Transcript Cleaning the OR - Indiana Chapter

Cleaning the OR
Debra Fawcett PhD, RN
Manager Infection Prevention and Control
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
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Objectives
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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.
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.
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Regulatory
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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
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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
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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
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Have the same person
clean the OR.
Teach them to wash their
hands.
Consistency has been
shown to be hard to
achieve.
Beginning
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Enhanced environmental cleaningenvironmental 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
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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.
Plain Facts
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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.
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).
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Between Cases
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.
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Only if used
Clarify only if used
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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
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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
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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 semirestricted areas.
You may call this sterile cleaning.
Reminders
Details
All equipment has to be cleaned
and moved about.
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Be sure to get
under the bed!!!
Floors
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)
Other Areas
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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.
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.
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Emerging Technology
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.
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Implementing
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ATP meter
◦ Does not tell you what is there just if not been
wiped off with a disinfectant.
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Hydrogen peroxide mist
Ultra violet light
Daziel marking
Other mists
Programs
Products
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
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Toolkit
Provides examples of cleaning checklists
Definitions related to environmental
cleaning.
 Will help staff have common terminology.
 Posters
 Other resources for the perioperative
practice area.
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Contents
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Questions