Nine Tips for Improved Surface Disinfection

Environmental cleaning between cases is fundamental to safe surgery. Here’s expert advice to make sure it’s done right — every time.

It’s a battle that never ends: disinfection of the many fixed and mobile surfaces in your ORs after every case, performed as quickly and as thoroughly as possible. Ensuring that all surfaces are free of pathogens and safe for every patient and OR team member after every room turnover requires a combination of diligence, collaboration, communication skills, efficiency and the right tools of the disinfection trade.

We’ve frequently revisited this core surgical site infection (SSI) prevention topic with your peers and industry experts, racking up an impressive number of tips for superior surface disinfection practices along the way. Here’s some collected advice to consider for this essential infection prevention practice.

1 Mind the dry times

Depending on the disinfection tools you use, staff must be mindful of their specific dry times, which can vary. Surveyors keep a close eye on staff practices in this area. “The disinfectants used must remain on surfaces for at least the amount of time the EPA says it takes to kill the organisms they’ve been tested against,” says Frank Myers III, MA, CIC, FAPIC, director of infection prevention and clinical epidemiology with UC San Diego Health System. “From a practical perspective, the quicker the agent can do that, the better.”

2 Protect your equipment

Keep in mind that certain disinfectants can damage your OR surfaces when used improperly. For example, Mr. Myers says some high-alcohol disinfectants with rapid kill times can cause cracking and chipping of plastic surfaces, or glaze to form on touchscreens that makes them unreadable over time unless they are protected with a plastic sheet. Another example: Some endoscopy centers concerned about Clostridiodes difficile (C. diff) use bleach-based products for surface disinfection, which can pit or corrode stainless steel.

“Solve the compatibility issue before making the purchase,” says Mr. Myers. “If your surgical center purchased eight new monitors and you just found out they can only be cleaned using a disinfectant that is incompatible with your cleaning requirements for your surgical lights, you have a big problem because those monitors’ screens can only be cleaned with a disinfectant that will destroy your surgical lights. Some key devices like blood glucose monitors, if cleaned with a non-compatible disinfectant, can give false readings. There are creative ways to solve problems like this, though. Often third parties can supply films to cover those screens so they can hold up to your regular disinfectants.”

The big take-home point here: Evaluate and be aware of each product’s instructions for use (IFU). “Read the IFUs before buying any equipment and a lot of headaches can be avoided,” says Mr. Myers.

Of course, following IFUs for all OR products may require different disinfectants that turnover staff will have a difficult time keeping straight, so engage your vendors and also look to the experts for help. For instance, AORN’s Guideline for Environmental Cleaning offers a wealth of evidence-based information.

3 The right disinfectant for the right organisms

Not all disinfectant manufacturers test their products against every pathogen you want to eradicate, so check the labeling and IFU of each agent closely. “Perform a risk assessment to determine how important it is to achieve a sporicidal kill on all surfaces in your facility,” says Mr. Myers, who notes that different specialties have different pathogen concerns. “Refer to the CDC’s guideline for minimum expectations for infection prevention in outpatient settings as a starting point.”

Although patients are in and out of care areas relatively quickly, the disinfection precautions at ASCs may look different than a hospital setting, but they still exist.

4 Disinfect all high-touch objects

Is your OR staff disinfecting all frequently handled pieces of equipment? These items can harbor pathogens just as much as other surfaces do. This includes anesthesia carts and machines, IV poles, patient monitors, OR beds and their attachments, reusable table straps, patient transfer and positioning devices, overhead surgical lights, keyboards, touchscreen monitors and Mayo stands.

Kimberly Jones, DNP, RN, CNOR, RHCNOC, CER, CRCST, nurse manager at Ascension St. Vincent Mercy Hospital in Elwood, Ind., notes that reducing clutter in your ORs naturally means there will be less equipment to disinfect after every case, and thus fewer pathogens turnover staff could miss.

5 ‘Clean’ vs. ‘disinfected’

There’s a big difference, and your team needs to understand the distinction to do their jobs properly. “If the surface has gross contamination, clean it first,” says Dr. Jones. “Then you can disinfect it thoroughly.”

6 Test, monitor, validate

Mr. Myers says checking your teams’ work consistently is crucial to effective surface disinfection. “Validate, validate, validate,” he says. “That isn’t just looking to see residual material but also using visual markers or ATP (adenosine triphosphate) tests. Don’t just put those markers in high-touch areas; also put them where you know you have missed before. If you noted dried blood on the positioning pads or on the side of the table, put the markers there.”

Just watching staff isn’t enough, adds Mr. Myers, as some may not be using enough mechanical force to remove residual organic material from the previous procedure. He recommends using bioluminescent markers to train staff and refresh their techniques and coverage. “Mark high-touch surfaces such as surgical lights, the side areas in the OR and the table where you’re setting up your sterile field,” he says. “Then have staff go in and clean the room. When they’re done, enter the room with the lights off and use a black or some other type of UV light to reveal which parts of the room were adequately cleaned and which weren’t. If the areas you marked don’t glow, you know they’ve been thoroughly cleaned.”

7 Teamwork makes the clean work

Turnover teams should be well-oiled machines. When approaching surface disinfection, each individual should know their precise mission among the collective team to ensure no one’s efforts are duplicated, which wastes time and disinfectant.

Staff must understand and adhere to their specific roles, hold each other accountable, avoid cutting corners and maintain the highest standards. “Without definition, each associate will do it the way they think is best or however they were trained,” says Dr. Jones. “A defined process removes any guesswork and dramatically decreases human error.”

Defined processes also prevent inadvertent cross-contamination, notes Dr. Jones, such as when a team member sets something on the floor or on top of a trash can during cleaning. Taking something that has been cleaned and disinfected and then placing it somewhere dirty to dwell or dry can lead to recontamination, she says.

8 First things first

Jennifer Parrott, RN, CNOR, clinical nurse educator, quality improvement manager and sterile processing department manager at Knoxville (Tenn.) Orthopaedic Surgery Center, says her facility’s teams methodically clean the OR from the outside in, from the cleanest to the dirtiest areas. “Our turnover team works their way into the center of the room, wiping down surfaces with a quick-drying cleaner that has a dwell time of one minute,” she says. “The team then wipes down the surgical table before cleaning the floor.”

9 Prioritize during onboarding and beyond

Be vocal about surface disinfection when onboarding and reinforce those principles on an ongoing basis, says Ms. Parrott. “Some staff members are more motivated than others to help turn over rooms when asked, which is why educating them on why the task is critically important always helps,” she says. “If someone on your team is not pulling their weight, they need to be held accountable.” OSM