Recommended practices for environmental cleaning in the surgical practice setting

AORN Journal, Dec, 2002

The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comments by members and others. They are effective Jan 1, 2003.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

Purpose: These recommended practices provide guidance for environmental cleaning in the surgical practice setting. Conscientious application of these recommended practices should result in a clean environment for surgical patients. These recommended practices should be carried out in a manner that minimizes health care workers' and patients' exposure to potentially infectious microorganisms. All patients potentially are infected with bloodborne and other pathogens. All surgical procedures, therefore, must be considered potentially infectious, and the same environmental cleaning protocols must be implemented for all procedures.

RECOMMENDED PRACTICE I

Patients should be provided a safe, clean environment.

1. Cleaning should be performed on a regular basis to reduce the amount of dust, organic debris, and microbial load in surgical environments. (1) Operating rooms should be cleaned before and after each surgical procedure and at the end of each day. Cleaning also may be necessary during any surgical procedure (see recommended practice II). Environmental cleaning is a team effort involving surgical personnel and environmental services personnel. The ultimate responsibility for ensuring a clean surgical environment rests with perioperative nurses. Administrative personnel should ensure that environmental cleaning practices comply with the standards established for the practice setting. (2)

2. All horizontal surfaces in the OR (eg, furniture, surgical lights, equipment) should be damp dusted before the first scheduled surgical procedure of the day with a clean, lint-free cloth moistened with an Environmental Protection Agency (EPA)-registered hospital disinfectant. (3) Equipment from areas outside the OR should be damp dusted before being brought into the OR. Dust and lint are deposited on horizontal surfaces. Proper cleaning of these surfaces helps reduce airborne contaminants that may travel on dust and lint. (4)

3. For subsequent surgical procedures, between-procedure cleaning is performed. Preparation of the OR should include visual inspection for cleanliness before case carts, supplies, and instrument sets are brought into the room. Although the level of contamination that can influence surgical site infection rates is not known, a clean surgical environment will reduce the number of microbial flora present. (5)

4. If at all possible, latex sensitive patients should be scheduled as the first procedure of the day. It is difficult to remove all traces of latex proteins when latex products have been used during the previous procedure. For additional information about latex sensitive patients, consult the AORN Latex Guideline. (6)

RECOMMENDED PRACTICE II

During surgical procedures, contamination should be confined and contained within the immediate vicinity of the surgical field to the degree possible.

1. Spills of contaminated debris (eg, blood, tissue, body fluids) in areas outside the surgical field should be removed as promptly as possible. Prompt cleanup and decontamination of potentially infectious materials helps maintain a safe, clean surgical environment. (7) When cleaning spills of blood or other potentially infectious material (OPIM), use gloves and other personal protective equipment (PPE) as appropriate to the task. It is unknown which patients may harbor harmful pathogens. Use of PPE protects health care workers from direct exposure to potentially infectious microorganisms. (8)

2. Small (ie, less than 10 mL) spills should be cleaned and disinfected using a soft, absorbent, low-linting cloth and either an intermediate-level germicide (ie, germicides that are EPA-registered for hospital use and have a tuberculocidal claim) or an EPA-registered germicide product having a label claim for HIV and/or hepatitis B virus. (9) The selected product should be used at the recommended dilution and for the full contact time. Sodium hypochlorite (ie, chlorine bleach) in a 1:100 dilution may be used for small spills (eg, blood, OPIM) on nonporous surfaces.