Environmental Cleaning Presentation 3 OR and Procedure Rooms

Cleaning in the OR
and Procedure Rooms

Module 3
Outcomes
Upon completion of this module, participants will be able to
• describe the different traffic areas: unrestricted, semi-
restricted, and restricted zones;
• describe end of procedure cleaning and terminal
cleaning;
• list high-touch objects in the operative and procedural
environment, and;
• describe how often cleaning should occur.
Definitions
• Clean
• the absence of visible dust, soil, debris, or blood
• Disinfection
• a process that kills pathogenic and other microorganisms by physical or
chemical means
• Terminal cleaning
• thorough environmental cleaning that is performed at the end of each day
the room or area is used
• End of procedure cleaning
• cleaning and disinfecting the operating or procedural room between patients
throughout the day while used
Traffic in the Surgical Area
• The surgical area is composed of unrestricted, semi-restricted,
and restricted zones
• traffic patterns show how the patient and team members
move into, through, and out of the areas
• signage helps clarify the requirements for what team
members must wear in each zone
• defined by the activities performed in each area
Traffic in the Surgical Areas
• OR and procedure rooms are in a controlled traffic area
• Monitoring of the flow of patients, team members,
equipment, and supplies occurs at certain points in the
space
• control desk
• double closed doors to hallways
Traffic Patterns
The surgical area is composed of three zones
• unrestricted
• semi-restricted
• restricted
Unrestricted Zone
• Central control point (front desk)
• monitor the entrance of patients, personnel, and
materials
• Street clothes are permitted in this area
• Traffic is not limited
• The entrance to the surgical suite should be restricted to
authorized personnel based on organizational policies
The Unrestricted Zone
The Semi-restricted Zone
• Includes
• scrub sink areas
• storage areas for clean and sterile supplies
• work areas for processing surgical instruments
• corridors leading to the surgical suite
• Traffic is only allowed for authorized team members and patients
• Team members wear
• hospital laundered scrub attire
• head and facial hair is covered
• masks are not required in this area
Indicate Semi-restricted and Restricted
From Unrestricted to Semi-restricted
Unrestricted Semirestricted
Signage
The Semi-restricted Zone
Semi-restricted - OR Corridors
Semi-restricted - Scrub Sinks
Semi-restricted - Sterile Processing Areas
Restricted Zone
• Includes
• OR
• procedure rooms
• clean core area
Restricted Zone
• Restricted zone
• traffic is only allowed for authorized team members and patients
• team members wear hospital laundered scrub attire, no outside clothes
• head and facial hair is covered
• masks are worn if open sterile supplies and equipment are being used
Restricted – The Operating Room
Surgical Attire for People coming into the Semi-restricted and
Restricted Zones for Brief Periods of Time for a Specific
Purpose
• Examples include
• law enforcement officers
• parents
• biomedical engineers
• Cover all head and facial hair
• Put on surgical scrubs or a single-use coverall suit
• all outside clothing must be covered
A Transition Area
• Team members can enter into an unrestricted area in street
clothing and exit into the semi-restricted in surgical attire
• locker rooms
• May also be used as a security point to monitor traffic
Types of Cleaning in the OR
• Damp dusting
• first thing in the morning before surgical supplies are
brought into the OR
• before surgical supplies are opened
• End of procedure cleaning and disinfecting
• cleaning and disinfecting between every patient during the
day
• Terminal cleaning and disinfecting
• cleaning and disinfecting done at the end of the day
Use Dedicated Cleaning Equipment
• Cleaning equipment for semi-restricted and restricted areas
• Should be dedicated equipment
• Wheels on carts and other equipment can transfer soil
from outside areas
• Using dedicated equipment for the semi-restricted and
restricted areas may decrease the risk of cross-
contamination from other areas in the hospital
Damp Dusting
• Use a clean, low-linting cloth moistened with
disinfectant
• Damp dust first thing in the morning
• before additional items or equipment are brought
into the room
• Damp dust from top to bottom
• Why damp dust?
• removes dust from horizontal surfaces
End of Procedure Cleaning
• Cleaning and disinfecting the OR or procedural room between patients
throughout the day
• Also called room turnover cleaning
• This step is very important!
• stopping the spread of germs from one patient to the next
• decreasing the amount of germs in the environment
Equipment and Supplies
• Gather the correct equipment and supplies needed to clean
and disinfect the room
• detergents and disinfectants
• low-linting cloths
• mop
• single-use disposable wipes
• Check the expiration dates on detergents and disinfectants
• if expired, discard the old product and replace it with new
supply
“Courtesy of Ecolab® Inc.”
Detergent or Disinfectant?
• Use a detergent before using a disinfectant to make sure all
soil and dirt are removed if equipment is visibly dirty
• Products are
• one step: combined detergent and disinfectant
or
• two step: two separate products for detergent and
disinfectant
Cleaning Before Disinfecting
• Cleaning of visible soil or dirt from objects is very
important
• soil and dirt can be a barrier stopping the
disinfectant from working to kill germs on the
surface
• Do not begin cleaning until the patient has left the area
• Put on appropriate PPE upon entering room
• standard precautions
What should be cleaned first?
• Clean from
• top to bottom
• clean to dirty areas
• Clockwise or counter-clockwise cleaning may be performed

