Which role does ist play?
While it is generally believed that the majority of surgical site infections (SSI) derives from the patient’s or healthcare worker’s transient flora, surfaces in the operating room (OR) are increasingly recognised as pathogen reservoirs despite standard environmental cleaning. Pathogens from surfaces can be transferred to the patient via the staff’s hands or via equipment, such as intravenous tubing, or they can even be stirred up and spread through the air. Thus, adequate surface hygiene in surgical areas is a basic requirement for patient safety in order to reduce SSI. More stringent cleaning and disinfection measures of the OR alongside standard procedures may be needed, particularly when dealing with virulent or drug-resistant organisms .
Which general recommendations apply to terminal and intermediate cleaning in the OR?
As the OR belongs to the areas of a hospital with an increased risk of infection, frequently touched and near-patient surfaces as well as floors have to be cleaned and disinfected regularly. Therefore, the Centers for Disease Control and Prevention (CDC) recommend cleaning and disinfection of high-touch surfaces, surfaces inside of the surgical field, as well as contaminated surfaces outside of the surgical field before and after each operation. In addition, cleaning, and disinfection of all horizontal surfaces, contaminated vertical surfaces (e.g. walls), utility areas as well as the entire floor must be carried out at the end of the daily surgical program. Moreover, low-touch surfaces, like ceiling and walls, must also be cleaned and disinfected on a scheduled basis. For disinfection, only facility-approved disinfectants should be used .
Who performs environmental cleaning of the OR and what are special challenges?
Cleaning of the OR is performed by environmental cleaning staff and requires special training. Qualified surgical cleaning staff are indispensable for the smooth daily OR program and strongly contribute to patient safety. Before entering the OR, the same hygiene standards apply to them as to healthcare workers. In addition to special clothing, this also means that they wear surgical masks, carry out hygienic hand disinfection, and do not wear jewellery on their forearms and hands.
In order to avoid hard-to-reach places in the OR, this aspect should actually be taken into account already during construction or planning. However, if there are still hard-to-reach areas, surgical cleaning staff can use spray solutions or foams .
For which areas apart from the actual OR do the recommendations apply?
The recommendations for environmental cleaning do not only apply to the actual OR, but also to associated areas, such as the recovery room, rooms for instrument preparation, or the scrubbing area . An exception applies to surgical areas in which only interventions with a low risk of SSI (e.g., small interventions on the skin, on the eyes, in the oral cavity) are carried out. Here, the rooms outside the OR can be combined, and disinfecting intermediate cleaning can be limited to visibly contaminated and near-patient surfaces .
- Yezli Set al.(2014) Surface contamination in operating rooms: a risk for transmission of pathogens? Surg Infect (Larchmt) 15: 694-699.
- CDC, Environmental Cleaning Procedures. https://www.cdc.gov/hai/prevent/resource-limited/cleaning-procedures.html (accessed on 28.03.2023)
- KRINKO (2022) Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Bundesgesundheitsbl 65: 1074-1115.
- KRINKO (2018) Prävention postoperativer Wundinfektionen. Bundesgesundheitsbl 61: 448-473.