No Surface Left Untouched

Believe it or not, there is some good news about the coronavirus. It's an enveloped virus, meaning it's very easy to kill on hard surfaces. Of course, there are a lot of surfaces to clean in your facility and the virus can live on every one of them for several days. As your facility resumes elective surgeries during this historic pandemic, here are a few tips for improving your surface disinfection practices in order to protect patients and staff from COVD-19.

Now's a great time to observe and audit your surface disinfection processes. "Think about all the stainless steel and plastic in operating rooms," says J. Darrel Hicks, BA, Master REH, CHESP, a St. Louis-based infection prevention consultant. "That's where COVID-19 lives longest. It remains on every surface that doesn't get properly cleaned and disinfected."

Don't leave any stone unturned (or uncleaned, in this case.) "You need to know what is actually being cleaned during OR turnovers," says Mr. Hicks. "That's done through observation, but also I believe we need to be measuring cleanliness."

He suggests using adenosine triphosphate (ATP) or invisible fluorescent markers to confirm that surfaces are being wiped, which can tell you if additional training or supervision is needed. This evaluation of cleaning efficacy involves engaging clinical staff as well as cleaning staff. "You need to identify who is responsible for cleaning the different surfaces in the OR," says Mr. Hicks.

For example, environmental services employees might be hesitant to touch equipment such as anesthesia carts and video monitors or assume anesthesia providers and nurses have already cleaned them. To clear up any miscommunication or confusion, Mr. Hicks suggests setting clear expectations of which staff members are responsible for cleaning specific surfaces in the OR, and including the assignments in your facility's cleaning protocols. Don't overlook often-missed items such as IV pumps, side rails and patient transport equipment, warns Mr. Hicks. "Make sure there aren't any gaps in what's getting wiped down, whether it's during between-case cleaning or end-of-the-day cleaning," he says.

Mr. Hicks suggests performing audits with staff present. Put your hand on a surface and ask, "Who cleans this?" Walk through the entire facility with staff and ask for feedback on who cleans every surface. Their responses will reveal where you need to refocus your cleaning.

Focusing on the basics of surface disinfection will help fight COVID-19, says Ann Marie Pettis, RN, BSN, CIC, FAPIC, director of infection prevention at University of Rochester (N.Y.) Medicine. She stresses that staff must always pay attention to the manufacturer's instructions for use (IFU) for whatever disinfectant they're using at any given time.

"Constantly remind your team that they need to be aware of what those specs are, and the importance of following them to the letter," says Ms. Pettis, who's also the president-elect of the Association for Professionals in Infection Control and Epidemiology (APIC). "One of the challenges we've found during the pandemic is that we constantly run out of surface disinfectants and have to use different products."

That switch could have a negative impact on surface cleaning. For example, staff might be accustomed to using a cleaning agent with a two-minute contact time, but due to supply issues, a disinfectant with a five-minute contact time is put into the rotation. "Posting visual reminders about dry times where disinfectants are used, and updating that information on a real-time basis, is important," says Ms. Pettis.

While surface disinfection heavily revolves around manual labor, technology can provide a huge helping hand. "It's one more tool in your toolbelt," says Ms. Pettis, referring to ultraviolent (UV) disinfecting robots and air purification systems. "No matter how well-intentioned staff are, they're in a hurry and under pressure. It's easy for them to miss surfaces. Technology is a safeguard to add on top of the basics. It provides an added sense of security and protection."

Mr. Hicks is bullish on electrostatic sprayers, which emit a mist that clings to surfaces based on interplay between positive and negative charges. "You can treat OR surfaces in about three minutes, where UV could take an hour," he says. "It's one of the most effective ways of delivering disinfectant to precleaned surfaces. It gets into the cracks and crevices that don't always get touched by wiping."

Don't forget to regularly clean public restrooms. "Ideally, you'd like to think those areas get sanitized after each use," says Ms. Pettis. "Realistically, that can't always happen.

"Top to bottom cleaning isn't required," she continues. "Wipe down the high-touch surfaces — doorknobs, the toilet seat, the sink levers. It only takes a few minutes to do."

Waiting rooms present another cleaning challenge. "You can't spring into action as soon as someone sets a coffee cup down on a table," says Mr. Hicks. "But someone should be cleaning the area routinely." During breaks, staffers should immediately think of heading to the waiting room to disinfect doorknobs and other high-touch surfaces.

In the COVID-19 era, fearful patients and even some staff are far more aware of cleanliness than ever before. Surgical facilities not only need to provide a safe environment, but also show everyone who enters that they are serious about it. This performative aspect of cleaning reassures patients and staff that the situation is being addressed and taken seriously.

"Perception is reality," says Ms. Pettis. "If patients perceive your facility as a safe environment, they'll be more comfortable being there."

You can never reach 100% cleanliness, but you need to aspire to it because it's now a default expectation of patients. Plus, threats of a second wave of the coronavirus and a potentially difficult influenza season should make a heightened emphasis on surface disinfection your new normal.

"Never take your eye off the basics, and anything you can do over and above the basics is a good thing," says Ms. Pettis. "You hope for the best and plan for the worst, and that's what we're continuing to do." OSM