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RP Summary: Recommended Practices for Environmental Cleaning
RECOMMENDED PRACTICES RP Summary: Recommended Practices for Environmental Cleaning PURPOSE: To provide guidance for environmental cleaning and disinfection in the perioperative practice setting.
RP Summary: Recommended Practices for Environmental Cleaning # Recommendation
Key points
I
n
II
A multidisciplinary team should establish cleaning procedures and frequencies in the perioperative practice setting.
The patient should be provided with a clean, safe environment.
1
A multidisciplinary team should select cleaning chemicals for use in the perioperative setting. A standardized product selection process assists in the selection of functional and reliable products that are safe, cost-effective, and environmentally friendly. n
High-level disinfectants or liquid chemical sterilants should not be used to clean and disinfect environmental surfaces or noncritical devices.
n
Alcohol should not be used to disinfect large environmental surfaces.
n
An environmental protection agencyeregistered disinfectant in the concentration indicated in the manufacturer’s instructions for nurseries and neonatal patient care areas should be used when the perioperative patient population includes neonates and infants.
n
A multidisciplinary team should select cleaning materials, tools, and equipment for use in the perioperative practice setting.
n
A multidisciplinary team should establish cleaning frequencies for high-touch objects and surfaces.
n
All horizontal surfaces in the OR (eg, furniture, surgical lights, booms, equipment) should be damp dusted before the first scheduled surgical or other invasive procedure of the day. n
n
Damp dusting should be performed methodically, from top to bottom.
Environmental protection agencyeregistered, hospital-grade disinfectants should be used to disinfect surfaces in the perioperative practice setting. n
Safety data sheets must be available and reviewed for each cleaning chemical used in the perioperative setting.
n
Cleaning chemicals must be prepared, handled, stored, and disposed of according to manufacturers’ instructions for use and local, state, and federal regulations. (table continued)
http://dx.doi.org/10.1016/j.aorn.2014.01.017
AORN, Inc, 2014
May 2014
Vol 99 No 5
AORN Journal j 583
May 2014
RP SUMMARY
Vol 99 No 5
(continued ) RP Summary: Recommended Practices for Environmental Cleaning # Recommendation
III A clean environment should be reestablished after the patient is transferred from the area.
Key points n
If the cleaning chemical is removed from the original container, the secondary container should be labeled with the chemical name, concentration, and expiration date.
n
Disinfectants should be applied and reapplied as needed per manufacturers’ instructions for the dwell time required to kill the targeted microorganism (eg, Clostridium difficile).
n
Spraying and misting methods should not be used to apply cleaning chemicals in the perioperative practice setting.
n
Floors should be mopped with damp or wet mops. Dry methods of environmental cleaning (ie, dusting, sweeping) should not be used in semirestricted and restricted areas.
n
Floors in the perioperative practice setting should be considered contaminated at all times.
n
A protective barrier covering should be used to protect noncritical equipment surfaces if the surface cannot withstand disinfection or is difficult to clean (eg, computer keyboards, foot pedals).
n
Equipment should be cleaned and disinfected before being brought into the semirestricted area.
n
Reusable noncritical, nonporous surfaces such as mattress covers, pneumatic tourniquet cuffs, and other patient equipment should be cleaned and disinfected according to manufacturers’ instructions after each patient use. n
IV Perioperative areas should be terminally cleaned.
