Cleaning is probably the least glamorous thing that happens in an operating room. Yet, it is critically important to do it properly to ensure asepsis and the success of your surgeries.
Among others, our job as a team is to keep patients alive and free of infection. There are multiple cleaning protocols for veterinary ORs, and they are typically passed from generation to generation. Without proper education and training, cleaning can seem like a chore or worse, a punishment. Yet, cleaning should be considered like one of several lifesaving procedures that take place in the OR, such as turning on the oxygen.
Every veterinary hospital should have (or should create) operating room cleaning checklists to ensure daily and weekly requirements.
Let's go over one possible comprehensive protocol to clean your surgical suite. We combined advice from several surgery nurses, as well as from Lisa Martini-Johnson, CVT, DVM, director and professor of the veterinary technician program at Lehigh Carbon Community College in Allentown, Pa.
Before each surgery
- Clipping hair should be done outside the surgery room. Ideally, reserve dedicated clipper blades for surgery patients, or even better, dedicated clippers. In other words, don't use the same clipper blade (or ideally clippers) your team uses to clip a cat abscess or remove matted fur from a patient. If that is not possible, clippers should be thoroughly cleaned between patients, using the appropriate disinfectant and recommended contact time.
- Nails should never be trimmed in the surgery room. Paws are notoriously dirty, and that includes nails.
- Make sure everything is clean of visible smudges. Those who used the OR before you should have cleaned it. That said, it is wise to get in the habit of double-checking everything.
During surgery
- Caps and masks should be worn at all times before entering an OR, even when there isn't a surgery being performed. This means caps and masks should be stored outside the OR, never inside. I regularly hear people who claim they can't breathe with a mask on. Interestingly, there has never been a case of mask-induced suffocation in the history of mankind. Not one.
- Traffic in and out of the OR should be kept to a minimum. Every time someone opens the door (you have a door in your OR, right?), its motion creates air turbulences that put multiple contaminated particles in motion. Of course, this debris would like nothing more than to land in a surgical site.
- Speaking of doors, the one to your OR should remain closed at all times, whether or not surgery is being performed.
After each surgery
- The patient table and instrument tables, as well as pulse oximeter and temperature probes, should be cleaned with appropriate veterinary disinfectants.
- Ideally, a new convection air warmer blanket should be used for each patient.
- Any soiled area should be spot-cleaned.
- Towels and blankets should be replaced. Always wash these separately from surgical drapes and instrument wraps, regardless of whether fecal material is present. All textiles are considered contaminated.
- The trash should be emptied, and a new trash bag should be used.
A note on trash cans: some doctors make a point of aiming for the trash can. Others not so much. It is important to prevent contaminated gauze and body parts from sitting on the floor. So choose trash cans that are wide and tall enough to improve aiming.
You don't need to spend a fortune on a stainless steel kick bucket. The only valuable trash can is the one that gets used. Doctors need to be able to toss contaminated items in the trash, rather than on the floor. This also saves time and hassle for the cleaning crew.
Daily routine
- Horizontal surfaces should be damp-dusted first thing in the morning. Martini-Johnson explains: "Horizontal surfaces include shelves, the surgery table, the top of equipment—anything that tends to collect dust. Horizontal cleaning reduces airborne contaminants that travel on dust and lint."
- The OR should be cleaned daily to reduce microbial burden: sweep or vacuum the floor, then mop it. Take out the garbage, too. All vertical surfaces should be cleaned using a damp cloth.
- Areas that are often overlooked include surgery lights, wheels, casters, foot pedals, walls, scrub sinks, cabinet handles, etc. And don't forget the clock on the wall. Drag a finger along the top of yours. You might be surprised!
- Have dedicated equipment used to clean the OR (e.g. brooms
and mops) to prevent cross-contamination from other areas of the practice, such as isolation and the kennel, but even the treatment room. - The Association of periOperative Registered Nurses (AORN), a human association, recommends cleaning a 3- x 4-ft section at a time.
- The entire OR should be cleaned with a disinfectant at the end of the day. According to the Centers for Disease Control and Prevention (CDC), the physical removal of microorganisms and soil by scrubbing is more important than the actual antimicrobial used.
Weekly routine
- Scrub the entire patient table and the instrument table, including the base and underside. If your patient table has a trough, it should be dismantled and cleaned. You might be surprised what you find in there.
- Clean all equipment surfaces, such as cautery, laser, suction machine, IV pumps and IV poles, scavenger, anesthesia machine, carts, walls, inside and outside of garbage cans, countertops, shelving, vents, windows, blinds, and both sides of doors.
- Even though it's not technically part of the cleaning protocol, it is important to check the date and integrity of all sterilized items (i.e. gauze, lap sponges, drapes, packs, individual instruments, etc.), especially those that are not used often.
- Ditto for replacing parts. It's not part of the cleaning protocol, but it might be a good time to check all filters and your soda lime, and replace them as needed.
- Anesthesia hoses and bags should also be cleaned regularly and allowed to air dry.
And lastly, take a critical look at your OR. Clutter retains dust, so get rid of it. Books, posters, approaches from a surgery book, decorations, a vacuum cleaner, clippers, or souvenirs from your last vacation have no place being in the OR. Your patients' safety depends on it.
| TEN IMPORTANT REMINDERS WHEN CLEANING |
| 1) Never mix cleaning solutions. Some mixtures, especially those containing bleach, can be dangerous.
2) Contact time is important. It all depends on the product you use. 3) Never eyeball dilutions. Instead, follow the manufacturer's specific ratios. 4) Never walk into an OR without a cap and mask. 5) Don't ever think "cleaning is not in my job description." 6) Never use a disinfectant without knowing how. 7) Never ask the least trained, lowest paid person to clean your OR. 8) Never use the same cleaning equipment in the OR, isolation, the kennel, and the treatment room. Have a dedicated set for each space. 9) Always wear gloves and follow appropriate safety measures, and not only because the Occupational Safety and Health Administration (OSHA) demands it. Cleaning products can be toxic and caustic. Protect yourself and your team. 10) Update and follow information in your safety data sheets (SDS) binder. It's the law. |
Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified, is a board-certified veterinary surgeon and serial entrepreneur whose traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. You can visit his website at www.DrPhilZeltzman.com. He also is cofounder of Veterinary Financial Summit, an online community and conference dedicated to personal and practice finance (www.vetfinancialsummit.com). AJ Debiasse, a technician in Stroudsburg, Pa., and Kelly Serfas, a certified veterinary technician (CVT) in Bethlehem, Pa, contributed to this article.
