In healthcare, the operating room (OR) is a critical component in providing safe surgical care, specifically, the process of operating room turnover.
It is one of the most important factors impacting patient safety and positive surgical outcomes. Most facilities conduct multiple surgical cases daily, and the cleanliness of the OR is paramount. The room turnover process between cases should not be viewed as a routine chore, but rather a crucial step in creating and maintaining a sterile environment and reducing the risk of infections. A seamless transition between cases also fosters improved teamwork and patient satisfaction.
The nature of surgical procedures creates biological debris and byproducts that have the potential to contaminate the OR space and pose a risk to subsequent patients. As a result, cleaning the surgical suite between cases is imperative. The process must be meticulous to follow stringent health and safety standards. When one case is finished, the turnover process immediately begins with a quick and thorough assessment by the surgical team. Items that need to be disposed of or cleaned are identified, which establishes a baseline before cleaning begins. Every step of the process has patient safety at the forefront, and by keeping this focus, the room can be quickly and efficiently turned over and prepared for the next patient.
The first step in the cleaning protocol is the removal of all used surgical instruments, linens, and waste. Instruments are sorted and placed in designated containers for sterilization, reusable linens are placed in appropriate bags, and waste is appropriately disposed of. Transport of soiled instruments and medical waste, including regulated waste disposal, should follow facility protocol and industry-established standards. The instrument sorting process has a two-fold purpose: to ensure that all items have been accounted for and so that no instruments are left unsterilized. Enzymatic cleaners must be used per the manufacturers’ instructions as a part of the initial instrument reprocessing, depending on the facility and the nature of the cases performed. The major exception to the use of enzymatic detergents is in the ophthalmic setting, where such cleaners may cause harm.
Next, the surfaces within the OR are cleaned by utilizing specialized detergents and hospital-grade EPA-approved disinfectants proven to effectively eliminate pathogens. Appropriate cleaners designed for surgical settings are a must, as the OR setting has a variety of materials, including metals and plastics. Each facility should have protocols that document which cleaning products are used on which materials. Keep in mind that the dwell time may vary with each cleaning product based on the manufacturer’s instructions for use. The cleaning process should be a workflow of high to low and start with the highest surfaces like lights and ceiling-mounted equipment. Followed by the tables, waist-high items, and lower equipment. The floors should complete the disinfection process and be cleaned from the farthest point of the room and working outwards toward the doorway, allowing sufficient dry time.
The OR has many high-touch areas, such as the table, lighting and light switches, anesthesia equipment, and door handles, which should be paid close attention to. These high-touch surfaces are key locations that foster contaminants and pathogens. Also, a systematic order of cleaning helps to increase efficacy and prevent cross-contamination.
Documentation of the cleaning process is vital for maintaining regulatory compliance and ensuring overall consistency of the task. Thorough documentation allows for opportunities of reflection and improvement if any undesirable outcomes or trends surface. Documentation also allows facilities to celebrate the positive trends and the data that showcases those outcomes.
Further, it is imperative to conduct on-going education and training on cleaning protocols for facility staff. Knowing the most up-to-date protocols and technologies helps to build staff confidence, increase compliance, and produce positive patient outcomes. Education and training should include all members of the surgical team so that each discipline knows their role in maintaining a sterile environment.
OR turnover is a vital process in a surgical facility's day-to-day operations. While it is routine, it is imperative that it is completed thoroughly and properly. Careful adherence to protocols, emerging technologies, and education and training reflects a commitment to high-quality care and helps minimize the risk of infection.
Together, we can improve patient safety!
We encourage your facility to reach out to our team at standards@quada.org with any standards-related questions.
Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.
