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5 high-touch objects to clean better

Publish Date: 7/10/2013

Environmental cleaning in the OR has become an important strategy in preventing infection.

Perioperative leaders are increasingly working with environmental services and infection prevention colleagues to discuss cleaning strategies. One reason for this increased collaboration is consideration of research recognizing the role environment can play in the development of health care associated infections and transmission of multi drug-resistant organisms.

However, research also shows that ORs may not be as clean as they could or should be, explains AORN Perioperative Nursing Specialist Amber Wood, MSN, RN, CNOR, CIC, CPN. Wood is developing an update to AORN’s practice recommendations for environmental cleaning.

Wood cites a 2011 study in which researchers observed a mean cleaning rate of 25% for objects monitored in the operating room setting in 6 acute care hospitals. “It’s studies like this that show us the concept of clean is still evolving in the perioperative setting,” she says.

Taking a closer look at your high-touch objects
High touch objects—objects that are frequently touched during patient care—may create a higher risk for transmitting infectious pathogens to patients.

“The concern is that organisms such as MRSA (Methicillin-resistant Staphylococcus aureus) and CRE (carbapenem-resistant Enterobacteriaceae) are colonized on the patient and health care providers are touching a patient and then touching the environment … creating reservoirs harboring these pathogens,” Wood explains.

She advises, “Identifying high-touch objects in each procedural setting and thoroughly cleaning these areas in collaboration with environmental services can help decrease contamination and transmission.”

Wood identifies five high-touch objects common in all procedural settings:

1. Anesthesia cart and equipment (including IV pole)
2. Anesthesia machine
3. Patient monitors
4. OR bed
5. Table strap

High-touch objects are unique to the procedural setting and MUST be identified by a multidisciplinary team that includes perioperative nursing, infection prevention and environmental services, Wood stresses. This team should work together to:

  • Identify ALL high-touch objects
  • Develop a detailed action plan for cleaning these objects
  • Consider enhanced cleaning 
  • Consider implementing advanced technologies for measuring cleanliness

Enhanced environmental cleaning—cleaning that is more in-depth than routine cleaning—was introduced in AORN’s recently updated “Recommended Practices for Prevention of Transmissible Infections” as a method of cleaning when care involves patients in isolation.

“Enhanced cleaning of high-touch objects may be a helpful strategy for lowering the risk of infection transmission and reducing the risk of creating reservoirs for infection in the OR with all patients, not only those in isolation,” Wood suggests. “This approach, which must be a shared decision with infection prevention, may be especially useful when there is concern about an outbreak.”

Considering the human factor
Evaluation of thorough cleaning practices across the health care setting shows the importance of cleaning accountability.

Wood notes an example of this: it may be assumed that environmental services personnel are cleaning the knobs and handles on a piece of technical equipment, but these team members may be too nervous to touch expensive, sensitive OR equipment, posing a risk for the next patient that the perioperative nurse in the room is unaware of.

“With the push for rapid turnover, cleaning corners may also be cut,” Wood adds. “A manufacturer’s recommended drying time for a cleaning agent may not be followed, or worse, cleaning may begin before the patient leaves the room—a problem because the team may be distracted from care of the patient.”

Making it a team approach
This is why team collaboration is absolutely essential, Wood emphasizes, noting “You need shared input from infection prevention, environmental services and perioperative nursing to develop a comprehensive plan for environmental cleaning that includes careful evaluation of the OR environment.”

This evaluation may include newer methods for measuring cleanliness, such as with Adenosine triphosphate (ATP) monitoring and fluorescence marking.

All team members must be held accountable for cleaning high-touch objects and following cleaning protocols developed collectively, Wood says. “Perioperative nurses are ultimately responsible for making sure the OR environment is clean. This focus must include cleaning competence and recognition of reservoirs for infectious pathogens lurking in places we might not be catching with current cleaning practices.”

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