with additional towels.

• 3 Towels
• 3 Medium Drapes
• 1 Large Drape
• 1 Laparotomy Drape
• 1 Folded Towel (Shaped as a Pouch)

Steps:

1. The circulating nurse holds and supports the affected arm at the elbow.

2. Place a folded medium drape on the armrest, extending from under the arm to the shoulder and chest.

3. Position the arm on the armrest and secure it with a wrist strap.

4. Insert the folded towel (shaped as a pouch) under the armpit and push it into place.

o   This helps fill the empty space under the armpit, preventing bacterial invasion and absorbing blood and sweat.

5. Unfold a medium drape and place it over the patient, covering the surgical area.

6. Unfold a large drape and position it below the surgical site.

7. Secure the drapes with towel clamps, placing one at each corner of the draped square.

8. Open the laparotomy drape and position it over the other drapes, ensuring the pre-cut opening aligns with the surgical site.

9. Cover any remaining exposed areas with additional towels.

o   The armrest may require extra towels for full coverage.

• 1 Towel
• 3 Medium Drapes
• 1 Large Drape
• 1 Laparotomy Drape
• Sterile Bandage

Procedure:

1. The circulating nurse lifts the arm from the hand.

2. Unfold a medium drape and place it on the patient’s chest, under the arm and armpit.

3. Wrap a towel around the upper arm and secure it with a towel clamp.

4. Fold another medium drape and position it for the assistant to place the forearm and hand without touching the sterile drape.

5. Wrap the arm and hand below the surgical site, leaving enough space for the procedure.

6. Secure the drape with a sterile bandage.

7. A second sterile assistant may help in positioning the bandage.

8. Unfold a medium drape over the chest and arm.

9. Secure the drapes around the arm using towel clamps.

10. Unfold the large surgical drape, threading the hand through the pre-cut opening.

11. Use additional towels to cover any exposed areas.