Logan Reid
Operating rooms require meticulous cleaning and disinfection to ensure asepsis and the success of surgeries. The cleaning process is a critical aspect of patient safety, aiming to prevent infections and other potential health risks. Effective cleaning protocols in hospital operating rooms involve multiple steps, including the removal of visible dirt, the use of disinfectants, proper waste management, dedicated cleaning equipment, and adherence to specific cleaning schedules. Additionally, the implementation of new technologies, such as UV disinfection units, further enhances the disinfection process, reducing the risk of hospital-acquired infections. Maintaining a clean operating room is a collaborative effort involving various teams and individuals, all working together to uphold the highest standards of cleanliness and patient care.
| Characteristics | Values |
|---|---|
| Cleaning agents | Detergent, water, Disinfectant |
| Cleaning tools | Brooms, mops, UV wands, vacuum |
| Cleaning schedule | Before the first procedure, between procedures, after the last procedure |
| Cleaning process | Wipe surfaces, mop the floor, disinfect |
| Cleaning team | Perioperative leader, infection preventionist, ES leaders, infectious disease and facilities personnel |
| Pest control | Integrated pest management system |
| Cleaning protocol | Veterinary ORs have multiple protocols, human ORs have checklists |
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What You'll Learn
Cleaning equipment and disinfectants
Cleaning an operating room is a critical task that requires proper procedures to ensure asepsis and the success of surgeries. It is a team effort that involves consistent review and open communication to identify potential gaps and improve patient safety. Here is some detailed information about cleaning equipment and disinfectants for hospital operating rooms:
Cleaning Equipment:
- Dedicated equipment: Use separate equipment, such as mops, brooms, and buckets, exclusively for cleaning the operating room to prevent cross-contamination from other areas.
- Mops and buckets: Utilize a hospital-grade wet vacuum or a mop to remove excess dirt and dust from the floor. Follow this by mopping with clean water to eliminate soap residue, and finally, use a disinfectant solution, such as a 1% sodium hypochlorite solution, for the last mopping session.
- Microfiber cloths: Use soft, non-abrasive microfiber cloths for cleaning sensitive equipment such as operating lenses and microscopes.
- Cautionary signs: Place a 'Wet Floor' sign at the entrance of the room when cleaning begins to ensure safety and prevent accidents.
- Pest control: Implement an integrated pest management system to reduce the risk of infestation and minimize the need for chemical use.
Disinfectants:
- Broad-spectrum disinfectants: Choose disinfecting solutions with broad-spectrum microbicidal activity, suitable for various surface types. Consult the pharmacy department to select effective and affordable options.
- UV light technology: Invest in UV light fixtures or wands to continuously kill harmful bacteria in the air and on surfaces. While the initial cost is high, the reduction in hospital-acquired infections can lead to significant savings.
- ATP bioluminescence: Utilize adenosine triphosphate (ATP) bioluminescence tools to rapidly assess the level of cleanliness on disinfected surfaces and ensure the effectiveness of the cleaning process.
- Veterinary disinfectants: In veterinary operating rooms, use appropriate veterinary disinfectants to clean patient tables, instrument tables, pulse oximeters, and temperature probes.
- Disinfectant wipes: For general surface cleaning, use disinfectant wipes to wipe down flat surfaces, starting from the top and moving down, then from the centre outwards.
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Cleaning protocols and procedures
A clean operating room is critical to ensuring asepsis and the success of surgeries. Operating rooms are highly specialised areas with a mechanically controlled atmosphere, requiring environmental cleaning at three distinct intervals: before the first procedure, between procedures, and after the last procedure (terminal cleaning).
Multidisciplinary team
A multidisciplinary team, including a perioperative leader, infection preventionist, environmental services (ES) leaders, infectious disease specialists, and facilities personnel, should establish guidelines for cleaning and disinfecting perioperative areas. This team should also manage quality, review procedures, and ensure compliance with regulatory standards.
Cleaning schedules
Walls, ceilings, waiting rooms, lounges, offices, storage areas, restrooms, and other similar elements should be cleaned according to a cycle schedule developed by the multidisciplinary team. All perioperative areas, including utility areas, should be cleaned and disinfected daily, even if they were not used. Operating rooms not in use for an extended period, such as on weekends, do not need to be cleaned every 24 hours.
