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PURPOSE: To maintain a safe and sanitary environment for patients in the
ambulatory surgery center (ASC) that minimizes the risk of patient and
healthcare personnel exposure to potentially infectious microorganisms
POLICY: The patient care environment throughout the facility will be
maintained in a state of cleanliness that meets professional standards in
order to protect patients and healthcare personnel from potentially infectious
microorganisms. Environmental cleaning is a team effort. Personnel
responsible for cleaning the environment and equipment will receive education
and training on proper environmental cleaning and disinfection methods, agent
use and selection, and safety precautions according to Occupational Safety
and Health Administration (OHSA) guidelines. The ASC shall maintain
oversight and assure the quality of services provided when contracting for
cleaning services provided by an outside agency. The facility shall use an
approved, hospital-grade, EPA-registered disinfectant/detergent approved by
the multi-disciplinary overseeing the infection prevention program.
PROCEDURE: Personal protective equipment (PPE) must be worn according
to the OSHA Bloodborne Pathogen Standard when disposing of waste that
could result in exposure to bloodborne or other potentially infectious
microorganisms and hazardous material. Attention to frequently touched
surfaces (e.g., light switches, door handles) is essential.
1. General Principles
a. Thorough scrubbing with friction (back and forth motion) will be used
for all environmental surfaces
b. Mop heads, cleaning cloths and cleaning solutions will be changed
frequently; mop heads and water are to be changed after each
c. Cleaning methods and machines that generate the re-suspension of
dust from surfaces will be avoided, especially in patient care areas.
Damp mopping or use of chemically treated mop for reduction of
airborne dust is generally recommended in patient care areas.
NOTE: The microfiber mop system has demonstrated superior
microbial removal compared with cotton string mops when used
with a detergent cleaner; this system may be considered/evaluated
for use
d. HEPA-filtered vacuums shall be used in patient care areas. Carpeting
will not be used in the surgical suite or in heavy soiling and spillage
areas. Carpeting will be vacuumed regularly, cleaned promptly if spills
occur and shampooed every three to six months or when indicated by
appearance or after contaminated with body fluids. Provide deep soil
extraction on an as-scheduled basis.

e. Cleaning, buffing and vacuuming should not be done during the day
when procedures are being done

In patient care areas, cleaning of non-carpeted floors and other

horizontal surfaces will be done daily and more frequently if spillage or
visible soiling occurs

2. At the beginning of each day or prior to the first procedure, the following
will be damp-dusted using a clean lint free cloth dampened with a facilityapproved, Environmental Protection Agency (EPA)-registered disinfectant:
horizontal surfaces, OR/procedure room lights, OR/procedure room
furniture including the back table, prep table, ring stands, Mayo stands,
and operating table
3. Preparation of the operating room should include a visual inspection of the
room for cleanliness before the case carts, supplies, and instrument sets
are brought into the room
4. Cleaning of OR/procedure room between procedures must be done with a
facility-approved, EPA-registered disinfectant
a. Prepare disinfectant solution according to manufacturers instructions
b. Clean hands and put on gloves
c. Collect and remove all soiled linen, including linen from open packs,
from operating room and place in an impervious bag for laundering;
place in the laundry hamper
d. Collect and remove trash. Soiled sponges, suction canisters, tubing,
and other waste should be handled as infectious waste. Clean outside
of suction canisters; lift the bag and carry it out of the operating room
to the pick-up point for this trash.
e. Remove gloves and clean hands

Use a cloth dampened in disinfectant solution to clean and disinfect

horizontal surfaces that have come in contact with a patient or body
fluids, including blood pressure cuffs, tourniquets and leads; damp
wipe overhead lamps

g. Clean and disinfect bed, Mayo stands, back table, prep table, and ring
table; remove gloves and wash hands
h. Damp mop floor only if visibly soiled; allow to air dry

