• Zone 1. Anesthesia machine and equipment
• Zone 2. OR bed and patient equipment
• Zone 3. Back table and surrounding areas
• Zone 4. Circulator charting area, equipment, supply cabinets and
entry/exit doors
• Zone 5. Walls and floor
A designated "zone captain" directs the crew from start to finish and
assigns cleaning zones so everyone understands their role. Upon com-
pletion of the room turnover, the OR circulator assesses the room for
cleanliness and completion of all zone cleaning tasks before releasing
the room.
Once we implemented zone cleaning, we needed to make sure our
staff was performing well. This included a competency validation tool
to assess between-case zone cleaning competency and the use of
adenosine triphosphate (ATP) testing to evaluate the quality of our sur-
face cleaning. At first, the new process increased room turnover by 5
to 10 minutes, which we expected simply due to the new process, but
we saw another big difference: The turnover staff entered the room
and immediately knew where to start and how to proceed from there.
Three of our hospitals adopted the between-case zone cleaning
method for our ORs in 2013, and we have already seen an improve-
ment in surgical outcomes. We've since expanded the process to other
invasive procedure rooms, like labor and delivery and endoscopy; and
as of last year, we've started to roll out the zone cleaning procedure to
the 10 other facilities in our health network.
Licia D. Hurd, MSN, BSN, RN
Memorial Hermann Health System
Houston, Texas
licia.hurd@memorialhermann.org
O C T O B E R 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 2 3