Environmental Assessment of Operating Room (OR) Surfaces to Evaluate Efficacy of Night Shift Terminal Disinfection and Case Turnover Disinfection in an Acute Care Hospital: A Pre/Post-Implementation Study.
Project Description: Surgical Site Infections (SSI) are a major burden within hospitals and can cause high morbidity and mortality for patients resulting in infection. Additionally, costs to treat an individual patient for a hospital acquired infection resulting from a surgery/procedure can cost thousands of dollars in lost reimbursement for the hospital, as Medicare/Insurance Companies have no responsibility in covering the costs since the hospital acquired infection was a direct result of the surgery/procedure that was performed. More importantly SSIs are devastating for the patient causing unnecessary suffering, long term morbidity, even death, which prompts the organization to find ways to prevent and control these infections. Many studies have assessed the risk factors for acquiring SSI, ranging from age, sex, race, socioeconomic status, as well as the presence of co-morbidities including diabetes, hypertension, obesity, malnutrition, co-infection/colonization, among others. It is of equal interest to understand the risk factors within the hospital that may increase a patient’s risk for acquiring an infection while at the facility, specifically during a surgical procedure. Some researchers have suggested factors such as behavior of healthcare providers; use of prophylactic antibiotic prior to surgery; ventilation in the operating room; and number of people within the operating room during a certain period. However, lack of research exists regarding the efficacy of disinfection of the surgical suite as well as the indirect effect of environmental surface contamination on patient outcome. For this reason, the following study looks to assess the efficacy of night shift terminal disinfection and case turnover disinfection in the OR at an acute hospital through environmental and microbiological methods. Furthermore, this study aims to understand how evidence based educational programs can improve technical skills in cleaning staff and increase the efficacy of disinfecting procedures in the OR. We believe that frequently assessing environmental surfaces in the OR will identify weaknesses in disinfection protocols and provide opportunities for improvement by introducing evidence based educational programs for cleaning staff. Although it is still unclear if this will influence patient outcome, improvement of disinfecting protocols will most likely lead to cleaner OR surfaces and reduce the patient’s risk for being exposed to potential pathogens. The pre-implementation portion of this study aims to assess disinfection on eight different operating room surfaces. The eight points/surfaces for testing will be consistent for each room tested. Particularly, this part of the study will serve to understand the efficacy of the current methods and protocol used for between case turnover disinfection and effectiveness of night time terminal disinfection. The Association for Operating Room Nurses (AORN) oversees the provision of guidelines for operating room disinfection. In regard to definitions, turnover is the periodbetween one case and another, when patient service technicians disinfect and prepare the operating room for the next case. Terminal disinfection is conducted on every operating room environment and equipment nightly from Monday through Friday and when a room is used on the weekend. In theory, turnover disinfection is completed in a hurry as operating room time costs money. Additionally, there is a push from management to complete as many cases as possible each day as surgery provides large revenue for the hospital. Therefore, the staff is pushed to produce a thirty minute turnover, which means one patient rolls out of the operating room suite and the next patient rolls into the operating room suite within thirty minutes. This means the patient services technician is in a hurry to complete the cleaning quickly. Finally, night time terminal disinfection becomes important so that the operating room suite receives a thorough disinfection once per day each night shift. For this reason, looking at adequate disinfection is important in the prevention of SSI. This study will serve to inform management, in order to modify and improve protocols and educational programs for staff. Finally, the post-implementation of the study will utilize the same methods used in the pre-implementation portion to re-assess surface disinfection on operating room surfaces and evaluate the efficacy of the proposed intervention.
QPI: Ricardo, Martinez Garcia, (firstname.lastname@example.org)
Advisors: Tara, Sabo-Attwood, (email@example.com)
UF Health Big Aims: Zero Harm None
MeSH Keywords: Disinfection, Environmental Exposure, Environmental Microbiology, Operating Rooms, Infection Control, Evidence-Based Practice, Quality Improvement, Operating Room Technicians, improved outcomes, Surgical Site Infection