Archive July 2013 XIV, No. 7

Are Those High-Touch Surfaces Clean?

Probably not. Learn the simple tricks to improving your OR environmental hygiene.

L. Munoz-Price, MD

transmission of bacteria SAFER SURGICAL SURFACES Interactions between patient body surfaces, hands and the OR environment play an important role in the transmission of bacteria.

When's the last time your OR floors, IV poles and OR entry-door handles were disinfected? I mean thoroughly disinfected. What about your bed control panels, anesthesia equipment and Mayo stands? If your facility's surface-cleaning practices are anything like my hospital's used to be, it's probably been a while, a long while, when it should happen between every case.

High-touch surfaces can harbor such infection-causing organisms as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile and Acinetobacter baumannii. Our recent observations of high-touch surfaces in the operating rooms at a large urban hospital showed that only 50% of surfaces were cleaned properly. The study also found that enhanced staff training and education yielded significant improvements. What did we learn? Two main lessons.

  • What gets measured gets done. Education of your environmental services staff or turnover team combined with feedback using ultraviolet (UV) markers has been shown to improve the thoroughness of environmental cleaning. At the beginning of the study, we found that less than 50% of tested surfaces had been cleaned within 24 hours after target application. Ongoing performance feedback over the next 4 months led to an 82% increase in cleaning rates.
  • Your ORs are probably dirty. Even though we assume and expect that our ORs will be sterile, surfaces are very rarely cleaned, especially between cases. The presence of UV material at 24 hours was considered to represent a lack of cleaning on the object tested. Removal of the UV marker was considered to be evidence of 1 or more episodes of cleaning of the monitored surfaces. Based on our findings and the existing literature, operating rooms might not be the clean settings that healthcare providers commonly believe them to be. Most of the high-touch surfaces we tested were neglected by the housekeeping staff's cleaning wipes and spray bottles: anesthesia-related equipment — keyboards, knobs, switches, oxygen reservoir bags and adjacent medication drawers — bed control panels, Mayo stands, intravenous poles, intravenous pumps, OR entry doors, overhead lamps and the floor. It's not a complete list, but it reflects most of the surfaces we checked for our study at our 1,500-bed teaching hospital, which has 42 ORs.
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