Special Edition on Operating Room Imperatives Special Edition- Operating Room Imperatives | Page 15

Rupp, et al. (2013) and other researchers disrupted EVS and
IP disciplines by bursting isolation balloons; however, they
also helped shine a light on the needs of both disciplines.”
So, the question remains, how long does it take to actually
clean various objects in the patient-care environment?
As Peters, et al. (2018) remind us, “Hospital environmental
hygiene is complex because it is dependent on the pathogen
present and the product used to remove it. There are five main
variables to cleaning, whether removing soil or disinfecting
and cleaning on a microbiological level. These elements are:
What product or intervention is applied, the technique and
equipment used to apply the product, the type of surface,
the level of contamination of the environment,
and last but not least, the environmental hygiene
personnel doing the cleaning. If any one of these
elements is lacking, the cleaning will, by definition,
be suboptimal. Because of this, changing cleaning
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Environmental practices in hospitals must be implemented through
Services
a multimodal strategy that takes these variables into
Optimization
account. The best cleaning substance in the world is
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useless if not applied correctly, and the best-trained
personnel are useless if the product they are using is not
effective against the particular pathogen that needs to be
removed or killed.”
Two studies (Saito, et al., 2015; Zoutman, et al., 2015)
estimated the time currently being spent by healthcare
workers on cleaning shared patient-care equipment and
three articles (Dancer et al., 2009; Rampling, et al., 2001;
Wilson et al., 2011) evaluated interventions which increased
the time spent on cleaning.
Saito, et al. (2015) observed the frequency of cleaning and
disinfecting tasks (recorded at 5-min intervals) as a proportion
of shifts (percentage of total shifts) and observed time spent
performing cleaning and disinfecting tasks per shift (minutes/
shift). The researchers concluded from their observational
study that healthcare workers undertaking multiple roles as
a part of their job (e.g. registered nurses) tended to perform
cleaning and disinfection tasks with a lower frequency and for
a shorter duration. In particular, housekeepers spent almost
twice as long on equipment cleaning (23 minutes per shift)
than registered nurses (13 minutes per shift). The average
duration of time spent cleaning fixed surfaces (e.g. beds and
chairs) was more than nine times as long for housekeepers
(94 minutes per shift) as it was for registered nurses (10
minutes per shift).
Zoutman, et al. (2015) estimated the time required to
perform routine cleaning and terminal cleaning of private,
semi-private and ward rooms. The researchers used a
questionnaire distributed to senior managers to ascertain
that routine cleaning of a private room required nearly half
as long a mean time (17.3 minutes) as that needed to clean
a ward room (34.2 minutes) with an unspecified number
of beds. Likewise, terminal cleaning of a private room took
almost twice as much time (30.4 minutes) as routine cleaning,
mainly due to additional tasks (e.g. replacement of privacy
curtains). This observation implies that higher room turnover,
resulting from a shorter length of stay, would further increase
the amount of time required to keep patient rooms clean.
Regarding studies that evaluated increased cleaning
times, Wilson, et al. (2011) found that twice-daily cleaning,
in addition to usual once-daily cleaning for three two-month
periods resulted in a statistically significant reduction in
environmental MRSA per bed-area day from 14.6 percent
to 9.1 percent, when sampling from five randomly selected
sites around the bed areas, staff hands and communal
sites. Dancer, et al. (2009) studied the impact of adding a
member of the cleaning staff for a period of six months;
the researchers found a statistically significant reduction in
levels of environmental contamination of 32.5 percent by
weekly sampling of 10 hand-touch sites and a borderline
statistically significant reduction in new MRSA infections
of 26.6 percent. Rampling, et al. (2001) studied the impact
of an increase in routine domestic cleaning time from 66.5
hours to 123.5 hours per week for a period of six months.
They found a reduction in patient acquisition of an outbreak
strain of MRSA from 30 cases in the six months prior to the
intervention to three cases over the following six months.
In a more recent study, Scott, et al. (2017) evaluated the
impact of cleaning duration on HAI rates and estimated the
time required to clean care equipment in accordance with
national specifications. The researchers conducted a systematic
review of the published literature on cleaning times as well
as an observational study in which nine healthcare workers
cleaned seven items of patient-care equipment while the
duration of time taken to clean each item was measured.
They reported that a limited amount of low-quality evidence
indicated increased cleaning times in hospitals can reduce the
incidence of infections. They found the interventional studies
that evaluated the impact of increased cleaning times operated
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