Controlling CDI —
OR room turn-over cleaning
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Objectives
 Review WHY the need to improve cleaning in the
OR
 Review HOW to use the Allina disinfectant
products
 Review WHAT surfaces to touch between every
case
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WHY is surface disinfection so
important??
 Methicillin-resistant Staphylococcus aureus
(MRSA), vancomycin-resistant enterococci (VRE),
and multi-drug resistant gram negative bacteria
(MDR-GNB) can survive in the environment for
weeks
 MDR-GNB hospital acquired infections on the rise
 New types of MDR-GNB resistant to ALL
commonly used antibiotics
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Clostridium difficile
 Spores can exist in environment for months
 Most often presents as diarrhea, can cause
pseudomembranous colitis and progress to toxic
megacolon, sepsis, and death
• Infection recurrence is common
 Spread is fecal-oral (you EAT it)
 Hospital-acquired C. difficile became publicly
reportable in 2013
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One patient’s story
 Cost of CDI:
• Lost his colon
• 9 readmissions
• 143 days in the hospital
• OVER 1.2 MILLION in
healthcare costs
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C. difficile in the U.S.
 From 2000 to 2009, the number of
hospitalized patients with any CDI discharge
diagnoses more than doubled, from
approximately 139,000 to 336,600
 The number with a primary CDI diagnosis has
more than tripled, from 33,000 to 111,000
 Patients with no past healthcare exposure
presenting with C. difficile
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Definitions you need to know
 Room turn-over
• Between case cleaning done by OR staff
 Terminal clean
• End of the day cleaning done by Environmental
Service staff
 Cycle cleaning
• Periodic deep cleaning, (e.g.,walls and ceiling)
done by Environmental Service staff
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Low-level disinfection
 Destroys vegetative bacteria, some fungi and
viruses, not mycobacteria or spores.
 Most commonly used in healthcare for
cleaning and disinfection of noncritical patient
care equipment and surfaces (bedside table).
 Non-critical items: those that contact intact
skin but not mucous membranes.
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Disinfection process
 Effective cleaning is critical.
• The processes are more important than products
o Need to touch the “right” surfaces consistently
 Disinfectants may vary by facility
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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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Quat and microfiber (preferred)
 Microfiber technology
 “Captures” more debris
from the environment
 Helps to remove
microbes
 Reduces crosscontamination
 Change cloths when not
delivering enough
solution to the surface
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Using AF or bleach wipes:
1)Use friction
2)If a surface is visibly soiled, it must first be
cleaned and then another wipe must be used
to disinfect (use 2 wipes)
3)Don’t overuse a wipe – use more for larger
surface areas (e.g., 5-6 wipes per surgical bed)
4)Do NOT dispose of them in the toilets!
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Wet Contact Time Requirements
 Increased attention by surveyors on staff
knowledge of and adherence to disinfectant
wet contact time
• HB 3M Quat – 10 minutes
• AF wipes – 3 minutes
• Bleach wipes – 4 minutes
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Key recommendations for the OR
 Dedicate cleaning equipment to the OR
 Use small bucket system with microfiber
cloths
 Dip cloths into disinfectant just before use. Do
not store cloths in bucket.
 Get a clean cloth when needed - never re-dip
a used (dirty) cloth into the cleaning solution
 Follow EPA approved contact time for
disinfectants
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Recommended cleaning procedures
 Before first case of the day
 Between cases
 Terminal clean after the last case of the day
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Before first case
 Verify date and time of last terminal clean
 Prior to bringing case cart into OR, visually
inspect the OR for cleanliness
 Spot clean as necessary or not completed
within last 24 hours, damp dust horizontal
surfaces
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Last Case of the day
 Remove instruments, basins, trays, to
appropriate locations for reprocessing. Place
all sharps in appropriate containers.
 Clean and disinfect as you would between
cases using cleaning checklist (room should be
ready if needs to be used urgently)
 Environmental services terminally cleans at
end of day
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Room turn-over
 Cleaning and disinfection cannot begin until after the room is
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
vacated unless emergent situation
Follow OR Cleaning Checklist
Clear room of contaminated items:
• Remove instruments, basins, trays to appropriate
•
•
locations for reprocessing
Place all sharps in appropriate containers
Remove all soiled linen including gowns, towels,
and washcloths
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Contents courtesy of Allina Health
Surgical equipment
 Equipment
• Examine for damage before cleaning/ disinfecting
• Remove clean equipment as appropriate
• Refer to cleaning checklists for equipment surgical
services staff cleaning responsibility
 Follow manufacturers’ equipment cleaning
instructions (disinfectant compatibility and
procedure)
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Room cleaning and disinfecting
Start with table:
1.Remove all unnecessary table attachments, and clean
all exposed surfaces with a cleaner disinfectant
2.Wipe joints, table attachments, frame, legs, and rails
3.Turn down mattress and wipe the table bed frame and
back of the mattress working from the top and repeat at
the bottom
4.Wipe sides of the mattress. Change disinfectant wipe or
cloth as needed.
5.Wipe both sides of coated pillows
6.Allow all elements to air dry.
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Room cleaning and disinfecting
 Remaining surfaces:
• Clean from top to bottom and front to back following
cleaning checklist
• Spot clean floor as needed
• Disinfect:
o Tables, instrument stands, and equipment (e.g. cables, leads,
o
o
o
o
o
BP cuff, stethoscope, phone, gas machine, monitor)
OR table and arm/leg boards
Non-disposable safety strap
Standing stools (lifts)
Kick buckets
Overhead OR lights and reflectors
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Environmental monitoring
 Environmental monitoring- used to identify
opportunities for improving cleaning process
• UV fluorescent gel
o Monitors whether the right surfaces are cleaned
• ATP
o Monitors the effectiveness of the cleaning process.
Measures the amount of organic debris on a surface in
relative light units (RLU)
• Both will be used to monitor the effectiveness of
our cleaning processes
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What types of surfaces are monitored?
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Summary of major cleaning changes
 Wait until the patient is out to start disinfecting



(gathering garbage, etc. is allowed while patient
is in room)
Starting with the patient bed to allow sufficient
contact time
Emphasis on sticking with required disinfectant
wet contact time
Terminal room clean and prep on last case of the
day just as you would for between case cleaning
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Summary
 C. difficile spores, MRSA, and VRE can survive
on surfaces for weeks
 Thorough between case cleaning is needed to
minimize risk of transmission between
patients
 Use new checklists to ensure that all items are
disinfected between cases
Contents courtesy of Allina Health