SAFE & EFFICIENT Be quick and thorough when turning over an operating room.

You don't want your OR idling for longer than it has to, but a quick room turnover shouldn't come at the price of patient and staff safety. Outpatient Surgery surveyed 68 facility managers about their turnover practices. While half do it fast — 50% of respondents can ready a room for the next case in less than 15 minutes — not all do it as they should. Are you cutting the same corners as some of our survey respondents?

1. When to start?
About 25% of our survey respondents say they start turnover when a patient is being aroused from anesthesia. At one facility, they begin to gather such items as trash, instruments and equipment while the patient is still in the room. Then once the patient is wheeled out, the wiping, cleaning and mopping begins. Not so fast, says AORN. An early jump on turnovers as a patient wakes up may cut times, but it can harm patients, says Amber Wood, MSN, RN, CNOR, CIC, perioperative nursing specialist for AORN. "Cleaning before the patient leaves the room is a mistake," she says. "That can be a negative effect to patient care. We really want to focus on the patient in the room."

2. What to wear?
What employees wear matters as well. Staff should at least wear gloves during turnover, but 11% of our survey respondents say their turnover crews wear no PPE at all. There are 2 major risks here, says Ms. Wood. First, a staff member could expose himself to a harmful microorganism. Ms. Wood notes that an unprotected employee could touch a surface he thinks is "clean" even though it's not disinfected. Secondly, the chemicals of the cleaning solutions pose a risk. Ms. Wood says AORN recommends facilities look at the manufacturers' guidelines for PPE to wear while using the solutions, noting that "almost all of the time, you'll see them recommend wearing gloves."

Another thing to keep in mind is that OSHA requires personnel to wear PPE based on the anticipated exposure. "So, if there's a risk of splashing into the eyes, they should wear a mask and eye protection," says Ms. Wood. "People don't think. They just reach and grab a wipe."

3. Are you using the right disinfectant?
Are you applying the right disinfectant in the right way? A 1-minute formula doesn't disinfect worse or better than a 10-minute formula, as long as you follow the manufacturer's guidelines, says Ms. Wood. About 39% of respondents say that they leave their disinfectant on for 3 minutes. Beyond that, respondents are split, with about 25% leaving theirs on for 1 to 2 minutes and another 31% saying their kill time is 5 minutes or longer.

"It's up to the teams — environmental, perioperative and infection control — to look at the kill time," says Ms. Wood. "Common sense, though, will tell you that if you have a contact time of a disinfectant with 10 minutes, and you're trying to get a 10-minute turnover, you need to look for a shorter kill time."

Also consider how to apply the disinfectant. If you're not using pre-moistened wipes, you should pour the disinfectant either directly on the surface or on a cloth. You shouldn't use spray bottles, as 17% of respondents do.

"When working in an environment with sterile supplies, we prefer that you pour the disinfectant on the surface or on a cloth," says Ms. Wood. "The spray can create a fine aerosol mist that could contaminate the supplies and increase the risk of the patient getting an infection."

About 60% of respondents prefer single-use impregnated wipes, which reduce the risks associated with aerosols. Respondents also note that wipes can be more convenient and reduce costs.

WAITING GAME AORN says that facilities should not start any part of the turnover process while a patient is in the room — including taking out the trash.

4. Which high-touch objects do you clean?
The question of what exactly should be cleaned between cases can be complicated. "We know that there are so many high-touch objects," says Ms. Wood. "It may not be practical to clean every item between cases unless you have a documented case of a multi-drug-resistant bacteria."

The important things to look at are the items that come directly in contact with patients during procedures, says Ms. Wood. In the survey, the items most disinfected after every case included tables and Mayo stands (97% of respondents), OR beds (88%), positioning devices (83%), patient monitors (77%), patient transfer devices (77%), anesthesia machines (76%), blood pressure cuffs (75%), electrosurgical unit (73%) and table straps (72%).

"I was happy to see that those types of things that are touching the patient the most are being cleaned the most during turnover," says Ms. Wood.

While those objects were the most likely to be cleaned, it was objects in the room like telephones (16%), computers (25%), light switches (27%) and door handles (39%) that were less likely to be cleaned between procedures. If you're one of those few scrubbing at the computer keyboard after every case, you might be able to save some time. Ms. Wood notes that studies have shown it "might not be necessary" to tackle those kinds of objects after every case, unless you're trying to control an outbreak or have a patient with a multi-drug-resistant organism.

5. When do you mop?
Our survey found that 70% of respondents mop after every case, while others say it depends on the procedure. "Not necessary for endoscopy cases," says one respondent, while another says they don't mop for cataracts. Another says that "for many smaller cases" where there is minimal blood loss and no use of arthroscopy fluids, "the floors do not need to be mopped." As a general rule, you only have to mop the floors if there's a chance that blood or other fluids spilled. "It's always good to be cautious," Ms. Wood says. "If you're worried something splattered, or if there was something like irrigation that might have leaked out, it's always better to be cautious."

WIPING WONDERS Experts recommend you follow manufacturers' guidelines on the proper PPE to wear and contact time for disinfectants.

6. Do you move the
OR table between cases?
When it comes to moving the OR table after every case, readers are split 50-50. Several note that the tables are moved automatically, since they use a convertible stretcher-to-table device for convenience. Others say they don't unless "the case is bloody or has a lot of fluids."

Experts say it's not only about spillage of fluids. Some recommend that underneath the table be checked after every case to make sure that small, contaminated items like sutures haven't fallen. Ms. Wood says that if there is a "reasonable concern" that something dropped, it should be moved. "It doesn't necessarily have to be moved between every case, but it doesn't hurt to check that something contaminated didn't fall and get lost underneath."

7. Do you use turnover kits?
Many respondents say that turnover kits are their secret to speedy turnovers. Using kits with "everything needed included in the pack" means there are "no extra steps," says Lynda Dowman-Simon, RN, a clinical educator at Mercy Surgery Center in Springfield, Mo. "They're obviously not necessary," says Ms. Wood. "But they can increase a facility's efficiency."

Another big help is having a facility-wide system to announce turnovers, experts say. "It not only alerts any OR staff that are free to assist, but also alerts PACU when a patient will be coming out of the OR," says one respondent.

In general, Ms. Wood says that teamwork, planning and communication are crucial for a safe and efficient turnover. "Not planning just wastes time," she says. "Turnover is more than just figuring out how to clean the room."