Ready for the New Normal in Surface Disinfection?

Infection Prevention

By: John Berry

Published: 11/29/2022

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Revisit your protocols before a return to the pace of pre-pandemic surgery.


The short- and long-term impact of COVID-19 will surely include a radical change in how surface disinfection is practiced and enforced. "All of my surgical facilities are asking the same thing: "When are we going to get back to normal?'" says Donna Nucci, RN, MS, CIC, infection preventionist at Yale New Haven (Conn.) Hospital and owner of her own consulting business.

She tells them the same thing: Surgery will eventually return to a new normal, one with an increased focus on how well and how often you clean high-touch areas in operating rooms and common areas. Case volumes will eventually ramp up and when they do some experts predict a boom in elective surgeries. That means it might be best to use this temporary lull in the action to revisit surface cleaning protocols and plan for improvement in a post-COVID-19 world.

"The science is most likely not going to change, but implementation will," says Ms. Nucci. "This is a wakeup call for outpatient facilities to make sure their cleaning protocols align with CDC guidance, including the use of EPA-approved cleaning products and a clear process for performing surface disinfection."

Ms. Nucci expects the CDC to increase its oversight of surface disinfection processes. "Regulatory agencies and patient advocacy groups may require you to have a structured environmental cleaning program in place," says Ms. Nucci. "I think we're going to see many more checks and balances."

That's why you should revisit your surface cleaning protocols now — before case volumes pick up again. To prepare and comply with surface disinfection requirements, Ms. Nucci recommends looking to CDC and AORN guidelines for the most effective products and practices.

There is a heightened awareness of cleanliness and disinfection right now.
— Dean A. Caruso, MBA

To take surface disinfection a step further, consider incorporating high-tech whole room disinfection solutions as an adjunct to your manual processes. Research has shown that ultraviolet (UVC) light technology can kill pathogens on OR surfaces, including multidrug-resistant superbugs. There are several available options in portable UVC equipment designed to enhance traditional disinfection practices. Another option is hydrogen peroxide vapor disinfection, which has already seen some success in disinfecting entire hospital wards efficiently and effectively, according to Nancy Havill, MT (ASCP), MHA, CIC, infection prevention manager at Yale New Haven Health. "We use the technology to disinfect the entire ward, then put patients back in it," explains Ms. Havill. "We did it back in 2006 when we had an increase in C. diff incidence and saw a significant decrease in our infection rates. We're currently exploring the opportunity to decontaminate our COVID-19 units."

While the coronavirus hasn't changed Yale New Haven's cleaning procedures or the chemicals staff use for disinfection, it has changed the frequency in which the process is done. Pre-pandemic, the hospital's environmental services staff would perform a high-level surface disinfection of common area bathrooms two to three times per shift, which is a very good rate. Now, however, they disinfect the bathrooms nine to 10 times per shift.

"There is a heightened awareness of cleanliness and disinfection right now," says Dean A. Caruso, MBA, executive director of support services and sustainability at Yale New Haven. "Everyone understands that just because something looks clean, it could still make them sick."

Patient expectations are also going to be different when surgery begins to ramp up, notes Ms. Nucci. "They're going to start asking questions — "?How often are you cleaning? What are you cleaning with? Am I safe?'" she says.

"We've had patients ask how often we clean our elevator," says Stephen Branch, director of environmental services at Yale New Haven's York Street facility. "That never happened before the pandemic."

Maintaining efficiencies

EVERY INCH Monitor your team's performance by ensuring they treat high-touch areas between every case.

One thing high-volume outpatient facilities often struggle with is how to reconcile proper surface disinfection with quick OR turnovers. This is one area in which the COVID-19 outbreak might work in your favor. It will require all facilities to meet a more rigorous standard of infection prevention, particularly among outpatient centers where turnover has been a fundamental concern. "In the past, environmental services was sometimes instructed to hurry cleaning along and asked how long their process would take," says Mr. Branch. "But now with the heightened awareness, it's "?Let make sure you have enough time to clean this space.'"

Another way in which Yale New Haven is marrying adequate surface disinfection with high-volume turnover is by using the highest caliber surface cleaning solutions. "We use a product with a one-minute dwell time," says Mr. Branch. "It will kill most pathogens in one minute or less."

When it comes to surface disinfection, verification is key. Administrators at Yale New Haven monitor staff performance by marking 17 high-touchpoints — based on CDC recommendations — with Tide pens. They then use black lights to make sure staff cleaned those areas. "The CDC recommends recleaning the room if three or more points still have a mark," says Mr. Branch. "We were exceeding our internal goals after just six months and went to a one touchpoint standard," says Mr. Branch.

While it might seem like adopting such a rigorous surface disinfection policy would result in longer room turnover times, that's not the case. "We're a very busy hospital, and it does not slow us down," says Mr. Caruso.

The key to maintaining a highly effective disinfection standard is consistent communication and teamwork among your staff. "Our supervisors and frontline staff work seamlessly together to make our process work, and also coordinate with our capacity command center, which is the group that oversees patient flow for the entire hospital," adds Mr. Caruso.

Beyond the OR

EXTRA HELP Ultraviolet light technology can kill most pathogens in the OR, including multidrug-resistant superbugs.

Cross-contamination and infection among staff is always a risk in any medical facility, but with the current strain on healthcare systems and the people who work in them, your staff needs to be concerned with the health of the patients they treat, their own safety and the cleanliness of their work environment. As the experts we spoke to note, major changes will also have to happen regarding the use of waiting rooms, lounge spaces and other common areas that may not have previously received the same level of attention as the OR.

Yale New Haven has already reduced seating in common areas. The facility has removed 40% to 50% of its common seating capacity in order to create social distancing spaces, says Mr. Branch. Changes like this not only prevent transmission of disease when patients or staff are in close proximity, but also have the added benefit of reducing contact points, slightly lessening the surface disinfection burden for staff.

Mr. Branch notes that disinfection routines at Yale New Haven have at least doubled in response to the COVID-19 pandemic, and it's likely that most facilities will have to adopt similar standards.

For facilities that are experiencing a halt or reduction in their operations, now is the time to ensure their spaces, equipment and personnel are ready to operate effectively. "This is a great opportunity to hire a company specializing in healthcare cleaning to remove all equipment from your operating rooms, storage and sterile processing department, and give the entire place a terminal cleaning," says Ms. Nucci. "Also clean the waiting room and all common areas."

The pressure on healthcare systems to improve their surface disinfection procedures and use technology that allows them to do so more effectively will certainly result in great strides toward safer and more sterile environments for staff and patients. The most important thing now is to see how those advancements unfold in research labs and on the frontlines of treatment. For outpatient facilities, planning and preparing for a post-COVID-19 world will allow for an easier transition and an overall improvement in patient care and staff safety. OSM

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