The Environmental Essentials to OR Cleaning

September 1, 2000

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The Environmental Essentials to OR Cleaning

By Ruth LeTexier, RN, BSN, PHN

The goal of environmental control in the operating room setting is to keep
microorganisms to an irreducible minimum in order to provide a safe environment for the
patient and healthcare worker. Consider the infection control methods used to accomplish
the goal:

  • Air handling or ventilation systems of the surgical suite are designed to minimize
    contaminants from external air.
  • Proper attire is donned to reduce the amount of contaminants carried in from outside of
    the operating room.
  • Traffic during the operative procedure is confined to minimize the number of people in
    the room during the procedure and to limit access throughout.
  • Perioperative cleaning and maintenance of the operating room environment.
  • Contamination within an operating room is introduced from a variety of sources. The
    patient, healthcare workers, and inanimate objects are all capable of introducing
    potentially infectious material onto the surgical field.1
  • Operating room air may contain microbial-laden dust, lint, skin squames, or respiratory
    droplets. The microbial level in the operating room air is directly proportional to the
    number of people moving about in the room.2 Therefore, efforts should be made
    to minimize personnel traffic during operations.3 The greatest sources of
    bacterial contamination are the persons in the room at the time of surgery, including the
    patient. This contamination increases with movement and talking.4
  • To ensure patient and personnel safety, operating room cleaning procedures should be
    standardized and applied universally. For safe care, OR cleaning must be considered an
    environmental essential.
  • Consider the most obvious source: the patient. The potential for transmission of
    bloodborne pathogens exists in every operating room scenario because the patient is in the
    operating room for an invasive procedure. Bloodborne pathogens are pathogenic
    microorganisms that are present in human blood and can cause disease in humans. These
    pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus
    (HCV), Delta hepatitis, and human immunodeficiency virus (HIV). Other human body fluids,
    including cerebrospinal, synovial, pleural, pericardial, peritoneal, amniotic, semen,
    vaginal secretions, and saliva (during dental procedures if mixed with blood) or
    combinations thereof, also have the potential to be infectious. Unfixed tissues or organs
    (other then intact skin) and cell or tissue cultures are also potentially infectious.
  • Sources of environmental contamination can be a source of infection to both caregivers
    and patients and may include people, supplies, equipment, insects, packaging materials,
    and anything that is not specifically intrinsic to the actual patient receiving care. Any
    surface, living or inanimate, can serve as a vector, or carrier, of a harmful substance.
    Contaminants include microorganisms, chemicals, foreign particulate matter, and other
    materials, which can interfere with the health and safety of patient and team.5
  • Cleaning procedures should be carried out in a manner that protects both patients and
    personnel from exposure to potentially infectious microorganisms. Cleaning measures are
    needed before, during, and after surgical procedures and at the end of each day.
  • Overall, housekeeping procedures such as wall and ceiling washing should be done on a
    defined, regular basis.6

Before First Case of the Day

Preliminary preparation of the operating room is completed by the circulating nurse and
scrub person before sorting and organizing the supplies needed for the day's caseload.
Before bringing supplies into the operating room for the first case of the day, the
following duties should be completed: Remove unnecessary tables and equipment from the
room, arrange remaining items away from the traffic pattern. Damp dust (with a
facility-approved agent) the overhead operating lights, furniture, and all flat surfaces,
and damp dust the tops and rims of the sterilizer and the countertops in the substerile
room.

When organic debris is present - or when terminal
cleaning - all cabinets and doors should be disinfected at the point of contact.
Middle: Push the casters of mobile furniture through
the disinfectant solution.
Damp dust furniture and all horizontal surfaces before
the first case of the day.

Visually inspect the room for dirt and debris. The floor may need to be damp mopped.7

Room Turnover between Patients: Team Tasks

After the procedure ends and the patient has exited the room, the following personnel
and areas are considered contaminated: members of the sterile team, all furniture, OR and
anesthesia equipment, the floor immediately surrounding the focus area or patient area,
and patient transport carts.

Decontamination of the above should use the following process: Clean gloves must be
worn during the cleanup process. For furniture, wash horizontal surfaces of all tables and
equipment with a disinfectant solution (avoid using spray bottles as this will aerosolize
particles). Operating table mattress pads must be washed also. Clean the casters of mobile
furniture by pushing through the disinfectant solution.

