RECOMMENDED PRACTICES FOR ENVIRONMENTAL CLEANING IN THE SURGICAL PRACTICE

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RECOMMENDED PRACTICESFOR ENVIRONMENTALCLEANING
IN THE SURGICALPRACTICE

• PRESENTED
• BY
• VONDA BELT
• SUPPORT TEAM LEADER
• SURGICAL SERVICES
• RAPID CITY REGIONAL HOSPITAL

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OBJECTIVES FOR PRESENTATION

• Standards of Practice Guidelines
• Specific Room Preparation
• Isolation Guidelines
• Training
• Quality Monitoring

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SURGICAL SERVICES DEPARTMENT

• The surgical services department at
• RCRH consist of 14 surgical rooms.
• Pre Op holding area
• Recovery room
• Endoscopy Unit

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STAFFING FOR ENVIRONMENTAL SERVICES

• Surgical services at RCRH has a cleaning team
  that is directly responsible to the department.
• Consisting of 8 full time and 3 part time
  custodians, cross trained for some orderly
  duties.
• We also have 6 orderlies, trained to assist
  with patient care and custodial duties when
  needed.

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• OBJECTIVE 1

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GUIDELINES USED FOR THIS PRESENTATION

• 2003 AORN Standards
• CDC recommendations
• Infection Control Standards
• These standards have been written into our
  policies and procedures.

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All of these guidelines are adaptable to various
practice settings.

• TO INCUDE
• Operating Room
• Ambulatory Surgery Units
• Physician offices
• Cardiac Catheterization suites
• Endoscopy suites
• Radiology departments
• Areas where operative and other invasive
  procedures may be performed.

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PURPOSE OF GUIDELINES

• These recommended practices provide guidance
  for environmental cleaning in the surgical
  practice setting. This results in a clean
  environment for surgical patients. Thus
  minimizing health care workers and patients
  exposure to potentially infectious microorganisms.

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• OBJECTIVE II

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SPECIFIC ROOM PREPARATION

• AM room preparation
• Turn Over and between case cleaning
• Terminal cleaning
• Ancillary area cleaning
• Floor care
• Weekly and monthly cleaning

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• NEWS REPORT
• A certain private school in Washington
  recently was faced with a unique problem. A
  number of 12-year-old girls were beginning to use
  lipstick and would put it on in the bathroom.
  That was fine, but after they put on the lipstick
  they would press their lips to the mirror leaving
  dozens of little lip prints.
• Every night, the maintenance man would
  remove them and the next day, the girls would put
  them back. Finally the principal decided that
  something had to be done. She called all the
  girls to the bathroom and met them there with the
  maintenance man. She explained that all these
  lip prints were causing a major problem for the
  custodian who had to clean the mirror every
  night.

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• NEWS REPORT CONTINUES
• To demonstrate how difficult it had been to
  clean the mirrors, she asked the maintenance man
  to show the girls how much effort was required/
  he took out a long-handled squeegee, dipped it in
  the toilet, and cleaned the mirror with it.
  Since them, there have been no lip prints on the
  mirror.

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AM ROOM PREPATATION

• Check room for cleanliness
• Check for stand equipment
• Put on gloves
• Wipe all flat surfaces with EPA approved cleaner
• Check the floor
• Wipe equipment coming in
• Check the equipment used for the procedure
• Bring in the case cart
• Designate the staff that will be responsible for
  these duties.

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OUR DEPARTMENT

• Cases are picked by Central Supply
• To surgery on the Clean Elevator
• Into our Center Core Area
• Items that are picked by surgery staff for the
  case carts
• Separate the clean sterile items for the non
  sterile items

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TURNING OVER A ROOM

• Develop turnover procedures and staff who will
  assist
• Case ended or computer shows case is coming down
• Over head call for turnover help and moving
  assistance
• Patient out of room
• All equipment is contained and put in case cart
  to return to decontamination area (dirty
  elevator)
• Trash and linen is bagged and also taken to dirty
  elevator
• All surfaces are wiped down with disinfectant and
  a clean cloth, the floor is mopped
• The room is made up for the next patient

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TERMINAL CLEANING

• Recommendations are to terminally clean each
  OR room every 24 hours.
• Terminal cleaning in the surgical practice
  setting reduces the number of microorganisms,
  dust, and organic debris present in the surgical
  environment.

