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M AY 2 0 1 4 | S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
To the naked eye, the phones, door handles and light switches in our ORs
certainly looked clean, but we found that looks can be quite deceiving.
Beyond visualization, the way we chose to evaluate the effectiveness of our
cleaning process was by using fluorescent gel and a black light to illuminate
surfaces where the gel was placed. We evaluated cleanliness in 14 ORs by
marking immobile high-touch areas with the fluorescent gel. The list of items
we marked was long: tabletops, surgical lights, anesthesia equipment, furni-
ture, monitor screens, computer keyboards, telephones, walls, doors, door
handles, and cabinet doors.
On average, we marked 24 surfaces in each room. We did so after the last case
of the day and before terminal cleaning. We evaluated the marked sites the fol-
lowing morning between 6:30 a.m. and 8 a.m. with a black light. The results,
quite frankly, were dismal. Many surfaces were hardly cleaned at all, others not
nearly enough. We had only cleaned those areas we tested 41% of the time — a
high of 61% and a low of 18%. We've improved our percentage of cleaned areas
to an average of 80% (high 95%, low 65%). We've sustained that level by continu-
ing to monitor and by celebrating our successes. Here's what we learned along
the way.
1. The periphery is neglected. We discovered that our cleanup crew
focused most of its attention on cleaning the area around where they know
patients are going to be: the OR table, overhead lights, the equipment tower. By
and large, whatever surfaces come into direct contact with the patient were
E N V I R O N M E N T A L H Y G I E N E
T
he OR has always enjoyed a reputation for being a bastion of
cleanliness and sterility, but is your sacred space as hyper-
hygienic as you think? When we here at the Johns Hopkins
Bayview Medical Center evaluated how well we were cleaning
the surfaces in our operating rooms, we were shocked at what
we saw. Or, more accurately, what we couldn't see.
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