Surface Cleaning

Measure most propagated by the WHO

Why is surface cleaning relevant for SSI prevention

Surface cleaning

The WHO states:1
“For many years, environmental contamination was considered to be less important than many other factors in contributing to HAI. However, recent evidence shows that a contaminated health care environment plays a significant role in the transmission of microorganisms. It is essential that the operating room (OR) is thoroughly cleaned on a daily basis."

The terms cleaning and disinfection often seem to be used interchangeably. We will primarily focus on information related to surface cleaning here.

Some definitions:

Image of a surface cleaning graph

Guidelines

Guidelines
GuidelineRecommendation

Category
(if mentioned)

CDC2“When visible soiling or contamination with blood or other body fluids of surfaces or equipment occurs during an operation, use an EPA-approved hospital disinfectant to clean the affected areas before the next operation.”

Category IB

“Do not perform special cleaning or closing of operating rooms after contaminated or dirty operations.”Category IB
WHO1

”General principles for environmental cleaning:

  • Cleaning is an essential first step prior to any disinfection process to remove dirt, debris and other materials.
  • The use of a neutral detergent solution is essential for effective cleaning. It removes dirt while improving the quality of cleaning by preventing the build-up of biofilms and thus increasing the effectiveness of chemical disinfectants.
  • If disinfectants are used, they must be prepared and diluted according to the manufacturer’s instructions. Too high and/or too low concentrations reduce the effectiveness of disinfectants. In addition, high concentrations of disinfectant may damage surfaces.
  • Cleaning should always start from the least soiled areas (cleanest) first to the most soiled areas (dirtiest) last and from higher levels to lower levels so that debris may fall on the floor and is cleaned last.
  • Detergent and/or disinfectant solutions must be discarded after each use.
  • Avoid cleaning methods that produce mists or aerosols or disperse dust, for example dry sweeping (brooms, etc.), dry mopping, spraying or dusting.
  • Routine bacteriological monitoring to assess the effectiveness of environmental cleaning is not required, but may be useful to establish the potential source of an outbreak and/or for educational purposes.”
-
NICE3--
KRINKO4At the end of the daily operating program, all floor surfaces and potentially contaminated surfaces in all rooms of the operating department must be subjected to disinfectant cleaning.

Category II

Documentation aids (e.g. IT equipment) also require regular disinfection.Category II

HARTMANN

Portrait of Denise Leistenschneider, Senior Clinical Consultant
Denise Leistenschneider, Senior Clinical Consultant
“Clean surfaces are a crucial aspect in the transmission of microorganisms and therefore also in the prevention of SSI.”

In general

Notes

  • Consider cleaning as an essential first step before any disinfection process to remove dirt, debris or other materials.1

  • Use neutral detergent solution for effective cleaning.1

  • Start cleaning always from the least soiled areas (cleanest) first to the most soiled areas (dirtiest) last.1

  • Clean all surfaces from top to bottom using a detergent, followed by a disinfectant if necessary, and then allow to dry.1

  • Avoid creating mist or aerosols or stirring up dust during cleaning process.

At the beginning of each day

Sun

  • “All flat surfaces should be wiped with a clean, lint-free moist cloth to remove dust and lint.”1

Between cases

Double

  • “Hand-touch surfaces and surfaces that may have come in contact with patients’ blood or body fluids, should be wiped clean first by using a detergent solution and then disinfected according to hospital policy and allowed to dry.”1

At the end of every day

Time

  • “It is necessary to perform a total cleaning procedure. All areas of the surgical suite, scrub sinks, scrub or utility areas, hallways and equipment should be thoroughly cleaned, regardless of whether they were used or not during the last 24 hours.”1

Cleaning requirements for various surface types

(adapted from WHO)1
Surface typeCleaning requirement
High touch surface (surface with frequent contact with hands)“Requires special attention and more frequent cleaning. After thorough cleaning, consider the use of appropriate disinfectants to decontaminate these surfaces.”
Minimal touch surface (floors, walls, ceilings, window sills, etc., which are not in close contact with the patient or his/her immediate surroundings)“Requires cleaning on a regular basis with detergent only or when soiling or spills occur. Also required following patient discharge from the health care setting.”
Administrative and office areas (no patient contact)“Require normal domestic cleaning with detergent only.”
Toilet area“Clean toilet areas at least twice daily and as needed.”
Surface contaminated with blood and body fluids“Requires prompt cleaning and disinfection.”

Transmission routes from contaminated surfaces (5)

Graph image of a contaminated surface

Relevance of anaesthesia work area for transmission of pathogenic bacterial organisms (6)

Image of Transmission of bacteria results

In the course of general anesthesia, potentially pathogenic, multidrug-resistant bacteria are transferred to both the anesthesia workstation and intravenous stopcock sets. Infection control measures in this area can help to reduce

  • the developing problem of increasing bacterial resistance
  • life-threatening infectious complications 6
  • consider 5 moments of hand hygiene

References

*to intravenous stopcock sets

  1. WHO (2018) Global guidelines for the prevention of surgical site infection. World Health Organization 2018.
  2. CDC (1999) Guideline for Prevention of Surgical Site Infection. Infect Control Hosp Epidemiol. 20(4): 247–278.
  3. NICE (2020) Surgical site infections: prevention and treatment. NICE guidelines. Published: 11 April 2019. Last updated:19 August 2020. www.nice.org.uk/guidance/ng125.
  4. KRINKO (2018) Prävention postoperativer Wundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
  5. KRINKO (2022) Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert-Koch-Institut. Bundesgesundheitsbl 65: 1074–1115.
  6. Randy W et al. (2008) Transmission of Pathogenic Bacterial Organisms in the Anesthesia Work Area. Anesthesiology 109: 399–407.

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