WIDESPREAD APPLICATION When assessing cleaning and disinfection products, make sure the active ingredients offer coverage against multiple microorganisms.

Your staff wipes down equipment and surfaces in the OR hundreds of times a week. Are they always focused on where they're working or are they already thinking about setting up the next case? It's tough to find the proper balance between cleaning quickly and cleaning right in a fast-paced surgical facility, but all-in-one wipes and whole room disinfection can ensure every patient is cared for in the cleanest possible environment.

Wipe and go
Cleaning involves wiping surfaces to remove visible soil and potentially infectious material. Disinfection involves going over the surface again to kill remaining microorganisms. Products that combine detergent and disinfectant in a single product can save your staff time during room turnovers.

Although wipes are billed as an all-in-one cleaning solution, using them still might require several steps: one wipe to remove gross contamination from the surface, and a second wipe to ensure that it's disinfected.

Assess a wipe's ability to remove visible soil and leave a layer of disinfectant (wetness) on treated surfaces. Keep in mind that wipes have various consistencies. For example, you might go through several thin wipes with a high alcohol content to properly clean and disinfect. On the other hand, it may only take a single thick wipe with a low alcohol content to achieve a solid clean, followed by a second wipe to disinfect.

Many facilities opt for wipes because they eliminate the need for reconstituting separate cleaning and disinfection products, and the potential inconsistencies that can occur with cleaning products that aren't in ready-to-use formats. Expiration dates are printed on the outer package, so there's no question among staff about how long the wipes can be used after opening. The flip side is cost. Wipes might be more expensive than 2-step cleaning, depending on your case volume and how many wipes are needed to clean the surfaces in your ORs. Ultimately, you have to decide if the increased cost is worth staff saving valuable minutes during room turnovers while using a product they prefer.

Rooms at a time
Whole room disinfection adds another layer of protection and can compensates for the limitations of manual cleaning, which is largely effective, but subject to human error with regard to required contact times and proper application of cleaning and disinfecting products. In addition, multidrug-resistant organisms can build up on surfaces, even with rigorous cleaning. Because the time needed to treat an OR with whole room disinfection is longer than the average room turnover time, many facilities use the technology as an effective adjunct to terminal cleaning.

There are several whole room disinfection options available. Ultraviolet light systems deliver pulses of xenon that penetrate and deactivate microorganisms by breaking down molecular bonds of DNA. The technology is effective against a wide range of microorganisms and is easy to set up and use; staff simply vacate the OR, shut the doors and let the unit go to work. However, the units work in a direct-line-of-sight format, so they must be repositioned several times to treat all surfaces in the room. They can also be the priciest option.

Hydrogen peroxide systems — available in vapor, aerosolized dry mist and vaporized ozone hydrogen peroxide — kill bacteria by oxidizing the cell membranes of microorganisms. This option is effective against a wide range of pathogens and excels in disinfecting complex equipment. Staff must seal the OR by taping the door and closing vents before treatment can occur. That's a time-consuming process that can also create logistical challenges.

Finally, units that deliver a continuous stream of ions into the OR attack airborne and surface-dwelling pathogens without the use of UV light or hydrogen peroxide.

SMART EVALUATION
Which Cleaning Product Is Right for Your Facility?

BELOW THE SURFACE Clean from top to bottom, and toward dirty areas.

Zeroing in on the right product for cleaning surfaces in your facility requires lots of label reading and digging into product safety data sheets. This handy form makes the process easier and helps organize a side-by-side comparison of your options.

Section 1: Fill out the top portion of the form using information from product-specific safety data sheets, labels and manufacturers' representatives.

Section 2: Check the product's label or safety data sheet for recommended contact times and demonstrated effectiveness for each type of microorganism. If the information isn't noted in either location, reach out to a product rep. Be aware that some products are marketed as having 5-minute kill times, but when you dig deeper into the product information, the microorganism you need to target might actually require a 10-minute kill time.

Section 3: Don't focus only on product cost when assessing the overall expense of stocking it. What are the PPE requirements? Do your cleaning policies support its use or will you have to change them? How much additional training and in-servicing will be needed to ensure staff know how to properly use the product? Do equipment manufacturers' instructions include approval for the cleaning product? What's the shelf life? Some products might be priced a little less, but if they have a short shelf life, you'll waste product if you're not using it before it expires. Note comments from staff who trialed the product. Is it easy to use? Does it have a bothersome smell or does it irritate the skin? Do surfaces feel slick or greasy after the product is applied?

— Heather A. Hohenberger, BSN, RN, CIC, CNOR

On the web:
To download a copy of this product evaluation tool, go to outpatientsurgery.net/resources/forms or click the form above. You can customize the form to meet the needs of your facility. For example, including a place to note the product's price might be a good idea.

Targeted approach
You must ensure cleaning and disinfecting products are effective against the microorganisms you're encountering at your facility, and decide which option will fit best based on your facility's process, culture and case volume. Include feedback from the frontline staff, the OR manager and infection preventionist — each must have a voice in product evaluations to determine how they can best be used in your specific clinical environment (see "Which Cleaning Product Is Right for Your Facility?").

Your infection preventionist should know which microorganisms have been present in patients who've suffered surgical site infections. She might also have access to antibiograms, which are lab tests that determine which organisms are common in patient populations served by specific facilities. Some public health departments have a good sense of microorganisms that are present in the community at large, so they're also a good resource. If you work at a freestanding facility with a solid working relationship with the local hospital, its infection preventionist might be willing to offer some guidance.

Ensure products are consistently prepared and applied according to the manufacturers' instructions for use. For example, a liquid product that has to be reconstituted is rendered ineffective if it's mixed improperly. Make sure that such a product is labeled, so staff members are aware that it needs to be reconstituted. Note the product's expiration date and its concentration, and ensure staff who do the reconstituting understand the process fully and can speak to the steps involved when accreditation surveyors come calling.

There's no doubt your staff understands that OR surfaces must be thoroughly cleaned during room turnovers, but they also might struggle to find the balance between maintaining efficiency and guaranteeing patient safety. It's up to you to ensure they find that balance and are able to clean properly while keeping up with a busy surgical schedule.