Controlling CDI —
Environmental services cleaning
and disinfecting in the operating
and procedure rooms
Contents courtesy of Allina Healthcare
Introduction
 Cleaning an operating room or procedure room requires a
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team approach. Surgical services, environmental services,
and infection prevention work closely to ensure a clean and
safe surgical environment.
Dedicate carts, cleaning tools, vacuums, and floor machines
to the OR. Dedicated equipment can help prevent
transmission of organisms, particularly from the wheels of
floor machines used in other areas.
Detergent and disinfectant solutions should be prepared as
needed according to manufacturers’ instructions and
properly labeled. Follow EPA approved contact time as
directed by the disinfectant manufacturer.
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Disinfection
 Detergent
• Contains surfactants that clean and remove “soil”
from surface
 Disinfectants
• Hospital approved chemicals that kill bacteria and
fungus
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Disinfection
 Adequate amount
• Enough chemical to keep surface wet for required
contact time
 Adequate contact time
• Amount of kill time required
• Determined by testing by the U.S. EPA
 Friction
• Wiping the surface removes bugs
 Saturation
• Having enough disinfectant on a cloth to ensure that
enough chemical gets to the surface for the right
amount of time
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OR/Procedure room cleaning
definitions:
 Room turn-over: Between case cleaning done
by OR staff
 Terminal clean: End of day cleaning done by
Environmental Services staff
 Cycle cleaning: Periodic deep cleaning (e.g.
walls and ceiling) done by Environmental
Services staff
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Value of standardized cleaning
protocol
 Studies have indicated that:
• Contamination of surfaces and equipment in the
patient room contribute to transmission of
hospital acquired pathogens
• The process of cleaning and disinfection can vary
from person to person, or even between rooms
with the same person
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Value of standardized cleaning
protocol
 Studies have indicated that:
• Taking the “randomness” out by standardizing our
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cleaning processes will help assure that surfaces
are consistently cleaned well and exposed to
adequate amounts of disinfectants.
Reducing the number of organisms in the patient’s
environment reduces the opportunity for
transmission of hospital acquired pathogens and
infections.
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Education plan
 Presentation
 Post test
 Demonstration
Ongoing education plan
 New employee initial orientation
 Yearly training and recertification
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Post education measures
 Return demonstration
 Evidence-based monitoring - UV testing
 Quarterly Quality Assessment (checklists)
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Quality control guidelines
 UV testing
 Direct observation
 Quality standards
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UV testing
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Room cleaning summary
 Turnover and terminal cleaning is important in
removing germs from the surgical
environment.
 Use the right tools
 Use the right chemical
 Use the right amount of chemical for the right
amount of time
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Infection control and cleaning
Suggested video
“From Top to Bottom: Cleaning Operating and
Procedure Rooms”
Found for purchase at:
https://envisioninc.net/programs/show/22
Contents courtesy of Allina Health
Please complete the Cleaning Operating and Procedure
Rooms Post Test (accompanies Top to Bottom Video)
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Break time
Return in 15 minutes
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Recommended equipment
 Properly stocked EVS cart
 Goggles or safety glasses
 Microfiber cleaning cloth or disposable wipes
 Bucket for cleaning solution
 Nylon toy broom/lobby dust pan
 Microfiber flat mop system
 Microfiber high dust tool
 Wet floor sign
 Putty knife
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Chemicals
 EPA registered hospital grade disinfectant
 Cleaner/disinfectants, such as:
• 3M 25 Quat
• PDI AF wipes
• 1:10 bleach wipes
 Neutral cleaner
 Ammonia free glass cleaner
 Cream cleanser
 Iodine remover and tape/adhesive remover
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Personal protective equipment (PPE)
 Eye protection
 Gloves
 Isolation gown
 Mask
 N95 respirator
 Papr
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Isolation cleaning procedures
 Airborne precautions
 Contact precautions
 Droplet precautions
 Enteric precautions
 Strict contact precautions
 Neutropenic
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Focus on high touch areas
 High touch surfaces are those that have
frequent contact with hands. High touch
surfaces in care areas require more frequent
cleaning and disinfection than minimal
contact areas.
 Cleaning and disinfection is usually done at
least daily and more frequently if the risk of
environmental contamination is higher (e.g.,
intensive care units).
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High touch areas
 OR/surgical table
 Push plates/door handles
 Overhead lights
 Telephone
 Computer keyboard
 Surgical equipment table
 Surgical chair
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Room zoning/hot zone cleaning
 The equipment and areas closest to the patient
are the most contaminated and considered the
“hot zone”.
 As you move further from the patient, surfaces
are less contaminated. Starting with the
OR/surgical table will allow adequate contact
time with the disinfectant.
 Once the hot zone has been cleaned and
contaminated, take a fresh cleaning cloth and
work clockwise throughout the entire
OR/procedure room.
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Concentric circles around patient signify levels of
potential environmental contamination
Sha red equipment &
common surface s
Item s touche d du ring
patient care
Patients & direc t
contact item s
HOT ZONE
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OR/Procedure room clean order
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General inspection
Remove linen
Remove waste
High dust
Clean overhead light
Clean overhead fixtures
Cleaning operating/procedure table
Clean movable equipment and fixtures
Spot clean walls and wall fixtures
Make the operating/procedure table
Wet mop the floor
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Equipment specific cleaning
instructions
OR/Procedure Table
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Push Plates/Door handles
OR overhead lights and fixtures
Overhead lights and fixtures
Equipment specific cleaning
instructions
Telephone
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Computer keyboard
Equipment specific cleaning
instructions
Surgical equipment table
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Movable equipment and furnishings
Equipment specific cleaning
instructions
Surgical chair
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Waste receptacles
Equipment specific cleaning
instructions
Sharps containers
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Wall fixtures
Equipment specific cleaning
instructions
Ventilation faceplate
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EVS does NOT clean or touch
Anesthesia work space
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Wall suction
Next steps
 Your manager will observe a return
demonstration after initial training is
complete.
 UV gel assessment will be done
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What questions do you have?
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