At the recent AORN Congress, I happened to hear the story of a surgeon using more than 20 drapes to perform a hip arthroplasty. I couldn't believe my ears: More than 20? What draping is done with 20-odd drapes that you can't do with six or seven?
You just don't need more than 20 drapes. For anything. What you do need is a touch of science, a pinch of creativity, a smidgen of vendor assistance and a heaping helping of common sense to make the most out of your drapes in terms of efficacy and cost-effectiveness.
Really, a simple job
It might seem as though there are as many different selections of drape configurations and properties as there are different patients that walk through your door, but what you need drapes to do is simple: minimize surgical site infections and the chance they might happen. In addition to isolating the wound from exogenous or endogenous sources of infection, a drape should not go up in flames (nor cause your budget to blister and melt) and your surgeons should like it.
Since the 1950s, when linen drapes were used, manufacturers have improved drape materials, imperviousness and strength. All brand-name companies offer drapes that meet all the requirements to isolate the wound. This begs the question: Is there any research to suggest that one layer of drape is any less effective than two or three? I would say that more is not better, only more expensive, as I haven't seen any evidence with respect to SSI rates that supports extra draping.
Right tool for the job
Drapes are in many ways no different than the tools in your toolbox at home. You can get one tool with many uses, but it might not be right for every task you need to perform. Or you can get many specialized tools, and risk ending up with a box full of not-so-useful tools. Remember: With customization comes increased cost and specialization in use. Now look at your drape selection, and then look at your usage of each type. Are there any similarities to the toolbox analogy?
I suggest the efficacy of a drape is directly related to its adaptability. With specialization comes lack of span and increased costs. Consider each type's ability to be used for more than one purpose.
Specialized drapes feature variations in touch, feel, durability, configuration, color and any number of other factors. The manufacturer incurs extra costs for this specialization, and that's why you pay premium price - not to mention the fact use is often limited by drape design.
With square and rectangular drapes, use is limited only by a user's lack of mental agility. Now before you discount this concept, consider the practice of free draping. We can take square and rectangular drapes and cover anything you could imagine, including a total hip, in no time. And it's unlikely you'll ever be limited by a lack of supply on the manufacturers' part (I've seen more than one facility caught shorthanded when it was on the national back-order list for its specialty drapes).
I'm not suggesting that you trash all those specialty drapes, though. Here at Union Hospital in Elkton, Md., we recently wanted something easier-to-use for a few types of procedures, and the vendors were only too happy to comply. We looked at using specialized drapes for high-volume procedures (such as sinus surgery) and those where speed is of the essence (such as ophthalmic procedures). We also thought long and hard about what kind of added value we were really in need of - such as ease of use, something that would not stick to everything in sight but that would still adhere to the patient, and something with which to attach all the lines and tubes. You should also keep in mind that drapes really haven't changed that much in recent years.
Right price for the job
So the remaining piece in the equation is cost. Specifically, how to contain it. Using the proper drapes in the proper fashion - as we've discussed - will save you money.
But so will good business sense. Buying items on the margin of practicality that cost more and have limited use can be expensive and damaging to the bottom line. It extends inventory cycle time in comparison to buying more utilitarian drapes. On the other hand, centers that are very narrow in their services will find they can do well with high volumes of specialized drapes.
Finally, look for a good vendor that will assist not only in spending but in saving your money. That way your efforts can follow the one-stop-shopping principle of getting what you want in one place at a good price. For the OR and materials managers, this means picking and sticking with one vendor and working with the vendor to decrease variety without changing the purchasing tier.
A faster low-temperature sterilizer
The new Sterrad NX low-temperature hydrogen peroxide gas plasma system terminally sterilizes a wide variety of surgical instruments - including cameras, light cords, drills and batteries - in its 28-minute standard processing time and processes single-channel flexible endoscopes and semi-rigid uretherscopes in 38 minutes, says Advanced Sterilization Products. The system uses a new vaporization system that removes most of the water from the hydrogen peroxide, which, says the manufacturer, improves diffusion of peroxide into lumens. The company says the Sterrad NX's compact, portable size lets you place it in OR substerile rooms and OR surgical cores in addition to the sterile processing department. The system also offers an easy-to-read touch screen for simple operation and instrument tracking, as well as networking software. List price is $45,000. Call (888) STERRAD, visit www.sterrad.com or Circle 166 on your Reader Service Card for more information.
A total anesthesia solution?
The new Apollo workstation can provide both a high level of ventilator performance during surgery and work well with low- and minimal-flow anesthesia, according to the manufacturer, Draeger Medical. Because it is modular, it can be expanded with software to create a custom workplace. For example, you could add the Infinity Patient Monitoring System and Innovian Anesthesia information system to better document patient information and save on investment and maintenance costs. The central TFT color screen controls the electric ventilator (E-Vent Plus), gas and ventilation monitoring, as well as future monitoring parameters. For convenience and safety, the electronic control system lets the ventilation parameters be retained when switching between modes, the company says. The company would not give a price. Call (800) 437-2437, visit www.draeger-medical.com, or Circle 167 on your Reader Service Card for more information.