Surgical Products

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 quality evidence.

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 cleaning:

1. Perform hand hygiene, use appropriate PPE and stage the cleaning supplies near the room. Take note of any posted transmission-based precautions.

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 sweep set.

8. Remove and discard PPE and perform hand hygiene. Put on new, appropriate PPE.

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.