When it comes to cleaning your OR, healthcare workers and infection control professionals have pretty much had the where and when - and even some of the what - down for quite some time.

Does this sound familiar? First, you should clean areas that are horizontal or high-touch, because that's where microbes or visible contamination will fall. Second, you should ensure a safe, clean area before each case.

"Cleaning between cases makes sense for the most part," says Judene Bartley, MS, MPH, CIC, the vice president of Epidemiology Consulting Services and a clinical consultant for the Premier Safety Institute. "But maybe when you're doing eye surgery, you don't need to do it between every case."

AORN recommends that you wet-mop visibly soiled areas of the floor or the immediate area (a three-foot to four-foot radius around the surgical field) with a hospital-grade germicidal agent, and clean to remove microbial debris from other surfaces.

But there might be a better way to prevent infections and maintain the environment: microfiber cleaning devices. They are more efficient, easier to use and more economical. Here's a look at how you might be able to improve your housekeeping.

Effectiveness
Healthcare facilities might be concerned with the happiness of their employees and with rising costs, but the most important reason microfiber mops are making inroads into cotton loop mop use (which has existed for nearly a century) remains the health of the patient.

Simply put, microfiber mops and rags clean more efficiently and decrease the odds of the transmission of nosocomial infections. Microfiber tools are made up of densely constructed nylon and polyester fibers that are one-sixteenth the size of human hair. The fibers, because of their density, are able to hold as much as six times their weight in water. The fibers also are positively charged, attracting negatively charged dust particles.

But the biggest advantage from an infection control standpoint is the fact you use a new mop head or rag to clean each room, each time. Housekeeping personnel simply remove mop heads (attached via Velcro-like strips) and replace them with new mop heads after every room. Under the loop-mop method, one mop services all rooms and is wrung out often into increasingly dirty water buckets.

"The old mops were good for two to three rooms," says Owen Grady, the director of environmental services at Phoenixville Hospital in Phoenixville, Pa., which has been using microfiber mops since January 2004. "Same mops, same buckets. Now, the chances of cross-contamination are nil."

"Microfiber just cleans better," says Arizona State Hospital director of environmental services David Polonsky, CHESP. "They don't slop the dirt around. But it works best where the floors are flat and the mop can flow easily."

In addition, microfiber mops and rags can be treated with antibacterial solutions to further promote bacteria-killing abilities.

Ergonomics
Ease of use is another compelling reason to switch to microfiber. Lifting heavier cotton mops and hauling 22-pound buckets is tougher physically on employees than removing the Velcro-like strips from microfiber mops while using the same bucket of water.

Microfiber mops weigh about five pounds less than cotton-loop mops, easing the burden on employees who have to carry the mops from station to station. You also don't need to wring out microfiber mops - you have to about once in every three rooms with cotton mops, according to Mr. Polonsky - because new mop heads are put on the mops after each room.

Additionally, employees don't have to lift heavy buckets to replace water and the extra chemicals required with cotton-loop mops. Mop buckets for microfiber mops, says Mr. Polonsky, require one gallon of water and chemicals. Cotton loop buckets require three or more gallons of water.

"Our workforce is middle-aged," says Bill Horton, the operations manager for environmental health services at Maine Medical Center. "We don't have a lot of high school kids applying for these jobs. To ask our people to go back to the closet so many times per day, lifting 22-pound buckets, is a lot of work. This is safer and does a better job, too."

Economics
At first glance, the cost of implementing microfiber operations appears to be daunting. The cost of a microfiber mop is two times to three times that of a traditional loop mop, and facilities must keep a greater number of microfiber mops in storage than traditional cotton-loop mops.

But those statistics might be misleading. The University of California Davis Medical Center found in a 1999 pilot test that microfiber mops saved more than $30 per 100 rooms. More money was spent initially on the pricier mops, but UCDMC realized a 60 percent lifetime savings on the mops themselves, a 95 percent reduction in chemical costs attached to mop usage and a 20 percent labor savings, according to the study. UCDMC completely replaced its loop mop system in patient-care areas within a year of the pilot test. Using microfiber mops, according to the study, saved UCDMC 638 work hours and $7,665 in labor costs per year.

Other less quantifiable factors include the reduction in workers' compensation claims, the savings in water usage and construction savings reaped by eliminating mop sinks in janitor closets.

"The investment is well worth it," says Mr. Polonsky.

Etcetera
Healthcare professionals cite several other factors in favor of microfiber.

Fewer injuries is one. Microfiber mops require less water and chemicals, resulting in a lighter load for employees and less back pain, neck strain and other upper body injuries. The wringing of heavy cotton mops also produces other injuries such as wrist tendonitis. Those injuries should be reduced with the use of microfiber mops. Finally, because microfiber mops hold more water than conventional mops, there is less dripping and subsequently less slipping on wet floors.

Pollution prevention is another potential plus. Microfiber mops require a relatively small amount of cleaning solution, reducing the amount of water and disinfectant disposed down the drain. And workers are not exposed to the potent chemicals used with cotton loop mops.

Finally, the use of microfiber mops is faster, quieter and less intrusive. "And that looks more appropriate to the patients," says Mr. Horton.

Expectations
Still, change has been slow: Published reports indicate less than 15 percent of U.S. hospitals have gone the microfiber mop route, choosing instead to stick with cotton loop mops. Why hasn't microfiber become the industry standard?

Startup costs preclude many surgical facilities from using a system that might prove cost-effective down the road. Floors that are worn or cracked might not be compatible with microfiber systems that work best on flat surfaces. Specific hospital areas - ORs for inpatient cases, emergency rooms - might be contaminated by too much blood and bodily fluids for microfiber cleaning implements to be effective. And then there is the natural aversion to change. Cotton loop mops have been the standard for nearly a century. Microfiber mops are the new kid on the block.

"We have staff who love it," says Mr. Horton. "But we also have staff who are skeptical."

Polonsky faced that skepticism when he introduced microfiber mops at Arizona State Hospital.

"Some people tried to spread the word against microfiber mops," says Mr. Polonsky. "But it didn't take long to realize the risk wasn't implementing the new technology, the risk was not implementing the new technology and losing the economic, environmental, infection control and ergonomic advantages."

Mr. Grady agrees microfiber mops improve infection control - when they stick around. "The only disadvantage we've found is that the mops tend to disappear," he says. "They appeal to everyone, unfortunately."