Special Edition on Operating Room Imperatives Special Edition- Operating Room Imperatives | Page 9

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
of the room, the high-touch surfaces were surveyed by study
personnel, and the rooms were scored according to the
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 consis-
tent 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.”
www.healthcarehygienemagazine.com • Operating Room Imperatives 2020
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