Cleaning of Operation Theatre

Environmental cleaning in surgical settings minimises patients’ and healthcare providers’ exposure to potentially infectious micro-organisms.

First cleaning of the day (before cases begin)

• This should be performed first, every morning irrespective of whether the OT will be used or not.
• Wear a clean gown, cap, mask and clean utility gloves
• The surgeon/anaesthetist should not enter the OT before cleaning is complete
• Clean all horizontal surfaces by wet wiping with an HLD Every horizontal surface should be cleaned• Follow the sequence of cleaning as mentioned previously (top to down; in to out)
• Clean all antiseptic bottles and the trays in which they are kept. Clean the sterile containers
• Ensure colour coded waste collection bags are placed in the waste bins
• Keep the OT closed for 10-15 min with ventilation equipment on after cleaning
• Wash the scrub basin and tap with soap and water. Check for leakage and report immediately if seen. Clean the soap and antiseptic bottles at the scrub basin. Replace the bottles if empty
• During cleaning, only cleaning personnel should be present in the OT and the doors should be kept closed
• After cleaning is over, wash and remove utility gloves, gown and cap. Wash hands and disinfect them by using an alcohol hand rub before proceeding to other work.

Cleaning Operating Rooms in between Cases

• Keep ventilation equipment on and OT door closed
• Wear OT dress, footwear and a cap
• Place a cautionary ‘Wet Floor’ sign at the entrance of the room
• Prepare fresh disinfectant solution according to manufacturer’s instructions
• Clean hands and put on gloves
• Collect and remove waste
• Collect and remove all soiled linen segregating soiled and dry linen
• Remove gloves and clean hands. Wear a different set of gloves
• Use a cloth dampened in hospital-approved disinfectant solution to clean and disinfect surfaces that have come in contact with a patient or body fluids, including tops of surgical lights, blood pressure cuffs, tourniquets and leads
• Clean suction canisters, reflective portion of surgical lights
• Clean and disinfect OT table
• Clean electronic equipment (i.e., monitors) according to manufacturer’s instructions
• Damp mop floor in a 1 to 1.3 metre (3 to 4 feet) perimeter around the OT table (larger area if contamination present)
• Insert colour coded bags in waste bins
• Damp-dust equipment from other areas such as X-ray machines, C-arm etc. before being brought into the operating room and prior to leaving
• When cleaning is complete, remove gloves and clean hands.

Procedure for Terminal Cleaning of Operating Rooms

• Place a cautionary ‘Wet Floor’ sign at the entrance of the room
• Prepare fresh hospital approved disinfectant solution according to manufacturer’s instructions
• Clean hands and put on gloves
• Collect and remove waste
• Collect and remove all soiled linen
• Clean hands and change gloves
• Clean and disinfect lights and ceiling-mounted tracks
• Clean and disinfect all door handles, push plates, light switches and controls
• Clean and disinfect telephones and computer keyboards
• Spot-check walls for cleanliness
• Clean and disinfect all exterior surfaces of machines and equipment (e.g., anaesthesia carts), allowing adequate drying time for the disinfectant before storage
• Clean and disinfect all furniture including wheels/casters
• Clean and disinfect exterior of cabinets and doors, especially around handles
• Clean and disinfect all surfaces

• Clean scrub sinks and surrounding walls
• Mop floor, making sure the OT table is moved and the floor is washed underneath; move all furniture to the centre of the room and continue cleaning the floor; apply a sufficient amount of disinfectant/detergent to ensure that the floor remains wet for five minutes; use a fresh mop/mop head and fresh solution for each room
• Replace all furniture and equipment to its proper location
• Wash the colour coded bins, dry them and put colour coded bags once it is dried
• Report any needed repairs
• Clean and store cleaning equipment
• Remove gloves and clean hands.

Detailed Wash-down of the OT Complex

• A detailed wash-down should be done at least once a week for OTs that are used daily
• For OTs that are used less frequently, detailed wash-down should be done at least once a month and before any camp patients are operated.

