Like many of you who've switched from aerosol spray bottles to more user-friendly disposable wipes to disinfect non-critical items and surfaces in the OR, it was the quest for efficiency and a shorter contact time that led Heather Huffman, RN, CNOR, to change. Ms. Huffman, administrative director of the Surgical Eye Center of Morgantown (W.Va.), recently switched from a "very expensive" solution that required mixing and had a "way-too-long" 10-minute kill time to impregnated wipes with a 3- to 5-minute kill time. Signaling a clear preference for wipes with contact times of 5 minutes or less, our survey of 115 facility managers found that:

• 57.7% use impregnated, disposable wipes;
• 31.5% spray the surface and then wipe it with a rag or cloth; and
• 10.8% spray or dip a rag or cloth in solution and then wipe down the surface.

More than one-third (36.5%) of our respondents who've switched to wipes did so for reasons of economy and efficiency: Besides costing less than sprays, wipes feature shorter kill times and faster dry times, are easy to use and don't require mixing. In addition to those benefits, Wanda Zack, BS, administrator of the Skin Surgery Center in Thousand Oaks, Calif., and her staff found wipes to be easier on the senses. They have a pleasant smell and don't irritate the eyes like a spray's mist can, she told us.

The need for speed
Speedy cleaning is valued in outpatient surgery. The less time staff have to wait for the disinfectant to do its job, the sooner they can wheel the next patient into the OR. To wit, 93% of our survey respondents rated kill time — the length of required contact time — as a key consideration in choosing a surface disinfectant.

Only about 8% of respondents still use surface disinfectants with a 10-minute manufacturer-recommended contact time, which was once the norm. The vast majority (91%) use products that take 5 minutes or less to achieve the desired microbial kill, with more than half (51%) using disinfectants that are effective in 2 minutes or less. "Products across the board are moving to shorter contact times," says Ann Marie Pettis, RN, BSN, CIC, director of infection prevention at the University of Rochester (N.Y.) Medical Center.

With the right turnover system in place, many of you said staff can accommodate a 1- to 3-minute dry time without holding up the day's schedule. "I would like to see a quicker time, but 3 minutes is not unreasonable," says Debbie Saltzman, RN, CGRN, manager of the Gastrointestinal Endoscopy Center in Evansville, Ill. "The staff member wipes and then goes about other tasks before completing" the room turnover.

Wipes trump sprays
One way to ensure staff are properly disinfecting high-touch, non-critical surfaces between cases and at the end of the day is to make the cleaning process as simple and comfortable as possible. To that end, many respondents who said they've recently switched products have converted from a spray to impregnated wipes. "We added a wipe to our process due to ease of use and improved compliance," says Lisa Sisk, RN, CPHQ, CASC, administrator of the Beckley (W.Va.) Surgery Center.

"The reason they're going to wipes is safety to the user and the environment, as opposed to anything having to do with infection prevention," says Ms. Pettis. Donna Nucci, RN, BSN, CIC, concurs that "the trend is going toward pre-moistened wipes," primarily for staff safety, as many employees complain of headaches and allergic reactions to harsh chemical aerosols. An infection control consultant based in New England, Ms. Nucci recommends her clients transition to wipes but keep spray bottles on hand for certain cases, such as dried blood or betadine solution, that require more saturation.

Although impregnated wipes are generally considered more user-friendly than aerosols, be sure to train staff on the proper use of wipes when and if you make the switch. "The only drawback with the wipes is sometimes the tendency is to try to use the wipe for too large a surface," says Ms. Pettis. "With a spray bottle you can keep spraying" to get the desired coverage, but "there's a finite amount of product in the wipe, and you have to follow manufacturer directions about the size of the surface you can use with 1 wipe." To avoid exhausting a single wipe's disinfectant power, have staff members use a new wipe for each surface or item they disinfect in the OR, says Nancy King, RN, BSN, CRNO, of Phoenix, Ariz. When observing practice, make sure staff members aren't using the same wipe to cover the entire room.

One product, one process
As with most infection prevention practices, standardizing the products you use for surface disinfection helps to ensure it's done right every time. Whether you decide to go with a spray or a wipe, a 10-minute kill time or a 2-minute kill time, experts say consistency is what really matters. "Pick your product, know your kill time, only stock that product and train staff to use it according to manufacturer instructions," says Ms. Nucci. Our survey results indicate that many of you have already taken this advice to heart: 82% of respondents said they use just 1 or 2 products to disinfect non-critical items.

Narrowing the number of products you use paves the way for a standardized cleaning and disinfection process, which in turn helps prevent missteps. Consider the example of Elkhart (Ind.) Clinic Endoscopy & Surgery Center, where Administrator Jen Moore, RN, BS, CNOR, says she "actively sought out products with short kill times to improve staff compliance with the wait." After choosing disinfectants delivered primarily via wipes with a 1- to 2-minute contact time, she and her staff "talked as a team about the products we use and the kill time, and all agreed on a particular order that turnover activities are done in to help ensure that we achieve the kill time of the disinfectant we use," says Ms. Moore. In the end, it was this communication and cooperation among the staff — not the products alone — that helped ensure the ORs were being cleaned and disinfected appropriately. "By talking about this issue and discussing how we're going to do things and why, team members have a better understanding of what's expected of them and hopefully are less likely to miss this important point."