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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