Surface cleaning and disinfection should be an integral part of your OR staff's daily routine, not just the responsibility of housekeeping or environmental services, for the simple reason that frequent hand contact with surfaces and items can transfer microorganisms to and from patients.

The CDC uses the Spaulding categories for classifying disinfection and sterilization requirements:

• Critical items. Those that must be sterilized, such as surgical instruments.
• Semi-critical items. Those that may come into contact with mucous membranes, such as endoscopes. High-level disinfection or sterilization may be performed on these items.
• Non-critical items and surfaces. Those that come in contact with intact skin, including stretchers, wheelchairs, countertops and phones. The disinfection of these surfaces, which require low-level disinfection, will be discussed here.

Cleaning and disinfecting aren't synonymous. Cleaning involves removing visible organic and inorganic matter, such as blood, body fluids, tissues or dirt and dust from an object or surface. Organic matter can inactivate many disinfectants, so if you notice gross contamination make sure that the surface receives a thorough cleaning. The physical action of scrubbing (don't be afraid to use some elbow grease) with a detergent such as soap before rinsing with water can significantly reduce the number of microorganisms on a surface.

Disinfection is a process intended to kill microorganisms on the surface. Cleaning and disinfection frequently occur at the same time if the gross contamination on the surface is minimal with no visible soiling. If you want to clean and disinfect at the same time, you must select a product that functions as both a detergent and disinfectant.

Clean and disinfect the OR after each procedure. By this, I'm referring to surfaces closest to the patient, surfaces frequently touched by care providers and items or surfaces that come in direct contact with the patient, blood or body fluids. These surfaces include procedure and instrument tables, kick buckets and other OR equipment that receives frequent hand contact during a case.

Between each case, clean and disinfect floor areas within a perimeter that would likely be soiled during a procedure. Spot clean general surfaces such as walls and cabinets between cases with the proper detergent if any blood, tissue or body fluids are visible. At day's end, terminally clean each OR. This rigorous process should include floors, walls, lights and booms, furniture, equipment, countertops, autoclaves, doors, cabinets and sinks. Horizontal surfaces such as countertops or procedure lights need special attention because dust is a vehicle for microorganisms and can accumulate in those locations.

Choose your weapon
Although many different products kill microorganisms, not all germicides are interchangeable. When selecting a disinfectant, verify the product's claims and consider the product's purpose; the effectiveness of the chemical when in contact with organic material; the amount of contact time required for effectiveness; the effect the chemical may have on surfaces; and its requirements for safe use. Germicides are regulated by the EPA, which verifies the manufacturers' effectiveness claims.

For most general surface disinfection in the OR, an EPA-registered quaternary ammonium compound is adequate. For specialized equipment, consult the manufacturer's cleaning and disinfection recommendations. OSHA requires that disinfectants used for blood spills be effective against hepatitis B and HIV or Mycobacterium tuberculosis.

Your staff may mistakenly believe that a tuberculocidal germicide is designed to prevent tuberculosis infection. This is not true. Tuberculosis is transmitted through airborne means, not from contact with a surface. In cleaning products, M. tuberculosis is used as a benchmark for measuring the germ-killing capabilities of a disinfectant, since this bacterium is more resistant to germicides than many other organisms. Bleach can be used for blood spills, too, but it can be harsh on skin and surfaces. Bleach is also recommended when increased transmission of Clostridium difficile is a concern.

In many facilities, an anesthesia tech is responsible for cleaning and disinfecting anesthesia equipment. Follow AORN's Recommended Practices for Anesthesia Equipment, Cleaning and Processing. Indeed, assigning ownership of certain pieces of equipment or areas can help ensure that there are no orphan items in the OR that don't receive needed attention. Include specific accountability for the cleaning of common items such as phones, keyboards and computer monitors.

Write policies that define requirements for the cleaning and disinfection of non-critical patient care items and surfaces. These policies must explain how often surfaces should be cleaned and which products and processes should be used in each situation. For example, you can use a quaternary ammonium compound for general surface cleaning and disinfection while a tuberculocidal phenolic is appropriate for blood spills.