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 patients 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)Dont 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
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
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