hygiene, we need to first understand what the cost of
maintaining a clean hospital environment is, and what its
value is. Although many hospitals are quick to spend money
on new software, specialized staff and fancy equipment,
they often look at maintaining the environment hygiene as
an opportunity to save in the budget.”
The researchers continue, “Hospitals often try to cut
environmental hygiene maintenance costs as much as
possible, both in the products that they use, and in the
training and continued education of their workforce. The
essential shift in approach needs to happen in how hospitals
assess this cost and value. Because the costs of not cleaning
can affect numerous budgets within a hospital, it is difficult
to accurately account for them. Hospitals must look beyond
actual expenditures to averted expenditures, such as increase
in patient-days due to HAI, as well as opportunity costs such
as hospital staff time or missed surgical revenue due to
increased turnaround time in an OR. There are also increases
in costs associated with antimicrobial resistance in HAI,
which has a cost estimated at over $100 trillion globally by
2050. Prevention is always better and less expensive than a
cure, especially when we are running out of antibiotics. So,
when making a decision about which environmental hygiene
maintenance systems to buy, which products to use, or how
much to invest in training the cleaning personnel, hospitals
would do well to look at the costs of not doing so, or
deciding on a cheaper solution. To save money and improve
patient satisfaction, hospitals must invest in quality, whether
in materials, disinfectants, technological innovation, or the
training, education, and certification of their workforce.”
The value analysis proposition aside, much of the debate
also centers around how effective improved cleaning can be.
Sometimes, logic and common sense that indicates that
a longer time spent cleaning and disinfecting would result
in better outcomes, are betrayed by scientific inquiry. In this
case, a study published in 2013 indicated, to the chagrin of
many, that additional time spent cleaning a hospital room
did not correlate to the thoroughness of the cleaning.
In their multi-center study, Rupp, et al. (2013) demon-
strated improved cleaning of high-touch surfaces by using
a fluorescent marking solution and rapid-cycle performance
feedback. As part of an earlier study, housekeepers were
instructed about the importance of environmental cleanliness
and appropriate cleaning of high-touch surfaces, and a room
cleaning checklist was introduced. In this study, the researchers
sought to examine the relationship between the amount of
time that a housekeeper spent cleaning a hospital room and
the thoroughness of surface cleaning.
The study was conducted in four adult medical-surgical
critical care units with 74 beds; 15 high-touch surfaces in each
critical-care room were covertly marked by study personnel
with a transparent, water-soluble solution that fluoresces
when exposed to UV light. The high-touch surfaces consisted
of the room door handle, thermometer, patient monitor,
bedside tray table, bedrails and release buttons, nurse call
box, faucet handle, computer mouse, light switches, cabinet
handle, and hand gel dispenser handle. EVS personnel
were not responsible for cleaning three of the surfaces (the
thermometer, monitor, and computer mouse). After discharge
of the patient from the hospital and routine terminal cleaning
14
Cleaning Turnover Times
in the Operating Room
By Kelly M. Pyrek
T
he emphasis on speed when turning over patient
rooms pales in comparison to the Indianapolis 500-like
speed that is encouraged in the operating room (OR), the
profit center of the hospital. The high levels of utilization,
the complexity of the cases, and the pathogens that are
present in the OR demand that the level of cleaning and
disinfection between cases matches its use. A search of
the literature reveals a plethora of papers on whittling
down turnover time and boosting efficiency; however,
less available are studies calling for an increase in the
time carved out for environmental hygiene-related
tasks. While healthcare institutions place priority on
profits, ignoring infection prevention through proper and
rigorous evidence-based cleaning and disinfection sets
up the institution for failure through increased surgical
site infections (SSI) rates and adverse events that can
eliminate those financial gains.
Achieving balance between speed and hygiene is
the desirable sweet spot, yet ORs remain notoriously
challenging to clean.
“Researchers have shown that cleaning practices in the
operating room are not always thorough or consistent with
the policies of the healthcare organization,” confirms the
Guideline for Environmental Cleaning, part of the 2020
Guidelines for Perioperative Practice from the Association
of periOperative Registered Nurses (AORN). “Jefferson,
et al. observed a mean cleaning rate of 25 percent for
objects monitored in the operating room setting in six
acute-care hospitals. Munoz-Price, et al. observed cleaning
in 43 operating rooms of a large urban hospital and found
only 50 percent of the surfaces were being cleaned. These
findings demonstrate that some operating rooms may not
be as clean as previously thought, although the literature
has not defined the concept of cleanliness.”
AORN’s guidelines continue, “In a literature review,
Ibrahimi, et al. stated that the amount of bacteria
present in the operative site is one of the most important
factors associated with SSI development, although the
minimum number of bacteria that causes an infection
varies depending on the qualities of the organism, the
host and the procedure performed. The review authors
also found that fomites near the surgical field may harbor
bacteria. These fomites may serve as a reservoir for wound
Continued on page 15
march 2020 • www.healthcarehygienemagazine.com