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TERMINALLY CLEANING IN THE OR SUITES

• Prepare your equipment and supplies
• Cleaning cart Germicidal
  detergent
• Mop Bucket wringer Sprayer
• Mop handle mops Wall mop
• Cleaning cloths 1 gal cleaning
  bucket
• Gloves
• Paper towels for sinks and sub sterile room.

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TERMIMAL CLEANING

• Set up the room pull all equipment away from
  walls
• Check the room for standard equipment and take
  out all extra equipment
• Take apart the bed, arm boards, kick buckets, and
  other equipment that can be taken apart
• Take out any sterile items left in room
• Take out all trash and lined missed after case
  clean up
• Shut all cabinet doors

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LETS GET TO THE DETAILS!

• Spray the bed, all of the pieces that you have
  taken apart, and the base of the bed.
• Spray the floor under and around the bed
• Take apart any other equipment.
• Spray all of the equipment, give it a nice
  soaking.
• Give 10 min. kill time.
• Do not spray Anesthesia equipment computer or
  electrical equipment.

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A FEW MORE DETAILS!

• Air dry
• Wash everything
• Overhead lights and wall mounted equipment
• Phones and cords
• Doors
• Glass
• Spot wash walls
• Vents
• Floors and wet vacuuming
• Check again

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SUB STERILE ROOMS

• Sinks and counters
• Warmers
• Autoclaves
• Shelves
• Floors
• Walls

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Ancillary areas

• Bathrooms and locker areas
• Offices
• Storage areas
• Lounges
• Corridors
• Control desk
• Recovery
• Pre Op holding
• Satellite Pharmacy

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WALL CARE

• Surgical suites
• Corridors
• Ancillary areas
• Maintenance of walls

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FLOOR CARE

• Daily mopping of all hard surface floors
• Burnishing and polishing
• Machine scrubbing
• Waxing
• Carpets daily, weekly, monthly, and yearly
• Cleaning sink mats and door mats
• Scheduling days
• Maintenance of

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• OBJECTIVE III

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ISOLATION GUIDELINES

• A variety of infection control measures are
  used to decrease the risk of transmission of
  microorganisms in hospitals.
• These measures make up the fundamentals of
  isolation precautions.

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ISOLATION SIGNS

• We have five different color coded signs that
  make up the fundamentals of isolation care and
  cleaning.
• Pink signs are AFB Precautions
• Bright Orange for Strict Airborne
  Precautions
• Light Orange for Respiratory Precautions
• Light Green for Contact Precautions
• Blue for MDR Contact Precautions

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ISOLATION

• Patient chart is flagged
• Patient transported to Pre Op
• Signs posted
• Patient out of Pre Op to surgery
• Housekeeping called
• Surgery preparation
• Patient in surgery
• Transported to Recovery
• Housekeeping called
• Cleaning recovery area

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• OBJECTIVE IV

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TRAINING

• Training is vital to the process of giving a
• new staff member a sense of belonging.
• Having very good training staff will assure
• that all new employees are given the same
• orientation.

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ORIENTATION GUIDELINES

• In our department at RCRH, the custodial and
  orderly team have assisted in writing the
  guidelines for terminal cleaning.
• They have assisted in setting up a training
  book with policies, guidelines, and orientation
  check lists. This will assist in assuring that
  new staff are all receiving the the same training
  and information.
• This also give me preceptors that are willing
  to train and do a good job, because they are
  confident that all staff are working the same and
  as a team.

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• OBJECTIVE V

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QUALITY MONITORING

• Each area has a position check list.
• Each check list has the area to be cleaned
  
• and general cleaning needs.
• The surgical department at RCRH has 3
• day position check lists and 5 evening
• position check lists.

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HAND WASHING

• Hand washing frequently is called the single
  most important measure to reduce the risks of
  transmitting microorganisms from one person to
  another or from one site to another on the same
  patient.

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CONCLUSION

• Standards of Practice Guidelines
• Specific Room Preparation
• Isolation Guidelines
• Training
• Quality Monitoring

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ENDING

• I hope that I have covered things in this
  presentation that will assist you.
• If you have question please contact me, my
  address is vbelt _at_ rcrh .com. My work phone
  number is 605-719-2029.
• It has been my great pleasure to have you
  with us and be able to present for you.