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After disinfecting the skin of the surgical area, sterile drapes are applied. The purpose is to establish a sterile safety zone, expose the minimum skin area necessary for the surgical incision, and cover the rest to avoid and reduce intraoperative contamination. The principle of draping is that, except for the surgical area, the surrounding area should be covered with 4-6 layers of sterile drapes, and the peripheral area should have at least 2 layers. Taking abdominal surgery as an example, the following 3 types of drapes/towels are generally applied:

1. Applying Sterile Towels (Incision Towels)

This step involves covering the area around the incision with 4 sterile towels.

1. The draping person stands on the right side of the patient. After confirming the incision, they first place 4 sterile treatment towels around the incision. The side of each towel near the incision is folded back by 1/4, with the folded part facing downward.
2. The scrub nurse folds the edge of each sterile towel by 1/3. For the 1st to 3rd sterile towels, the folded edge faces the draping person; for the 4th towel, the folded edge faces the scrub nurse themselves. The nurse then passes the towels to the draping person in sequence.
3. The draping person places the 1st treatment towel on the lower part of the surgical area, then places the remaining towels in sequence on the upper part, opposite side, and same side of the surgical area. The inner edge of each towel should be within 3 cm of the incision line. Once placed, sterile towels cannot be moved arbitrarily; if movement is necessary, they can only be moved outward from the incision.
4. After the 4 treatment towels are placed crosswise over the surgical area, they are secured with 4 towel clamps. When using towel clamps, avoid clamping the skin and prevent the clamps from tilting upward.

2. Applying Surgical Medium Drapes

The draping person and the scrub nurse stand on both sides of the operating table respectively. The scrub nurse passes the medium drapes, and the two people place two sterile medium drapes on the upper and lower parts of the incision respectively. The drape on the head side extends beyond the anesthesia screen, and the one on the foot side extends beyond the operating table. The draping person must avoid touching unsterilized items with their hands.

3. Applying Surgical Hole Drape (Laparotomy Drape)

After applying the medium drapes, the draping person should soak their hands in disinfectant for 3 minutes or wipe their arms with a povidone-iodine preparation. They then put on a sterile surgical gown and sterile gloves.

Finally, a perforated laparotomy drape is applied. Align the opening of the drape with the incision site, with the short end toward the patient’s head and the long end toward the lower limbs. First unfold and place the upper end to cover the patient’s head and the anesthesia screen, hold the upper part in place, then unfold and place the lower end to cover the instrument tray and the patient’s foot end. The sides and foot end of the drape should hang down more than 30 cm below the edge of the operating table.

Precautions for Surgical Area Draping

1. For major surgery, place a transverse medium drape on the side of the anesthesia table.
2. If a subcostal incision is required, place a double-folded medium drape under the patient’s lower back on the affected side before applying the 4 treatment towels. If an abdominal transverse incision is required, place a double-folded medium drape on each side.
3. When applying drapes, only touch the edges and corners of the surgical drapes; avoid touching the part of the sterile drapes around the surgical incision. When applying medium or large drapes, grasp the corner of the drape and roll it inward to cover the back of the hand, preventing the hands from touching surrounding contaminated items (such as the anesthesia screen or infusion tubes) and becoming contaminated.
4. To prevent the draping person from touching the part of the drapes around the incision when locating the corners of the laparotomy drape, the draping person leaves after applying the small surgical drapes. Generally, the placement of the large surgical drape is performed by the surgeon or other assistants after they have put on sterile surgical gowns and gloves.