Pest control
A pest control program is necessary to reduce the risk of infestation. Packaging materials should be kept out of invasive-procedure areas to prevent harbouring insects or rodents. An integrated pest management system helps prevent infestations and reduce chemical use.
Cleaning procedures
Before beginning, ensure that all cleaning tools and equipment are in the room and close the door to prevent microorganisms from entering. Wear the appropriate personal protective equipment (PPE), including a clean gown, cap, mask, and utility gloves.
Clean all flat surfaces, wiping from top to bottom and then from the centre outwards. This includes the patient bed, attachments, positioning devices, patient transfer devices, containers for sterile instruments, antiseptic bottles, trays, scrub basins, taps, and walls. Check soap and antiseptic solution bottles, refilling if necessary. Prepare waste bins with colour-coded waste collection bags.
Clean operating microscopes and lenses with a soft, non-abrasive cloth and a cloth dampened with 70% alcohol or disinfectant, respectively. Do not use soapy water as it can damage lenses.
Clean anaesthesia machines, IV poles, patient monitors, and carts. Change hand towels, patient sheets, and blankets.
Mop the floor using a detergent and water solution to remove dirt and grime. Then, mop with plain water to remove soap residue. Once the floor is dry, mop with a disinfectant solution, working from the corner of the room towards the door.
After cleaning, keep the door closed for 10-15 minutes with ventilation equipment turned on.
Disinfection
Disinfectants should be used after cleaning to kill harmful bacteria. The entire operating room should be disinfected at the end of the day. Select disinfecting solutions with broad-spectrum microbicidal activity, suitable for each surface type.
Validation
Use tools like adenosine triphosphate (ATP) bioluminescence to assess the level of cleanliness of disinfected surfaces. Ensure environmental services workers are educated about disease transmission, properly trained, and equipped to perform their duties effectively.
High-touch surfaces
Identify high-touch surfaces in each patient care area and include them in cleaning checklists. High-touch surfaces outside the patient zone should be cleaned before those inside the patient zone to prevent contamination.
Terminal cleaning
Terminal cleaning involves a comprehensive, top-to-bottom disinfection of the entire operating room, including all surfaces and equipment. This is typically done at the end of the day or every 24 hours, whichever comes first.
Technology
UV light technology is used to disinfect operating rooms, treating each room at least once a week. Motion-activated overhead light fixtures combine white light with indigo light to continuously kill bacteria in the air and on surfaces.
Education and training
Proper education and training of cleaning staff are essential. Cleaning should be viewed as a lifesaving procedure, and standard operating procedures should be followed consistently.
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Pest control
Identify Entry Points and Seal Them:
Pests can enter the operating room through various entry points. Seal any cracks or openings around doors and windows, and pipes that pests could use to gain access. This is especially important for cockroaches, which can fit through incredibly small spaces.
Maintain Sanitation and Hygiene:
Cockroaches, flies, and ants are attracted to food debris and moisture. Ensure that the operating room and surrounding areas are meticulously cleaned and sanitized. Regularly clean under appliances and shelves to eliminate overlooked food and water sources. Proper waste management is also crucial, keeping trash receptacles closed and frequently emptied.
Staff Education and Vigilance:
Educate all staff, including kitchen, laundry, and housekeeping staff, on pest identification and prevention. Regularly check all areas of the facility for signs of pests, as early detection is key. Be vigilant about personal belongings and clothing, as pests like bed bugs and cockroaches can hitchhike into the operating room on these items.
Implement Pest Monitoring and Prevention:
Use pest-monitoring methods such as glue boards to capture pests and determine their traffic patterns. Work with professional pest management companies to develop educational materials and hold regular seminars to reinforce the staff's role in pest prevention.
Engage Professional Pest Control Services:
Professional pest control companies offer tailored solutions with specialized knowledge. They can provide safe and effective treatments, such as Sterifab, that minimize disruption to hospital operations. Regular pest control services are crucial for prevention and early detection, reducing the need for more aggressive treatments later.
By following these instructions and adapting them to the unique challenges of your hospital, you can effectively manage and eliminate pests in operating rooms, ensuring a safe and sterile environment for patients and staff.
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Room ventilation
Firstly, it is crucial to minimise traffic in and out of the operating room (OR) during the cleaning process. Each time the door opens, air turbulence occurs, putting multiple contaminated particles in motion. This can lead to the introduction of microorganisms into the room. Therefore, it is advisable to keep the door closed while cleaning and to limit the movement of people and equipment in and out of the OR suite.
