Terminal cleaning; regulated waste; sponge items; patient instructions; preoperative assessment; damaged pocks; storage

AORN Journal, Oct, 2000 by Dorothy M. Fogg

Question: We currently are updating our policy on environmental cleaning in the surgical setting. What are the recommended practices for "terminal" cleaning? How often should the ceilings, walls, vents, drawers, and cupboards be cleaned? Are there any recommended cleaning agents?

Answer: According to the "AORN recommended practices for environmental cleaning in the surgical practice setting," the procedure rooms and utility areas of the surgical suite should be terminally cleaned daily.(1) This cleaning should include

* surgical lights and tracks;

* fixed and ceiling-mounted equipment;

* furniture and equipment, including wheels and casters;

* cabinet handles;

* horizontal surfaces (eg, counter tops, open shelving, sterilizers); * air-handling vent covers;

* substerile areas;

* scrub sinks;

* scrub and utility areas; and

* hallways and floors

This cleaning usually is done at the end of the day's schedule when no additional procedures are planned. If the facility provides 24-hour services, a protocol should be established so that all designated areas are cleaned once during a 24-hour period. The Centers for Disease Control and Prevention (CDC) further recommends that floors be wet-vacuumed "after the last operation of the day or night."(2)

Neither AORN nor the CDC makes a recommendation about the frequency of cleaning walls, ceilings, vents, cupboards, and drawers. AORN recommends that such cleaning be done according to a protocol established within the individual facility.(3) Considerations for developing such a protocol might include general air pollution in the geographic location; ambient humidity trod amount of dust in the environment; traffic and use of cupboards and drawers; air exchange rates; and number, type, and placement of filters in the airhandling system. The protocol should be established with the goal of keeping the environment visibly clean. Any actual, visible contamination that occurs as a matter of practice should be contained and removed at the time it occurs.(4)

AORN does not recommend or endorse any specific product for environmental cleaning. In all cases, a US Environmental Protection Agency-approved hospital disinfectant should be used for environmental cleaning in the surgical suite.

Question: We recently began placing all trash, except that which is heavily saturated with blood or body fluids, into clear plastic trash bags. This has allowed us to reduce our red-bag trash to a minimum. What is the recommended treatment or disposal of suction irrigation collected in the irrigation canisters? We use a powdered product to solidify the liquid. Is it necessary to label the canister as infectious waste and discard this solid mass into red-bag trash, or can the solidified waste and canister be discarded in the clear plastic bag?

Answer: Check with local authorities to learn the correct method for disposal of regulated waste in your community. In some geographic areas, the correct method of disposal is to pour the suction contents directly into the municipal sewer system. In others, the waste is buried in the local landfill. Still others may require incineration. Unless you are instructed to pour the suction contents into the sewer, the suction canisters and their contents should be placed in the red-bag trash, and the bag should be labeled appropriately according to the Occupational Safety and Health Administration (OSHA) "Occupational exposure to bloodborne pathogens; Final rule."(5)

It is possible that the powdered product you are using to solidify the canisters' contents has some antiseptic properties; however, it would be impossible to determine that all potentially dangerous pathogens in the fluid are inactivated by the addition of the solidifier. Further, it is possible that the canister and/or liner could be damaged in transit and release liquid and/or semi-liquid waste.

In a more recent document, OSHA uses the term regulated waste as opposed to infectious waste. The term regulated waste refers to

   the following categories of waste which require special handling, at a
   minimum: liquid or semi-liquid blood or other potentially infectious
   materials (OPIM); items contaminated with blood or OPIM and which would
   release these substances in a liquid or semi-liquid state if compressed;
   items that are caked with dried blood or OPIM and are capable of releasing
   these materials during handling.(6)

Given this definition, some of the articles now being discarded in the clear plastic bag most likely should be placed in the red bag. Notice that the OSHA definition does not say "dripping upon compression," but rather indicates that the criterion is simply releasing the substance (ie, leaving a residue) when compressed. This means that if you press on a sponge or other contaminated item, it need only leave a smear, smudge, or dried particle on the dependent surface to be considered regulated waste, which requires special handling.

Question: Is there any contraindication to having the scrub person retain used sponge items (eg, 4 x 4 cottonoids) in a basin on the back table rather than discarding them into a kick bucket?