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Controlling CDI

OR room turn-over cleaning

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Objectives

Review WHY the need to improve cleaning in theOR

Review HOW to use the Allina disinfectantproducts

Review WHAT surfaces to touch between everycase

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WHY is surface disinfection soimportant??

Methicillin-resistant Staphylococcus aureus(MRSA), vancomycin-resistant enterococci (VRE),and multi-drug resistant gram negative bacteria(MDR-GNB) can survive in the environment forweeks

MDR-GNB hospital acquired infections on the rise

New types of MDR-GNB resistant to ALLcommonly used antibiotics

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One patients story

Cost of CDI:

Lost his colon

9 readmissions

143 days in the hospital

OVER 1.2 MILLION in

healthcare costs

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C. difficile in the U.S.

From 2000 to 2009, the number ofhospitalized patients with any CDI discharge

diagnoses more than doubled, from

approximately 139,000 to 336,600 The number with a primary CDI diagnosis has

more than tripled, from 33,000 to 111,000

Patients with no past healthcare exposurepresenting with C. difficile

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Definitions you need to know

Room turn-over

Between case cleaning done by OR staff

Terminal clean

End of the day cleaning done by Environmental

Service staff

Cycle cleaning

Periodic deep cleaning, (e.g.,walls and ceiling)

done by Environmental Service staff

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Low-level disinfection

Destroys vegetative bacteria, some fungi and

viruses, not mycobacteria or spores.

Most commonly used in healthcare for

cleaning and disinfection of noncritical patient

care equipment and surfaces (bedside table).

Non-critical items: those that contact intact

skin but not mucous membranes.

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Disinfection process

Effective cleaning is critical.

The processes are more important than products

o Need to touch the right surfaces consistently Disinfectants may vary by facility

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Disinfection

Adequate amount

Enough chemical to keep surface wet for requiredcontact time

Adequate contact time

Amount of kill time required

Determined by testing by the U.S. EPA

Friction

Wiping the surface removes bugs

Saturation

Having enough disinfectant on a cloth to ensure thatenough chemical gets to the surface for the rightamount of time.

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Quat and microfiber (preferred)

Microfiber technology

Captures more debris

from the environment

Helps to removemicrobes

Reduces cross-contamination

Change cloths when notdelivering enoughsolution to the surface

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Using AF or bleach wipes:

1)Use friction

2)If a surface is visibly soiled, it must first be

cleaned and then another wipe must be usedto disinfect (use 2 wipes)

3)Dont overuse a wipe use more for largersurface areas (e.g., 5-6 wipes per surgical bed)

4)Do NOT dispose of them in the toilets!

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Wet Contact Time Requirements

Increased attention by surveyors on staff

knowledge of and adherence to disinfectant

wet contact time HB 3M Quat10 minutes

AF wipes3 minutes

Bleach wipes4 minutes

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Key recommendations for the OR

Dedicate cleaning equipment to the OR Use small bucket system with microfiber

cloths

Dip cloths into disinfectant just before use. Donot store cloths in bucket.

Get a clean cloth when needed - never re-dipa used (dirty) cloth into the cleaning solution

Follow EPA approved contact time fordisinfectants

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Recommended cleaning procedures

Before first case of the day

Between cases

Terminal clean after the last case of the day

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Last Case of the day

Remove instruments, basins, trays, to

appropriate locations for reprocessing. Place

all sharps in appropriate containers.

Clean and disinfect as you would between

cases using cleaning checklist (room should be

ready if needs to be used urgently)

Environmental services terminally cleans atend of day

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Room turn-over

Cleaning and disinfection cannot begin until after the room is

vacated unless emergent situation

Follow OR Cleaning Checklist

Clear room of contaminated items: Remove instruments, basins, trays to appropriate

locations for reprocessing

Place all sharps in appropriate containers

Remove all soiled linen including gowns, towels,

and washcloths

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Surgical equipment

Equipment

Examine for damage before cleaning/ disinfecting

Remove clean equipment as appropriate

Refer to cleaning checklists for equipment surgical

services staff cleaning responsibility

Follow manufacturers equipment cleaning

instructions (disinfectant compatibility and

procedure)

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Room cleaning and disinfecting

Start with table:1.Remove all unnecessary table attachments, and cleanall exposed surfaces with a cleaner disinfectant

2.Wipe joints, table attachments, frame, legs, and rails

3.Turn down mattress and wipe the table bed frame andback of the mattress working from the top and repeat atthe bottom

4.Wipe sides of the mattress. Change disinfectant wipe or

cloth as needed.5.Wipe both sides of coated pillows

6.Allow all elements to air dry.

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Room cleaning and disinfecting

Remaining surfaces: Clean from top to bottom and front to back following

cleaning checklist

Spot clean floor as needed

Disinfect:o Tables, instrument stands, and equipment (e.g. cables, leads,

BP cuff, stethoscope, phone, gas machine, monitor)

o OR table and arm/leg boards

o Non-disposable safety strapo Standing stools (lifts)

o Kick buckets

o Overhead OR lights and reflectors

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Environmental monitoring

Environmental monitoring- used to identifyopportunities for improving cleaning process

UV fluorescent gel

o Monitors whether the right surfaces are cleaned ATP

o Monitors the effectiveness of the cleaning process.

Measures the amount of organic debris on a surface in

relative light units (RLU)

Both will be used to monitor the effectiveness of

our cleaning processes

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What types of surfaces are monitored?

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Summary of major cleaning changes

Wait until the patient is out to start disinfecting(gathering garbage, etc. is allowed while patientis in room)

Starting with the patient bed to allow sufficientcontact time

Emphasis on sticking with required disinfectantwet contact time

Terminal room clean and prep on last case of theday just as you would for between case cleaning

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Summary

C. difficile spores, MRSA, and VRE can survive

on surfaces for weeks

Thorough between case cleaning is needed to

minimize risk of transmission between

patients

Use new checklists to ensure that all items aredisinfected between cases

Contents courtesy of Allina Health