Answer: a
Researchers (tinyurl.com/nbc926r) used a transparent disclosing agent and handheld ultraviolet light to determine whether potentially contaminated surfaces in 71 operating rooms in 6 acute-care hospitals had been contacted by wet disinfection cleaning cloths during terminal cleanings. They found that only 237 of 946 targeted surfaces (25.1%) had the disclosing agent removed — meaning only 1 in 4 surfaces had been cleaned.

Answer: a
The goal is behavior modification. If you do sampling and show people where they're falling short, it's very effective, because it provides a visual. People really start to see where they're failing to use enough elbow grease. In a 2012 study (tinyurl.com/p4onspp) researchers using UV markers evaluated 2,820 objects in 194 operating rooms and found that only 47% (284 of 600) of marks had been removed after 24 hours. After an educational intervention, the number increased to 82% (634 of 777). But as the authors point out, it's easy for people to slip back into old, bad habits. "Preliminary findings," they say, "suggest that the impact of such programs may deteriorate once feedback is no longer ongoing."

Answer: b
Disinfectants don't terminally disinfect on contact. They must remain wet on a surface for a specified length of time ("contact time") to completely achieve disinfection. There's a fairly significant range of contact times among products, with some taking as long as 10 minutes to disinfect. So if a product with a 10-minute kill time air-dries in 2 or 3 minutes, you'd have to keep reapplying it to achieve disinfection. Since that's likely an unrealistic expectation, I recommend using products with shorter kill times.

Answer: a
IIf you're having a problem with C. diff or you suspect that C. diff cases may be originating in OR, consider using bleach disinfectant. Bleach kills spores, whereas most other standard disinfectants cannot. But CDS and SHEA guidlines don't recommend the routine use of bleach. The problem with bleach is that it damages surfaces, which can lead to unintended and unforeseen consequences. If you're destroying mattresses, are you throwing them out when you should or continuing to use them? When surfaces get worn down, and little nooks and crannies form, they can be impossible to sanitize.

Answer: f
Do you know for sure that the people doing the cleaning at your facility are always using microfiber mops? Sometimes what you're sue is happening isn't what's really happening. During a recent cluster of resistant Acinetobacter we discovered that cotton string mops were still being used, against our recommendation that microfiber mops be used insstead. Despite being a university based medical center, we weren't using an evidence-based practice. We're definitely making the switch now.

As far back as 1970, an influential study addressed the "massive spread of bacterial contamination by the wet-mopping techniques in use." But microfiber mops have become common only in the last 10 or 15 years. They offer a litany of advantages over conventional mops. They reduce the risk of cross-contamination, because you use only one mop per room. They reduce employee aches, pains and potential injuries, because users don't have to dump out several gallons of water from a bucket every three rooms. They clean better, because the microfibers have a positive charge that attracts dust and holds it tightly instead of redistributing it. Additionally, the microfibers can penetrate the microscopic surface pores of any material. Even if the mops themselves are more expensive, they cut down on water and chemical usage, reduce employee injuries and improve efficiency, which, taken together, offset any additional cost.

Answer: e
Always working from cleanest to dirtiest makes sense, but are people remembering to do that? It's worth an occasional reminder. There's such pressure in ORs to turn the room over quickly that sometimes nurses are doing the cleaning while having to do 55 other things — many of which may seem more important for the patient at hand — at the same time. In cases like that, shortcuts become inevitable and workarounds happen. It's also important to realize that as nurses, we're not trained in the science of environmental cleaning and that there is indeed a science when it comes to cleaning. I believe that the less nurses are tasked with cleaning, the better. Of course that means you need to have good a training program for all of the people who are tasked with cleaning.

Answer: b
Ramona Conner, MSN, RN, CNOR, manager of standards and recommended practices at AORN, has said that attitudes have changed and that the current recommendation is that the floor be mopped in high-traffic areas or when there's a spill. With cataract surgeries, for example, where patients may be moving in and out every 5 or 10 minutes, it may not be practical or necessary to mop every square inch every time.

Answer: b
Everyone tends to focus on the OR proper, and rightfully so, but don't ignore other areas, like the core area right outside the OR. You must have policies, procedures and schedules for taking care of ancillary areas as well. There are things that can get overlooked, like those big, heavy-duty rubber mats that are often found near scrub sinks. Environmental service staff may forget to lift them up on at least a daily basis to clean underneath them. They often have holes in them, and when water splashes off arms or sinks and gets under the mats, that becomes a perfect breeding ground for bacteria.

Break rooms are another example of often overlooked areas. People are very nonchalant about leaving uncovered food lying around or about not emptying garbage. Often, break rooms are in the basement, near the loading dock, making it easy for flies to get in and, make a beeline to that spoiled or uncovered food. We've actually had a fly land on the operative field during surgery. So yes, the OR requires the most attention, but the rest of the facility needs to be scrupulously cleaned, as well.