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Controlling CDI — Environmental services cleaning and disinfecting in the operating and procedure rooms
Contents courtesy of Allina Healthcare
Introduction
Cleaning an operating room or procedure room requires a team approach. Surgical services, environmental services, and infection prevention work closely to ensure a clean and safe surgical environment.
Dedicate carts, cleaning tools, vacuums, and floor machines to the OR. Dedicated equipment can help prevent transmission of organisms, particularly from the wheels of floor machines used in other areas.
Detergent and disinfectant solutions should be prepared as needed according to manufacturers’ instructions and properly labeled. Follow EPA approved contact time as directed by the disinfectant manufacturer.
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Disinfection
Detergent• Contains surfactants that clean and remove “soil”
from surface Disinfectants
• Hospital approved chemicals that kill bacteria and fungus
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Disinfection Adequate amount
• Enough chemical to keep surface wet for required contact time
Adequate contact time• Amount of kill time required• Determined by testing by the U.S. EPA
Friction• Wiping the surface removes bugs
Saturation• Having enough disinfectant on a cloth to ensure that
enough chemical gets to the surface for the right amount of time
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OR/Procedure room cleaning definitions:
Room turn-over: Between case cleaning done by OR staff
Terminal clean: End of day cleaning done by Environmental Services staff
Cycle cleaning: Periodic deep cleaning (e.g. walls and ceiling) done by Environmental Services staff
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Value of standardized cleaning protocol
Studies have indicated that:• Contamination of surfaces and equipment in the
patient room contribute to transmission of hospital acquired pathogens
• The process of cleaning and disinfection can vary from person to person, or even between rooms with the same person
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Value of standardized cleaning protocol
Studies have indicated that: • Taking the “randomness” out by standardizing our
cleaning processes will help assure that surfaces are consistently cleaned well and exposed to adequate amounts of disinfectants.
• Reducing the number of organisms in the patient’s environment reduces the opportunity for transmission of hospital acquired pathogens and infections.
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Education plan
Presentation Post test Demonstration
Ongoing education plan New employee initial orientation Yearly training and recertification
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Post education measures
Return demonstration Evidence-based monitoring - UV testing Quarterly Quality Assessment (checklists)
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Quality control guidelines
UV testing Direct observation Quality standards
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UV testing
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Room cleaning summary
Turnover and terminal cleaning is important in removing germs from the surgical environment.
Use the right tools Use the right chemical Use the right amount of chemical for the right
amount of time
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Infection control and cleaning
Suggested video
“From Top to Bottom: Cleaning Operating and Procedure Rooms”
Found for purchase at: https://envisioninc.net/programs/show/22
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Please complete the Cleaning Operating and Procedure Rooms Post Test (accompanies Top to Bottom Video)
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Break time
Return in 15 minutes
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Recommended equipment
Properly stocked EVS cart Goggles or safety glasses Microfiber cleaning cloth or disposable wipes Bucket for cleaning solution Nylon toy broom/lobby dust pan Microfiber flat mop system Microfiber high dust tool Wet floor sign Putty knife
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Chemicals
EPA registered hospital grade disinfectant Cleaner/disinfectants, such as:
• 3M 25 Quat• PDI AF wipes• 1:10 bleach wipes
Neutral cleaner Ammonia free glass cleaner Cream cleanser Iodine remover and tape/adhesive remover
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Personal protective equipment (PPE)
Eye protection Gloves Isolation gown Mask N95 respirator Papr
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Isolation cleaning procedures
Airborne precautions Contact precautions Droplet precautions Enteric precautions Strict contact precautions Neutropenic
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Focus on high touch areas
High touch surfaces are those that have frequent contact with hands. High touch surfaces in care areas require more frequent cleaning and disinfection than minimal contact areas.
Cleaning and disinfection is usually done at least daily and more frequently if the risk of environmental contamination is higher (e.g., intensive care units).
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High touch areas
OR/surgical table Push plates/door handles Overhead lights Telephone Computer keyboard Surgical equipment table Surgical chair
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Room zoning/hot zone cleaning
The equipment and areas closest to the patient are the most contaminated and considered the “hot zone”.
As you move further from the patient, surfaces are less contaminated. Starting with the OR/surgical table will allow adequate contact time with the disinfectant.
Once the hot zone has been cleaned and contaminated, take a fresh cleaning cloth and work clockwise throughout the entire OR/procedure room.
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Concentric circles around patient signify levels of potential environmental contamination
Patients & direct contact items
I tems touched during patient care
Shared equipment & common surfaces
HOT ZONEHOT ZONE
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OR/Procedure room clean order
General inspection Remove linen Remove waste High dust Clean overhead light Clean overhead fixtures Cleaning operating/procedure table Clean movable equipment and fixtures Spot clean walls and wall fixtures Make the operating/procedure table Wet mop the floor
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Equipment specific cleaning instructions
OR/Procedure Table Push Plates/Door handles
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OR overhead lights and fixtures
Overhead lights and fixtures
Equipment specific cleaning instructions
Telephone Computer keyboard
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Equipment specific cleaning instructions
Surgical equipment table Movable equipment and furnishings
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Equipment specific cleaning instructions
Surgical chair Waste receptacles
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Equipment specific cleaning instructions
Sharps containers Wall fixtures
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Equipment specific cleaning instructions
Ventilation faceplate
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EVS does NOT clean or touch
Anesthesia work space Wall suction
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Next steps
Your manager will observe a return demonstration after initial training is complete.
UV gel assessment will be done
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What questions do you have?
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