Cleaning the OR

1. Cleaning the OR Debra Fawcett PhD, RN Manager Infection Prevention and Control

2. Provide update from the new AORN Recommended Practice for cleaning the OR • Provide definitions of cleaning in the OR • Discuss terminal cleaning in the OR Objectives

3. In March of 2014 the AORN Recommended Practice on Environmental Cleaning came out. • Addresses many new aspects of cleaning in the OR • Provides level of evidence for each RP. • Supports a comprehensive cleaning program. • Research demonstrates that cleaning practices in most OR’s have not been thorough or consistent. Recommended Practice

4. CDC states that floors in the OR should be wet vacuumed after the last procedure of the day. • Centers for Medicaid and Medicare states that surveyors should inspect OR suites to assure that appropriate terminal cleaning has been applied. • OSHA – Standard precautions must be followed by personnel who are cleaning the OR. Regulatory

5. Working together with IPC, Perioperative services and environmental services can enhance and ensure that cleaning is thorough and consistent. • Meets recommended practices • Develop a multidisciplinary team. May even include your safety officer. • Can also be a part of EOC rounds. Togetherness

6. More research needs to be conducted to determine the impact of environmental cleaning on the transmission of disease from the OR. Team should review what is there. Research

7. Education before start. • Make sure your personnel change into hospital provided scrubs. (No bunny suits) • EVS needs to follow policies of facility and be familiar with policies. • Education to staff • Have the same person clean the OR. • Teach them to wash their hands. • Consistency has been shown to be hard to achieve. Beginning

8. Enhanced environmental cleaning- environmental practices implemented to prevent spread of infections or outbreaks. Beyond routine cleaning. MDRO’s • Between case cleaning- cleaning that occurs after a surgical procedure has finished and before the next one. (turnover) • Terminal cleaning- a thorough environmental cleaning that is completed at the end of the day after all cases have been completed. Includes floors, walls, casters, etc. (sterile clean) Definitions

9. No spray bottle should be used in the OR. • Only low linting cloths (need more research on type of cleaning materials) • All bio burden should be removed before disinfecting and cleaning. • Know policy of facility. • All linen, trash, special devices should be removed before cleaning. • No tacky mats. • Re-usable cleaning materials are to changed after each use. • Change water after each use. Plain Facts

10. EVS may not be responsible for between cleaning. • Trash and linen are to be removed before any cleaning occurs. • Cleaning of high touch surfaces: things like door handles, control panels, staff work area, OR beds (have mattresses taken off bed). • OR straps. • Floors only if soiled or suspected of being soiled from splash. • Clean according to manufacturers instructions • Anything that comes in contact with a patient should be cleaned between cases. • Be sure to use manufacturers recommended cleaning procedure. Between Cases

12. Clarify only if used Only if used

13. High Level Disinfectants are not to be used to clean surfaces of non-critical items. • Alcohol is not to be used to disinfect large environmental surfaces. Reminders

14. Done at the end of the day.(No designated time). • All exposed surfaces are to be cleaned • All linen and trash should be removed before cleaning commences. • Floors can be wet vacuumed using a disinfectant or a single use mop with disinfectant. • Everything is to be cleaned. • Clean perimeter first. Terminal Cleaning

15. Center of the room is considered dirtiest and extra time should be taken to clean. • Use the current process by your facility. • Like the 12 step or seven step making sure all high touch surfaces are cleaned. • Include wheels and casters of all items. • Terminal cleaning in restricted and semi-restricted areas. • You may call this sterile cleaning. Reminders

16. Details

17. All equipment has to be cleaned and moved about.

18. Be sure to get under the bed!!! Floors

19. Sterile processing areas should be terminally cleaned as well. Any patient care areas within the OR suite such as preop and post op areas should be terminally cleaned as well. (Frequency should be determined by the multidisciplinary committee) • The multi disciplinary team should determine the frequency of cleaning in the OR of areas that are not being used daily. • Keep in mind the transmission of bacteria to patients. Other Areas

20. It is easy to move to new technology because we want to do well but often have limited resources. • The team should evaluate the technology and determine what is best for their facility. • All emerging technology is an adjunct and we need to keep that in mind. Emerging Technology

21. There is also research out there that demonstrates that new technology may not sustain the lowering of contamination in the areas. More research needs to validate. • Often the area still has to be cleaned after the use of the new technology. • Read the research first. Implementing

22. ATP meter • Does not tell you what is there just if not been wiped off with a disinfectant. • Hydrogen peroxide mist • Ultra violet light • Daziel marking • Other mists • Programs Products

23. AORN has a tool kit that can help your perioperative staff and environmental services work together to achieve maximum safety for the perioperative patient. • http://www.aorn.org/Secondary.aspx?id=26537&terms=Environmental%20cleaning%20tool%20kit Toolkit

24. Provides examples of cleaning checklists Definitions related to environmental cleaning. • Will help staff have common terminology. • Posters • Other resources for the perioperative practice area. Contents

25. Questions