1-28. INTRODUCTION
The maintenance of cleanliness at all times in the OR suite is of extreme importance because infectious organisms are present both on floors and in the air. Such organisms exist in large numbers wherever dirt and dust are present. In addition, soil of any kind (dirt, blood, pus, and so forth) serves to protect infectious organisms; therefore, the suite must be kept spotlessly clean. For the same reason, the suite must be kept as free from dust as possible. Thus, housekeeping procedures are vital to the maintenance of aseptic technique and the prevention of wound infection. The OR specialist will be assigned various cleaning tasks and should therefore have knowledge of the methods employed as well as their limitations in order that cleaning will be most effective.
1-29. RULES
a. Discussion. Cleaning routines and procedures may vary somewhat among hospitals, but they are based upon a number of rules, which should always be observed. These rules are as follows:
(1) The formation and the dispersion of dust should be suppressed.
(2) Time should be allowed for dust to settle.
(3) Dust and soiled laundry should not be allowed to accumulate.
(4) A systematic housekeeping plan should be followed.
(5) Periodic cultures of the floors should be taken before and after cleaning, as should cultures of the air in an oOR during periods of minimum and maximum activity.
b. Local Policy. Within the surgical suite of a hospital, the time and the frequency for cleaning the various areas in the suite will be done as a matter of routine. This routine, as well as the specific procedure to be used, is included in the OR policy. Although various cleaning procedures are set forth in the following paragraphs for the information of the specialist, he should follow local policy when performing cleaning assignments.
1-30. FLOOR CLEANING
Cleaning of the floors in the OR may be accomplished by any of several methods or by a combination of methods, the wet-dry-vacuum method (refer to paragraph 1-31), the mop-and-pail method (refer to paragraph 1-32), and the scrub-or-spray-machine method (refer to paragraph 1-33). The wet-vacuum method is used more frequently than the other methods.
1-31. WET-VACUUM METHOD (RECOMMENDED)
a. Discussion. For floor cleaning at the end of a day’s schedule, the wet-vacuum method is more effective in reducing the bacterial count on the floor than the mop-and-pail method.
b. Procedure.
(1) Wipe down the furniture with a germicide solution and remove it from the room.
(2) Flood the floor with a germicide, beginning with the most heavily contaminated area (usually the area around the operating table). If flooding does not remove the soil, scrub the area with a clean mop head and pour additional solution on the area. At this point, the solution will have been on the floor for several minutes.
(3) Remove the excess solution from the floor with the wet vacuum pickup. This ensures that dirty solutions are removed from cracks, crevices, corners, and so forth.
(4) Wheel the furniture into the OR over a germicide-soaked mat.
(5) Wipe the furniture down with a germicidal solution.
1-32. MOP-AND-PAIL METHOD (ALTERNATIVE)
a. Rules. The mop-and-pail method of floor cleaning can spread infectious organisms throughout the OR suite unless certain rules are understood and followed.
(1) There should be an individual mop for each area within the surgical suite.
(2) Operating room mop heads should be laundered and sterilized daily.
(3) A fresh germicidal solution should be used for each area.
(4) Mop heads should not be stored in used germicidal solution between periods of utilization.
(5) Mop heads should be changed between all cases.
b. Procedure.
(1) For cleaning an OR between cases, the soiled areas of the floor are damp-mopped using a germicidal solution. Furniture may be pushed aside as necessary, but is not to be removed from the room.
(2) Before surgery begins in the morning, the floor is damp-mopped with a germicidal solution.
(3) For cleaning the floor at the end of the day’s schedule, observe the rules listed in paragraph 1-32a then apply the following procedures:
(a) Wipe down the furniture with a germicidal solution.
(b) Remove the furniture from the room.
(c) Mop the floor using fresh germicidal solution and a clean mop head.
(d) Rinse the floor well to prevent the accumulation of soap film and the film left by certain germicides because such a film would interfere with the conductivity of the floor.
(e) Wheel the furniture back into the room over a mat saturated with a germicidal solution.
(f) Wipe down the furniture again with a germicidal solution.
1-33. SCRUB-OR-SPRAY-MACHINE METHOD
The is the same procedure as described for the wet-dry vacuum method, except that the machine has a capability of either scrubbing the floor or of spraying the germicide onto the floor. The wet-vacuum pickup is done as described in paragraph 1-31b (4).
1-34. ROUTINE CLEANING OF AN OPERATING ROOM
a. Before Surgery is Begun. Before surgery begins in the morning, all furniture and the OR light are dusted with a germicide-dampened cloth and the floor wet-vacuumed or is wet-vacuumed or damp-mopped with germicidal solution. Dry dusting is never done in the surgical suite because of the hazard of increased airborne bacteria. Damp dusting is done to remove any dust that may have accumulated overnight. This dusting should be done by the circulator 30 to 60 minutes prior to the operative procedure to allow the time for the dust particles to settle before sterile packs and supplies are opened.
(1) The dusting is accomplished by starting with the highest equipment and working down. The OR overhead light is dusted first, then the table, working from the center of the room outward and from top to bottom.
(2) As the circulator dusts and sets up the equipment, he conserves steps and energy by checking each piece of equipment at this time.
(a) The overhead light is turned on to check the bulb.
(b) The OR table is checked for proper operation.
(c) The suction machine, electro surgery machine, and other pieces of equipment in the OR are checked, whether or not they are to be used.
(3) As the supply cupboards are dusted, they are checked to be sure they are completely stocked. If there is an evening or night shift working in the OR,one of these persons may be assigned to do the dusting rather than the day personnel.
(4) When the dusting of the furniture and equipment is finished, the floor is wet-vacuumed using the germicide prescribed by local policy.
b. Between Cases. Following each operation, the soiled areas of the floor are wet-vacuumed or damp-mopped and any furniture, which may have become soiled or damp is cleaned. The kick bucket liner, containing soiled sponges and waste material, is removed and placed in a waste receptacle for incineration. If the suction machine was used, the container and tubing are discarded. Also, the apparatus is checked to make certain that it is functional.
c. At the End of the Day’s Schedule. The floors are cleaned as described in paragraphs 1-31 and 1-32. As the furniture is wheeled back into the room, the furniture is cleaned with a damp cloth containing a germicidal solution being sure to remove any stains. Casters on the furniture must be cleaned and any accumulation of suture materials or dust removed. If the casters require lubrication, only dry graphite or graphite oil is used. All equipment, such as operating lights, portable lights, and suction machine, is cleaned. All electrical and mechanical equipment is checked, and any defected or nonoperational equipment is reported at once for repair. Cabinet, doors, and windows are damp dusted using a germicidal solution.
1-35. CLEANING OF OTHER AREAS IN THE SUITE
Scrub rooms (including sinks, plumbing fixtures, and walls) must be cleaned thoroughly with germicidal solution each day because bacteria multiply rapidly near plumbing fixtures. At least once a week, all cabinets, cupboards, and storage areas are washed. Sterile supplies are checked and arranged in proper order. Walls, windows and frames, and doors are washed. Metal ware is cleaned. Radiators and ventilators, if present, are vacuumed and cleaned. Air conditioning filters are cleaned as prescribed by local policy. All equipment is kept in its proper place. All painted articles, walls, and ceiling should be repainted once a year and more often if necessary. Rigid adherence to daily and weekly cleaning will ensure a clean, safe OR and increase effective and efficient care of the patient.