Method

• Wear utility gloves
• Shift all movable equipment and materials out of the OT
• Inspect the OT surfaces for cracks, loose tiles etc. If any maintenance work is required, perform the maintenance before proceeding
• In case the maintenance involves civil work that generates dust, then the cleaning and disinfection protocol for cleaning and disinfection new OT should be followed after the maintenance work is completed.
• Wipe all surfaces of the OT liberally with soap and water
• Begin at the ceiling. Use a long handled mop to wipe the ceiling
• Proceed down the walls. Clean all wall fixtures on the way down
• Clean all ceiling mounted fixtures e.g., OT lamp
• Then clean all fixed floor based equipment
• Lastly scrub the floor with soap and water
• Repeat cleaning until all visible dust is removed
• Allow the OT to dry naturally
• Then wipe all surfaces with HLD. Allow the disinfectant to dry naturally
• Meanwhile, clean all the equipment moved outside with soap and water. Remove all dirt and dust. Clean every surface of the equipment
• Remove all materials stored on trolleys and clean the entire trolley. Also clean the bottles, containers, etc. by wiping them on the outside to remove all soiling
• Clean the wheels by running them 10-15 times over a Turkish towel soaked with soap and water
• Wipe the equipment with HLD and allow to air dry
• Move the equipment back into the OT. Wipe equipment with high-level disinfectant
• Cover electronic equipment with properly fitting plastic covers and fog the OT with high-level disinfectant until a fog is seen in the air
• Keep the OT closed for at least one hour
• Meanwhile, clean the rest of the OT complex (passages, other rooms) with soap and water followed by wiping with high-level disinfectant. Clean and wipe from ceiling to floor. Clean all furniture
• The OT may be used after it has remained closed for at least one hour.

Cleaning and Disinfection of New OT and after any Civil Work

• First ensure all civil work is completed
• Ensure all movable equipment has been shifted out
• Wear utility gloves
• Wipe all surfaces of the OT using liberal amount of soap and water. Repeat wiping until all visible dust is removed
• Clean all fixed equipment like OT lamp with soap water until all visible dust is removed
• The mechanical action of wiping is very important to remove spores and improve the action of disinfectants used subsequently
• Allow all surfaces to dry completely
• Wipe all surfaces (including the ceiling) with a high-level disinfectant. Allow to dry completely
• Wipe down all equipment to be moved into the OT with soap and water to remove all visible dust. Allow to dry completely. Clean the wheels by running them 10-15 times over a Turkish towel soaked with soap and water. This equipment cleaning is to be done outside the OT
• Move the cleaned equipment into the OT
• Wipe all surfaces (excluding the ceiling and walls up to the height the hands can reach) with highlevel disinfectant
• Allow to dry completely
• Fog the OT with high-level disinfectant until a fog is seen in the air
• Stop and remove the fogger and close the OT for at least one hour with any ventilation system/AC off
• After 1-2 hours open the OT and take post fogging swabs. Change into OT dress, cap, mask and use sterile gloves when performing the sampling. Only the person taking the samples should enter the OT.

Sample the following sites at the minimum

• OT table upper surface
• OT lights lower glass surface
• Anesthesia machine (swab the area where medications are placed during use)
• Sterile instruments trolley surface
• Any two walls (sample sites above OT table height)
• Floor (two samples on either side of the OT table
• Air conditioner outlet louvers (if AC present)
• After sampling close the OT. No one should enter the OT until next day
• On second day, wear OT dress, footwear and cap; wipe all surfaces (including ceiling with a long handled mop) once with soap water, allow drying and then wiping once with a high-level disinfectant
• Keep OT closed for at least one hour with ventilation system/AC off
• Repeat the OT swab sampling as mentioned above
• On third day, repeat the entire procedure (third time) and sample the swabs (third sampling)
• Wait for the OT swab reports. The OT can be used if all the three swabs reports show no growth of any organisms OR sparse growth of skin commensals in any one out of nine swabs taken per sampling
• In case growth of spore bearing organisms, pathogens (e.g. Staphylococcus aureus), aerobic gram negative bacilli or fungus is seen, disinfectant wiping of the entire OT and fogging should be repeated and swabs sampled again (once only)
• If results are not satisfactory even now, seek help of an expert in infection control

Source: : Guidelines For Implementation Of "KAYAKALP" Initiative