Spot clean walls and ceilings, if necessary


Insert new linen hamper bags and waste liner bags

k. Pick up disinfectant solution from floor using wet vacuum


When cleaning is complete, remove gloves and clean hands

m. Remake the operating table with clean sheets

5. Terminal cleaning of each operating and procedure room will be completed
daily when the scheduled procedures are completed for the day. Unused
rooms should be cleaned once during each 24-hour period during the
regularly scheduled work week because personnel entering unused rooms
and moving equipment and supplies in and out of the room can increase

the risk of environmental contamination. Mechanical friction and a facility

approved EPA-registered agent will be used to clean the operating and
procedure rooms.
a. Clean hands and put on gloves
b. Collect and remove all soiled linen from operating room, including linen
from open packs, and place in an impervious bag for laundering; place
in the laundry hamper
c. Collect and remove trash. Soiled sponges, suction canisters, tubing,
and other waste should be handled as infectious waste. Clean outside
of suction canisters; lift the bag and carry it out of the operating room
to the pick-up point for this trash.
d. Clean hands and change gloves
e. Clean and disinfect lights and ceiling tracks

Clean and disinfect all door handles, push plates, light switches and
controls, and all wall mounted equipment

g. Clean and disinfect telephones and computer keyboards

h. Spot wash all walls

Clean and disinfect all exterior surfaces of machines and equipment

(e.g., anesthesia carts)


Clean and disinfect all furniture, Mayo stands, back table, prep table,
and ring table, including wheels/casters

k. Clean and disinfect exterior of cabinets and doors, especially around


Clean and disinfect all horizontal surfaces

m. Clean suction canisters

n. Clean and disinfect bed, including operating table cushions and
removable pads
o. Wipe all kick buckets, racks, and waste receptacles with disinfectant
p. Clean floor making sure the bed is moved and the floor is washed
underneath; move all furniture to the center of the room and continue
cleaning the floor
q. Replace all furniture and equipment to its proper location

Damp wipe waste receptacles, kick buckets, and racks; re-line after
items are dry

s. Place a cautionary Wet Floor sign at the entrance to the room

t. Remove gloves and clean hands
u. Clean and store cleaning equipment
v. Report any needed repairs
6. Other patient care areas and environmental surfaces that come in direct
contact with patients will be cleaned with a facility-approved, EPA
registered disinfectant
a. Assemble supplies


Ensure an adequate supply of clean cloths is available

ii. Prepare fresh disinfectant solution according to manufacturers

a. Clean hands and put on gloves
b. Remove dirty linen, and then remove gloves and clean hands
c. Apply clean gloves and clean room, working from clean to dirty and
high to low areas of the room using fresh cloth(s) for cleaning each
patient bed space; complete the cleaning of each bed space before
moving to the next

If a bucket is used, do not double-dip cloth(s)

ii. Do not shake out cloth(s)

iii. Change the cleaning cloth when it is no longer saturated with
disinfectant and after cleaning heavily soiled areas; surfaces should
be visibly wet and allowed to dry before use
iv. Start by cleaning doors, door handles, push plate and touched
areas of frame
v. Check walls for visible soiling and clean if required
vi. Clean light switches and thermostats
vii. Clean wall mounted items such as alcohol-based hand rub
dispenser and glove box holder
Check privacy curtains for visible soiling and
replace if required; replace if patient was in contact precautions
ix. Clean all furnishings and horizontal surfaces in the room including
chairs, window sill, call lights, television, telephone, computer
keypads, tables or desks. Lift items to clean the tables. Pay
particular attention to high-touch surfaces.
x. Wipe equipment on walls such as top of suction bottle, intercom
and blood pressure manometer as well as IV pole
d. Clean the bed

Clean top and sides of mattress, turn over and clean underside

ii. Clean exposed frame

iii. Clean headboard, foot board, bed rails, call bell and bed controls;
pay particular attention to areas that are visibly soiled and surfaces
frequently touched by staff
iv. Clean all lower parts of bed frame, including casters
v. Allow mattress to dry
e. Clean floors


Place soiled cloths in designated container for laundering or dispose

ii. Remove soiled linen if bag is full

iii. Place obvious waste in receptacles
iv. Check sharps container and change when three-fourths full (do not

dust the top of a sharps container)

v. Remove waste
g. Remove gloves and clean hands; if hands are visibly soiled, wash with
soap and water
h. Replenish supplies as required (e.g., gloves, ABHR, soap, paper towels)

Clean hands

7. Clean bathrooms, working from clean areas to dirty areas

a. Remove soiled linen from floor; wipe up any spills; remove waste
b. Clean door handle, door frame, and light switch
c. Clean wall attachments
d. Clean inside and outside of sink, sink faucets and mirror; wipe
plumbing under the sink; apply disinfectant to interior of sink; ensure
sufficient contact time with disinfectant; rinse sink and dry fixtures
e. Clean all dispensers and frames

