The Environmental Essentials to OR Cleaning


The Environmental Essentials to OR Cleaning

By Ruth LeTexier, RN, BSN, PHN

The goal of environmental control in the operating room setting is to keepmicroorganisms to an irreducible minimum in order to provide a safe environment for thepatient and healthcare worker. Consider the infection control methods used to accomplishthe 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 andscrub 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, thefollowing duties should be completed: Remove unnecessary tables and equipment from theroom, arrange remaining items away from the traffic pattern. Damp dust (with afacility-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 substerileroom.

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 personneland areas are considered contaminated: members of the sterile team, all furniture, OR andanesthesia 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 beworn during the cleanup process. For furniture, wash horizontal surfaces of all tables andequipment with a disinfectant solution (avoid using spray bottles as this will aerosolizeparticles). Operating table mattress pads must be washed also. Clean the casters of mobilefurniture by pushing through the disinfectant solution.

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

After all cleaning procedures have been completed, cleaning cloths are discarded or putinto a laundry bag. Close the laundry bag securely and send to the linen reprocessingarea. All trash is collected in plastic or impervious bags and sealed before removal fromthe operating room. Floors must be cleaned a perimeter of several feet surrounding thefocus point or patient area between cases. Wet vacuuming with a filter-diffuser exhaustcleaner is the method of choice for floor care in the OR. If wet-vacuum equipment is notavailable, freshly laundered, clean mops can be used. The floor can be flooded with adetergent-disinfectant solution using one mop. A clean mop is used to take up thesolution. Following one-time use, mop heads are removed and placed in a laundry hamper orin a plastic bag. Clean mops and disinfectant solution are used for each clean-upprocedure. If walls are splashed with blood or organic debris during the surgicalprocedure, 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 EnvironmentalCleaning in the Surgical Practice Setting" states, "surgical procedure rooms andscrub/utility areas should be terminally cleaned daily."9 This is done toreduce 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 arecleared of suture ends and debris and washed with a disinfectant solution. Equipment suchas electrosurgical units or lasers need special care and attention when cleaning to avoidsaturation of the internal machine. Ceiling and wall-mounted fixtures and tracks arecleaned on all surfaces. Kick buckets, laundry hamper frames, and trash receptacles arecleaned and disinfected. Floors are wet vacuumed thoroughly. Walls and ceilings should bechecked 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 becleaned.10

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

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

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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