The operating room (OR) is a highly controlled environment where specialized cleaning protocols are necessary to protect patients from infection. Damp wiping, also known as damp dusting, is a technique that uses a cloth or mop moistened with an approved detergent or disinfectant solution to clean surfaces. The consistent and correct application of damp wiping is a fundamental practice in the OR, playing a direct role in minimizing the risk of Surgical Site Infections (SSIs) by maintaining a clean field.
The Role of Damp Wiping in Particle Control
Damp wiping is the preferred cleaning method in surgical environments because it directly addresses the issue of airborne contamination. Dry methods, such as sweeping or using a dry cloth, aerosolize dust, lint, and microorganisms, suspending them in the air where they can settle onto sterile equipment and open wounds. This action effectively increases the microbial load and potential for infection.
The damp technique utilizes the moisture and surface tension of the disinfectant solution to trap particulates and pathogens onto the cloth or mop head. The particles are physically removed from the environment rather than being redistributed or becoming airborne. This practice is central to meeting guidelines set by organizations like the Association of periOperative Registered Nurses (AORN) for dust suppression, ensuring a safer environment for patient care.
Protocols for Routine Operational Cleaning
Routine cleaning in the operating room is structured around the daily surgical schedule, involving two primary, time-dependent procedures. The first is the initial morning damp dusting performed before the first scheduled procedure of the day. This initial cleaning focuses on all horizontal surfaces, such as lights, booms, and equipment, to remove dust and debris that have settled overnight.
Turnover Cleaning (Between Cases)
Turnover cleaning is the rapid procedure performed immediately after one patient is transferred out of the room and before the next patient is brought in. This process is designed for quick efficiency while addressing immediate contamination risks from the previous surgery. The primary focus is on high-touch surfaces contaminated with blood or body fluids, including the OR table, equipment handles, anesthesia machine, and monitor surfaces. Cleaning efforts also target the floor area immediately around the operating table and any visible spills. The goal is to remove visible soil and bioburden quickly using a facility-approved cleaner or disinfectant, preventing the transfer of microorganisms between surgical patients.
Terminal Cleaning (End of Day/24-Hour Cycle)
Terminal cleaning is a comprehensive, deep cleaning process performed when scheduled surgical procedures are complete for the day or at least once every 24 hours in continuously used rooms. This procedure is far more thorough than turnover cleaning and involves damp wiping virtually every surface. All horizontal surfaces, including surgical lights, supply carts, and equipment wheels, are meticulously cleaned and disinfected.
The cleaning extends to low-touch areas not addressed between cases, such as walls up to the height of splash zones, doors, cabinets, and baseboards. The operating table is often disassembled to clean all joints and the underlying floor area, which can harbor debris. The entire floor of the OR is then cleaned and disinfected, often utilizing a wet vacuum or a single-use mopping system.
Scheduled and Post-Contamination Procedures
Beyond the daily routine, damp wiping is incorporated into specialized, non-routine procedures, which are either scheduled or event-driven.
Periodic Deep Cleaning
Periodic deep cleaning, also known as cycle cleaning, addresses areas that accumulate dust but are not included in the daily terminal clean. This includes less frequently accessed areas like storage shelves, ceiling tracks, and air ventilation grilles. These deep cleans are typically performed on a weekly or monthly basis, often requiring specialized equipment like high-reach dusting tools. The purpose is to remove settled dust and debris that could potentially enter the sterile field over time, ensuring the long-term maintenance of the controlled environment.
Post-Contamination Procedures
Post-contamination procedures are required for unexpected events, such as major spills of blood or other bodily fluids. For gross contamination, the first action is to contain the spill and remove the organic material using an approved absorbent material and disinfectant. This event-driven cleaning must occur immediately to prevent the spread of contamination and restore the safety of the workspace. Special containment protocols are often required before the standard damp wiping and disinfection process can be completed.