Special Edition on Operating Room Imperatives Special Edition- Operating Room Imperatives | Page 22

& A
Environmental Cleaning in the OR:
A Q&A with AORN Perioperative Practice Specialist
Karen deKay, MSN, RN, CNOR, CIC
Healthcare Hygiene magazine spoke with
Karen deKay, MSN, RN, CNOR, CIC, a periop-
erative practice specialist at the Association
of periOperative Registered Nurses (AORN),
about updates to the organization’s recom-
mendations for environmental cleaning.
HHM AORN’s revised Guideline on Environmental
Cleaning recommends that cleaning equipment, tools,
and materials used in the surgical suite should not be used
outside of the surgical suite because cleaning cart and
equipment wheels could transfer soil and microorganisms
to the surgical suite. Why was this issue added to the
2020 guidelines?
Karen deKay (KD): The source of this recommendation
is the Association for the Healthcare Environment (AHE)’s
guidance on environmental cleaning in the operating room.
This recommendation was added because when a surgical
incision is made, no matter what the size, by breaking the
integrity of the skin we are compromising the patient’s
natural defense mechanism for preventing entrance of
exogenous organisms. As patient advocates, by implementing
actions to minimize sources of exogeneous organisms in
the perioperative environment, we can potentiate safe
patient outcomes. Another example of this concept is the
recommendation that states equipment, which is not stored
in the surgical suite, should be cleaned and disinfected before
it is brought into the semi-restricted area.
Reference:
Association for the Healthcare Environment, American Hospital Asso-
ciation, American Society for Healthcare Environmental Services. Practice
Guidance for Healthcare Environmental Cleaning: The Essential Resource
for Environmental Cleaning and Disinfection. Chicago, IL: Association for
the Healthcare Environment of the American Hospital Association; 2012.
HHM A separate recommendation in the guideline states
that a spray bottle should not be used when applying
disinfectants to surfaces; was the evidence for this
recommendation (Sehulster, et al.) indicative of real-world
examples that warranted this recommendation?
KD: The recommendation to not use a spray bottle when
applying disinfectants to surfaces was based on studies cited
in the Centers for Disease Control and Prevention (CDC) and
Healthcare Infection Control Practices Advisory Committee
(HICPAC) Guidelines for Environmental Infection Control in
Health-Care Facilities. A study found that when a disinfectant
22
was placed in a dirty container, stored for a long period of
time or diluted incorrectly the spray mechanism allowed
aerosolization of the contaminated liquid. An additional study
found Gram-negative bacilli present in some disinfectants.
The generated contaminated aerosols can be carried by air
currents onto the sterile field, surgical wound or other sterile
supplies in the room. Additionally, aerosols may cause acute
or chronic respiratory symptoms in personnel and patients.
Ready-to-use disinfectants in a bottle that can pour solution
is recommended in the CDC HICPAC guideline.
References:
Ehrenkranz NJ, Bolyard EA, Wiener M, Cleary TJ. Antibiotic sensitive
Serratia marcescens infections complicating cardiopulmonary operations:
contaminated disinfectant as a reservoir. Lancet 1980;2:1289-92.
Givan, KF, Black BL, Williams PF. Multiplication of Pseudomonas species
in phenolic germicidal detergent solution. Can J Pub Health 1971;62:72.
HHM Has AORN received reports from its membership
of occupational asthma related to the use of sprays?
KD: Three new moderate-quality studies on healthcare
worker exposure to disinfectants were added to strengthen
the recommendation that an interdisciplinary team should
consider personnel safety when selecting disinfectants for
use in perioperative setting. In a survey of 3,650 healthcare
professionals in the United States, those exposed to cleaning
chemicals were found to be at a greater risk of developing
work-related asthma, with prevalence being higher among
females. In another study, air samples of environmental
worker breathing zones in nine departments of a large
hospital found that a higher prevalence of work-related
wheezing and watery eyes were found among disinfectant
users. This led authors to conclude that respiratory risks
should be considered when selecting disinfectants. In the
third study conducted in four hospitals, measurements of
100 healthcare workers’ personal and mobile-area air for five
volatile organic compounds (VOC) were taken. Researchers
found that the product ingredient and disinfection task
determined the type of VOC exposure.
References:
Arif AA, Delclos GL. Association between cleaning-related chemicals and
work-related asthma and asthma symptoms among healthcare professionals.
Occup Environ Med. 2012;69(1):35-40.
Casey ML, Hawley B, Edwards N, Cox-Ganser JM, Cummings KJ.
Health problems and disinfectant product exposure among staff at a large
multispecialty hospital. Am J Infect Control. 2017;45(10):1133–1138
Su FC, Friesen MC, Stefaniak AB, et al. Exposures to volatile organic
compounds among healthcare workers: modeling the effects of cleaning
tasks and product use. Ann Work Expo Health. 2018;62(7):852–870.
Operating Room Imperatives 2020 • www.healthcarehygienemagazine.com