How should the operating room environment be cleaned and disinfected?

The operating room is the surgeon's primary battlefield, where patients undergo surgery and their illnesses are cured. Bodily fluids, blood, secretions, and excretions from patients can easily contaminate the operating room environment, making surfaces a reservoir for pathogens and a major risk of surgical site infection. Therefore, ensuring the quality of cleaning and disinfection of surfaces in the operating room is crucial. Let's thoroughly understand how cleaning and disinfection of the operating room environment should be implemented!

1. Operating Room Environmental Contamination Risk Classification and Cleaning and Disinfection Requirements
The operating room is a high-risk area for nosocomial infections. All areas of the operating room are categorized according to contamination risk levels into low, medium, and high environmental contamination risk areas. Operating rooms should select appropriate cleaning and disinfection methods, intensity, and frequency based on the specific environmental contamination risk areas and hygiene management requirements.

II. Operating Room Cleaning and Disinfection Principles
Wet cleaning methods should be used for cleaning and disinfection of the operating room environment, adhering to the principle of clean first, then disinfect. Cleaning should be carried out in an orderly manner, proceeding from top to bottom, from peripheral areas to central areas, and from clean areas to contaminated areas. For small spills (<10ml), clean first and then disinfect; or use disinfectant wipes directly to achieve a one-step cleaning and disinfection approach. For large spills (≥10ml), first cover with absorbent material and remove contaminants before disinfecting. For surfaces that are difficult to clean or require infrequent wiping, barrier protection, such as membranes or other coverings, should be used, with a "replace once used" or "clean once used" approach. When cleaning and disinfecting the surfaces of precision instruments and equipment, refer to the instrument manual, pay attention to the compatibility of detergents and disinfectants, and select appropriate cleaning and disinfection products. Disinfectants should be prepared freshly. Floors in areas at high risk of environmental contamination should be disinfected with a disinfectant containing 500-1000 mg/L of available chlorine and allowed to stand for 10 minutes. Surface disinfection methods are similar to those for floors, or 1000-2000 mg/L of a quaternary ammonium salt disinfectant should be used.

III. Daily Cleaning and Disinfection

Daily Cleaning and Disinfection of the Operating Room: Before daily use, surfaces should be cleaned with clean water. If blood or body fluids contaminate surfaces, floors, and equipment around the operating table during surgery, or if contamination is suspected, spot cleaning and disinfection should be performed immediately. Between surgeries, the operating table and surrounding high-touch surfaces within a radius of at least 1-1.5 meters (including shadowless lamps, IV poles, instruments, body cushions, and computer desks) should be cleaned and disinfected. All surfaces should be terminally disinfected promptly after the day's surgeries. After cleaning and disinfection, cleaning utensils should be washed and disinfected according to the operating procedures and stored dry. Purification System Maintenance: Clean the return air grille daily; clean the fresh air inlet filter weekly; clean the operating room ceiling exhaust filter at least monthly and replace it annually; clean the return air filter weekly and replace it annually. If contaminated, replace it immediately. Wipe the inner surface of the return air vent with a disinfectant appropriate for the pathogen. Weekly Cleaning and Disinfection: Wipe with clean water first, then disinfect with an appropriate disinfectant. In addition to cleaning and disinfecting all operating room floors, surfaces, interior and exterior corridors, instruments, equipment, and cables at the end of each day, the fresh air vent and filter, doors, windows, glass, cabinet interiors, operating room walls, ceilings, IV rails, and shadowless light arms should also be cleaned and disinfected. In addition to the operating room, auxiliary rooms should also be cleaned or both cleaned and disinfected, including the dressing room, instrument room, and anesthesia preparation room.

IV. Use and Management of Cleaning Supplies
The number of cleaning supplies should be appropriately allocated based on the size of the operating room. Fabrics that do not shed fibers should be selected, preferably microfiber cloths and removable floor towels. Cleaning utensils in different areas should be clearly labeled and used separately. Medical institutions where conditions permit should prioritize mechanical cleaning and disinfection. Cleaning and disinfection methods should refer to the "Technical Specifications for Laundry and Disinfection of Medical Fabrics in Hospitals." Fabrics that are less likely to shed fibers should be selected, and microfiber cloths and detachable floor towels are preferred. When manual cleaning and disinfection is chosen, cloths and floor towels should be cleaned and disinfected separately. Typically, they should be cleaned first, disinfected second, and dried for later use. Do not re-soak cloths and floor towels in the same water, detergent, or disinfectant solutions as they are currently being used. After cleaning and disinfection, they should be dried promptly for later use. Cleaning utensils used by patients with infectious diseases such as multidrug-resistant bacteria, hepatitis B, and syphilis should be handled separately, disinfected first, then cleaned, and dried for later use.

V. Cleaning and Disinfection Quality Monitoring
Members of the operating room hospital infection management team should participate in the quality oversight of daily cleaning and disinfection, as well as terminal disinfection, to strengthen process management. Regular evaluation and feedback on cleaning and disinfection effectiveness should be conducted. Audits of environmental surface cleaning quality should primarily rely on visual inspection, although microbiological and chemical methods may be used depending on the specific situation. Visual inspection is primarily used to check whether the environment is clean, tidy, and dust-free. Fluorescent powder trace, fluorescent labeling, and ATP methods are primarily used to assess the quality of surface cleaning. Environmental microbiology monitoring should be conducted quarterly. If an outbreak of surgical wound infection is suspected to be related to the operating room environment, timely hygiene monitoring and targeted indicator bacteria testing should be conducted.