CLEAN SLATE Staff must follow written policies on cleaning and decontamination when turning over rooms.
Wipe. Wait. Repeat. You may think that surface cleaning in the OR comes down to common sense, but there are plenty of ways to do it incorrectly. Test your knowledge on cleaning protocols and practice with this 10-question quiz to see if you're properly disinfecting every inch of the areas you touch.
MOPPING MATTERS Always use a fresh mop head and an EPA-approved germicidal agent when cleaning the floor.
1. To limit staff's exposure to bloodborne pathogens and other potentially infectious material, you must provide a clean and sanitary work environment. To accomplish this, OSHA requires that you _____________.
a. assemble a room turnover team
b. have a written policy on cleaning and decontamination
c. hire a third-party cleaning outfit
d. ensure cleaning supplies are readily available for staff
Show Answer
Answer: b
OSHA requires that you do all you can to keep your staff safe from bloodborne pathogens and other potentially infectious materials. It's a big task, but having a written policy that explicitly dictates cleaning and decontamination is the first step. For example, OSHA requires that all facilities have and implement an appropriate written schedule for cleaning and methods of decontamination.
According to OSHA, this written schedule must be based on the location within the facility, type of surfaces to be cleaned, type of soil present and the tasks or procedures performed in the area. That means you should have specific policies in place for different tasks, such as between-case turnovers and terminal cleaning. Review the policies annually and make them easily accessible to staff.
2. How long can hepatitis B survive outside the body?
a. 1 day
b. 6 hours
c. 5 days
d. 7 days
Show Answer
Answer: d
According to the CDC, hepatitis B can survive outside of the body for at least 7 days in dried blood on environmental surfaces or contaminated needles and instruments. During that time, the virus can still cause infection.
There are a couple of ways to prevent this. First, all healthcare providers should receive immunizations for all diseases that pose risks, including hepatitis B. You also want to make sure that the disinfectant you're using explicitly states it's effective against hepatitis B, as well as tuberculosis, staphylococcus, pseudomonas, salmonella, hepatitis C, HIV and poliovirus. Staff must always wear personal protective equipment while cleaning a room and follow all manufacturers' guidelines for the disinfectant.
3. Hospital and healthcare providers must choose appropriate and approved disinfectants as determined by the___________.
a. CDC
b. EPA
c. FDA
d. CMS
Show Answer
Answer: b
All appropriate and approved disinfectants are determined by the EPA. If it hasn't approved your disinfectant, you could face fines or be dinged during accreditation surveys. You also want to make sure the disinfectant is compliant under your state's regulations, which can vary. A list of EPA-approved antimicrobial products is maintained by the Office of Pesticide Programs and can be found at osmag.net/FbkSN1.
4. OSHA requires that you use which kind of disinfectant for surface disinfection?
a. tuberculocides
b. sterilants
c. products registered against HIV or hepatitis B
d. any of the above
Show Answer
Answer: d
OSHA requires that work surfaces be cleaned with an "appropriate disinfectant." That wide category includes EPA-registered antimicrobial products such as tuberculocides, sterilants and products registered against HIV or hepatitis B. Any of these products are considered effective as long as you use them according to manufacturers' instructions, and the surfaces you're cleaning aren't contaminated with agents that require a higher level of disinfection.
It's important to note that products registered by the EPA as HIV-effective are not necessarily effective against tuberculosis or hepatitis B. When choosing a disinfectant, find one that's active against all of these viruses.
