The Association of periOperative Registered Nurses (AORN) Recommended Practices state that “Every patient deserves a clean OR,” but historically there has been no easy way to objectively quantify that the OR is clean. In addition, surgical site infections (SSIs) continue to be a significant source of clinical complication and economic consequence for hospitals. SSIs account for 17 percent of all healthcare-associated infections (HAI) – an estimated 300,000 cases each year in the U.S. alone – and cost up to $10 billion annually.(1)
The very nature of an operating room makes it a high-risk environment for transmission and acquisition of pathogens. Organisms such as Staphylococcus aureus, Enterococus spp., Acinetobacter baumanii, and Clostridium difficile can survive for extended periods of time on surfaces. If not cleaned and disinfected properly, these pathogens can be passed on to patients and healthcare workers.
This highlights the need for thorough and effective cleaning in operating rooms. An OR environmental hygiene program that can be completed quickly and thoroughly and a clearly defined OR room turnover process can help hospitals provide a clean OR for each and every patient.
The AORN Recommended Practice on Environmental Cleaning is one of the most practical sets of recommendations for disinfection available to healthcare facilities seeking guidance on improving cleanliness in the OR. Recently updated, AORN’s recommendations for cleaning the OR include engaging a multi-disciplinary team, focusing on high touch objects, and objectively monitoring cleaning outcomes.[ii]
A comprehensive environmental hygiene program can help hospitals turn rooms in less time, improve thoroughness of cleaning, document essential processes, reduce and properly handle red bag waste, and follow appropriate infection control techniques and AORN Recommended Practices.
To properly address environmental hygiene, there are several key components that must be in place to deliver improved cleaning outcomes, such as:
- Training and education on best practices
- Standardized processes to consistently disinfect high touch objects
- Objective ways to measure program effectiveness and the thoroughness of cleaning
- Infection control practices to prevent cross contamination
- A fast, effective disinfectant with consistent delivery of correct concentration
- Ergonomic tools and practices to prevent injury
But to be effective, any environmental hygiene program for the OR must also be efficient. OR turnover time is critical and must be kept to a reasonable minimum, while still achieving optimum cleaning and disinfection. This is easier to accomplish with well established cleaning processes and protocols.
Due to the multitude of activity that occurs when one patient leaves an OR to when the next patient enters it (“wheels out to wheels in”), clearly defining the roles for each member of the perioperative team helps minimize any confusion about the cleaning process. When everyone on the team knows what and where to clean, the risk of missing an area or double cleaning an area can be minimized. In addition, providing cleaning supplies and tools that are available when and where they are needed help the OR staff save valuable time by not having to go find the tools required to clean the OR.
OR turnover kits that include microfiber mops and cloths can help to reduce the time to clean and prepare the OR for the next procedure because they are easy to use and provide all the supplies needed to clean the room together in one place. These kits have been shown to help OR teams reduce turnover time, improve infection control, and provide a consistent standard of care for each patient. And they comply with AORN, OSHA and Joint Commission recommendations.
Environmental cleaning and disinfection of the OR is a team effort often involving both perioperative and environmental services personnel. Today, it is vital that all members of the perioperative team work together to improve cleanliness and patient safety. A multifaceted approach to room turnover including best practices cleaning protocols, high touch object cleaning, the use of OR turnover kits and objective monitoring of cleaning outcomes can be an effective means of reducing the risk of infections in your OR.