After consulting with our hospital system's infection prevention
nurse, we realized we were no longer the center that specialized in
cataracts and knee scopes. We'd evolved into doing total joints,
bariatrics and spine fusions — more intense, complicated and bloodier
cases. The change in procedures brought with them a change in
patient population; older and more obese individuals with comorbidi-
ties that put them at a greater risk for infection.
The stakes were clearly raised for how well we cleaned every inch
our clinical space. We've made changes to our environmental cleaning
practices throughout our surgical department and stepped up enforce-
ment on how we turn over ORs during the day and clean them
overnight. We think the following new cleaning efforts are a big part
of why we've significantly reduced our facility's infection rate in
recent months.
• Pick the right product. Make sure the cleaners you're using are
formulated for the areas you're applying them to and strong enough
to disinfect the treated surfaces. We switched from a general-pur-
pose cleaner to a quaternary ammonium chloride-based disinfectant
cleaner concentrate for use on floors and a quaternary-based, heavy-
duty alkaline cleaner and disinfectant concentrate for use on walls.
We also changed the product we use to clean flat surfaces, switching
from germicidal wipes to wipes that employ hydrogen peroxide to
kill pathogens.
• Hit trouble spots. Be sure staff hit the high-touch surface areas in
ORs during room turnovers. When we were falling out of compliance
with wiping down all the surfaces in our 4 ORs, we assigned the day's
earliest arriving staff member to go into each room 30 minutes before
the first case start time to wipe down all horizontal surfaces. The staff
member then hangs a laminated sign in rooms she hits that says,
"Wipe down completed." If the sign is present when the OR team
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