Single-use items should be discarded after each patient use.
n
Cleaning of high-touch objects after each patient use should include cleaning of any soiled surface of the item and any frequently touched areas of the item (eg, control panel, switches, knobs, work area, handles).
n
Operating and procedure rooms must be cleaned after each patient. n
Environmental cleaning, including trash and contaminated laundry removal, should not begin until the patient has left the area.
n
Items that are used during patient care should be cleaned and disinfected after each patient use.
n
Items that are used during a surgical or invasive procedure should be cleaned and disinfected.
n
Preoperative and postoperative patient care areas must be cleaned after each patient has left the area.
n
Patient transport vehicles, including the straps, handles, side rails, and attachments, should be cleaned and disinfected after each use.
n
Terminal cleaning and disinfection of perioperative areas, including sterile processing areas, should be performed daily when the areas are being used. n
584 j AORN Journal
1
For terminal cleaning in semirestricted and restricted areas (eg, operating or procedure rooms, sterile processing areas, corridors, storage areas), a multidisciplinary team should determine the frequency and extent of cleaning required when areas are not occupied (eg, unused rooms, weekends).
RP SUMMARY
www.aornjournal.org
(continued ) RP Summary: Recommended Practices for Environmental Cleaning # Recommendation
Key points n
All floors in the perioperative and sterile processing areas should be disinfected. n
n n
n
V
All areas and equipment that are not terminally cleaned should be cleaned according to an established schedule.
VI All personnel should take precautionary measures to limit transmission of microorganisms when performing environmental cleaning and handling waste materials.
1
Floors may be terminally cleaned with either a wet vacuum or a single-use mop and a disinfectant. The floor should be wet with the disinfectant for the dwell time indicated on the manufacturer’s instructions for use. Cleaning should progress from the cleanest to dirtiest areas of the floor. Floor surfaces at the perimeter of the room should be disinfected before floor surfaces in the center of the room. The entire floor should be disinfected, including areas under the OR bed and mobile equipment.
n
Terminal cleaning of operating and procedure rooms should include cleaning and disinfecting of all exposed surfaces, including wheels and casters, of all items.
n
Terminal cleaning of preoperative and postoperative patient care areas should include cleaning and disinfecting of all exposed surfaces, including wheels and casters, of all items.
n
Sterile processing areas should be terminally cleaned.
n
A multidisciplinary team should establish a cleaning schedule for perioperative areas and equipment that should be cleaned on a regular (eg, weekly, monthly) basis.
n
Health care personnel who are cleaning must follow standard precautions to prevent contact with blood, body fluids, or other potentially infectious materials.
n
Cleaning and disinfection activities should be performed in a methodical pattern that limits the transmission of microorganisms. n
Cleaning should progress from clean to dirty areas.
n
Cleaning should progress from top to bottom areas.
n
Clockwise or counterclockwise cleaning may be performed when used in conjunction with clean-to-dirty and top-to-bottom methods.
n
When visible soiling by blood, body fluids, or other potentially infectious materials appears on surfaces or equipment, the area must be cleaned and disinfected as soon as possible.
n
Items that are contaminated with blood or tissue and that would release blood, body fluids, or other potentially infectious materials in a liquid or semi-liquid state if compressed and items that are caked with dried blood, body fluids, or other potentially infectious materials must be placed in closable, leak-proof containers or bags that are color-coded, labeled, or tagged for easy identification as biohazardous waste.
n
Contaminated sharps (eg, needles, blades, sharp disposable instruments) must be discarded immediately in a closable, puncture-resistant container that is leak-proof on its sides and bottom and is labeled or color-coded. (table continued)
AORN Journal j 585
May 2014
RP SUMMARY
Vol 99 No 5
(continued ) RP Summary: Recommended Practices for Environmental Cleaning # Recommendation
1
Key points n
Laundry contaminated with blood, body fluids, or other potentially infectious materials must be handled as little as possible. n
Contaminated laundry must be placed in labeled or color-coded containers or bags at the location where it was used.
n
Contaminated laundry that is wet and may soak or leak through the container or bag must be placed and transported in containers or bags that prevent soak-through or leakage of fluids to the exterior.
1. Recommended practices for environmental cleaning. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014: 255-276. Copyright ª AORN, Inc, 2014. All rights reserved.
AORN has developed this RP Summary as a service to AORN members. The summary is intended to be an adjunct to the complete recommended practices document upon which it is based and is not intended to be a replacement for that document. Individuals who are developing and updating organizational policies and procedures should review and reference the full recommended practices document.
