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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:
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
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.|
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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