Making sense of today's many drape designs is enough to make your head spin. Need to cover a shoulder and collect a lot of fluid during an arthroscopy case? There's a drape for that. What about cataract procedures? There are drapes for those, too. Hand and foot surgeries? There are drapes well, you get my point. As you'll see in this review, the seemingly endless catalog of draping options means you're able to tailor sterile field coverings to fit the specialties you host.

• Procedure-specific. The latest specialized drapes are designed with specific specialties in mind, with slight variations to match surgical techniques and clinical needs. For example, newer specialized orthopedic drapes are built with enough textile strength to resist the push of heavy-duty instrumentation, coated material to resist fluid absorption or fluid-collection pouches to help capture the high amount of irrigation liquid generated during arthroscopic procedures.
• Easy to apply. While cloth drapes must be held in place with towel clips, you can secure disposable options with built-in adhesive strips. Elastic fenestrations that make placing the openings over surgical sites easier are available on some extremity drapes. Draping systems come in 1-piece options that don't require adhesive strips or clips, or multiple pieces that are placed and held in place with adhesives or non-penetrating towel clips.

How are drapes packaged and how easily are they applied to the sterile field? Those are 2 big questions you might overlook. Just like any sterile product, your surgical team needs to look at a drape's packaging and know immediately the type, level of protection and specialty for which it's intended and how it should be applied. This was a huge issue in my hospital before we addressed it during the trial and purchase of our current drapes. We noticed that surgical nurses were repeatedly having to re-drape patients — and wasting perfectly good drapes in the process — because the products were packaged in such a way that made unfolding and maneuvering them correctly on the surgical field difficult. Look for packaging that marks the end of the drape that goes near the patient's head so staff can tell with a glance which way the drape should be unfolded and laid out. Drapes should promote setup efficiency, not impede it.

• Fluid control aids. A variety of strategically placed fluid pouches are available on drapes used during cases that produce large amounts of fluids. Some pouches have drainage ports that connect to direct-to-drain suction for procedures that generate an excessive amount of fluid flow. Fluid-resistant or absorptive materials are options to consider, depending on how much fluid control you need and the preferences of your OR team.
• Cord and instrument organizers. Consider the number of cords on the surgical field, particularly during electrosurgical procedures, and how drapes can hold and organize them. Specialized drapes come with a variety of straps, fasteners, pouches and tabs made of Velcro, drawstrings or malleable bars that help control cords and keep them from becoming tripping hazards and tangled messes that slow down case efficiency. Some drapes also feature magnetic pads that keep instruments secure and prevent them sliding off the tops of slippery surfaces, providing a safe place for them to sit when they're not in use.

Matching your needs
It's best to trial drapes so you're sure the models you're considering fit and work the way you want them during actual procedures. Choose the 2 or 3 options that look like they'll work best in your setting and develop an evaluation form for each so surgeons and staff can note their preferences.

The Association for the Advancement of Medical Instrumentation rates all forms of barrier protection — from Level 1 (lowest form of protection) to Level 4 (the highest). How drapes rate in a manufacturer's lab is one thing; how they work in practice is something else entirely. For example, how does fluid react on a Level 1 water-resistant drape? Does it run right off or absorb into the material? Can a Level 3 drape designed for messier procedures handle the liquid volume you need it to, or will it need help from other fluid-control devices such as suction mats and strips, floor suction devices and closed-fluid disposal systems? Take note of these things during product trials because they'll impact how you use the drape and which product is right for the cases you host.

What about cost?
The cost of drapes clearly needs to be considered on a case-by-case basis and is oftentimes dependent on supply-purchasing contracts. What works at my large university teaching hospital that hosts specialties ranging from cataract to cardiac may not be the best option for a single-specialty ASC. The value-analysis process between both facility types is similar, however.

Review your local red-bag regulations. Do drapes used during all procedures need to go into regulated waste containers, which will add to their weight and disposal costs? At my hospital, for example, coverings used during cataract cases can be tossed with unregulated trash. Would reusable drapes (which are much more comfortable and effective than the cloth dinosaurs we used decades ago) make more sense from a waste-disposal standpoint? You can certainly make the argument that they're more environmentally friendly, which is one of the ways manufacturers are trying to push facilities back to reusable materials. From a cost perspective, however, the choice isn't as obvious. You'll save the expense of constantly purchasing single-use drapes and paying for their disposal, but you'll incur laundering costs instead, which could be significant. Also consider that you'll need access to a laundry service that can handle the volume produced by busy ORs. If you don't have that service in-house, be sure there's a reputable and local healthcare launderer nearby. That's not the case here in Morgantown, making the switch to reusable textiles moot.

Are fluid-capturing, specialized drapes really worth inflating case costs by, say, $5 or more? At first blush perhaps not, but it might make sense if the drapes eliminate the need for an $8 suction mat. When considering the costs of your draping options, what looks like a clear-cut winner is not always the best choice. You need to drill down and consider the associated expenses before making that decision.