Operating rooms, surgical theaters, and other places where patients receive critical care need to be kept immaculately clean and properly sterilized. This is a critical component in ensuring that the patient and healthcare staff are safely protected from harmful microorganisms. This type of “Terminal Cleaning” and sanitizing is typically performed after an operating room or another treatment area has been used to treat a patient for some type of multidrug-resistant organism infection.
Also known as MDROs, this includes things like Methicillin-Resistant Staph aureus (MRSA), as well as Vancomycin-Resistant Enterococci (VRE) and Clostridioides Difficile Infection, which is known as either CDI or C-Diff. These MDROs and other exotic pathogens are typically resistant to several different types of antibiotics. Making sure that they are chemically sterilized plays a critical role in ensuring they do not spread to other patients or medical staff.
Terminal cleaning needs to be conducted in an operating room after it’s used to treat any patient with a known MDRO infection to prevent the spread of these deadly contagions. There are strict regulations on how this is done and how to properly dispose of all treatment materials as well as other biological waste debris.
What Is Involved In Terminal Cleaning?
Terminal cleaning refers to the specific cleaning procedures and techniques that are used to control the spread of infectious diseases in a healthcare environment. They are explicitly specific when it comes to dealing with a surgical setting where a known MDRO is or has been present.
This typically involves, but is not limited to the following things:
- The careful removal of all detachable objects
- Meticulously disinfecting lighting
- Meticulously cleaning air duct surfaces
- Cleaning every surface down to the floor
Afterward, all items that are removed from the room are disinfected or sanitized according to the strictest of guidelines before being returned to the treatment environment. Complete documentation of these items and the methods used to sanitize them is then recorded for posterity, as well as ensuring compliance with regulations was maintained.
Step By Step Terminal Cleaning of Operating Rooms & Other Treatment Areas
There are several steps in the terminal cleaning process. The first, critical step calls for all staff to suit up in barrier garments. This includes:
- Surgical grade face masks
- Gloves and disposable boot covers
- Goggles and face shields
These measures as specifically designed to prevent the spread of microorganisms outside of the potentially contaminated room.
Terminal Cleaning Procedures
Once the cleaning staff has donned the necessary level of personal protection equipment they will use the following steps to ensure the elimination of all pathogenic presence in the surgical theatre, operating room, or treatment area.
Carefully remove all detachable objects from the room. They will then be placed in sealed containers to be fully disinfected in a specified controlled environment. This allows them to be returned after the terminal cleaning has been completed.
The terminal cleaning staff then uses specially approved cleaning chemicals to thoroughly disinfect the room from the ceiling to the floor. This includes a meticulous approach to sanitizing every square inch.
Any equipment or instruments that cannot be removed from the room before cleaning, must be scrubbed and disinfected thoroughly.
The terminal cleaning staff starts by cleaning all lighting fixtures and grates adorning the ceiling, working down to the walls and eventually the floor.
Permanently affixed items or items that cannot be removed from the treatment area need to be meticulously cleaned and disinfected. This includes disinfecting wheels, pads, railings, and any other surface. The underlying goal is to ensure the most thorough disinfecting of the treatment area before any other patient or medical staff can safely enter it again.
After the room has been deemed safe for further use, disinfected machinery and equipment that was initially removed can be reinstalled in its proper place for future treatments or diagnostics. Some hospitals and clinics require a specific amount of time between treatments in a room where a known MDRO was present and will rotate treatment areas accordingly.
The end of the Terminal Cleaning process calls for the proper disposal of all barrier garments and personal protective equipment. This is done in a specific order with the gloves being the last thing removed for disposal. All the garments and PPEs are then placed in a plastic bag and sealed before being disposed of or professionally cleaned and sanitized.
Electrostatic Spray Disinfection For Terminal Cleaning
One new and highly effective way to augment terminal cleaning procedures is to use electrostatic spray disinfection. This is considered to be a comparable alternative to terminal cleaning for operating rooms and similar surgical environments. Electrostatic spraying is essentially a hands-free way to easily cover surfaces with an electrically charged mist that neutralized pathogens to prevent the physical spread of MDROs.
The disinfecting mist is electrically charged and the spray mist easily envelopes the surfaces of all the machinery, equipment, light fixtures, and other surfaces. Most areas can be effectively treated by spraying them from two or more angles to ensure 100% total coverage.
Many hospitals, outpatient treatment centers, and clinics with surgical treatment areas will use electrostatic spraying in conjunction with other terminal cleaning techniques in operating rooms and surgical environments. Not only7 does this help ensure thorough disinfection before the room is reused, but it provides everyone with greater peace of mind when using a hands-free technique to prevent the spread of dangerous MDROs.
Terminal Cleaning In Diagnostic Environments
While terminal cleaning is most often used in surgical environments, it is not limited to them. Any clinical area or diagnostic environment might need terminal cleaning. Especially if the initial presence of an MDRO was not originally known.
This might include things like administering injections, contrast dyes and using ultrasounds to alleviate pressure in traumatized tissues. Having the right equipment and properly trained staff will go a long way toward ensuring that all terminal cleaning procedures are completed correctly and that all potentially compromised materials are disposed of according to pertinent requirements.