1. Environmental Cleaning Tool Kit Funded through the AORN Foundation and supported by a grant from Ecolab Quality in Environmental Cleaning Module 6

2. Objectives Upon completion of this module, participants will be able to: - explain why quality is important in perioperative environmental cleaning; - describe what is included in process monitoring; - use a cleaning checklist or log, and; - state how to measure cleaning practices.

3. Definitions Quality - meeting or exceeding expectations at a cost that represents value to the customer Performance improvement - the continuous study and adaptation of a healthcare organization’s functions and processes to increase the probability of achieving desired outcomes and to better meet the needs of individuals and other users of services Benchmark - a comparative “best” as baseline for improvement

4. Why is quality important? Every patient deserves care in a clean, safe environment

5. Quality Assurance/ Performance Improvement Team members should - understand and comply with principles and processes involved with environmental cleaning - participate in a variety of quality assurance and performance improvement activities Quality assurance and performance improvement - assists in evaluating worker safety - formulates plans for corrective action

6. How can quality tools help us? Obtaining data from quality assurance or performance improvement tools can - tell if benchmark goals are met - identify areas where additional help is needed Ongoing feedback can show if problems are - improving - stabilizingl - worsening

7. Process Monitoring Process monitoring is a necessary part of every facility’s environmental cleaning program Process monitoring must include - compliance with regulatory standards - review of products and manufacturers’ instructions for use - cleaning procedures - monitoring cleaning and disinfection practices - reporting and investigation of adverse events outbreaks, product issues, corrective actions, evaluation

8. How should cleanliness be measured? Thoroughness of cleaning is the focus of performance improvement Measure cleaning practices visual observation fluorescent marking visual inspection of cleanliness ATP monitoring cultures

9. How should cleanliness be measured? Fluorescent marking Visual inspection of cleanliness Cultures ATP monitoring

10. Fluorescent Marking Gel Courtesy of Ecolab ® Inc.

11. Visual Inspection for Cleanliness

12. Cultures 1. http://www.cdc.gov/exposurereport/pdf/FourthReport_UpdatedTables_Sep2013.pdf 2. http://www.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf 2 1

13. Cultures Courtesy of Ecolab ® Inc.

14. Adenosine Triphosphate (ATP) Monitoring ATP Monitoring - assists in evaluation of the environmental cleaning process - the technology counts living and non-living organic matter in Relative Light Units (RLUs) - uses a hand held device and swab

15. Providing Feedback Providing timely feedback to team members of cleanliness in the perioperative area will improve practices - If possible, immediate communication regarding cleanliness is best

16. Documentation Documenting completion of terminal and scheduled cleaning meets - Regulatory requirements - Facility standards Use a standard checklist or log

17. Cleaning Log for OR, Preoperative, and Postoperative Areas

18. Cleaning Log for OR, Preoperative, and Postoperative Areas (continued)

21. Cleaning Log for Operating Rooms and Procedural Areas

22. Cleaning Log for Operating Rooms and Procedural Areas (continued)

23. Cleaning Log for Sterile Processing Areas

24. Checklist for Enhanced Environmental Cleaning

25. Resources Association for the Healthcare Environment of the American Hospital Association. Practice Guidance for Healthcare Environmental Cleaning. 2nd ed. Chicago, IL: American Hospital Association; 2012. Brown JA. Healthcare Quality Handbook: A Professional Resource and Study Guide. 27th ed. Pasadena, CA: JB Quality Solutions Inc; 2013 Pasadena: 1,7, 9. Guidelines for environmental infection control in health-care facilities. Centers for Disease Control and Prevention. http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf. Accessed February 7, 2014. http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf Recommended practices for environmental cleaning. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014:255-276.