Special Edition on Operating Room Imperatives Special Edition- Operating Room Imperatives | Page 10

percentage of surfaces appropriately cleaned. Twenty-four
different housekeepers were involved, and their identities
were not recorded as part of the project. The amount of
time spent by housekeepers to clean a room was monitored
through use of an automated system that required personnel
to document by telephone when they arrived at the room
and when room cleaning was complete.
Six hundred high-touch surfaces were marked in 40 critical
care rooms (10 rooms per unit). Cleaning thoroughness ranged
from a low of 5 percent for the monitor to a high of 79 percent
for the computer mouse. Cleaning of high-touch surfaces
was similar from unit to unit except for the room door handle
(which was cleaned less well in unit B; and cabinet handle
(which was cleaned less well in units B and D). The room
cleaning checklist was completed less frequently in unit C (30
percent completion) than in the other three units (60 percent
to 90 percent completion). However, the median number of
surfaces cleaned was similar for a room whether the checklist
was completed or not. The overall thoroughness of cleaning
(percentage of high-touch surfaces cleaned) was 41 percent
and ranged from 33 percent to 51 percent among intensive
care units. Specific room cleanliness ranged from a low of
0 percent to a high of 80 percent. There was no significant
correlation between the thoroughness of cleaning high-touch
surfaces (with or without consideration of the three surfaces
that housekeepers were not responsible for cleaning) and
the amount of time required to clean the room. There was
a wide discrepancy between thoroughness and efficiency.
Although a few rooms were fairly well cleaned within 30
minutes (which is an accepted industry benchmark), many
of the rooms with below-average cleaning took considerably
longer to clean.
As Rupp, et al. (2013) explain, “Unexpectedly, there was
no correlation between the amount of time spent cleaning a
room and the thoroughness of cleaning high-touch surfaces
as documented by the UV-tagged marking system. This
finding has important implications for institutions that devise
strategies to optimize cleaning. Our study lends support
to and may explain earlier studies that have shown that
improved cleaning performance can be achieved without
substantial additional cost. Clearly, adequate time must
be allotted for personnel to clean a room properly, but it is
apparent that additional time taken to clean a room is no
guarantee of adequate cleaning. These data also support
additional evaluation to discern whether an optimum outlier
(positive deviance) process improvement program could be
employed to improve environmental cleanliness. Because
several of the environmental service staff in our study appear
to be optimum outliers and are able to clean hospital rooms
quickly and thoroughly, they may be able to provide personal
and programmatic insights to explain their proficiency and
serve as models for their coworkers.”
The researchers concluded that their findings emphasize
that process improvement interventions should evaluate both
the efficiency and thoroughness of hospital surface cleaning
to optimize the cost effectiveness of cleaning practice in
healthcare settings.
This study paved the way for follow-up research by
Mark Rupp, MD, professor in the Department of Internal
Medicine; chief of the Division of Infectious Diseases; and
10
Continued from page 9
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 contamination through either
direct contact with the patient’s skin or by personal
contact with the fomite and subsequent skin to
skin or glove to skin contact with the patient.”
The guideline adds, “A high risk for pathogen
transmission exists in the perioperative setting be-
cause of multiple contacts between perioperative
team members, patience, and environmental ser-
vices. Cleaning and disinfecting the environment
is a basic infection prevention principle used to
reduce the likelihood that exogenous sources will
contribute to healthcare-associated infections.
Operating room environmental surfaces and
equipment can become contaminated with
pathogens that cause surgical site infections,
particularly if cleaning is suboptimal, and patho-
gens can then be transmitted to the hands  of
perioperative team members. Thus, thorough
cleaning and disinfection of high touch objects as
part of a comprehensive environmental cleaning
and disinfection program that includes hand
hygiene are essential in preventing the spread of
potentially pathogenic microorganisms.”
Many practitioners instinctively know that
to achieve optimal results, environmental
hygiene should not be rushed. Unfortunately,
great emphasis on quickness-driven efficiencies
persists, such as a scoring system promulgated
by a 2006 opinion piece that encouraged higher
scoring if turnover times (average set-up and
clean-up turnover times for all cases was less
than 25 minutes.
As Macario (2006) observes, “Most U.S.
hospitals perform all cases scheduled by their
surgeons, provided a case can be done safely. This
reflects the desire to retain and grow surgeons’
practices, to enhance market share and reputa-
tion, and to fulfill community-service missions.
Getting the right case in the right room at the
right time is the goal for every OR director. For
anesthesiologists, efforts to increase anesthesia
group productivity are the same as increasing
the efficiency of use of OR time. Often, though,
defining how well the OR suite runs depends
on who you ask. The hospital administrator may
Continued on page 12
Operating Room Imperatives 2020 • www.healthcarehygienemagazine.com