BENEATH THE SURFACE Monitor the cleaning crew to ensure they pay attention to the details of terminal cleaning.

The last OR clean of the day is arguably the most important. Here are 6 keys to ensuring terminal cleaning is done effectively and efficiently, so every surface in the room is cleaned and disinfected before the next day's first case.

1. Daily double-checks
At the end of each day, hang a checklist in the OR (see "10 Steps to Terminal Cleaning Success") so your terminal cleaning crew can check off each task as they complete it. Staff who arrive first the next morning inspect the ORs and confirm on the checklist that the areas were terminally cleaned the night before. The day's early arrivals should perform any skipped or missed tasks, and report the oversight to you or your infection preventionist. Keep the checklists on file should you ever need proof that a room was terminally cleaned. In addition to your staff's daily spot checks, you should occasionally walk through the pre- and post-op areas and the ORs.

2. The right products
Use single-use disinfecting wipes, disposable, lint-free mop heads, and low-lint cloths to dust and clean surfaces. Stock enough mop heads so the cleaning crew can use a fresh one for each OR and each area it cleans. Clean ORs from top to bottom and from the perimeter to the center of the room — the center of the room where surgery occurs is likely to be the dirtiest. Terminal cleaners should wear personal protective equipment, including gloves, masks, surgical caps and surgical gowns.

3. Consider outside help
We contract with a cleaning company that works in several local healthcare facilities to terminally clean our facility. The same crew of cleaners arrives every evening after we go home to clean the pre-op and PACU areas, the ORs and GI procedure rooms. They're good at what they do and know our facility inside and out, so it's a positive partnership that takes some of the cleaning burden off of our full-time staff.

4. Always be ready
Even if, like us, you contract out the service, every staff member must know the proper protocols for a terminal clean because there may be times when terminal cleaning can't wait until the end of the day. For example, we occasionally can't schedule a patient with a latex allergy for the first case of the day or we may not find out a patient has a latex allergy until we ask them about it in pre-op. Our facility is latex safe, but there are a couple items that are not latex-free, so we'll terminally clean the OR before bringing a patient with a latex allergy into the room.

Although we have very strict guidelines about the type of patients we bring into the facility, we might end up operating on a patient with a MRSA or Clostridium difficile infection. We would definitely terminally clean the OR after those procedures.

DAILY CHECKLIST
10 Steps to Terminal Cleaning Success

— Nikki Williams, RN, CNOR

This form lists the 10 must-do tasks our terminal cleaning crew must complete each night. We hang the list in each area that requires a terminal clean so the cleaning crew can check off the items as they complete them. The pass inspection column on the far right lets our OR staff ensure the next morning that terminal cleaning has taken place. We also use this checklist to document that we're meeting our infection control standards.

Cleaning Task

Task Complete Initials of cleaning person

Pass Inspection Initials of inspector

Clean and dust the ceiling, AC returns/vents, fire sprinklers, anesthesia plugs and gas outlets.

 

 

Clean and dust walls, doors, wall panels, suction wall mounts, X-ray view boxes, gas panels, wall outlets and fire extinguisher cages.

 

 

Ensure glass, blinds, surface counters, cabinets and all flat surfaces are cleaned, dusted and spot-free.

 

 

Ensure all furniture, metal tables, OR exam table and carts are thoroughly wiped down, cleaned and dusted.

 

 

Clean and dust the surgical lights.

 

 

Ensure the sub-sterile room's autoclave and warmer are dusted and lint-free, and the floor is mopped, cleaned and spot-free.

 

 

Move all equipment before thoroughly sweeping and mopping the floor.

 

 

Clean kick buckets and receptacles, and replace red bag liners.

 

 

Wipe clean laundry and trash collection frames and lids.

 

 

Remove and properly dispose of all trash and biohazardous waste.

 

 

5. Observe and assess
Conduct annual competencies on the performance of your cleaning crew, whether they're in-house staffers or outside contractors. Observe the team as they perform every step of a terminal clean. Stop them if you see incorrect practices and show them the proper way to complete the step. Stress that removing visible soil from surfaces is the vital first step that lets cleaning solutions or whole-room systems reach bacteria that linger on surfaces.

6. Consider whole-room disinfection systems
We're a small surgery center, so cost could be a prohibitive factor, but we're seriously considering investing in a whole-room disinfection unit to maximize our terminal-cleaning efforts. We require our cleaning crew to move all pieces of equipment and furniture in order to touch every area of the OR, but human error will always be part of the process. Whole-room technology appears to be effective in reaching places that staff can't reach or forget to cover and is ideally suited for a terminal clean. There are several options to chose from, each with its own benefits and potential drawbacks. Units that deliver ultraviolet light are straightforward to set up and use, and are effective at inactivating a wide range of microorganisms. But they must be in direct line of sight of the surfaces they're treating, so you must reposition them several times to reach all areas of the room. Hydrogen peroxide systems treat surfaces with vapor, aerosolized dry mist and vaporized ozone hydrogen peroxide. While you don't have reposition them, staff face the challenge of sealing rooms off before treating them. OSM