Guidance on Ongoing Port Strike, Hurricane Helene Aftermath
Organizations are offering guidance to surgical facilities that might experience supply chain disruptions from the port workers’ strike and the aftermath of Hurricane Helene....
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By: L. Munoz-Price
Published: 7/10/2013
When's the last time your OR floors, IV poles and OR entry-door handles were disinfected? I mean thoroughly disinfected. What about your bed control panels, anesthesia equipment and Mayo stands? If your facility's surface-cleaning practices are anything like my hospital's used to be, it's probably been a while, a long while, when it should happen between every case.
High-touch surfaces can harbor such infection-causing organisms as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile and Acinetobacter baumannii. Our recent observations of high-touch surfaces in the operating rooms at a large urban hospital showed that only 50% of surfaces were cleaned properly. The study also found that enhanced staff training and education yielded significant improvements. What did we learn? Two main lessons.
CLEANING RATES
Thoroughness Of Cleaning
After the study, the most striking improvement in cleaning rates was seen in anesthesia equipment, particularly in the cleaning of anesthesia machines. Here's how other objects fared.
Significant Improvement | No Clear Improvement |
Bed control panels | Floors |
Mayo stands | Intravenous poles |
Overhead lamps | OR entry-door handles |
Scratching the surface
Spotty surface cleaning is not an isolated problem at our hospital, but something that occurs in most ORs, as many studies besides ours have proven. Why does this happen? A couple reasons:
The biggest improvement during the study? Anesthesia machines were cleaned 150% more frequently as a result of the study. Rightly or wrongly, anesthesia providers have been shown to have low hand hygiene compliance while providing care in the OR, despite having high rates of interactions between patients, machines and medications. Researchers have shown a correlation between the contamination of anesthesia machines and contamination of IV stopcocks, as well as an association between hand contamination among anesthesia providers and contamination of IV stopcocks. If an anesthesia machine isn't adequately cleaned between cases, for example, the implications for the next patient could be serious.
Providers in the OR (circulating nurses, ancillary staff, anesthesia providers) often place objects that fall onto floors back on work surfaces or on patients themselves. For example, IV tubing frequently contacts the floor as it drapes between the patient and the IV pump. Keep in mind that the OR floor is often contaminated with hospital organisms; therefore, items that fall on the floor should not be put back on top of patients. The biggest change we made to decrease OR pathogen contamination was to make our anesthesia techs responsible for the cleaning of the anesthesia machine and associated equipment — including ECG leads, blood pressure cuffs, IV pumps, IV poles and oxygen reservoirs — between procedures.
ON THE WEB
To download "Decreasing Operating Room Environmental Pathogen Contamination through Improved Cleaning Practice," published in the September 2012 issue of Infection Control and Hospital Epidemiology, go to http://lib.bioinfo.pl/pmid:22869263
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