Surprise Check on Environmental Cleansing in the Operating Theatre

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Authors (including presenting author) :
Ngan WCA(1), Kwong PSJ(1), Ng LK(1)
Affiliation :
(1)Operating Theatre, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
The environment in the operating theatre is a potential source for bacteria leading to occurrence of surgical site infections. This is the basis for between-procedure and end-of-day “terminal” theatre cleansing and disinfection, which has been widely accepted as a standard practice. Although, daily routine of theatre cleansing is established, effectiveness of theatre cleansing is seldom inspected and documented. Ultraviolet (UV) marker is used to denote the high touch area and let cleansing staff see the results at the time of the assessment.
Objectives :
This project is to inspect and assess the cleanliness of high risk contaminated area of operating theatre and to enhance staff alertness of environmental hygiene in the operating theatre.
Methodology :
From January 2017 to December 2018, a cleanliness inspection programme was conducted in four operating theatres of RTSKH. We had briefed the related staff about the objectives of the programme. The assessment tools included a chop showing “HKEC” with fluorescent ink, a UV light torch, and an assessment form which was developed with reference to the Association of peri-operative Registered Nurses (AORN) about high risk contaminated items in operating theatre. These items consisted of operating tables, anesthetic machines and anesthetic trolleys, theatre lamps, IV drip stands, theatre platforms, storage shelves and shelf covers. 9 assessment sessions were conducted every 3 months without previous notice, consisting of 90 samples in total. Before theatre cleansing, ten samples were selected and chopped with fluorescent ink markings. These markings were confirmed under illumination of UV light. The sample sites were chosen based on the high risk items highlighted by AORN. Operating tables, anesthetic machines and anesthetic trolleys were crucial assessment items. During theatre cleansing, responsible staff cleansed and disinfected all theatre items with wet cloth soaked in 1000 ppm hypochlorite solution. After cleansing was done, the ink markings on selected items were inspected again by the UV light torch. When fluorescent markings were found at the samples after theatre cleansing, responsible staff learned the result immediately after the assessment, and their cleaning skills and work flows were reviewed and reinforced afterward. The programme had two phases. During the first phase, staff was notified the time of assessment, whereas unannounced inspection executed during phase two of the project.
Result & Outcome :
99% of the samples (n=90) had the markings satisfactorily removed. The fail items were parts of operating theatre (OT) tables, especially the trunk part. It was thought that the trunk part of OT table had no contact with patients and was easily skipped from cleaning process. However, the Association of peri-operative Registered Nurses (AORN) stated that trunk of OT table got high potential of contamination due to blood and body fluid. Therefore the cleaning process should be enhanced leading to thorough coverage of OT environment. After visually learning the effectiveness of cleaning process, education of high contamination areas, cleaning skills and cleaning flows were given to staff. Staff’s alertness of cleaning was enhanced as demonstrated by no fail samples were found in the subsequent assessment after re-education. However, underwent assessment of cleaning effectiveness in operating theatre was not a usual practice. Proper and thorough communication was utmost important to avoid violation of trust relationship throughout the assessment procedures. In conclusion, the overall effectiveness of cleansing in operating theatre was satisfactory. The results were visually shown by fluorescent markings and the effectiveness could be documented. Staff involved in the project could learn their performances, which could be further enhanced via re-education.

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