Environmental Hygiene: Steps That Matter Most Between Cases

It's a common scenario.

A surgeon has five back-to-back cases, a full office waiting room, and an urgent add-on case. Turnover pressure builds as the next case approaches.

When time is tight, cutting the simplest corners between cases can increase the risk of infectious pathogens remaining on OR surfaces.

AORN Senior Perioperative Practice Specialist Karen deKay, MSN, RN, EBP-C, CNOR, CIC, FAPIC, has focused on this risk as lead author of the upcoming update to the Guideline for Environmental Hygiene (formerly the Guideline for Environmental Cleaning).

Her top strategy to improve OR environmental hygiene: take a team approach.

This is a new recommended practice in the update, reflecting "environmental hygiene is everyone's responsibility to reduce the risk for the OR to become a vector for infection transmission," deKay says.

She encourages teams to examine how turnover pressures can lead to missed cleaning steps and identify where processes can be strengthened.

What You Are Probably Missing During Turnover

OR turnover pressure can lead to these common cleaning misses:

• Using the same cleaning cloth on multiple surfaces, whether reusable or disposable
• Missing/not cleaning and disinfecting items or surfaces that were used or that had contact during patient care.
• Placing items such as sterile packages or sheets on surfaces before the disinfectant has reached its contact/dwell/kill time— the length of time needed to achieve disinfection.
• Wiping quickly without covering the entire surface so it remains visibly wet with disinfectant.
• Cleaning and disinfecting "dirty" areas before cleaning "clean" areas or moving back and forth between the two.
• Not giving adequate attention to "high touch" items to be cleaned and disinfected between patients.
• Bringing in clean or sterile supplies before environmental hygiene is complete.

Ways to Improve Environmental Hygiene

To support effective cleaning between cases, deKay highlights these practices that have the greatest impact on patient safety during room turnover:

1. Apply disinfectants exactly as instructed by the manufacturer to ensure effective microbial kill.
   Following the disinfectant's IFU or product label—including maintaining the required wet contact time for targeted microorganisms such as viruses, C. difficile, and other bacteria—is critical. Surfaces must remain wet for the full duration. Reapply as needed to maintain wetness. This ensures the disinfectant performs as intended and reliably reduces pathogens.
2. Clean from least soiled areas to the most soiled areas.
   Start with the cleanest surfaces and move toward the dirtiest to reduce the risk of transferring contaminants. This sequencing helps prevent cross‑contamination and maintains the integrity of cleaned surfaces throughout the process. Because debris, dust, and contaminated cleaning solutions fall downward, begin with high surfaces so any fallout lands on areas not yet cleaned.
3. Use clean disposable or reusable cleaning materials for each room or bay.
   Reused cloths, wipes, or mop heads can transfer contaminants between spaces. Changing materials between rooms helps prevent cross contamination and maintains disinfectant effectiveness.

Next Step: Refresh Safe Environmental Hygiene Knowledge as a Team

Perioperative nurses and environmental services professionals should begin preparing for updates in the guideline that reflect changes in how cleaning and disinfection are approached in the perioperative environment, deKay says.

She says a smart goal is to "engage staff, support an organization culture shift, and raise the profile of cleaning and environmental services personnel."

Ahead of the guideline update e-release, you can refresh your environmental hygiene know-how with these checklists and reminders from Guideline Essentials for Environmental Hygiene (exclusive member content):

• Environmental Hygiene Checklist
• Cleaning Checklist – MDROs
• Cleaning Checklist – Sterile Processing
• Cleaning Checklist – OR, Preop, Postop
• Cleaning Procedure Differentiation for High Touch Objects
• Examples of Between-Patient Cleaning: Operating and Procedure Rooms
• Examples of Between-Patient Cleaning: Preoperative and Postoperative Areas