1. Section Editor(s): Allen, George PhD, RN, CNOR, CIC

Article Content

Healthcare-associated infections (HAIs) have been linked to external sources, including environmental surfaces.1 Dust, soil, and microbial contaminants on surfaces are sources of HAIs. Effective and efficient cleaning methods are necessary to maintain a healthy environment. The risk of infection from pathogenic microorganisms on environmental surfaces is related to their presence, capability to survive for varying time periods, and the ability to be transferred to many surfaces.2


In the OR, principles of asepsis coupled with implementing prudent procedures to prevent surgical site infections (SSIs) is the standard of care; therefore, environmental sanitation is critically important. The Association of periOperative Registered Nurses (AORN) recommended practice for environmental cleaning states that patients should be provided with a clean environment and that a safe, clean environment should be reestablished after each surgical procedure.3 It's estimated that SSIs extend the hospital stay on average by 9.7 days and increase overall costs by $20,842 per admission.4 Following AORN's recommendations can reduce the development of SSIs.


What must be done

Although cleaning is a team effort involving surgical personnel and environmental services staff, it's the responsibility of the perioperative nurse to ensure a clean surgical environment after each surgical procedure so that the next patient is provided with a clean/safe environment.3 The following are tips for an efficient and effective OR cleaning process:


* Develop a daily cleaning schedule.


* Educate personnel to use trash containers and disposal equipment correctly throughout the procedure.


* Ensure that environmental services staff use the appropriate personal protective equipment.


* Begin cleaning after the patient has left the room; environmental services staff should develop and follow a pattern when cleaning (beginning at the top and progressing downward).


* Clean visible soiling and the OR table after each procedure.


* Clean high-touch areas (such as door handles, door knobs, push/touch plates, computer screen/keyboards, radiology viewer, telephone and intercom buttons, I.V. poles, and room/overhead light controls) with a fresh cloth using a hospital-grade, Environmental Protection Agency-approved solution.


* Clean furnishings-stainless-steel tables/trays, Mayo stand, chairs, stools, cabinets, and machines in the room paying particular attention to castors and wheels.


* Verify that the room is safe and clean before preparing for the next patient.


* Terminally clean (ceiling-mounted equipment to floor) at the end of the day's schedule or every 24 hours even if the room wasn't used.


* Assign a perioperative nurse to monitor the terminal cleaning process.





1. Seavey R. Environmental cleaning and disinfection in the OR and other invasive procedure rooms. Education & Training, February 2010.[Context Link]


2. Association for Professionals in Infection Control and Epidemiology. Guide to the elimination of multidrug-resistant Acinetobacter baumannii transmission in healthcare settings. 2010.[Context Link]


3. Association of perioperative Registered Nurses (AORN). Recommended Practices: environmental cleaning in the perioperative setting. In: Retzlaff K, ed. Perioperative Standards and Recommended Practices. Denver: AORN Inc.; 2012:237-250. [Context Link]


4. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB.Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37(5):387-397. [Context Link]