586 j AORN Journal
RP Summary: Recommended Practices for Environmental Cleaning # Recommendation
Key points
I
n
II
A multidisciplinary team should establish cleaning procedures and frequencies in the perioperative practice setting.
The patient should be provided with a clean, safe environment.
1
A multidisciplinary team should select cleaning chemicals for use in the perioperative setting. A standardized product selection process assists in the selection of functional and reliable products that are safe, cost-effective, and environmentally friendly. n
High-level disinfectants or liquid chemical sterilants should not be used to clean and disinfect environmental surfaces or noncritical devices.
n
Alcohol should not be used to disinfect large environmental surfaces.
n
An environmental protection agencyeregistered disinfectant in the concentration indicated in the manufacturer’s instructions for nurseries and neonatal patient care areas should be used when the perioperative patient population includes neonates and infants.
n
A multidisciplinary team should select cleaning materials, tools, and equipment for use in the perioperative practice setting.
n
A multidisciplinary team should establish cleaning frequencies for high-touch objects and surfaces.
n
All horizontal surfaces in the OR (eg, furniture, surgical lights, booms, equipment) should be damp dusted before the first scheduled surgical or other invasive procedure of the day. n
n
Damp dusting should be performed methodically, from top to bottom.
Environmental protection agencyeregistered, hospital-grade disinfectants should be used to disinfect surfaces in the perioperative practice setting. n
Safety data sheets must be available and reviewed for each cleaning chemical used in the perioperative setting.
n
Cleaning chemicals must be prepared, handled, stored, and disposed of according to manufacturers’ instructions for use and local, state, and federal regulations. (table continued)
http://dx.doi.org/10.1016/j.aorn.2014.01.017
AORN, Inc, 2014
May 2014
Vol 99 No 5
AORN Journal j 583
May 2014
RP SUMMARY
Vol 99 No 5
(continued ) RP Summary: Recommended Practices for Environmental Cleaning # Recommendation
III A clean environment should be reestablished after the patient is transferred from the area.
Key points n
If the cleaning chemical is removed from the original container, the secondary container should be labeled with the chemical name, concentration, and expiration date.
n
Disinfectants should be applied and reapplied as needed per manufacturers’ instructions for the dwell time required to kill the targeted microorganism (eg, Clostridium difficile).
n
Spraying and misting methods should not be used to apply cleaning chemicals in the perioperative practice setting.
n
Floors should be mopped with damp or wet mops. Dry methods of environmental cleaning (ie, dusting, sweeping) should not be used in semirestricted and restricted areas.
n
Floors in the perioperative practice setting should be considered contaminated at all times.
n
A protective barrier covering should be used to protect noncritical equipment surfaces if the surface cannot withstand disinfection or is difficult to clean (eg, computer keyboards, foot pedals).
n
Equipment should be cleaned and disinfected before being brought into the semirestricted area.
n
Reusable noncritical, nonporous surfaces such as mattress covers, pneumatic tourniquet cuffs, and other patient equipment should be cleaned and disinfected according to manufacturers’ instructions after each patient use. n
IV Perioperative areas should be terminally cleaned.
Single-use items should be discarded after each patient use.
n
Cleaning of high-touch objects after each patient use should include cleaning of any soiled surface of the item and any frequently touched areas of the item (eg, control panel, switches, knobs, work area, handles).
n
Operating and procedure rooms must be cleaned after each patient. n
Environmental cleaning, including trash and contaminated laundry removal, should not begin until the patient has left the area.
n
Items that are used during patient care should be cleaned and disinfected after each patient use.
n
Items that are used during a surgical or invasive procedure should be cleaned and disinfected.
n
Preoperative and postoperative patient care areas must be cleaned after each patient has left the area.
n
Patient transport vehicles, including the straps, handles, side rails, and attachments, should be cleaned and disinfected after each use.
n
Terminal cleaning and disinfection of perioperative areas, including sterile processing areas, should be performed daily when the areas are being used. n
584 j AORN Journal
1
For terminal cleaning in semirestricted and restricted areas (eg, operating or procedure rooms, sterile processing areas, corridors, storage areas), a multidisciplinary team should determine the frequency and extent of cleaning required when areas are not occupied (eg, unused rooms, weekends).
