The Importance of Clean OR Air

The science supports getting assistance for manual cleaning protocols in operating rooms and leaning on technology to purify the air.

While the jury may still be deliberating on how effective some whole-room disinfection and/or air purification systems are in reducing healthcare-associated infections, promising evidence is adding up that they do.

Research-backed

For example, a 2021 study by the Environment, Exposure Science and Risk Assessment Center (ESRAC) at the University of Arizona in Tucson found that whole-room disinfection technologies demonstrated significant reductions with a broad array of pathogens, including the highly resistant Clostridium difficile spores. C-diff is a real issue in acute-care settings and is being watched closely by infection prevention professionals in ambulatory settings as well.

“We found that the use of whole-room atomized disinfection with terminal cleaning protocols lowered manual labor times, improved disinfection outcomes and eliminated the transfer of bacterial pathogens to uncontaminated surfaces in healthcare environments,” says Kelly A. Reynolds, MSPH, PhD, director of ESRAC.

Purchasing such systems, which can be pricey, is reasonable even without a mountain of evidence as to their efficacy because, chances are, facilities will achieve a return on their investment, says J. Darell Hicks, BA, CHESP, CMIP, owner of Safe, Clean and Disinfected, a Missouri-based infection control company.

STAY AWAY One considersation when searching for whole room systems: Whether staff can be in the room when in use.

“You certainly achieve a cost avoidance if you do prevent infections from happening, and there’s evidence to show that less than 50% of terminally cleaned rooms actually get disinfected,” says Mr. Hicks. “That fact alone, to me, shows me there is a place for these systems in OR environments.” With all the high-tech help, it’s crucial to not slack on manual cleaning. Even if you know automated whole-room systems don’t replace between-case cleaning by nurses and overnight cleaning by environmental services, it’s important to not get complacent about manual-cleaning protocols after the purchase of an effective complement.

“Whole-room disinfection systems can be a valuable adjunct to routine disinfection and room turnover procedures. It does require leadership support for the staff training and utilization of those systems,” says Marie H. Wilson, MSN, RN, CIC, FAPIC, chair of the Association for Professionals in Infection Control and Epidemiology’s Communications Committee and an infection preventionist at Fred Hutchinson Cancer Center in Seattle. “It also requires auditing, just like any other cleaning verification that we do for performance, to ensure they’re being used properly, consistently and only as an adjunct that’s not taking place of the routine.”

Ambulatory facilities who would be prime candidates for whole-room disinfection methods include those who have suboptimal SSI rates or those that have done risk assessments and found their manual cleaning practices to be insufficient, says Nancy Havill, MT(ASCP), MHA, CIC, an infection prevention manager at Yale New Haven Health System in Connecticut.

Hydrogen peroxide misting machines, UV robots, UV lighting systems and other disinfection products are effective but different and Ms. Havill advises that facilities educate themselves about each of them to see which one is the best fit for you. Cleaning OR air by using laminar airflow, thermal-controlled or high-level HEPA filtration systems also work well.

Just as disinfection systems don’t change the rules for manual cleaning, those in ASCs shouldn’t forget to follow the ABCs of infection prevention, reminds Frank Edward Myers, MA, CIC, FAPIC, director of infection prevention and clinical epidemiology at University of California San Diego Health.

“Of prime importance in ambulatory surgery centers is making sure: One, the patient is properly bathed; two, your instruments have been effectively sterilized; and three, the patient understands correct postoperative care,” says Mr. Myers. “Those to me must always be done properly and done well as facilities also consider investing in devices to clean the environment.”

Mr. Hicks says the additional efforts to back up manual cleaning practices are more important than ever. “With healthcare’s staffing shortages and other challenges, the human element of our efforts isn’t getting any better,” he says. “We have to do something that is more of a belt-and-suspenders approach.”

Dr. Reynolds agrees, saying successful cleaning protocols should be standardized and multimodal. “By adding a whole-room disinfection system to your infection prevention arsenal and using it properly and regularly, you provide extra assurance that the risk to your patients and staff of contracting a healthcare-associated infection will be reduced,” she says.

There are also nonclinical benefits to buying a whole-room disinfection system, says Suraj S. Soudagar, MS, MBA, LEED, principal at IMEG Corp., an Illinois-based medical equipment and engineering firm.

“They are nice to have and are effective extra measures to take, so they make sense to purchase if you can afford them,” he says. “These tools also help from a marketing perspective to tell your story, which includes that you’re doing everything you can to reduce SSIs and HAIs.” OSM