Secondly, the ventilation system plays a vital role in maintaining proper air exchanges. The ventilation equipment should be turned on after cleaning to facilitate air circulation and the removal of any remaining contaminants. It is recommended to keep the door closed for 10-15 minutes with the ventilation system activated to optimise this process.
Additionally, the use of specialised technologies, such as UV light, can enhance room ventilation and disinfection. UV light fixtures can be installed to emit high-intensity narrow-spectrum light that kills harmful bacteria in the air and on surfaces. These fixtures can provide continuous environmental disinfection, improving the overall air quality in the OR.
Furthermore, a well-executed terminal clean is essential for optimal room ventilation. This involves a comprehensive top-to-bottom, floor-to-ceiling, and edge-to-centre cleaning of the OR at the end of each day or every 24 hours, whichever comes first. All surfaces, including walls, ceilings, and equipment, should be disinfected to prevent the spread of microorganisms.
Finally, it is important to validate the effectiveness of the cleaning process. Utilise tools such as adenosine triphosphate (ATP) bioluminescence to assess the level of cleanliness on disinfected surfaces. Ensure that environmental services workers are properly educated about disease transmission, adequately trained, and equipped with the necessary tools to ensure a thorough cleaning process.
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Cleaning checklists
The cleaning and disinfecting of hospital operating rooms are critical to ensuring asepsis and the success of surgeries. Here are detailed checklists to ensure a thorough cleaning process:
Daily Cleaning Checklist:
- Before the first procedure: Clean all flat surfaces, including walls, countertops, and shelves. Ensure all soap and antiseptic solution bottles are full and prepare waste bins with colour-coded bags.
- Between procedures: Perform a quick environmental clean to remove accumulated bioburden from surfaces within a close proximity to the operating table.
- After each procedure: Clean the patient table, instrument tables, and all equipment surfaces, such as anaesthesia machines, IV poles, and patient monitors. Change towels, sheets, and blankets.
- End of the day: Scrub and disinfect the entire patient table, instrument table, and equipment surfaces. Dismantle any components, such as the patient table trough, for cleaning.
- Before the next day: Clean and disinfect the operating room, including walls, ceilings, and floors. Prepare the room for the next day by restocking supplies and ensuring all equipment is functioning.
Weekly/Monthly Cleaning Checklist:
- Weekly: Use UV light to disinfect the operating room at least once a week.
- Monthly: Perform a deep clean of all areas, including waiting rooms, lounges, offices, storage areas, restrooms, and utility rooms. This should be done on a cycle schedule developed by the multidisciplinary team.
General Cleaning Guidelines:
- Ensure proper ventilation during cleaning to prevent the spread of microorganisms.
- Use dedicated cleaning equipment, such as mops and brooms, to prevent cross-contamination.
- Wear appropriate personal protective equipment (PPE), such as gowns, caps, masks, and utility gloves, during cleaning.
- Validate the effectiveness of cleaning by using tools like adenosine triphosphate (ATP) bioluminescence to assess the level of cleanliness.
- Establish a multidisciplinary team, including a perioperative leader, infection preventionist, and environmental services leaders, to set guidelines and maintain quality.
By following these comprehensive checklists and guidelines, hospital staff can ensure that operating rooms are properly cleaned and disinfected, reducing the risk of infections and contributing to the overall success of surgical procedures.
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Frequently asked questions
Operating rooms should be cleaned at three distinct intervals throughout the day: before the first procedure, between procedures, and after the last procedure. All flat surfaces should be wiped from top to bottom and then from the centre outwards. The patient bed, containers for sterile instruments, scrub basins, taps, and walls should be cleaned. The soap and antiseptic solution bottles at the scrub basin should be checked and refilled if needed. The trash should be emptied and a new bag should be used. Finally, the floor should be cleaned using either a mop or a hospital-grade wet vacuum.
It is important to prevent cross-contamination by using dedicated equipment to clean the operating room. The door should remain closed while cleaning and traffic in and out of the room should be kept to a minimum. Nails should never be trimmed in the operating room as paws are notoriously dirty. Masks and caps should be worn at all times before entering the room and should be stored outside the operating room.
A multidisciplinary team consisting of the perioperative leader, infection preventionist, environmental services leaders, infectious disease and facilities personnel should be established to set guidelines for cleaning and disinfecting the perioperative areas. Operating rooms should be treated with UV light during a terminal clean at least once a week.
