Think about how you feel after cleaning your overfilled garage, untidy basement or messy bedroom. It's cathartic, isn't it? The spaces are usable again and more enjoyable to live in and around. You can create that same sensation for your staff by following the 5 S's: sort through clutter, straighten equipment, shine surfaces, standardize supplies and sustain the fresh, clean look.

Sort. Set aside several hours on an off day to pick through supplies and equipment lining your halls or jamming your shelves. Work with your staff to remove non-essential items, keeping only those used on a daily basis. Round up volunteers to help. You need to work with members of your clinical team who know which supplies and equipment are in constant use. If your all-star surgical tech doesn't volunteer for the big clean, sell her on the idea that you need her help. Don't ignore potential help from staff without clinical backgrounds. Members of our business office cleaned surfaces, typed labels and created signage to help organize our supplies and equipment.

Think small at first, perhaps focusing on clearing one wall outside your main ORs. Target rarely used supplies and equipment. Stick a label on those items instead of getting rid of them, noting the type of cases they're used for and the date of the big clean. Move the tagged equipment to a temporary holding area. It'll be out of the staff's main traffic patterns but easily accessible if needed. When equipment is requested, note the date on its tag. After several months, take a second look at the stored equipment. You can discard the devices that haven't been requested since the initial move, but you'll need to find a permanent home for items used several times.

Straighten. After you sort, take a look at what remains. Straightening involves creating permanent storage areas for each piece of equipment and each supply so that you're left with cleared entry and exit routes. We relocated cabinets to create storage space for larger equipment such as C-arms. We relocated and reorganized peel pack carts, and organized and labeled equipment carts. Label the places where specific equipment and supplies should be stored, providing visual cues for the staff. Place labels on walls and shelves, and matching labels on equipment. Also consider hanging signs above locations where larger equipment is kept. The labeled equipment and corresponding labels and signage around storage areas will help staff return items to designated locations at the end of each case or day.

Shine. On the day of the big clean, have a couple of volunteers move every piece of equipment, every supply cart and each supply. Sweep and mop the floors, and wipe surfaces and furniture with a damp cloth. After the once-over, make surface cleaning a routine activity.

Standardize supplies. Doing so maintains control and consistency. Store like items together as much as possible. For example, place all bed attachments on the same shelf, making it easier for staff to locate items before a case and to replace them afterward.

Sustain. Keeping your clinical area uncluttered is easily this program's hardest part. Stick to the standards you create, keeping the workplace clean and consistently organized. This can't be a one-time effort; regularly monitor all five steps of this process. We've divided our clinical areas into two cleaning zones, repeating the 5 S's in each space annually. Cleaning and sustaining an orderly workplace gives your staff a sense of pride in their facility. It also helps on a practical level. Clutter-free entry and exit areas will improve staff flow and organized, standardized storage areas will promote efficient room turnovers and supply pulls.

Culture change
Sustaining a clean work environment is everyone's responsibility. During lulls in the surgical schedule, take a few minutes to return equipment and supplies to their labeled locations. Ask each staff member to do the same. For cleanliness to become a part of your facility's daily work culture, emphasize the 5 S's during staff meetings.