The Essentials: The Cornerstones of Surface Disinfection

A comprehensive primer on the standardized techniques and high-tech tools that encompass one of infection control’s most important tasks — preventing contamination in the OR.

The techniques and tools used for surface disinfection are crucial to the goal of continuously reducing infection rates. In the OR, you can never assume a surface is free of contamination. The right tools and clear, consistent processes are the only way to ensure decontamination and efficiency in the surface disinfection process.

When OR staff assume that a surface is clean and disinfected but it actually isn’t, both providers and patients are at risk, says Kimberly Jones, DNP, RN, CNOR, RHCNOC, CER, CRCST, nurse manager at Ascension St. Vincent Mercy Hospital in Elwood, Ind. “Not all organisms require a host to live,” she says. “Some can remain viable on an inorganic surface for months or longer. This increases the risk for cross contamination.”

Best tools for the job

Not all disinfectants are created equal. Different surfaces, equipment and procedures may require different disinfection chemicals to achieve the best outcomes.

“One of the most important tools is the right chemical for the job,” says Dr. Jones. “The chemical I would use to clean my OR after a general, straightforward case is not the same that I would use to clean endoscopy after a case where the patient is suspected or diagnosed as having C. diff.”

Staff also need proper rags and mops. Dr. Jones says that while microfiber rags are great at reducing lint, microfiber mops may prove difficult to use when there’s flooding of the floor in the OR.

Access to effective hand hygiene is also crucial, says Stacy Austin, BSN, RN, CIC, an infection prevention practitioner at both Ascension St. Vincent Mercy and Ascension St. Vincent Randolph Hospital in Winchester, Ind. “Hands must always be clean when charting and accessing storage,” she notes. “Having access to hand hygiene products in the anesthesia workspace and using them must be consistent. Alcohol-based hand rub increases hand hygiene and having surface disinfectants with both proper kill claims and short dwell time keeps disinfection practical and attainable.”

Additionally, convenient and handy wipes that are moist and large enough are key to keeping surfaces clean. During busy operations, and as clutter builds, easy access to proper disinfectants is an absolute must.

Latest, greatest and most available

THE BAD TOUCH Keep a list of high-touch objects in the OR handy to ensure you and your team tackle them before the next case.

Part of having the right tools for the job is keeping up with the newest ones. “There is always some new chemical with claims of being less harsh on equipment or having a shorter dwell time or faster kill time,” says Dr. Jones. She adds that it’s important to thoroughly research and seek out the experience of other users before switching to a new disinfectant product.

Even when switching seems beneficial, there are other considerations. “Consult the IFU (instruction for use) for the equipment on which you would be utilizing the tool or chemical. The two may not be compatible,” says Dr. Jones. Of course, cost is another factor. “Small facilities like ours will never be able to afford or justify the purchase of UV [ultraviolet light] disinfection, for example,” says Dr. Jones. “This is why strict adherence to the basics of disinfection is so important.”

While tools like hydrogen peroxide foggers or UV can be helpful, nothing beats old-fashioned elbow grease, says Ms. Austin. “If you do high-quality cleaning and disinfection, additional measures shouldn’t be needed,” she says.

Beyond standard cleaning and disinfection between each procedure, it’s also a good idea to perform weekly and monthly deep cleans.

Defined processes

MISSED THE BOAT Research shows that objects such as light switches and doorknobs often go uncleaned by busy staff in between cases.

Having standardized techniques in place, as well as awareness and teamwork among cleaning crews, helps to prevent mistakes or overlooked areas. Dr. Jones says staff must hold each other accountable, avoid cutting corners and maintain the highest standards.

Defined processes help prevent corner-cutting. “Without definition, each associate will do it the way they think is best or however they were trained,” says Dr. Jones. “A defined process takes out any guesswork and dramatically decreases human error.”

Defined processes also prevent cleaned materials from being placed on contaminated surfaces. An example of this type of mistake is when a team member sets something on the floor or on top of the sharps box or trash can during cleaning, says Ms. Austin. Another example is a team member taking something apart to let it dry before reassembly, such as a break away bed, bed mattress or patient positioning aid. Taking something clean and placing it somewhere dirty to dwell/dry can lead to contamination that gets missed.

Remember also that “clean” does not mean “disinfected.” Dr. Jones says it’s impossible to disinfect something that isn’t clean. “If the surface has gross contamination, clean it first. Then you can disinfect thoroughly,” she says.

Keeping your ORs tidy and free of unnecessary equipment and containers will help simplify and accelerate surface disinfection between cases. After all, the more cluttered the OR gets, the more items there are to disinfect. “Reducing clutter and keeping only what is absolutely necessary in the area are key to making those areas easy to clean and disinfect,” says Dr. Jones.

Take your time

While efficiency is important in a busy OR (and to your bottom line), health and safety should always come first. Using chemicals with fast kill times, and using pour bottles instead of wipes in certain situations, can help cleaning teams ensure both safe and more efficient turnovers, says Dr. Jones.

Leaders and surgeons must respect that the turnover process takes time because the team must prioritize safety. “External pressures can’t insist on unrealistic turnover times,” says Ms. Austin. Some cases simply require more time than others, depending on the operation performed and the level of contamination caused by the procedure.

It’s important to limit interruptions during the process, Ms. Austin adds. Disruptions can throw off the rhythm and focus of the team.

Rooms for improvement

Some objects in the OR are more difficult to clean than others. Dr. Jones provides examples such as computers, screens and Velcro straps, just to name a few. “In some instances, like screens, the products are not as readily available,” says Dr. Jones. In other cases, the product itself, such as Velcro, may have a design that is inherently tricky to disinfect.

Any busy workstation in the OR can be complicated to keep clean. The anesthesia station is a prime example. It’s usually positioned in an area that easily and quickly becomes cluttered.

There is always some new chemical with claims of being less harsh on equipment or of having a shorter dwell time or faster kill time.
Kimberly Jones, DNP, RN, CNOR, RHCNOC, CER, CRCST

Any storage area where hands go in and out frequently requires diligence to keep clean, says Ms. Austin. Hands always need to be clean, because if a storage cart gets contaminated, for example, everything inside should be assumed to be contaminated as well.

Ms. Austin says anesthesia providers should have hand hygiene tools available in their workspaces because it can be difficult or disruptive for them to access them in other areas during a procedure.

Putting it all together

To prevent contamination in the OR, it’s essential to employ the right tools and techniques. The right disinfectants are, of course, important, but they must also be easily accessible to staff. Make sure objects and surfaces are clean before disinfecting and work to reduce clutter to reduce the chances of misses and mistakes.

Bottom line: Turnover times are important, but safety and sanitation come first. A well-trained team equipped with the right tools, guided by defined processes, and provided with the time and focus needed for the task at hand can effectively carry out the important work of preventing contamination in the OR. OSM