New AORN Best Practices For OR Cleaning
Preventing postoperative surgical-site infections (SSIs) is a prima- ry goal for all members of the perioperative team as they remain a significant source of clinical complications and economic
consequence. SSIs account for 17 percent of all healthcare-associated
infections (HAI) – an estimated 300,000 cases annually in the U.S. alone
– and can cost up to $10 billion annually. (1)
As nurses, most of us would agree that the emphasis was placed on
aseptic technique as one of the most important things to prevent a surgical site infection. But with the frequency of Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile and other drug resistant
diseases, more emphasis is being placed on environmental hygiene.
In the last decade more research shows the link between hospital
patient area surfaces and the transmission of dangerous bacterial and
viral pathogens to patients. Adding to that, research has also found OR
and patient room cleaning is not as thorough as it needs to be. But proper environmental cleaning breaks the cycle of contamination in which
pathogens are spread by high-touch object surfaces and healthcare
workers’ or patients’ hands.
What is heartening though is that studies have also found that
significant improvements in the thoroughness of cleaning (determined
by environmental contamination) can be achieved and sustained when
hospitals use a programmatic approach based on best practices that
includes training and monitoring.
To that end, there are three key elements for between-case OR cleaning:
1. Use best cleaning practices and products that were developed based on the Association of periOperative Registered Nurses’
(AORN) Recommended Practices for Environmental Cleaning and
practical experience in the operating room. These recently updated
recommendations provide guidance for environmental cleaning and
disinfection in the perioperative practice setting based on the highest
2. Provide support and training materials that teach best practices. It is important that best practices be taught on an ongoing basis
and that staff is given the right tools for the job. Consider what solutions
you are using, and why and how they can support improved outcomes
and efficiencies. For example, tools like disposable room turnover kits,
disinfecting wipes and appropriate cleaning chemistries add efficiency.
A toolkit on environmental cleaning was developed by AORN to help
educate staff about recommended practices to prevent the spread of
infection in the perioperative environment. It is available for download.
3. Provide an objective system to monitor and report clean
environments. While a standardized processes can greatly improve
the effectiveness of OR cleaning, continuous monitoring is also needed
to ensure compliance with those steps. Using a fluorescent marker to
monitor cleaning can actually prevent problems by “catching” surfaces
that have not been cleaned thoroughly, as well as communicating overall
cleanliness improvements with your team.
AORN Environmental Hygiene recommendation III, “A clean
environment should be reestablished after the patient is transferred from
the area to reduce the risk of cross-contamination and disease transmission,” speaks to the strong evidence for cleaning high-touch objects after
each patient use. This includes cleaning frequently touched areas such
as control panels, switches, knobs, work areas, handles, etc. Items that
are used during patient care or during a surgical or invasive procedure
should also be cleaned and disinfected, as should the floors and walls of
operating and procedure rooms after every procedure if they are soiled
or potentially soiled (by splash, splatter, or spray).
Looking at cleaning as a flow chart, there are 10 steps for OR
1. Perform hand hygiene, use appropriate PPE and stage the cleaning
supplies near the room. Take note of any posted transmission-based
2. After the patient is transferred from the OR, begin the cleaning
process by removing drapes and covers from the table and removing
soiled linen and trash.
3. Remove visible soil from surfaces, floors and walls.
4. Disinfect the area using an EPA-registered disinfectant. Wipe sur-faces/objects in the immediate patient area in a methodical fashion, such
as top-to-bottom to avoid missing things. Allow surfaces to air dry.
5. Next, start at the door and work clockwise or counter-clockwise
around the room cleaning high-touch and other surfaces.
6. Remove non-standard, mobile equipment from the room.
7. Remove large debris from the floor using a sweep set (be sure to
move the OR table), and mop using a clean mop head. Place the soiled
mop head in the proper waste container. Disinfect the mop stick and
8. Remove and discard PPE and perform hand hygiene. Put on new,
9. Assemble and place clean linens on the OR table. Put new bags in
hampers. Set up the room for the next case.
10. Take cleaning tools to their designated location and restock
the cleaning cart. Transport waste and soiled linen to designated area.
Remove and discard PPE, then repeat hand hygiene.
Perioperative nurses are responsible for providing a clean environment for their surgical patients. In this role, they should assess the
environment frequently for cleanliness and take appropriate action to
implement cleaning and disinfection procedures such as verifying the
cleanliness of the OR before the start of an operative procedure and
before case carts, supplies, and equipment are brought into the room.
Still, environmental hygiene is a team effort so it is vital that all
perioperative and environmental services personnel work together to
improve cleanliness and patient safety.
1. Anderson DJ, et al. Strategies to prevent surgical-site infections in acute care
hospitals. Infect Control Hosp Epidemiol 2008; 29
38 May | 2014 | www.SurgicalProductsMag.com
by Judy Pins, RN, BSN, MBA and Linda Homan, RN, BSN, CIC, Ecolab Healthcare
Advocating for a programmatic approach that includes training and monitoring.