With front line nurses having more responsibility for sanitizing the environment in the OR, teaching every member of your clinical team about the proper use of surface disinfectants is more important than ever. Here are 5 guidelines your staff should follow to be sure they're administering disinfectants properly and safely.

1 Limit contact. Have staff wear vinyl gloves when applying surface disinfectants to limit the possibility that they'll develop allergic reactions to products. Case in point: Last summer my hospital switched from a commonly used quaternary ammonium compound to bleach wipes because of an increased incidence in cases of Clostridium difficile. In recent years we had also witnessed more negative patient outcomes due to the increased virulence of some strains of C. diff. The switch to bleach resulted in an immediate decrease in cases, but some staff developed allergic reactions to the bleach wipes. We don't routinely require our staff to don masks when using disinfectants, although that's a reasonable precaution for those who develop hypersensitivity to a particular disinfectant or those who have a history of allergies.

2 Control the spray. Use products that let staff control the application of the disinfectant. When using spray bottles, instruct staff to use the lowest spray or stream setting to limit overspray. Those settings will focus the product's application to the targeted area. The finer particles of an aerosol application carry a greater potential for harm through inhalation.

3 Use wipes. We use disinfectant bleach wipes, a safer delivery option because they eliminate the possibility of overspray and aerosolization of harmful chemicals. While inherently safer, in our experience disinfectant wipes increase the likelihood of inefficacy because of user error.

Our disinfectant wipes come packaged in a dispenser similar to a tub of baby wipes. Like baby wipes, you pull individual disinfectant sheets from an opening in the top of the dispenser. When the dispenser is not in use, a hinged top must be snapped over the opening. Remind staff to snap the dispenser's lid shut. Wipes left sticking out of the top of a dispenser lose their ability to disinfect because bleach evaporates rapidly when exposed to air and sunlight. Therefore a hurried or untrained nurse or tech might use a wipe that's ineffective.

Some disinfectant wipes come individually wrapped, eliminating the problem of staff forgetting to close the dispenser's top. That's a great option, but we found that individually packaged wraps are costlier. Instead, we've concentrated on emphasizing the importance of proper disinfectant use. Of course, we instruct our staff to make sure dispenser tops are closed when not in use. We also approached the manufacturer of the wipes. The company's first-generation dispenser featured a top that was difficult to close securely. Based on feedback from us and others, the company designed a sturdier top that's easier to secure and easier for staff to determine when the lid is closed. Seemingly minor design features like that can make a big difference in the proper use and efficacy of the disinfectant you use.

4 Assign help. No product can engineer staff laziness out of the disinfection equation. With that in mind our infection control liaison nurses act as a set of eyes on the "frontline." We meet with our liaisons once a month to review the protocols they need to monitor. For example, they watch the hospital's wipe dispensers to ensure the lids are closed when not in use.

5 Follow directions. Require staff to carefully read each disinfectant's manufacturer-supplied directions for use. Also review equipment labels for directives on the proper cleaning and disinfecting of OR equipment (see "FDA Issues Warning For Disinfecting Equipment" on page 61). Having a staff that is "blissfully ignorant" of the fine nuances of handling disinfectants safely is not something that we or patients can afford.