when used along with clean-to-dirty and top-to-bottom
cleaning methods
Cleaning the OR
in the OR or Procedural Room
Adapted with permission from Perioperative Standards and Recommended Practices.

Copyright © 2014, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved.
What must be cleaned?
In the OR or procedural room
• anesthesia machine and carts
• equipment booms
• IV poles and pumps
• patient monitors
Telephones
OR Lights
Anesthesia Cart
Anesthesia Machine
IV Poles
IV Poles
• Chairs, stools, and step stools

• Linen receptacles
• Tables and Mayo stands
• Trash receptacles
Tables
Mayo Stand
Ring Stand
• Overhead procedure lights
• Mobile and fixed equipment
• electrosurgical units
• lasers
• medical gas gauges
• microscopes
• radiology equipment
• robots
• suction regulators
• viewing monitors
Keyboards
Electrosurgical Units
Light Source
Headlights
Monitors
Door Handles
• OR beds and attachments
• Positioning devices
• Patient transfer devices
• Reusable patient safety straps
OR Bed
OR Bed
OR Bed Arm Boards
OR Bed Arm Boards
OR Bed
OR Bed
Suction Devices
Suction Devices
Kick Bucket and Holder
Floor Cleaning
• Clean and disinfect the floor surfaces
• at the edge of the room first
• moving toward the center of the room
• The center of the room is where most patient care happens
• the center is likely to be dirtier
• Remove all cleaning equipment brought into the room
• Place all disposable cleaning supplies and equipment in the
trash
• Remove trash and linen bags from the room
• use the corridor doors only
• do not bring trash or any contaminated items through the
clean/sterile core area
Terminal Cleaning
• Terminal cleaning and disinfection of the OR and
procedural areas should be performed at the
end of the day every day the room or area is
used
Terminal Cleaning
• Clean and disinfect all exposed surfaces
• including wheels and casters
• all equipment in the room
• Move the equipment around the room to clean the
floor underneath
Scheduled Cleaning
• Not all areas in the OR and procedural areas are cleaned
daily
• Each facility will decide how frequently these areas should
be cleaned
• weekly or monthly
Scheduled Cleaning
• These areas include
• clean and soiled storage areas
• corridors
• elevators
• environmental service closets
• shelves and storage bins
• stairwells
• sterile storage area
Scheduled Cleaning
• Scrub sinks
• Walls and ceilings
• Privacy curtains
• Pneumatic tubes and
carriers
• Lounges
• Workstation desks
Coordinated Cleaning
• Cleaning of the following equipment will need to be done along with
facility maintenance
• eyewash stations
• ice machines
• refrigerators
• sterilizers
• ventilation ducts
• Routine maintenance of these items is necessary
• Equipment must be cleaned before bringing patients in for care
The End

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Environmental Cleaning Presentation 3 OR and Procedure Rooms

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Cleaning in the OR

and Procedure Rooms

• Clockwise or counter-clockwise cleaning may be performed

Adapted with permission from Perioperative Standards and Recommended Practices.

• Chairs, stools, and step stools

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