Archive October 2019 XX, No. 10

Clean Up After Yourself

A back-to-basics approach and consistent oversight will help you wipe away infection-causing bacteria.

Jana Edney-Poole

Jana Edney-Poole, RN, BSN

BIO

Raven Hulin

Raven Hulin, RN, BSN

BIO

ROOM SERVICE
Lafayette General Surgical Hospital
ROOM SERVICE Regularly monitor your staff's work to make sure they're touching every surface between cases.

When we experienced an uncharacteristic increase in SSIs starting in August 2018 — 9 infections over the next 6 months — we assumed the spike was related to opening too many peel packs to piecemeal instrument sets for our fledgling spine program. But then the SSIs started spiking in mastectomies, lumpectomies and hernias, procedures we've been performing for years. We were dumbfounded and worried.

After consulting with our hospital system's infection prevention nurse, we realized we were no longer the center that specialized in cataracts and knee scopes. We'd evolved into doing total joints, bariatrics and spine fusions — more intense, complicated and bloodier cases. The change in procedures brought with them a change in patient population; older and more obese individuals with comorbidities that put them at a greater risk for infection.

The stakes were clearly raised for how well we cleaned every inch our clinical space. We've made changes to our environmental cleaning practices throughout our surgical department and stepped up enforcement on how we turn over ORs during the day and clean them overnight. We think the following new cleaning efforts are a big part of why we've significantly reduced our facility's infection rate in recent months.

  • Pick the right product. Make sure the cleaners you're using are formulated for the areas you're applying them to and strong enough to disinfect the treated surfaces. We switched from a general-purpose cleaner to a quaternary ammonium chloride-based disinfectant cleaner concentrate¬†for use on floors and a quaternary-based, heavy-duty alkaline cleaner and disinfectant concentrate for use on walls. We also changed the product we use to clean flat surfaces, switching from germicidal wipes to wipes that employ hydrogen peroxide to kill pathogens.
  • Hit trouble spots. Be sure staff hit the high-touch surface areas in ORs during room turnovers. When we were falling out of compliance with wiping down all the surfaces in our 4 ORs, we assigned the day's earliest arriving staff member to go into each room 30 minutes before the first case start time to wipe down all horizontal surfaces. The staff member then hangs a laminated sign in rooms she hits that says, "Wipe down completed." If the sign is present when the OR team arrives to open its case, the surgery can proceed. If the sign's not up, the team knows that they have to wipe down surfaces before starting the case.
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