Archive July 2017 XVIII, No. 7

The New Rules of Terminal Cleaning

Has your approach to end-of-day OR disinfection evolved with the times?

Randy Barnes

Randy Barnes, CHESP, CHEST


a well-executed terminal clean HIGH AND LOW A well-executed terminal clean is a mostly low-tech enterprise, but high-tech tools have armed facilities with new weapons to bust those bugs.

Last year, our hospital had 81 cases of hospital-acquired Clostridium difficile. We're on pace to have about one-third fewer hospital-acquired infections of all kinds this year, a decrease I attribute to the whole-room disinfection technologies we've added to our manual cleaning.

Here's how we approach the manual terminal clean in our ORs. At the end of a day or every 24 hours — whichever comes first — each OR undergoes a top-to-bottom, floor-to-ceiling, edge-to-center terminal clean. As opposed to the environmental cleaning we do between cases, which is a 5- to 7-minute process designed to remove accumulated bioburden from surfaces within a 10-foot diameter of the OR table, the terminal clean leaves no stone unturned.

Whole-room disinfection is an adjunct to your terminal clean, not a replacement and not a reason for your cleaning crew to take shortcuts during the manual clean. Here's the protocol we follow:

  • Start top to bottom, meaning the ceiling to the walls to the floor, and clean from the edge to the center; the center of the room is typically the dirtiest.
  • Use a checklist, and move in a uniform fashion — clockwise or counterclockwise — throughout the terminal clean to eliminate the potential for an oversight.
  • Use each disinfecting agent according to the manufacturer's instructions for use, being sure to leave adequate dwell time for proper disinfection. Some take 2 minutes, while others take as long as 10 minutes.
  • Disinfect every surface, including all wheels and casters and every nook of every vent.
  • Validate that the work has been effective before releasing the room. Tools such as adenosine triphosphate (ATP) bioluminescence can rapidly assess the level of cleanliness of disinfected surfaces.
  • Ensure that environmental services workers are properly educated about the transmission of disease, properly trained, equipped and afforded the necessary time to complete the job at hand.
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