title: A standardized and safe method of sterile field maintenance during intra-operative horizontal plane fluoroscopy.
abstract: BACKGROUND
  Intra-operative fluoroscopy for orthopaedic procedures frequently involves imaging in the horizontal plane, which requires the lower portion of the C-arm (x-ray tube) to be rotated from an unsterile zone (beneath the table) into the sterile field. To protect the integrity of the sterile field the C-arm must be draped repeatedly throughout the surgical case. The current, un-standardized, practice employs draping procedures which violate the Association of peri-Operative Registered Nurses (AORN) Standards and Recommended Practices, waste time and material, and pose an increased risk for surgical site infection.
  
  
  OBJECTIVE
  Use of a novel sterile C-arm drape (C-armor) that maintains the integrity of the sterile field, will improve operating room efficiency and reduce surgical site infection risk factors. This reduction in risk factors may potentially reduce surgical site infections in orthopaedic surgical cases requiring repeated horizontal x-ray imaging.
  
  
  METHODS
  Savings in time and material and the reduction in surgical site infection risk factors afforded by using C-armor are intuitive to those skilled in the practice of orthopaedic surgery. Testing for a reduction in the number of microorganisms introduced to the surgical site by improved C-arm draping would be challenging due to the multiple confounding factors during a surgical operation. Determination of an absolute reduction in surgical site infections may be possible, but will require accounting for many confounding variables and a large study sample in order to achieve statistical significance.
  
  
  CONCLUSIONS
  Improved intraoperative workflow, healthcare savings and a reduction in surgical site infection risk factors will be achieved by utilizing a standardized and safe method of sterile field maintenance during intra-operative horizontal plane fluoroscopy.
authors.affiliation: 488 East Valley Parkway Suite 214, Escondido, CA 92025, 760-432-6311, 760-432-0531. skaska@uci.edu.
authors.forename: Serge C
authors.initials: SC
authors.lastname: Kaska