RP SUMMARY
www.aornjournal.org
(continued ) RP Summary: Recommended Practices for Environmental Cleaning # Recommendation
Key points n
All floors in the perioperative and sterile processing areas should be disinfected. n
n n
n
V
All areas and equipment that are not terminally cleaned should be cleaned according to an established schedule.
VI All personnel should take precautionary measures to limit transmission of microorganisms when performing environmental cleaning and handling waste materials.
1
Floors may be terminally cleaned with either a wet vacuum or a single-use mop and a disinfectant. The floor should be wet with the disinfectant for the dwell time indicated on the manufacturer’s instructions for use. Cleaning should progress from the cleanest to dirtiest areas of the floor. Floor surfaces at the perimeter of the room should be disinfected before floor surfaces in the center of the room. The entire floor should be disinfected, including areas under the OR bed and mobile equipment.
n
Terminal cleaning of operating and procedure rooms should include cleaning and disinfecting of all exposed surfaces, including wheels and casters, of all items.
n
Terminal cleaning of preoperative and postoperative patient care areas should include cleaning and disinfecting of all exposed surfaces, including wheels and casters, of all items.
n
Sterile processing areas should be terminally cleaned.
n
A multidisciplinary team should establish a cleaning schedule for perioperative areas and equipment that should be cleaned on a regular (eg, weekly, monthly) basis.
n
Health care personnel who are cleaning must follow standard precautions to prevent contact with blood, body fluids, or other potentially infectious materials.
n
Cleaning and disinfection activities should be performed in a methodical pattern that limits the transmission of microorganisms. n
Cleaning should progress from clean to dirty areas.
n
Cleaning should progress from top to bottom areas.
n
Clockwise or counterclockwise cleaning may be performed when used in conjunction with clean-to-dirty and top-to-bottom methods.
n
When visible soiling by blood, body fluids, or other potentially infectious materials appears on surfaces or equipment, the area must be cleaned and disinfected as soon as possible.
n
Items that are contaminated with blood or tissue and that would release blood, body fluids, or other potentially infectious materials in a liquid or semi-liquid state if compressed and items that are caked with dried blood, body fluids, or other potentially infectious materials must be placed in closable, leak-proof containers or bags that are color-coded, labeled, or tagged for easy identification as biohazardous waste.
n
Contaminated sharps (eg, needles, blades, sharp disposable instruments) must be discarded immediately in a closable, puncture-resistant container that is leak-proof on its sides and bottom and is labeled or color-coded. (table continued)
AORN Journal j 585
May 2014
RP SUMMARY
Vol 99 No 5
(continued ) RP Summary: Recommended Practices for Environmental Cleaning # Recommendation
1
Key points n
Laundry contaminated with blood, body fluids, or other potentially infectious materials must be handled as little as possible. n
Contaminated laundry must be placed in labeled or color-coded containers or bags at the location where it was used.
n
Contaminated laundry that is wet and may soak or leak through the container or bag must be placed and transported in containers or bags that prevent soak-through or leakage of fluids to the exterior.
1. Recommended practices for environmental cleaning. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014: 255-276. Copyright ª AORN, Inc, 2014. All rights reserved.
AORN has developed this RP Summary as a service to AORN members. The summary is intended to be an adjunct to the complete recommended practices document upon which it is based and is not intended to be a replacement for that document. Individuals who are developing and updating organizational policies and procedures should review and reference the full recommended practices document.
586 j AORN Journal