Clean call bell and cord

g. Clean support railings, ledges/shelves

h. Clean shower/tub faucets, walls and railing, scrubbing as required to
remove soil; apply disinfectant to interior surfaces of shower/tub,
including soap dish, faucets and shower head; ensure sufficient contact
time for disinfectant; rinse and wipe dry

Clean bedpan support, entire toilet including handle and underside of

flush rim; ensure sufficient contact time with disinfectant


Change all waste bags, clean waste can if dirty

k. Remove gloves and wash hands


Replenish paper towels, toilet paper, waste bag, soap and ABHR as

8. Clean and disinfect all sinks, including scrub sinks, floors, and surfaces
including those at the nursing stations and staff lounges in the facility
9. Reprocessing and other sterile storage areas are to be cleaned according
to the following schedule:
a. Clean all counters and floors daily
b. Clean shelves daily in sterilization, preparation, packing and
decontamination areas
c. Clean shelves every three months in sterile storage areas
d. Clean case carts after every use
e. Clean walls every six months

Clean light fixtures, sprinkler heads and other fixtures every six

10.Personnel responsible for cleaning must perform hand hygiene:

a. Before initial patient environment contact (e.g., before coming into the
operating/procedure room or patient bed space)

b. After potential body fluid exposure (e.g., after cleaning bathroom,

handling soiled linen, equipment or waste)
c. After patient environment contact (e.g., after cleaning patient bed
space or operating/procedure room; after cleaning equipment such as
stretchers; after changing mop heads)
d. Gloves must be removed on leaving each operating/procedure room or
patient bed space. Personnel must clean hands after removing
gloves as gloves do not provide complete protection against hand
11.Cleaning blood spills
a. Blood spills will be cleaned using an approved blood spill kit. The spill
kit manufacturers recommendations for cleaning and decontaminating
the spill will be followed.
b. As an alternative, a fresh 1:10 dilution of bleach may be used. Gloves
and other appropriate personal protective equipment (based on the
specific situation) will be worn.
NOTE: If a blood spill kit is used, the disinfectant should be EPA-registered
and have kill data against Hepatitis B and HIV or should be tuberculocidal.
Blood spill kits have expiration dates that must be monitored.
12.Evaluating environmental hygiene quality
a. Routine environmental cultures are not recommended
b. Regularly scheduled rounds of the environment should be done to
monitor housekeeping, regulated medical waste and compliance to
policies, including use of cleaning checklists or other monitoring
Association of perioperative Registered Nurses. (2010). Recommended practices
for environmental cleaning. In Standards, Recommended Practices, and
Guidelines. Denver, Colorado.
Bennett, G. & Kassai, M. (2011). Infection Prevention Manual for Ambulatory
Surgery Centers. ICP Associates: Rome, Georgia.
Guh, A., Carling, P., and Environmental Evaluation Workgroup. (2010). Options for
Evaluating Environmental Cleaning. Atlanta, Georgia: Centers for Disease Control
and Prevention.
Sehulster, L.M., Chinn, R.Y.W., Arduino, M.J., Carpenter, J., Donlan, R., Ashford, D.,
Besser, R., Fields, et. al. (2004). Guidelines for environmental infection control in
health-care facilities. Recommendations from CDC and the Healthcare Infection
Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for
Healthcare Engineering/American Hospital Association.
Guidelines for Environmental Infection Control in Health-Care Facilities. (2003).
Atlanta, Georgia: Centers for Disease Control & Prevention.
Rutala, W.A., Weber, D.J., & the Healthcare Infection Control Practices Advisory
Committee. (2008). Guideline for Disinfection and Sterilization in Healthcare
Facilities. Atlanta, Georgia: Centers for Disease Control & Prevention.

DISCLAIMER: All data and information provided by the Oregon Patient Safety
Commission is for informational purposes only. The Oregon Patient Safety
Commission makes no representations that the patient safety recommendations will
protect you from litigation or regulatory action if the recommendations are
followed. The Oregon Patient Safety Commission is not liable for any errors,
omissions, losses, injuries, or damages arising from the use of these