Archive December 2017 XVIII, No. 12

Is Your Cleaning Barely Scratching the Surface?

Tap into the science of surface disinfection to rid your rooms of infection-causing bioburden.

Daniel Cook

Daniel Cook, Executive Editor


surface cleaning WIPE OUT Your staff might think they've got surface cleaning covered, but studies suggest most high-touch items aren't disinfected properly between cases.

Take a few minutes to watch your staff in action the next time they turn over ORs. Do they wipe down the keyboards and mice at nursing and anesthesia workstations? What about the beds, door handles and anesthesia workstations? Those are the high-touch items Terri Link, MPH, BSN, CNOR, CIC, a perioperative patient safety specialist at the University of Colorado Hospital in Aurora, Colo., identified in a study published in the American Journal of Infection Control ( If your turnover teams don't touch on those areas between cases, the surfaces in your ORs might not be as clean you think they are.

Unfortunately, that might be the rule rather than the exception. "On average, only about 40% of surfaces that need to be disinfected are being addressed," says Philip Carling, MD, MPH, a clinical professor of medicine at the Boston (Mass.) University School of Medicine. "Environmental cleaning is an underappreciated area of concern because surgical professionals assume surfaces are being cleaned properly."

In fact, it's best to assume the opposite and focus on making sure your staff does more than skim the surface when disinfecting ORs between cases.

Ms. Link suggests you gather representatives from infection control, anesthesia, radiology and surgery — any department that brings equipment into the OR — to determine who will be responsible for cleaning specific surfaces between cases. You should also develop a way to document that every surface in the OR has been wiped down between cases. "Establish enhanced cleaning protocols to ensure high-touch areas are addressed between cases," she says. "The OR surfaces stay the same, but the people who clean them varies."

Dr. Carling's widely referenced study published in the journal Infection Control & Hospital Epidemiology used transparent fluorescent gel to mark surfaces in 43 ORs of a major teaching hospital before the first case of the day ( His research team then used a UV lamp to evaluate how many of the marks were removed 24 hours later. They also took environmental cultures in unused ORs that had been terminally cleaned the night before.

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