1. Environmental Cleaning Tool Kit
Quality in
Environmental Cleaning
Module 6

2. Objectives
Upon completion of this module, participants will be able to:
explain why quality is important in perioperative environmental cleaning;
describe what is included in process monitoring;
use a cleaning checklist or log, and;
state how to measure cleaning practices.

3. Definitions Quality Performance improvement Benchmark
meeting or exceeding expectations at a cost that represents value to the customer
Performance improvement
the continuous study and adaptation of a healthcare organization’s functions and processes to increase the probability of achieving desired outcomes and to better meet the needs of individuals and other users of services
Benchmark
a comparative “best” as baseline for improvement

4. Why is quality important?
Every patient deserves care in a clean, safe environment

5. Quality Assurance/ Performance Improvement
Team members should
understand and comply with principles and processes involved with environmental cleaning
participate in a variety of quality assurance and performance improvement activities
Quality assurance and performance improvement
assists in evaluating worker safety
formulates plans for corrective action

6. How can quality tools help us?
Obtaining data from quality assurance or performance improvement tools can
tell if benchmark goals are met
identify areas where additional help is needed
Ongoing feedback can show if problems are
improving
stabilizing l
worsening
Information or “data” is collected in a systematic way such as using a checklist to observe that everyone is cleaning the environment correctly. This information can show trends if we are getting better, staying the same, or in some cases, not performing as well as before.
Benchmark is a process of comparing a practice’s performance (how we are performing our cleaning) with an external standard (such as national recommendations or guidelines). This type of comparison can be called a comparative “best” and can be used as a baseline (starting point) for improvement. Information is collected and then reported using different types of charts. Note, you could add your own line charts after this slide as an example.

7. Process Monitoring
Process monitoring is a necessary part of every facility’s environmental cleaning program
Process monitoring must include
compliance with regulatory standards
review of products and manufacturers’ instructions for use
cleaning procedures
monitoring cleaning and disinfection practices
reporting and investigation of adverse events
outbreaks, product issues, corrective actions, evaluation
What is process monitoring? This means a standard way to look at what is occurring in the facility; are we following regulations, do we have access to the product instructions for use, and are we cleaning and disinfecting correctly. And if something happens, an “adverse event”, how does this get reported? How is it corrected so it does not happen again? If a procedure is changed, we look at how the change affects our cleaning processes. For example, did the change make a positive difference?

8. How should cleanliness be measured?
Thoroughness of cleaning is the focus of performance improvement
Measure cleaning practices
visual observation
fluorescent marking
visual inspection of
cleanliness
ATP monitoring
cultures
Multiple measures should be used as a comprehensive assessment of environmental cleaning practices. Identify what types of measurement are used in your facility for team members now. Explain the process used at your facility so team members have clear idea and expectations. The information gathered by measuring cleaning practices can be used to drive process improvement activities, encourage compliance with established cleaning protocols, educate team members, and verify the competency of team members.

9. How should cleanliness be measured?
Fluorescent marking
Visual inspection of cleanliness
Cultures
ATP monitoring
Explain to team members the steps involved with each type of process. Let’s go through each process. Please advance slide.

10. Fluorescent Marking Gel
Courtesy of Ecolab® Inc.
Fluorescent marking involves using a fluorescent pen to write on specific objects in the room, for example, the stainless steel tray in the picture. The room is then cleaned by team members. Once completed, an auditor will come back into the room with a black light and look for remaining marks on the items that were “tagged”.
Courtesy of Ecolab® Inc.

11. Visual Inspection for Cleanliness
Visual inspection is looking through the room, moving furniture, purposefully looking for dirt, dust, and debris.

12. Cultures 2
Obtaining cultures means items that have been cleaned are tested to see if microbial organisms (germs) are still on the cleaned objects. Sterile swabs, like long q-tips, are rubbed over the items and sent to the microbiology lab for further testing. 1

13. Cultures
Courtesy of Ecolab® Inc.

14. Adenosine Triphosphate (ATP) Monitoring
assists in evaluation of the environmental cleaning process
the technology counts living and non-living organic matter in Relative Light Units (RLUs)
uses a hand held device and swab
ATP monitoring, or adenosine triphosphate monitoring, is the direct measure of biological concentration on surfaces. ATP is the universal unit of energy in all living cells and can immediately tell if surfaces and equipment are clean. Using a hand-held device and swabs similar to culturing, surfaces are wiped with the swab. The swab is then placed into the hand-held monitoring device and a reading is given.

15. Providing Feedback
Providing timely feedback to team members of cleanliness in the perioperative area will improve practices
If possible, immediate communication regarding cleanliness is best

16. Documentation
Documenting completion of terminal and scheduled cleaning meets
Regulatory requirements
Facility standards
Use a standard checklist or log
Share with team members the logs and checklists used at your facility. Go over the lists and make sure staff know what sections they are responsible to complete. Use the teach back method and have team members state what is expected prior to completing the education.

17. Cleaning Log for OR, Preoperative, and Postoperative Areas
This sample checklist is available in the AORN Environmental Cleaning Tool Kit at
This sample checklist is a three page document and it shown on the following four slides. This cleaning checklist includes the OR, preoperative, and postoperative areas. You can print this out and have it available for your team members as you go over each area to clean.

18. Cleaning Log for OR, Preoperative, and Postoperative Areas (continued)

19. Cleaning Log for OR, Preoperative, and Postoperative Areas (continued)

20. Cleaning Log for OR, Preoperative, and Postoperative Areas (continued)
This is the last slide for this checklist.

21. Cleaning Log for Operating Rooms and Procedural Areas
This is another sample checklist is available in the AORN Environmental Cleaning Tool Kit at
Note, the checklist is two pages and shown on this slide and the following slide. There are three sections of the checklist which include cleaning before the first case of the day, end of case cleaning, and terminal cleaning. This same checklist continues on the following slide.

22. Cleaning Log for Operating Rooms and Procedural Areas (continued)
This is a continuation of the same checklist with the second page starting at the end of case cleaning and the last section of the checklist for terminal cleaning.
This sample checklist is available in the AORN Environmental Cleaning Tool Kit at

23. Cleaning Log for Sterile Processing Areas
This sample checklist is available in the AORN Environmental Cleaning Tool Kit at

24. Checklist for Enhanced Environmental Cleaning
This sample checklist is available in the AORN Environmental Cleaning Tool Kit at

25. Resources
Association for the Healthcare Environment of the American Hospital Association. Practice Guidance for Healthcare Environmental Cleaning. 2nd ed. Chicago, IL: American Hospital Association; 2012.
Brown JA. Healthcare Quality Handbook: A Professional Resource and Study Guide. 27th ed. Pasadena, CA: JB Quality Solutions Inc; Pasadena: 1,7, 9.
Guideline for environmental cleaning. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2016:7-28.
Guidelines for environmental infection control in health-care facilities. Centers for Disease Control and Prevention. Accessed March 23, 2016.
Please use the above resources for additional guidance, if needed.