1. Controlling CDI — Environmental services cleaning and disinfecting in the operating and procedure rooms Contents courtesy of Allina Healthcare

2. Introduction  Cleaning an operating room or procedure room requires a team approach. Surgical services, environmental services, and infection prevention work closely to ensure a clean and safe surgical environment.  Dedicate carts, cleaning tools, vacuums, and floor machines to the OR. Dedicated equipment can help prevent transmission of organisms, particularly from the wheels of floor machines used in other areas.  Detergent and disinfectant solutions should be prepared as needed according to manufacturers’ instructions and properly labeled. Follow EPA approved contact time as directed by the disinfectant manufacturer. Contents courtesy of Allina Health

3. Disinfection  Detergent Contains surfactants that clean and remove “soil” from surface  Disinfectants Hospital approved chemicals that kill bacteria and fungus Contents courtesy of Allina Health

4. Disinfection  Adequate amount Enough chemical to keep surface wet for required contact time  Adequate contact time Amount of kill time required Determined by testing by the U.S. EPA  Friction Wiping the surface removes bugs  Saturation Having enough disinfectant on a cloth to ensure that enough chemical gets to the surface for the right amount of time Contents courtesy of Allina Health

5. OR/Procedure room cleaning definitions:  Room turn-over: Between case cleaning done by OR staff  Terminal clean: End of day cleaning done by Environmental Services staff  Cycle cleaning: Periodic deep cleaning (e.g. walls and ceiling) done by Environmental Services staff Contents courtesy of Allina Health

6. Value of standardized cleaning protocol  Studies have indicated that: Contamination of surfaces and equipment in the patient room contribute to transmission of hospital acquired pathogens The process of cleaning and disinfection can vary from person to person, or even between rooms with the same person Contents courtesy of Allina Health

7. Value of standardized cleaning protocol  Studies have indicated that: Taking the “randomness” out by standardizing our cleaning processes will help assure that surfaces are consistently cleaned well and exposed to adequate amounts of disinfectants. Reducing the number of organisms in the patient’s environment reduces the opportunity for transmission of hospital acquired pathogens and infections. Contents courtesy of Allina Health

8. Education plan  Presentation  Post test  Demonstration Ongoing education plan  New employee initial orientation  Yearly training and recertification Contents courtesy of Allina Health

9. Post education measures  Return demonstration  Evidence-based monitoring - UV testing  Quarterly Quality Assessment (checklists) Contents courtesy of Allina Health

10. Quality control guidelines  UV testing  Direct observation  Quality standards Contents courtesy of Allina Health

11. UV testing Contents courtesy of Allina Health

12. Room cleaning summary  Turnover and terminal cleaning is important in removing germs from the surgical environment.  Use the right tools  Use the right chemical  Use the right amount of chemical for the right amount of time Contents courtesy of Allina Health

13. Infection control and cleaning Suggested video “From Top to Bottom: Cleaning Operating and Procedure Rooms” Found for purchase at: https://envisioninc.net/programs/show/22 Contents courtesy of Allina Health

14. Please complete the Cleaning Operating and Procedure Rooms Post Test (accompanies Top to Bottom Video) Contents courtesy of Allina Health

15. Break time Return in 15 minutes Contents courtesy of Allina Health

16. Recommended equipment  Properly stocked EVS cart  Goggles or safety glasses  Microfiber cleaning cloth or disposable wipes  Bucket for cleaning solution  Nylon toy broom/lobby dust pan  Microfiber flat mop system  Microfiber high dust tool  Wet floor sign  Putty knife Contents courtesy of Allina Health

17. Chemicals  EPA registered hospital grade disinfectant  Cleaner/disinfectants, such as: 3M 25 Quat PDI AF wipes 1:10 bleach wipes  Neutral cleaner  Ammonia free glass cleaner  Cream cleanser  Iodine remover and tape/adhesive remover Contents courtesy of Allina Health

18. Personal protective equipment (PPE)  Eye protection  Gloves  Isolation gown  Mask  N95 respirator  Papr Contents courtesy of Allina Health

19. Isolation cleaning procedures  Airborne precautions  Contact precautions  Droplet precautions  Enteric precautions  Strict contact precautions  Neutropenic Contents courtesy of Allina Health

26. Focus on high touch areas  High touch surfaces are those that have frequent contact with hands. High touch surfaces in care areas require more frequent cleaning and disinfection than minimal contact areas.  Cleaning and disinfection is usually done at least daily and more frequently if the risk of environmental contamination is higher (e.g., intensive care units). Contents courtesy of Allina Health

27. High touch areas  OR/surgical table  Push plates/door handles  Overhead lights  Telephone  Computer keyboard  Surgical equipment table  Surgical chair Contents courtesy of Allina Health

28. Room zoning/hot zone cleaning  The equipment and areas closest to the patient are the most contaminated and considered the “hot zone”.  As you move further from the patient, surfaces are less contaminated. Starting with the OR/surgical table will allow adequate contact time with the disinfectant.  Once the hot zone has been cleaned and contaminated, take a fresh cleaning cloth and work clockwise throughout the entire OR/procedure room. Contents courtesy of Allina Health

30. OR/Procedure room clean order  General inspection  Remove linen  Remove waste  High dust  Clean overhead light  Clean overhead fixtures  Cleaning operating/procedure table  Clean movable equipment and fixtures  Spot clean walls and wall fixtures  Make the operating/procedure table  Wet mop the floor Contents courtesy of Allina Health

31. Equipment specific cleaning instructions OR/Procedure TablePush Plates/Door handles Contents courtesy of Allina Health

32. OR overhead lights and fixtures Overhead lights and fixtures

33. Equipment specific cleaning instructions TelephoneComputer keyboard Contents courtesy of Allina Health

34. Equipment specific cleaning instructions Surgical equipment tableMovable equipment and furnishings Contents courtesy of Allina Health

35. Equipment specific cleaning instructions Surgical chairWaste receptacles Contents courtesy of Allina Health

36. Equipment specific cleaning instructions Sharps containersWall fixtures Contents courtesy of Allina Health

37. Equipment specific cleaning instructions Ventilation faceplate Contents courtesy of Allina Health

38. EVS does NOT clean or touch Anesthesia work spaceWall suction Contents courtesy of Allina Health

39. Next steps  Your manager will observe a return demonstration after initial training is complete.  UV gel assessment will be done Contents courtesy of Allina Health

40. What questions do you have? Contents courtesy of Allina Health