Effectiveness of Manual Terminal Cleaning varies on different high touch surfaces in OTs, finds study

Jason M. Jennings et al conducted a study to evaluate the contamination level of selected high-touch surfaces in the operating room (OR) using a blacklight fluorescent marking system after a manual terminal clean.

Prior to the manual terminal clean, 16 high-touch surfaces were marked using a blacklight fluorescent gel. The marked areas were assessed the next morning for thoroughness of cleaning. Surfaces were categorized based on the average percent of the marks removed as "clean" (>75%), "partially clean" (26%-74%), or poorly cleaned(<25%). This process was repeated randomly 12 times. Terminal cleaning was done in the standard fashion, and the perioperative team was unaware of the initiation of this study.

The observations of the study were:

A total of 936 marks were analyzed. There was a significant difference in the number of marks completely clean (29.1%, 272/936) vs marks that were not touched (40.8%, 382/936), P<0.001.

Only the OR back table (75%) had a rating of clean.

Partially clean areas included

Mayfield table (72%),

overhead lights (70.1%),

infusion pump (61.1%),

clock reset button (58.3%),

table remote control (50%),

tourniquet machine (50%),

the OR table (33.3%).

Poorly cleaned surfaces included

anesthesia medication cart (21.8%),

door handles (20.8%),

phone (16.7%),

electrocautery unit (16.7%),

foot pedal (16.7%),

anesthesia cart (16.2%),

nurses' station (14.1%),

supply cabinet doors (6%).

"Despite the use of trained perioperative service personnel and policies at our institution, we found many areas of improvement needed in the terminal OR disinfection process. Of the high-touch surfaces we investigated, only the OR back table had an average rating of "clean". This inconsistency of cleaning and environmental contamination is similar to previous reports in the literature. These studies have clearly shown that visual inspection alone is not adequate in the terminal disinfection process. As such, most of these studies have recommended an enhanced cleaning protocol (i.e, staff education, UV light) to supplement this process" the authors opined.

The authors concluded that - Effectiveness of manual terminal cleaning varied greatly across surfaces. In general, surfaces further from the operative field were less likely to have markings removed. An adjunct to cleaning (ie, UV light) and perioperative education may be warranted, and future studies are needed to determine the best method to decrease environmental contamination

Further reading:

Effectiveness of Manual Terminal Cleaning Varies on High-Touch Surfaces Near the Operative Field

Jason M. Jennings, Roseann M. Johnson et al

Arthroplasty Today 17 (2022) 53-57

https://doi.org/10.1016/j.artd.2022.07.002