To Cover or Not to Cover Your Back Table... That is the Question

This week on the First Case Podcast, we dove into a topic that always seems to spark debate in the OR: Is it okay to cover your back table?

Picture this: You’ve got your instruments set up, you’re ready to go, and then... delay. Maybe anesthesia decided to draw another lab, or maybe an issue came up with the patient, or maybe the surgeon got stuck in traffic and isn't at the facility yet. Regardless of the reason, you're now faced with a delay, and you find yourself wondering, "Can I cover my table?"

Listen to the podcast here!

The Short Answer: Yes, But Only If It’s Done Right

Here’s the thing: it is okay to cover your back table, as long as it’s done correctly. Both AORN and AST guidelines allow for covering the sterile field in certain situations. But, the key words here are correctly and certain situations. The back table should never be covered out of convenience or because of staffing shortages.

For example: Your team doesn't have enough scrub techs available to assist with cases and get rooms set up for other cases. So one scrub goes ahead and sets up their next room, covers their table, and then leaves that room to go assist in another case. In this example, the back table is covered simply to make turnover faster later, and because no one is available to set up the case. This is a matter of convenience, and not a valid reason to cover the table.

Additionally, applying a cover to your back table incorrectly can contaminate your table, and lead to additional delays as the table is broken down and set up again. Training is required to ensure that all team members know how to properly apply and remove a table cover.

To correctly cover your back table, according to the AORN Guideline for Sterile Technique, "cover the sterile field with a sterile surgical drape in a manner that allows the cover to be removed without compromising the sterility of the table by using a sterile drape designed for this purpose, or by using a sterile two-'cuffed'-drape method." (Section 7.1.2)

To do this correctly:

• Place the first drape horizontally over the table or other area to be covered, with the cuff at or just beyond the halfway point. Place the second drape from the opposite side of the table with the cuff positioned so that it completely covers the cuff of the first drape.

• Remove the drapes by placing the hands within the cuff of the top drape and moving the drape away from the sterile field. Remove the second drape from the opposite side in the same manner. (Section 7.1.2)

• And remember, areas below the level of the sterile field are not considered sterile, including the section of the drape that hangs below the level of the sterile field. Never bring the portion of the drape that was below the level of the sterile field up to or over the field to reduce the risk of contamination.

In the first image, the table is only covered with one drape, which isn't an approved draping method. The other two tables demonstrate acceptable ways of covering your back table. For more information on the sterile drape shown in this picture, click here.

Why It’s Sometimes Avoided

Many facilities have policies that don't allow covering back tables for any reason. This is simply because covering the back table incorrectly can easily introduce contamination, which then increases delays as tables have to be broken down, new items and instruments pulled, and another table set up. It can also further delay a procedure if instruments aren't available, leading to additional delays as instruments are sterilized. So, there's definitely a risk associated with covering a table, and many facilities would rather not take on the additional risk.

What the Guidelines Actually Say

Both AORN and AST give the green light to covering a sterile field, under the right circumstances. According to the AORN Guideline on Sterile Technique:

“Cover the sterile field with a drape if it will not be used immediately (e.g., procedural delay, sterile field set up for closure, multiple tables) or during periods of increased activity (e.g., pre-incision, repositioning).”

That means if you’ve got an unexpected delay, if you’re prepping multiple fields, or if there’s a lot of movement happening in the room, a properly placed sterile drape can protect your setup.

The Bottom Line

Covering your back table isn’t a “never” or “always” kind of thing, it just really depends on circumstances. Specifically:

• Your facility policy

• Your team’s skill and training

• The drapes or technique that is used

• The specific circumstances of your case

If your facility allows it and you’ve been trained to do it properly, covering your sterile field can help keep your instruments protected. But if your policy prohibits it, there’s usually a solid reason behind that decision, too.

So, the next time the question comes up in your OR, the answer is:

Yes, it’s okay to cover your back table - as long as facility policy allows it and you know how to do it right!

Until next time,

Melanie

This blog post is cross-posted on The Circulating Life.