Ever catch your staff wrestling with a package of equipment drapes, trying to figure out which end to open, which side is up, how to open it in a sterile field and then cover the machine? Not a pretty sight, especially if the drapes are winning. Here are four questions to ask to be sure you're getting the best drapes for your needs.

1. How easy are your drapes to open and apply?
It takes teamwork to set up an OR for a procedure, and if the person in charge of the drapes is struggling to get the drapes over the equipment, that can set everyone back. "We look for drapes that are packaged so they can be opened and draped easily, and designed so the scrub nurse and the circulating nurses can quickly figure it out," says Patricia Armstrong, RN, director of surgical services at Connecticut Orthopaedic Specialists in Hamden, Conn.

To tell how well-packaged and -designed a drape is, ask how many people it takes to open and apply it, says Chris Rosenthal, RN, MSN, director of surgical services for Jackson Hospital in Montgomery, Ala. "It shouldn't take two or more people to get it out and apply it," she says.

It's also important to look at how easy the drapes are for your staff to handle, says Andrew Bala, president of ABS Med, a medical supply distributor in Burr Ridge, Ill. "Sometimes manufacturers forget nurses are scrubbed or have gloves on and can't let anything fall below the waist," he says. For example, since shorter nurses may have trouble with some of the larger drapes, they may be better off using smaller ones. "In the old days, drapes were only available in the 54-inch size, but now some of the microscope drapes are only about 46 inches wide," he says. "It's very easy for someone who isn't very tall to use these. And since some of the neuro-microscopes have long boom arms, nurses may need a stepstool to reach something that's seven or eight feet off the ground."

To avoid these process surprises when considering the purchase of a new type or brand of drape, be sure to have the vendor provide you with an adequate number of packaged samples so that various staff members can open actual packages and drape equipment in a controlled test situation, says Nancy Burden, director of ambulatory surgery at BayCare Health System in Tampa, Fla.

2. How well do your drapes fit?
Microscopes, C-arms and other equipment are getting more flexible, and Mr. Bala says the biggest challenge for many drape manufacturers is to design covers that don't hinder or impede their function. "A sterile cover can hinder the movement or just get in the way if it's not well-designed," he says.

Some facilities may want to look beyond the standard "one-size-fits-all" solutions. Whether you need enough flexibility to warrant customized drapes depends on what you use the machines for, says John Lochner, marketing and sales coordinator for CFI Medical Solutions in Fenton, Mich. "If the facility is just covering a C-arm to pull it up to the table and take a shot, they should buy generic drapes," he says. But if the machine is going to be moved often, he suggests considering the extra room and more precise fits you'll get from customized drapes. "Customized drapes can cover the C-arm without allowing the bulk of the drape to get caught in the pivot joint," he says.

New options for fasteners can also allow for tighter fits, says Mr. Bala. "In the past, all we had were rubber bands. Almost all the manufacturers now use poly draw straps placed throughout the body of the drape, so when the nurses apply the drape, they have six or seven different options on where to tighten up." In addition, Mr. Bala says there are new systems that make drapes easier to fasten, such as "barber pole" or "candy cane" fasteners, which have a draw strap on one end that wraps around the pole of a microscope and keeps the drape contoured to the instrument.

The new fasteners also make application considerably easier, says Ms. Rosenthal. "We now have drapes that are fastened with Velcro and tape, which are certainly improvements because you can pull and wrap them around with one hand," she says.

But even if a fastener appears to be a great idea, you may want to pay extra attention to how well it works in the trials. At Rockford Orthopedic Surgery Center in Rockford, Ill., Nurse Manager Denise Roland, RN, BSN, MS, CNOR, says that sometimes the paper over the adhesive fastening strips doesn't come off completely. When this happens, the OR staff has to work to make sure it stays in place. "I know it frustrates the surgeons when that happens," she says. "If there's any paper remaining, then it's not as adhesive."

Another thing to consider when choosing a drape is the potential for last-minute alterations being made by your surgeon, says Ms. Burden. If the fit of the drape being used isn't acceptable, the surgeon may decide to cut it, opening the potential for a breakdown in your sterile process and defeating the intent of careful draping. Again, having samples that the physician can test before purchase may help to avoid this concern.

3. Is it strong (or clear) enough?
Another factor to look at is how strong the drapes are, because it's not unknown for them to tear during a procedure. "I'd compare the drapes' materials to trash bags," says Ms. Rosenthal. "You can buy the cheapest bag, but don't be surprised if it breaks when you pick it up."

In addition to integrity, look at how drapes for orthopedic equipment handle fluids. "If you're doing arthroscopies or fluid-type cases, be sure it's water-resistant so you'll avoid strikethrough contamination," says Ms. Roland.

Since these drapes cover everything near the surgeons in an orthopedic procedure, including the Mayo stand, Leslie R. Jebson, MHA, CHE, associate director of the University of Florida Orthopaedics & Sports Medicine Institute in Gainesville, Fla., says it's important that they stay in place despite all the motions involved in the procedure. "The newer drapes on the market don't seem to lose their positioning during an arthroscopy," he says.

For orthopedic microscopes, Nicholas Langley, president of the Atlanta-based medical distribution company BuyMD, says you should consider how clear the protective area is around the lens. "Plenty of companies put a plastic cover in the drape that sits over the front lens that faces the patient, so when the surgeon looks through it they see the light reflected from the plastic that goes back up into the microscope," he says. "If you're spending all that money on a good optical system for your microscope, you should have high-quality glass lenses in your drapes as well."

Some companies make improved lenses in the drapes a selling point by inserting a high quality glass or polymer in this area. The result, says Mr. Langley, is that the surgeon gets a better view of the surgical site without compromising the sterile barrier.

4. Can you work with me on the price?
Three tips to save on drapes: One, vendors that sell OR devices such as warming systems may provide the equipment for free if you use their drapes, says Ms. Rosenthal. Two, you can save if your procedure pack vendor also stocks drapes, says Ms. Roland. Three, consider the potential savings of bulk buying or securing a price freeze with a time or use commitment as long as you are confident in the long-term value and use of the drape, says Ms. Burden.