FIVE EASY PIECES Memorial Hermann's turnover crew divides each OR into 5 distinct zones. A "zone captain" directs the cleaning process from start to finish.

Divide and Conquer
Zone Cleaning Your ORs During Turnover

Four years ago, we reviewed our approach to operating room turnovers as a strategy to prevent surgical site infections. Here's what we found: Our environmental cleaning staff would sometimes hesitate at the OR door, almost as if they were thinking: Where do I start? After assessing the normal work flow and cleaning effectiveness of our turnover team, we discovered that the whole cleaning process could be random and a little chaotic, so we saw an opportunity to standardize the process by creating 5 distinct cleaning zones.

The premise behind zone cleaning is that you can walk into even the busiest post-orthopedics OR and take a uniform approach to cleaning it from top to bottom. If you follow the protocol as prescribed, you should have confidence that the room has been completely disinfected at the turnover's conclusion. You're using the same list of approved cleaning solutions as before; the only significant change is how you approach the room, because you're essentially dividing the space into manageable, clearly defined areas, or zones. Now, when our turnover team enters an OR, they break it down into the following:

• Zone 1. Anesthesia machine and equipment
• Zone 2. OR bed and patient equipment
• Zone 3. Back table and surrounding areas
• Zone 4. Circulator charting area, equipment, supply cabinets and entry/exit doors
• Zone 5. Walls and floor

A designated "zone captain" directs the crew from start to finish and assigns cleaning zones so everyone understands their role. Upon completion of the room turnover, the OR circulator assesses the room for cleanliness and completion of all zone cleaning tasks before releasing the room.

Once we implemented zone cleaning, we needed to make sure our staff was performing well. This included a competency validation tool to assess between-case zone cleaning competency and the use of adenosine triphosphate (ATP) testing to evaluate the quality of our surface cleaning. At first, the new process increased room turnover by 5 to 10 minutes, which we expected simply due to the new process, but we saw another big difference: The turnover staff entered the room and immediately knew where to start and how to proceed from there.

Three of our hospitals adopted the between-case zone cleaning method for our ORs in 2013, and we have already seen an improvement in surgical outcomes. We've since expanded the process to other invasive procedure rooms, like labor and delivery and endoscopy; and as of last year, we've started to roll out the zone cleaning procedure to the 10 other facilities in our health network.

Licia D. Hurd, MSN, BSN, RN
Memorial Hermann Health System
Houston, Texas
[email protected]