For overhead lighting, the light reflectors must be washed with the
manufacturer-recommended disinfectant solution. Clean all areas where gross debris is
evident. All reusable anesthesia masks and tubing are to be removed, cleaned, and
sterilized before reuse. All disposable masks, tubing, and circuits are placed in the
trash.

After all cleaning procedures have been completed, cleaning cloths are discarded or put
into a laundry bag. Close the laundry bag securely and send to the linen reprocessing
area. All trash is collected in plastic or impervious bags and sealed before removal from
the operating room. Floors must be cleaned a perimeter of several feet surrounding the
focus point or patient area between cases. Wet vacuuming with a filter-diffuser exhaust
cleaner is the method of choice for floor care in the OR. If wet-vacuum equipment is not
available, freshly laundered, clean mops can be used. The floor can be flooded with a
detergent-disinfectant solution using one mop. A clean mop is used to take up the
solution. Following one-time use, mop heads are removed and placed in a laundry hamper or
in a plastic bag. Clean mops and disinfectant solution are used for each clean-up
procedure. If walls are splashed with blood or organic debris during the surgical
procedure, those areas should be washed with a detergent disinfectant.8

Room turnover requires special attention to cleaning
the OR table. The mattress must be cleaned with vigor.
Breakdown of the table is essential to removing all
contaminants.

Daily Terminal Cleaning

At the completion of the day's schedule, each OR, whether or not it was used that day,
should be terminally cleaned. The AORN "Recommended Practices for Environmental
Cleaning in the Surgical Practice Setting" states, "surgical procedure rooms and
scrub/utility areas should be terminally cleaned daily."9 This is done to
reduce the number of microorganisms, dust, and organic debris present in the environment.
The following routine should be used at the end of the day's schedule.

Furniture is scrubbed thoroughly, using mechanical friction. Casters and wheels are
cleared of suture ends and debris and washed with a disinfectant solution. Equipment such
as electrosurgical units or lasers need special care and attention when cleaning to avoid
saturation of the internal machine. Ceiling and wall-mounted fixtures and tracks are
cleaned on all surfaces. Kick buckets, laundry hamper frames, and trash receptacles are
cleaned and disinfected. Floors are wet vacuumed thoroughly. Walls and ceilings should be
checked for soil spots and cleaned as needed. Cabinets and doors should be cleaned,
especially at the contact points. Air intake grills, ducts, and filter covers should be
cleaned.10

The obligation of the surgical team is to use safety measures in all efforts to protect
the patient from harm. One of the elements inherent to this safe environment is reducing
the risk of infection by using standard cleaning procedures. The duties of the OR team
demand that one exercise reasonable and prudent judgment when preparing the operating room
for use.

Ruth LeTexier, RN, BSN, PHN, is a nurse educator and Program Director of Surgical
Technology at Northwest Technical College (East Grand Forks, Minn).

References

1. Meeker M, Rothrock J. In: Alexander's
Care of the Patient in Surgery.
11th ed. St. Louis: Mosby; 1999, 149-150.

2. Ayliffe GA. Role of the environment of the operating suite in surgical wound
infection. Rev Infect Dis. 1991;13(suppl 10):S800-4.

3. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis W. Guideline for pre-
vention of surgical site infection. AJIC. 1999;27(2):97-134.

4. Kneedler J, Dodge G. In: Perioperative Patient Care, The Nursing Perspective.
3rd ed. Boston: Jones and Bartlett; 1994:158-159.

5. Fortunato N. In: Perioperative Educator's Resource Manual to accompany Berry
& Kohn's Operating Room Techniques. 9th ed. St. Louis: Mosby; 2000:35.

6. Association of Operating Room Nurses (AORN). Recommended practices for
environmental learning in the surgical practice setting. In: Standards, Recommended
Practices and Guidelines.
Denver: AORN; 1998:209-214.7. Fortunato N. In: Berry
& Kohn's Operating Room Techniques:
9th ed. St. Louis: Mosby; 2000:170.

8. Fortunato N. In: Berry & Kohn's Operating Room Techniques: 9th ed.
St. Louis: Mosby; 2000:174-175.

9. Recommended Practices for environmental cleaning in the surgical practice
setting. In: AORN Standards, Recommended Practices and Guidelines. Denver: AORN;
1998:209-214.

10. Fortunato N. In: Berry & Kohn's Operating Room Techniques. 9th ed.
St. Louis, MO: Mosby; 2000:175-176.

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