Stepping Up to Keep ORs Clean

The pandemic has increased the importance of properly disinfecting ORs between cases, and facilities have maintained safe spaces for surgery with rigorous manual cleaning and the strategic use of disinfection technologies. Adding new protocols to room turnover routines on the fly and having to stock various cleaning products hasn't been easy.

"It's been difficult at times to acquire disinfectant wipes," says Ann Marie Pettis, RN, BSN, CIC, FAPIC, director of infection prevention at University of Rochester (N.Y.) Medicine and president-elect of the Association for Professionals in Infection Control and Epidemiology (APIC). Although she says the situation has stabilized as of late March, her facility has at times had to use whatever type of cleaning product was available — bleach, quaternary ammonium compounds, alcohol-based solutions.

Keeping them straight, including how they should be applied, is challenging. "The manufacturers' instructions for use vary depending on the active ingredient and the substrate chemical that's embedded," says Ms. Pettis.

Informing staff about that variability, especially regarding length of application times, is an issue Ms. Pettis and others have faced throughout the pandemic. "Contact times can vary from one to 10 minutes," she says. "If you're using an agent that's long-acting, and it dries before the required time, you need to reapply it, which means you actually need to time the application and drying process."

Ms. Pettis and her team came up with a low-tech solution to the "which disinfectant are we using today and what's its dry time?" problem. "When containers of disinfecting wipes come in, staff use a sharpie to mark the product's contact time in big lettering right on the front of the package," she says. "Now staff doesn't need to look at the tiny print on the container to see what it is."

Ms. Pettis reinforces this tactic with posters that remind workers to check contact times. "Little things like that can help get the message across," she says.

It's one thing to have access to all the disinfectants you need. Ensuring they're being applied correctly is something else entirely. "When you're in a rush, it's easy to miss areas," says Ms. Pettis, who notes it's been difficult for facilities to audit compliance with cleaning protocols because resources have been stretched thin during the pandemic. However, tools to confirm compliance exist, such as ultraviolet light, which you can shine on surfaces staff just cleaned. Areas they missed will glow brightly.

Compliance is also important with soft surfaces like privacy curtains around pre- and post-op bays and upholstered waiting room furniture, which Ms. Pettis says require special soft surface disinfectants. Many outpatient facilities typically launder their privacy curtains twice a year. "Now we've all had to step up our game," she says. "Don't worry about cleaning the entire curtain every time a patient is moved from a bay, but you should disinfect the curtain's grab area."

Overall, Ms. Pettis suggests viewing your entire facility from the patient's perspective. "The most important point I've shared with staff, particularly at our ASCs, is that perception is reality," she says. "A lot of patients were afraid to come back to our facilities after the elective surgery shutdown. We've had to think long and hard about how we get the message to the public and our patients that our facilities are safe. We've had to rethink our cleaning protocols and make sure every surface looks spick-and-span, down to the carpeting in the waiting room. We need to continue looking at our practices with a new eye."

High-tech help

Surface disinfection technologies such as short-wave ultraviolet light (UV-C) and hydrogen peroxide mist have attracted increased attention during the pandemic, and for good reason. They effectively augment rigorous manual cleaning and provide a level of assurance that ORs are clean.

UV-C lights built into ORs, as well as portable UV-C robots, have been increasing in use for several years in outpatient facilities. UV-C attacks the DNA and RNA cellular material of bacteria and viruses, stops them from replicating and leaves them non-infectious. When a UV-C robot is used in an OR, the room must be cleared as it disinfects and performs multiple cycles to ensure the entire room is treated.

Patients see we're taking extra steps to keep them safe, and they're letting other people know about it.
— Nadine Calloway Reese, BSN, CCRN, TNCC

Hydrogen peroxide mist systems continue to gain supporters. "We've been successfully using hydrogen peroxide sanitizers before and during the pandemic," says Ms. Pettis. The systems employ one of three types of fogging technologies: dry vapor, which turns liquid disinfectant into gas; micro-condensation, which produces microscopic aerosols; and activated or ionized, vaporized aerosols that are electrically charged before they're sprayed.

Although technology is undeniably helpful, Ms. Pettis and Ms. Reese both stress that it's no substitute for effective manual cleaning. The important thing is to employ everything at your disposal to clean your surfaces, and to make sure your patients and staff know about it.

Ms. Reese points to the process improvements her ASC has made during the pandemic as a positive development. "Some of the things that have come out of it are probably things we should have been doing all along," she says. OSM