If you ask 5 different nurses how surface disinfection is supposed to be done, you may end up with 5 different answers. To clear up some of the confusion surrounding the required products and acceptable techniques, consider what AORN and the CDC have to say about these common questions.

1 Is surface disinfection really needed?
Yes. The answer seems obvious but, believe it or not, it's a question some clinicians and healthcare workers still ask. When they do, you should explain that surface disinfection is important from both a patient safety and a staff safety standpoint.

In its Recommended Practices for Environmental Cleaning in the Surgical Practice Setting, AORN says that patients should be provided with a clean, safe environment. "Healthcare-associated infections have been linked to external sources, which can include environmental surfaces," says AORN. "The risk of infection from pathogenic organisms on environmental surfaces is due not only to their presence, but to their ability to survive on and be transferred to many surfaces."1

Meanwhile, the Bloodborne Pathogen Standard passed by OSHA in the 1990s requires healthcare facilities to implement policies and procedures to identify and eliminate potential exposures to bloodborne pathogens for all healthcare workers. It's up to you to determine the best way to ensure that all equipment and surfaces that come into contact with blood and other potentially infectious materials are cleaned and decontaminated. Failure to do so could bring sanctions from OSHA, CMS and accrediting bodies.2

2 Which surfaces need to be targeted, and when?
Environmental surfaces that come into contact with intact skin are considered non-critical and therefore require low-level disinfection. The CDC recommends that floors, walls, tabletops and other housekeeping surfaces be kept visibly clean, and that you wet-vacuum or mop OR floors after the last procedure of the day.3 For patient-care areas where "uncertainty exists as to the nature of the soil on the surfaces" or "regarding the presence of multi-drug resistant organisms," use a consistent process and an EPA-registered detergent/disinfectant to clean surfaces, paying particular attention to high-touch areas such as doorknobs, bed rails and lightswitches, and horizontal surfaces such as furniture, lights, booms and other equipment. All equipment entering the OR from other areas should be cleaned before it's brought into surgery. Finally, be sure to use mechanical friction when cleaning; scrubbing action and friction are the keys to effective surface disinfection (see "For Surface Dis-infection, Third Time's the Charm" on page 16).

Examine your facility with your OR staff to understand the types of procedures performed and desired turnover times, which in turn will help you develop practical, scientifically based policies and procedures for environmental cleaning and disinfection. These policies must be written, reviewed annually and readily available for your staff to consult. Note that between-case cleaning and terminal cleaning (performed every 24 hours) are very different procedures.

• Between cases. Perform a visual inspection of the OR and perform spot cleaning of areas (walls, doors, lights) that are visibly soiled or contaminated. All receptacles (bins, kick-buckets, pails), work surfaces and tables should be cleaned. Clean visibly soiled areas of the floor with a new or freshly laundered mop head and an EPA-registered germicidal agent.4 Do not cut corners: AORN says you must re-establish a safe, clean surgical environment after every procedure.
• Terminal cleaning. Terminally clean your ORs and procedure rooms at the end of each day, when scheduled procedures are completed. "This should occur each 24-hour period during the regular work week," says AORN. During this step, dust all environmental surfaces — not just those that are visibly soiled — and clean with an EPA-approved germicidal agent. AORN also recommends that "all horizontal surfaces, hallways and floors, sub-sterile areas, scrub utility areas, sterile storage areas and eye wash stations should be cleaned and checked weekly," and that "scrub sink and wash basins should be cleaned on a regular basis." If you have a contracted cleaning company that terminally cleans your facility, make sure they have specific training in the unique cleaning and disinfection needs of a healthcare facility. (For more on terminal cleaning, see the "Infection Prevention" column in the April 2011 issue of Outpatient Surgery Magazine.)

3 Which products should we use?
Use only EPA-registered disinfectants to clean floors, non-critical equipment and other environmental surfaces. Be sure to change reusable string and microfiber mops and cloths after each use. You should use a new mop head for each surgical area and after each cleaning. Do not return used mops or cloths to the cleaning solution container. When selecting a disinfectant or cleaning product for your facility, consider these factors:

• Intended use. What will you be cleaning with the product? Is it appropriate for those surfaces?
• Ease of use. How many wipes does it require? How long must the product remain in contact with the surface in order to be effective? How will this impact your turnover time and efficiency?
• Efficacy. Consult the literature: Does this product effectively kill all the microbes necessary to protect your patients and staff from potential contamination?
• EPA approval. Surveyors will verify that the product you use is approved for use in the healthcare setting.
• Safety. For example, does the product have a harsh smell or give off vapors that are potentially harmful to staff?
• Cost. Conduct a cost-benefit analysis just as you would with any other product.

4 Should we use sprays or wipes?
AORN actively frowns upon using spray bottles containing disinfectant for surface cleaning. Instead, use a clean, lint-free cloth moistened with an EPA-registered detergent/disinfectant. Review manufacturers' instructions, particularly the specified contact and dry times. Infection control surveyors will check to make sure you have these instructions in writing and that they are being followed to the letter.

5 Who's responsible for cleaning the OR?
Ultimately, it's up to the perioperative nurses to check the OR and its surfaces to ensure they are clean and ready for patient use. "Preparation of the OR should include visual inspection for cleanliness before case carts, supplies, equipment and instrument sets are brought into the room," recommends AORN. Instruct your perioperative nurses to assess the OR environment frequently for cleanliness and take action to implement cleaning procedures when and if they're needed.