5. Where should you look for special instructions for decontaminating surfaces soiled with body fluid contaminated with HIV or hepatitis B?
a. in AORN guidelines
b. on the EPA's website
c. on the disinfectant's label
d. there are no special instructions for these cases
Show Answer
Answer: c
For patients infected with HIV or hepatitis B, OSHA recommends you follow special instructions listed on the disinfectant. These instructions are printed on the labels of EPA-approved disinfectants under the header "Special Instructions for Cleaning and Decontamination Against HIV and Hepatitis B of Surfaces/Objects Soiled with Blood/Body Fluids." In this this section several instructions are listed, including:
- personal protective equipment must be worn during the task;
- all blood must be cleaned thoroughly before applying the disinfectant;
- any infectious waste must be disposed of in accordance with federal, state and local regulations; and
- the disinfectant must be left wet on surfaces for 30 seconds when treating against HIV and 10 minutes when treating against hepatitis B.
Another important note: Limited data suggests that bleach may be the best disinfectant against Clostridium difficile. Studies have shown that the use of a fresh 1:10 dilution can help reduce C. diff transmission.
6. The entire OR floor must be mopped after every case.
a. true
b. false
Show Answer
Answer: b
You only have to mop the entire OR floor during terminal cleaning or if there's a chance body fluids dripped or splattered outside of the immediate surgical area. Any visibly soiled areas of the floor outside of the surgical area must be cleaned after each case.
It's also important to note that the floors should be the last surface you clean, since particles from shoes and equipment wheels can easily transfer and contaminate the surface. Also note that microfiber mops with disinfectant are more effective than cotton loop mops. No matter what, make sure you're using an EPA-approved germicidal agent and a new or fresh mop head each time.
7. When using disinfectant wipes, you should only use _______________.
a. each wipe once
b. each side of the wipe once
c. 1 wipe to clean several surfaces
d. both a and b
Show Answer
Answer:: d
Disinfectant wipes can be a great and convenient way to clean surfaces in the OR, but they must be used carefully. When used improperly, impregnated wipes can cross-contaminate surfaces and potentially spread microorganisms.
To eliminate that risk, make sure you use each wipe — and each side of the wipe — only once before you dispose of it. Disinfectant wipes tend to be best for smaller surface areas. Don't forget to close the container's cap completely, so the wipes don't dry out.
QUICK WIPE Newer disinfectants have shorter dry times, which let you turn over rooms quickly and safely.
8. Products with a 10-minute dry time are more effective than those with a 1-minute dry time.
a. true
b. false
Show Answer
Answer: b
One of the biggest problems during surface cleaning is that often the contact time specified by the label is too long for facilities to follow in actual practice. Several products registered by the EPA require a contact time of 10 minutes, which is a while if you're searching for speedy room turnovers.
The good news is that new EPA-approved disinfectants have a contact time of 1 to 3 minutes and are just as effective as ones with longer dry times. Switching to these products can help decrease turnover time while increasing staff's compliance with contact time, ensuring the disinfectant's effectiveness.
9. Which of the following can contribute to the contamination of disinfectants?
a. dilution
b. improper storage
c. not following the manufacturer's directions for use
d. all of the above
e. none of the above
Show Answer
Answer: d
Contaminated disinfectants and antiseptics have been vehicles for healthcare-acquired infections for more than 50 years. These disinfectants can become contaminated during use through multiple human factors that are easy to prevent.
First, read a disinfectant's label for instructions to determine whether it can be diluted. Also, be aware of potential sources of contamination, like the water used to make the dilution and the containers holding the solution. Finally, make sure that the disinfectant is stored according to the label's instructions, because the EPA verifies any claims against the growth of microorganisms.
10. UV light disinfection systems should be used ________________.
a. during terminal cleaning
b. only after manual cleaning is performed
c. between each case
d. both B and C are correct
e. both A and B are correct
Show Answer
Answer: e
Ultraviolet light sanitation systems should be a complement to manual cleaning — not a replacement. After your staff cleans the room, the disinfection system is brought in and completes multiple cycles for disinfection. Typically this can take between 20 and 30 minutes.
Because of the amount of time it takes, most experts recommend it only be used for terminal cleaning or after cases involving patients with an infectious disease. The guidelines for the technology are still developing, but with a 99.9% effective kill rate against the majority of organisms, more and more facilities are considering the machines.
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