Infection Prevention: Be Exact When Cleaning Surfaces

Surface cleaning has been at the top of everyone’s mind for nearly two years during the pandemic. The truth is, this should always be the case, as ORs are high-risk areas for infection. It’s important to be diligent in the between-case cleaning of all high-touch items such as keyboards, imaging monitors, surgical tables, overhead lights and anesthesia carts to ensure they remain free of infectious organisms. The practice demands understanding the active ingredients in the products that are used and ensuring staff always follow proper methods while wiping down surfaces.

Chemicals commonly used in cleaning products include quaternary ammonium compounds, alcohols, chlorine compounds, hydrogen peroxide and phenolics. Some cleaning products may contain a mixture of compatible compounds, such as a quaternary ammonium-based product that also includes an alcohol. When used together, these formulations can be more effective at killing certain bacteria, viruses or fungi than a single chemical and may shorten kill times.

Low- or intermediate-level disinfecting chemicals, which are regulated by the U.S. Environmental Protection Agency (EPA), are used during environmental cleaning. When it comes to surface disinfection, bacterial spores are considered the hardest to kill. Mycobacteria, such as mycobacterium tuberculosis, are close to bacterial spores on the gradient of kill difficulty.

In general, low- and intermediate-level disinfectants are not considered sporicidal unless certain chlorine formulations are used. Tuberculocidal activity sets the difference between a low- and intermediate-level disinfectant. Knowing this, selecting an EPA-registered intermediate-level disinfectant provides a greater level of microbicidal activity compared to low-level disinfectants and would be a better selection for OR cleaning. Use of standard precautions, which cautiously assume that any bodily fluid is potentially infectious, includes the use of disinfectants that will cover the broadest range of disinfection capability to cover more difficult-to-kill organisms.

When choosing a product for your facility, there are several aspects in addition to cost to evaluate during the selection process. Look for a product that works on a broad array of microbes and can be used on as many surfaces in your OR as possible, so you don’t have to purchase multiple products. Avoid chemicals with strong odors as this can lead to poor compliance, team dissatisfaction and potential downstream health-related issues for cleaning personnel. Additionally, try to add products with short dwell (wet) times, which is how long it takes to effectively meet the kill claims according to the manufacturers. Doing so will help achieve better compliance.

Always confirm a product’s compatibility with the surfaces you’re cleaning. Equipment manufacturers might not evaluate their products with a large array of cleaning/disinfecting agents, so consider reaching out to the manufacturers of cleaning products to determine if compatibility testing has been conducted on the devices in your ORs.

Confirm a product’s compatibility with the surfaces you’re cleaning.

Also check whether the cleaning product requires a dilution before being used and how stable it remains over time. You don’t want to use a product that leaves a residue, generates toxic fumes or damages equipment over time. A highly effective cleaning product is an inappropriate choice for your facility if it’s toxic or is known to damage certain types of expensive equipment. Cleaning and disinfection products are available in pre-moistened wipes, sprays or undiluted concentrates. Check a cleaning product’s instructions for use to determine if it’s an all-in-one product (it can be used as both a cleaner and disinfectant) or calls for cleaning with one application and disinfection with another application. Prior to use, always make sure a cleaning product is not expired or discolored and pre-moistened wipes haven’t dried out.

Cleaning shouldn’t begin until patients have left the OR to prevent exposing them to potentially harmful chemicals or contaminants that may be spread during the cleaning process. The dirtiest area of the OR is assumed to be where the patient was operated on or where the procedure was performed, which is typically near the center of the room. Therefore, generally clean from top to bottom, and from the outside in. Try to work in the same direction, be it clockwise or counterclockwise, to make sure you’re not backtracking into an area that has already been cleaned. While walls and floors are typically cleaned during terminal cleanings at the end of each day, these surfaces might need to be treated on an as-needed basis if there was a spill of blood or other bodily fluid during the case or if they’re visibly contaminated.

Surface cleaning responsibilities vary between facilities, with environmental services personnel generally handling the bulk of the duties at hospitals while members of an OR team often play important roles at independent ASCs. Regardless of where the cleaning process occurs, it should be a collaborative effort based upon the facility’s written processes and procedures.

Educate and train new employees on how to properly use your facility’s cleaning agents and perform frequent competency assessments of staff members’ cleaning practices, regardless of their tenure, to ensure maximum proficiency. Emphasize to every team member involved in the cleaning and disinfection of ORs that they’re playing a critically important role in preventing the transmission of healthcare-associated infections and their focus on following proper cleaning protocols is needed between every case and at the end of each day. OSM